Hostname: page-component-8448b6f56d-tj2md Total loading time: 0 Render date: 2024-04-24T09:26:27.769Z Has data issue: false hasContentIssue false
  • English
  • Français

An innovative approach for the assessment of mood disturbances in patients with eating disorders

Published online by Cambridge University Press:  15 April 2019

Lucia Tecuta ,
Giovanni Andrea Fava Open the ORCID record for Giovanni Andrea Fava [Opens in a new window]  and
Elena Tomba
Lucia Tecuta
Affiliation:
Department of Psychology, University of Bologna, Bologna, Italy
Giovanni Andrea Fava*
Affiliation:
Department of Psychology, University of Bologna, Bologna, Italy Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA
Elena Tomba
Affiliation:
Department of Psychology, University of Bologna, Bologna, Italy
*
*Address correspondence to: Giovanni A. Fava, MD, Department of Psychology, University of Bologna, Viale Berti Pichat, 5, 40127Bologna, Italy, Phone: +39-051-2091339, Fax: +39-051-243086. (E-mail: giovanniandrea.fava@unibo.it)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Assessment of mood in eating disorders (EDs) has important clinical implications, but the current standard psychiatric classification (DSM-5) has limitations. The aim of the current study is to broaden the evaluation of depressive symptomatology by providing a comprehensive and innovative assessment approach in EDs through instruments that capture clinical phenomena of demoralization, subclinical distress, and psychological well-being.

Methods.

Seventy-nine patients who met diagnostic criteria for EDs of the Diagnostic and Statistical Manual of Mental Disorders – Fifth edition (DSM-5) were evaluated for depressive symptoms through Paykel’s Clinical Interview for Depression, the Structured Clinical Interview for DSM-5 for major depressive episode and persistent depressive disorder, and the Diagnostic Criteria for Psychosomatic Research (DCPR) interview for demoralization. Further, self-report inventories encompassing psychological well-being and distress were used.

Results.

Guilt, abnormal reactivity to social environment, and depressed mood were the most common depressive symptoms in the sample. DSM-defined depressive disorders were found in 55.7% of patients. The DCPR-demoralization criteria identified an additional 20.3% of the sample that would have been undetected with DSM criteria. Both DSM and DCPR diagnostic categories were associated with compromised psychological well-being and distress. Demoralization, unlike depression, was not associated with the severity of ED symptomatology.

Conclusion.

The findings indicate that a standard psychiatric approach, DSM-5-based, captures only a narrow part of the spectrum of mood disturbances affecting patients with EDs. A broadened clinimetric assessment unravels the presence of demoralization and yields clinical distinctions that may entail prognostic and therapeutic differences among patients who would be otherwise simply labeled as depressed.

Keywords

Demoralizationdepressioneating disorderspsychological well-being
Type
Original Research
Information
CNS Spectrums , Volume 25 , Issue 1 , February 2020 , pp. 71 - 78
Copyright
© Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

The authors would like to thank the therapists and the collaborators of the Eating Disorder Clinics “Centro Gruber” (Bologna, Italy) and “Residenza Gruber” (Bologna, Italy), in particular Dr Donatella Ballardini, MD, Dr Romana Schumann, PsyD, and Dr Anna Franco, PsyD, for assistance in participant recruitment and data gathering.

References

References:

Puccio, F, Fuller-Tyszkiewicz, M, Ong, D, et al.A systematic review and meta-analysis on the longitudinal relationship between eating pathology and depression. Int J Eat Disord. 2016; 49(5): 439–454.Google Scholar
Godart, N, Radon, L, Curt, F,, et al.Mood disorders in eating disorder patients: Prevalence and chronology of onset. J Affect Disord. 2015; 185: 115–122.Google Scholar
Godart, NT, Perdereau, F, Rein, Z, et al.Comorbidity studies of eating disorders and mood disorders: Critical review of the literature. J Affect Disord. 2007; 97(1–3): 37–49.Google Scholar
Mischoulon, D, Eddy, KT, Keshaviah, A, et al. Depression and eating disorders: Treatment and course. J Affect Disord. 2011; 130(3): 470–477.Google Scholar
Meehan, KG, Loeb, KL, Roberto, CA, et al. Mood change during weight restoration in patients with anorexia nervosa. Int J Eat Disord. 2006; 39: 587–589.Google Scholar
Mattar, L, Huas, C, Duclos, J, et al. Relationship between malnutrition and depression or anxiety in Anorexia Nervosa: A critical review of the literature. J Affect Disord. 2010; 132(3): 311–318.Google Scholar
Garfinkel, PE, Garner, DM. Anorexia Nervosa: A Multidimensional Perspective. New York, NY: Brunner/Mazel Inc; 1982.Google Scholar
Casper, R. Depression in eating disorders. Depress Anxiety 1998; 8: 96–104.Google Scholar
Fava, GA, Rafanelli, C, Tomba, E. The clinical process in psychiatry: A clinimetric approach. J Clin Psychiatry 2012; 73(2): 177–184.Google Scholar
Fava, GA. Subclinical symptoms in mood disorders. Psychol Med. 1999; 29(1): 47–61.Google Scholar
Paykel, ES. The clinical interview for depression: Development, reliability and validity. J Affect Disord. 1985; 9(1): 85–96.Google Scholar
Guidi, J, Fava, GA, Bech, P, et al. The clinical interview for depression: A comprehensive review of studies and clinimetric properties. Psychother Psychosom. 2011; 80(1): 10–27.Google Scholar
Fava, GA, Freyberger, HJ, Bech, P, et al. Diagnostic criteria for use in psychosomatic research. Psychother Psychosom. 1995; 63(1): 1–8.Google Scholar
Fava, GA, Cosci, F, Sonino, N. Current psychosomatic practice. Psychother Psychosom. 2017; 86(1): 13–30.Google Scholar
Tecuta, L, Tomba, E, Grandi, S, et al. Demoralization and its clinical characterization. Psychol Med. 2015; 45(4): 673–691.Google Scholar
Abbate-Daga, G, Delsedime, N, Nicotra, B, et al. Psychosomatic syndromes and anorexia nervosa. BMC Psychiatry. 2013; 13: 14.Google Scholar
Fava, GA, Cosci, F, Guidi, J, et al. Well-being therapy in depression: new insights into the role of psychological well-being in the clinical process. Depress Anxiety. 2017; 34(9): 801–808.Google Scholar
Tomba, E, Offidani, E, Tecuta, L, et al. Psychological well-being in out-patients with eating disorders: A controlled study. Int J Eat Disord. 2014; 47(3): 252–258.Google Scholar
Tomba, E, Tecuta, L, Schumann, R, et al. Does psychological well-being change following treatment? An exploratory study on outpatients with eating disorders. Compr Psychiatry. 2017; 74 : 61–69.Google Scholar
First, MB, Williams, JBW, Karg, RS, et al. Structured Clinical Interview for DSM-5 Disorders, Clinician Version (SCID-5-CV). Arlington, VA: American Psychiatric Association; 2015.Google Scholar
Hamilton, M. Development of a rating scale for primary depressive illness. Brit J Soc Clin Psychol. 1967; 6(4): 278–296.Google Scholar
Bech, P. Fifty years with the Hamilton Scales for Anxiety and Depression. Psychother Psychosom. 2009; 78(4): 202–211.Google Scholar
Galeazzi, GM, Ferrari, S, Mackinnon, A, et al. Inter-rater reliability, prevalence and relation to ICD-10 diagnoses of the Diagnostic Criteria for Psychosomatic Research in consultation-liaison psychiatry patients. Psychosom. 2004; 45(5): 386–393.Google Scholar
Beck, AT, Steer, RA, Brown, GK. Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation; 1996.Google Scholar
Wang, YP, Gorenstein, C. Psychometric properties of the Beck Depression Inventory-II: A comprehensive review. Rev Bras Psiquiatr. 2013; 35(4): 416-431.Google Scholar
Ryff, CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol. 1989; 57(6): 1069-1081.Google Scholar
Ryff, CD. Psychological well-being revisited: advances in the science and practice of eudaimonia. Psychother Psychosom. 2014; 83(1): 10-28.Google Scholar
Garner, DM, Garfinkel, PE. The eating attitude test: An index of the symptoms of anorexia nervosa. Psychol Med. 1979; 9(2): 273–279.Google Scholar
Garfinkel, PE, Newman, A. The eating attitudes test: Twenty-five years later. Eat Weight Disord. 2001; 6(1): 1–24.Google Scholar
Miller, GA, Chapman, JP. Misunderstanding analysis of covariance. J Abnorm Psychol. 2001; 110(1): 40–48.Google Scholar
Frank, ES. Shame and guilt in eating disorders. Am J Orthopsychiatry. 1991; 61(2): 303–306.Google Scholar
Petry, N, Vasconcelos, FAG, Costa, LDCF. Feelings and perceptions of women recovering from anorexia nervosa regarding their eating behavior. Cad Saude Publica. 2017; 33(9): e00048716.Google Scholar
Burney, J, Irwin, HJ. Shame and guilt in women with eating-disorder symptomatology. J Clin Psychol. 2000; 56(1): 51–61.Google Scholar
Tomba, E, Rafanelli, C, Grandi, S, et al. Clinical configuration of cyclothymic disturbances. J Affect Disord. 2012; 139(3): 244–249.Google Scholar
Raffi, AR, Rondini, M, Grandi, S, et al. Life events and prodromal symptoms in bulimia nervosa. Psychol Med. 2000; 30(3): 727-731.Google Scholar
Tapajóz, P, de Sampaio, F, Soneira, S, et al. Emotional reactivity to social stimuli in patients with eating disorders. Psychiatry Res. 2015; 229(3): 887-894.Google Scholar
Gutiérrez-Maldonado, J, Ferrer-García, M, Caqueo-Urízar, A, et al. Assessment of emotional reactivity produced by exposure to virtual environments in patients with eating disorders. Cyberpsychol Beh. 2006; 9(5): 507–513.Google Scholar
Swinbourne, JM, Touyz, SW. The co-morbidity of eating disorders and anxiety disorders: A review. Eur Eat Disord Rev. 2007; 15(4): 253–274. .Google Scholar
Steinglass, J, Albano, AM, Simpson, HB, et al. Fear of food as a treatment target: Exposure and response prevention for anorexia nervosa in an open series. Int J Eat Disord. 2012; 45(4): 615–621.Google Scholar
Arkell, J, Robinson, P. A pilot case series using qualitative and quantitative methods: Biological, psychological and social outcome in severe and enduring eating disorder (anorexia nervosa). Int J Eat Disord. 2008; 41(7): 650-656.Google Scholar
Bamford, BH, Attoe, C, Mountford, VA, et al. Body checking and avoidance in low weight and weight restored individuals with anorexia nervosa and non-clinical females. Eat Behav. 2014; 15(1): 5-8.Google Scholar
Steinglass, JE, Albano, AM, Simpson, HB, et al. Confronting fear using exposure and response prevention for anorexia nervosa: A randomized controlled pilot study. Int J Eat Disord. 2014; 47(2): 174–180.Google Scholar
Grandi, S, Sirri, L, Tossani, E, et al. Psychological characterization of demoralization in the setting of heart transplantation. J Clin Psychiatry. 2011; 72(5): 648–654.Google Scholar
de Figueiredo, JM. Depression and demoralization: Phenomenologic differences and research perspectives. Compr Psychiatry. 1993; 34(5): 308–311.Google Scholar
de Figueiredo, JM. Distress, demoralization and psychopathology: Diagnostic boundaries. Eur J Psychiatry. 2013; 27(1): 61–73.Google Scholar
Garner, DM. EDI2—Eating Disorders Inventory 2. Professional manual. Odessa, FL: Psychological Assessment Resources; 1991.Google Scholar
Surgenor, LJ, Maguire, S, Russell, J, et al. Self-liking and self-competence: Relationship to symptoms of anorexia nervosa. Eur Eat Disord Rev. 2007; 15(2): 139–145.Google Scholar
Fassino, S, Pierò, A, Tomba, E, et al. Factors associated with dropout from treatment for eating disorders: A comprehensive literature review. BMC Psychiatry. 2009; 9: 67.Google Scholar
Ackard, DM, Richter, S, Egan, A, et al. The meaning of (quality of) life in patients with eating disorders: A comparison of generic and disease-specific measures across diagnosis and outcome. Int J Eat Disord. 2014; 47(3): 259–267.Google Scholar
Jahoda, M. Current concepts of positive mental health. New York, NY: Basic Books; 1958.Google Scholar
Fava, GA, Bech, P. The concept of euthymia. Psychother Psychosom. 2016; 85(1): 1–5.Google Scholar
Tomba, E, Tecuta, L. Well-being therapy in a patient with anorexia nervosa. Psychother Psychosom. 2016; 85: 369–370.Google Scholar
Fava, GA. Well-being therapy. Treatment Manual and Clinical Applications. Basel: Karger; 2016.Google Scholar
Padierna, A, Quintana, J, Arostegui, I, et al. The health-related quality of life in eating disorders. Qual Life Res. 2000; 9(6): 667–674.Google Scholar
Hatsukami, DK, Mitchell, JE, Eckert, ED, et al. Characteristics of patients with bulimia only, bulimia with affective disorder, and bulimia with substance abuse problems. Addict Behav. 1986; 11(4): 399–406.Google Scholar
Bulik, CM, Sullivan, PF, Carter, FA, et al. Lifetime anxiety disorders in women with bulimia nervosa. Compr Psychiatry. 1996; 37(5): 368–374.Google Scholar
Hughes, EK, Goldschmidt, AB, Labuschagne, Z, et al. Eating disorders with and without comorbid depression and anxiety: Similarities and differences in a clinical sample of children and adolescents. Eur Eat Disord Rev. 2013; 21(5): 386–394.Google Scholar
Brand-Gothelf, A, Leor, S, Apter, A, et al. The impact of comorbid depressive and anxiety disorders on severity of anorexia nervosa in adolescent girls. J Nerv Ment Dis. 2014; 202(10): 759–762.Google Scholar
Herpertz-Dahlmann, B, Remschimdt, H. Depression in anorexia nervosa at follow-up. Int J Eat Disord. 1993; 14(2): 163–169.Google Scholar
Anderson, DA, Lundgren, JD, Shapiro, JR, et al. Assessment of eating disorders: Review and recommendations for clinical use. Behav Modif. 2004; 28(6): 63–82.Google Scholar
Bowers, WA, Haedt-Matt, AA. Psychological assessment of eating disorders. In: Preedy, VR, Watson, RR, Colin, RM, eds. Handbook of Behavior, Food and Nutrition. New York, NY: Springer; 2011: 3425-3435.Google Scholar
Waller, G. The myths of motivation. Time for a fresh look at some received wisdom in the eating disorders? Int J Eat Disord. 2012; 45(1): 1-16.Google Scholar
Wade, TD, Wilksch, SM, Paxton, SJ, et al. How perfectionism and ineffectiveness influence growth of eating disorder risk in young adolescent girls. Beh Res Ther. 2015; 66 : 56-63.Google Scholar
Dawson, L, Rhodes, P, Touyz, S. “Doing the Impossible”: The process of recovery from chronic anorexia nervosa. Qual Health Res. 2014; 24(4): 494–505.Google Scholar
Nordbø, RHS, Espeset, EMS, Gulliksen, KS, et al. Reluctance to recover in anorexia nervosa. Eur Eat Disord Rev. 2012; 20(1): 60–67.Google Scholar
Frank, JD. Persuasion and healing. Baltimore: Johns Hopkins University Press; 1961.Google Scholar
Tomba, E, Tecuta, L, Guidi, J, et al. Demoralization and response to psychotherapy: A pilot study comparing the sequential combination of cognitive-behavioral therapy and well-being therapy with clinical management in cyclothymic disorder. Psychother Psychosom. 2016; 85(1): 56–57.Google Scholar
Agras, WS, Walsh, BT, Fairburn, CG, et al. A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Arch Gen Psychiatry. 2000; 57(5): 459–466.Google Scholar
Collin, P, Power, K, Karatzias, T, et al. The effectiveness of and predictors of response to inpatient treatment of anorexia nervosa. Eur Eat Disord Rev. 2010; 18(6): 464–474.Google Scholar
Fluoxetine Bulimia Nervosa Collaborative Study Group. Fluoxetine in the treatment of bulimia nervosa. Arch Gen Psychiatry. 1992; 49(2): 139–147.Google Scholar
Walsh, BT, Wilson, GT, Loeb, KL, et al. Medication and psychotherapy in the treatment of bulimia nervosa. Am J Psychiatry. 1997; 154(4): 523–531.Google Scholar
Romano, SJ, Halmi, KA, Sarkar, NP, et al. A placebo-controlled study of fluoxetine in continued treatment of bulimia nervosa after successful acute fluoxetine treatment. Am J Psychiatry. 2002; 159(1): 96–102.Google Scholar
Walsh, BT, Kaplan, AS, Attia, E, et al. Fluoxetine after weight restoration in anorexia nervosa: A randomized controlled trial. JAMA. 2006; 295(22): 2605–2612.Google Scholar
Fava, GA, Carrozzino, D, Lindberg, L, et al. The clinimetric approach to psychological assessment. Psychother Psychosom. 2018; 87(6): 321–326.Google Scholar