Exploring alexithymia, depression, and binge eating in self-reported eating disorders in women

TOPIC: Binge eating is often a way of life for many women even if the diagnostic criteria for the tentative DSM-IV-TR diagnosis of binge eating disorder is not met. METHODS: Binge eating was conceptualized as a problem in affect regulation. Affective indices of alexithymia and depression were measure with the Toronto Alexithymia Scale (TAS), the Alexithymia-Provoked Response Questionnaire (APQR), and the Beck Depression Inventory (BDI), respectively. This study was an exploratory study of 65 subjects, 35 of whom self-reported as eating disordered and 30 as non-eating disordered. FINDINGS: Of the eating-disordered subjects, 95% scored significantly on the Eating Habits Checklist as binge eaters, 18% as anorexic, and 23% as bulimic. Significant relationships were found between alexithymia and binge eating and depression. A stepwise logistic regression found that both alexithymia and depression discriminated between women with and without binge eating at .001 and .002, respectively. CONCLUSIONS: This study found that alexithymia was more highly correlated with binge eating than with either anorexia or bulimia. In addition, a significant history of trauma and health problems for those who reported as binge eaters was reported. Implications for practice are discussed.     

Clinical differentiation between major depression only, major depression with panic disorder and panic disorder only. Childhood, personality and personality disorder

A consecutive sample of 298 nonpsychotic psychiatric outpatients was classified according to DSM-III and divided into 4 diagnostic groups: pure major depression, mixed major depression/panic disorder, pure panic disorder and a remaining group of other disorders. The patients' report of childhood relationship to parents and siblings, family atmosphere, their own personality characteristics as children and precipitating events were compared in the various groups. In addition, differences in personality and frequencies of personality disorders were investigated by means of various instruments. Our results show that the type of relationship to parents in childhood differed in the various groups. The mother seems to be the most crucial person for the development of depression, the father for the development of panic disorder. Patients with major depression are more obsessive and patients with panic disorder more infantile and avoidant with less control of their personality. Finally, patients with mixed conditions are more in accordance with the DSM-III anxious personality disorder cluster.     

Personality disorder comorbidity in panic disorder patients with or without current major depression

To investigate the relationship between current or past major depressive disorder (MDD) on comorbid personality disorders in patients with panic disorder, we compared the comorbidity of personality disorders using the Structured Clinical Interview for DSM-III-R personality disorders (SCID-II) in 34 panic disorder patients with current MDD (current-MD group), 21 with a history of MDD but not current MDD (past-MD group), and 32 without lifetime MDD comorbidity (non-MD group). With regard to personality disorders, patients in the current-MD group met criteria for at least one personality disorder significantly more often than patients in the past-MD group or the non-MD group (82.4% vs. 52.4% and 56.3%, respectively). The current-MD group showed statistically significantly more borderline, dependent, and obsessive-compulsive personality disorders than the past-MD group or non-MD group. With stepwise regression analyses, number of MDD episodes emerged as an indicator of the comorbidity of cluster C personality disorder and any personality disorders. Future studies should determine whether aggressive treatment of comorbid personality disorders improves the outcome (e.g., lowers the likelihood of comorbid MDD) of patients with panic disorder.     

Platelet imipramine binding in patients with panic disorder and major familial depression

Platelet 3H-imipramine binding was investigated in 15 normal subjects, 17 patients with major depressive disorder and 43 patients with panic disorder, to further study the relationship between depressive and anxiety disorders. Whereas patients with major depression had a significantly lower mean Bmax value than healthy volunteers, mean Bmax values in patients with panic disorder did not differ significantly from normal controls. Furthermore, apparently normal Bmax values were observed even in those panic disorder patients who had concurrent major depression or a past history of depression. Thus, despite previous findings of an overlap between panic and depressive disorders, the present results suggest that the two syndromes may have distinct neurochemical substrates.     

抑郁症、焦虑症、强迫症患者主观幸福感比较

目的:比较抑郁症、焦虑症、强迫症患者主观幸福感的异同,探索主观幸福感稳态理论对三者的适用性. 方法:对门诊和病房的抑郁症(n=79)、焦虑症(n=53)、强迫症(n=48)患者,及正常对照组(n=57)被试进行24项汉密顿抑郁量表(HAMD)、幸福感指数问卷测评分析. 结果:①抑郁症组、焦虑症组、强迫症组与正常对照组的主观幸福感差异具有统计学意义(F=16.55,P＜0.01).②抑郁症组的主观幸福感得分与绝望感因子分呈负相关(P＜0.01),焦虑症组与认知因子分、睡眠因子分、绝望感因子分呈负相关(P＜0.05),强迫症组分别与HAMD总分、日夜变化因子分、迟缓因子分、绝望感因子分呈负相关性(P＜0.05).③逐步回归分析结果表明,抑郁症患者的绝望感因子和焦虑因子、焦虑症患者的认知因子和睡眠因子、强迫症患者的绝望感因子是影响各自主观幸福感的主要因素. 结论:抑郁症、焦虑症、强迫症患者的主观幸福感均低于正常人;抑郁症患者的主观幸福感更低;均与抑郁症状有关.     

Alcohol use disorders in relatives of patients with panic disorder

OBJECTIVE: The aim of this study was to use data from a family study of anxiety disorders to examine the familial association between alcohol use disorders and panic disorder (PD), controlling for alcohol use disorders in the proband. METHOD: Data from a family study of anxiety disorders were used to compare rates of alcohol use disorders in the relatives of 3 proband groups (PD with lifetime alcohol use disorders, PD without lifetime alcohol use disorders, and not-ill controls). RESULTS: There was a significantly higher rate (12%) of alcohol use disorders among the relatives of PD probands compared with relatives of controls (5%), even in the absence of alcohol use disorders in the proband and after adjusting for differences in sociodemographic characteristics and lifetime drug use disorders (chi2 = 5.4; df = 1; P = .02). Anxiety symptoms were more frequent among the male relatives of panic probands who received an alcohol diagnosis, compared with those who did not have alcohol use disorders (10/25 vs 22/111; chi2 = 4.6; df = 1; P = .03). A similar pattern was found in women (8/11 vs 63/156; chi2 = 4.4; df = 1; P = .036). CONCLUSIONS: These findings suggest a familial association between PD and alcohol use disorders. Future studies with more refined alcohol diagnoses are needed to replicate and investigate the mechanism of this association.     

Divided and selective attention in panic disorder. A comparative study of patients with panic disorder,major depression and healthy controls

OBJECTIVE: While depression is definitely a condition with diminished attentional functioning, there is little evidence as to whether attention is also disturbed in panic disorder. In the present study patients with panic disorder and with depression were compared by means of neuropsychological tests which assess selective and divided attention. METHOD: Twenty-one inpatients with a Panic Disorder, 21 inpatients with a Major Depressive Disorder (DSM-IV diagnoses) and 20 healthy control subjects were investigated drug free. Neuropsychological standard tests were used to measure selective attention (Signal Detection, Wiener-Test-system) and divided attention (Gesichtsfeld-/Neglectprüfung, TAP), which allow the discrimination between left and right visual field stimulus processing. RESULTS: Patients with panic disorder and depression responded significantly slower than healthy control subjects in the test for divided attention, while no differences were found between the two groups of patients. In contrast, there were no differences among the groups of patients and control subjects in regard to reaction time in the test for selective attention. Stimulus presentations in the left and right visual fields did not affect the reaction times differently. CONCLUSIONS: Patients with panic disorder appeared as disturbed in their attentional functioning as patients with depression. Therefore, ignoring attentional deficits in patients with panic disorder is not justified.     

The use of psychotropic medications in eating disorder patients with personality disorders

The use of psychotropic medications in eating disorder patients with personality disorders (PDs) is a complex topic. In this overview, we do not focus on individual studies, but rather on the philosophical issues and broader management principles of medications in this comorbid population. We review a general construct of personality and PD development, the theories that underlie how medications might work in PDs, and the target-symptom approach to treatment. We also discuss the essential elements of the prescribing context, an approach to psychotropic medication selection in the borderline personality population, and general caveats for medication use in those with eating disorders. Despite available data, significantly more research is needed in this area.     

Clinical features and implication of the patients with substance use disorder and eating disorder

In this paper, we firstly reviewed the hypotheses of etiologies concerning high prevalence of comorbidity of eating disorder (ED) and substance use disorder (SUD). Secondary, our previous studies on comorbidity of ED and SUD were presented, which suggested that female patients with both of ED and SUD were likely to have clinical features of "multi-impulsive bulimia," while they might select the substance abuse for body-weight control. Finally, we discussed clinical implications of comorbidity of ED and SUD in the view of suicide prevention.     

Observer- and self-rated alexithymia in eating disorder patients: levels and correspondence among three measures

OBJECTIVES: Our objectives were to evaluate the psychometric properties of the Observer Alexithymia Scale (OAS) in eating disorder patients, alexithymia severity across diagnostic subgroups, and correspondence among three alexithymia measures. METHOD: Seventy-five women, each with an eating disorder diagnosis, completed two alexithymia self-reports, the 20-item Toronto Alexithymia Scale (TAS-20) and the Bermond-Vorst Alexithymia Questionnaire-version B (BVAQ-B), and asked a relative or an acquaintance to rate them using the OAS. RESULTS: The OAS showed acceptable discriminant validity and interrater reliability. Patients' OAS scores were higher than scores reported for people-in-general samples and lower than those for outpatient clinical samples. No statistically significant OAS, TAS-20, and BVAQ-B score differences were found between the patients with anorexia nervosa restrictive type and those with bulimia nervosa. OAS, TAS-20, and BVAQ-B total scores were moderately, positively, and significantly correlated. CONCLUSION: These clinical data show the psychometric strength of the OAS, which reasonably can be recommended for use with the TAS-20 in research and clinical practice.     

Body image disturbance, parental bonding and alexithymia in patients with eating disorders

BACKGROUND: To evaluate if body image disturbance and alexithymia, two major clinical features of eating disorders (ED), are predicted by an altered parental bonding. SAMPLING AND METHODS: 64 female ED outpatients and 68 female healthy controls were assessed by means of the Parental Bonding Instrument (PBI), the Body Uneasiness Test (BUT), and the Toronto Alexithymia Scale (TAS-20). Pearson's correlations and multiple stepwise regression analysis were applied to explore the contribution of PBI factors on BUT and TAS scores. RESULTS: BUT weight phobia, body image concerns, avoidance, depersonalization, Global Severity Index and positive symptom total were predicted by low parental care, while compulsive self-monitoring was predicted by parental overprotection. TAS total score and difficulty in describing feelings were predicted by low maternal care. CONCLUSIONS: Body image disturbance in ED may be conceptualized as a deficit in self-development, resulting from failures in parent-child interactions which impaired the ability to distinguish bodily needs from emotional experiences.     

惊恐障碍患者患病行为与述情障碍的相关性

目的探讨惊恐障碍患者的患病行为与述情障碍的相关关系。方法采用患病行为问卷（IBQ）和多伦多述情障碍量表（TAS）对47名惊恐障碍患者评估．结果惊恐患者患病行为因子中一般疑病、情感压抑、情绪状态与TAS因子I、Ⅱ呈正相关,而与TAS因子Ⅲ呈负相关关系;情绪紊乱与TAS因子Ⅰ呈正相关,与因子Ⅲ呈负相关关系;易激惹与因子Ⅰ呈正相关（P〈0．05）。疾病信念因子与TAS因子Ⅰ、Ⅱ呈正相关,疾病确信和疑病指数与因子Ⅰ呈正相关,否认心因与因子Ⅰ、Ⅱ呈负相关（P〈0．05）;心理取向与TAS各因子无相关关系（P〉0．05）。结论惊恐障碍患者患病行为中不良情绪、病感、否认心因与其描述情感、认识和区别情绪和躯体感受的能力相关．提示在心理治疗时要注意针对性地改善其述情障碍。     

Clozapine use and relapses of substance use disorder among patients with co-occurring schizophrenia and substance use disorders

BACKGROUND: Previous correlational research with schizophrenic patients has suggested that the second-generation antipsychotic medication clozapine helps to induce remissions of substance use disorder in patients with co-occurring psychosis and substance abuse. This research, however, could be biased by selection factors. Studying patients who are currently in substance abuse remission could control for level of motivation to stop using substances and other methodological confounds. METHODS: To test whether clozapine was associated with prevention of substance abuse relapses, we examined patients with schizophrenia or schizoaffective disorder who were in their first 6-month remission of substance use disorder during a prospective 10-year follow-up study. All patients received yearly multimodal assessments of substance use. Antipsychotic medications were prescribed by community doctors as part of usual clinical care. RESULTS: Patients using clozapine at the first 6-month period of substance abuse remission (n = 25) were much less likely to relapse over the next year compared with those on other antipsychotic medications (n = 70): 8.0% vs 40.0%, chi(2) = 8.73 (df = 1), P = .003. Although medication assignment was not randomized, several potential confounders were similar between the groups. CONCLUSION: Clozapine should be considered for the treatment of patients with schizophrenia and co-occurring substance use disorder to prevent relapses to substance abuse.     

Drug use and the risk of major depressive disorder,alcohol dependence,and substance use disorders

BACKGROUND: The Children in the Community Study is a prospective longitudinal study investigating the association between early drug use (childhood, adolescence, and early 20s) and later psychiatric disorders (in the late 20s). METHODS: Using data from a community-based sample of 736 adults (50% female) from upstate New York, the subjects were interviewed at the mean ages of 14, 16, 22, and 27 years. Psychiatric disorders, measured by age-appropriate versions of the University of Michigan Composite International Diagnostic Interview, and participant's drug use were assessed. RESULTS: Adolescent and young adult tobacco use was significantly associated with an increased risk of alcohol dependence and substance use disorders at a mean age of 27 years, but not with new episodes of major depressive disorder. Earlier alcohol use significantly predicted later major depressive disorder, alcohol dependence, and substance use disorders in the late 20s, as did early marijuana use and other illicit drug use. Except for the effect of tobacco use on major depressive disorder, early drug use was significantly related to later psychiatric disorders, even after statistically controlling for age, sex, parental educational level, family income, and prior episodes of major depressive disorder and substance use disorders. CONCLUSIONS: Our results suggest that early drug use is associated with and predicts later psychiatric disorders. Preventive implications stem from the importance of studying a range of psychiatric disorders in the context of substance use assessed over a wide age range.     

Moderating effects of major depression on patterns of comorbidity in patients with panic disorder

Given the high rate of co-occurring major depression in patients with panic disorder, it is unclear whether patterns of comorbidity in individuals with panic disorder reported in the literature are associated with panic disorder or with the presence of major depression. Subjects were 231 adult subjects with panic disorder and major depression (n=102), panic disorder without comorbid major depression (n=29), major depression without comorbid panic disorder (n=39), and neither panic disorder nor major depression (n=61). Subjects were comprehensively assessed with structured diagnostic interviews that examined psychopathology across the life cycle. Panic disorder, independently of comorbidity with major depression, was significantly associated with comorbid separation anxiety disorder, simple phobia, obsessive-compulsive disorder, generalized anxiety disorder, and agoraphobia. Major depression, independently of comorbidity with panic disorder, was significantly associated with comorbidity with psychoactive substance use disorders and childhood disruptive behavior disorders. Overanxious disorder was associated with both panic disorder and major depression. Major depression has important moderating effects on patterns of comorbidity of panic disorder in referred adults.     

Personality differences in the Munich Personality Test between patients with major depression and panic disorder

This study attempted to determine whether patients with major depression and panic disorder could be differentiated by personality features, measured by the Munich Personality Test (MPT). One of the six MPT personality dimensions, `rigidity', was developed in relation to the `melancholic type of personality', which may be a specific personality feature of depressive subjects. We therefore hypothesized that the MPT might be sensitive to possible personality differences between patients with major depression and panic disorder. Sixty-six patients with major depression and 27 patients with panic disorder, taken from consecutive intakes at an outpatient unit, were compared in terms of six personality dimensions of the MPT. The results demonstrated that rigidity could significantly differentiate the two patient groups, even after the possible confounding effects on the personality assessments were statistically partialled out. The MPT was suggested to be powerful for describing distinctive personality features of depressive subjects from anxiety subjects.     

Serum cholesterol levels in patients with panic disorders: A comparison with major depression and schizophrenia

Abstract Results of several long-term follow-up studies suggest that mortality due to cardiovascular diseases is high in males with panic disorder (PD). Based on these data, various studies have been undertaken to determine the relationship between PD and total cholesterol (TC) levels; however the results obtained so far have not been consistent. We compared TC levels in 46 PD patients to those in 46 sex, age, smoking and alcohol consumption matched patients with major depression and 46 matched patients with schizophrenia. The relationship between TC and the severity of PD was investigated, and before- and after-treatment TC change was compared. TC levels were significantly higher in the PD group than in the other groups, regardless of sex. The severity of PD was not correlated with TC levels. TC levels did not decrease in remitted PD patients. These findings suggest that relatively high TC levels in PD patients are attributable to endogenous disease-specific factors. Clinicians should pay close attention to the correlation between high mortality due to cardiovascular diseases and relatively high TC levels in male PD patients.