A Multi-Faceted Evaluation of Impulsivity Traits and Early Maladaptive Schemas in Patients with Anorexia Nervosa

(1) Background: patients with Anorexia Nervosa (AN) are classified either as restrictive (ANr) or binge/purge (ANbp) according to the absence or presence of impulsive eating and compensatory behaviors. The aim of the present study was to assess the levels of impulsivity in both AN subtypes and to explore whether individual differences in impulsivity may be explained by differences in the presence of early maladaptive schemas. (2) Methods: the sample group included 122 patients with ANr, 112 patients with ANbp, and 131 healthy women (HW). All of these participants completed the UPPS-P scale for an assessment of impulsive behaviors and the Young Schema Questionnaire (YSQ-S3) for an assessment of early maladaptive schemas. (3) Results: the patients with ANbp displayed higher levels of impulsivity compared with the patients with ANr and HW. Patients with AN, especially the restrictive subtype, also reported higher levels of early maladaptive schemas than HW, and regression analyses revealed that specific maladaptive schemas partially explain the variability in impulsivity in both patients and HW. (4) Conclusions: it appears that maladaptive beliefs developed during childhood or adolescence may predict the development of impulsivity, a personality trait usually associated with maladaptive behaviors, and appears to be prevalent among ANbp patients. The clinical effects of this, as well as directions for future study, are also discussed in this paper.

Case Report: Repeated Transcranial Magnetic Stimulation Improves Comorbid Binge Eating Disorder in Two Female Patients With Treatment-Resistant Bipolar Depression

Introduction: Binge eating disorder (BED) is the most common eating disorder, affecting a large population worldwide. It is characterized by recurrent episodes of binge eating, with no compensatory behaviors. BED is often associated with psychiatric comorbidities, and still represents a challenge in terms of treatment strategies. In the last years, neuromodulation has represented a promising approach in the treatment of BED. We report the cases of two women, affected by Bipolar Disorder Type II (BD-II) and comorbid BED, whose BED symptoms improved after a course of accelerated intermittent Theta Burst Stimulation (iTBS).Methods: We carried out a clinical study, involving neurostimulation on six patients with a treatment-resistant depressive episode. The trial consisted of a 3-week accelerated iTBS treatment, delivered to the left dorsolateral pre-frontal cortex. Clinical evaluation scales (Hamilton Rating Scale for Depression, Montgomery-Åsberg Depression Rating Scale, and Young Mania Rating Scale) were administered at baseline, after 2 weeks, and at the end of the stimulation cycle. Pharmacotherapy was maintained unchanged during iTBS treatment. Patients gave their informed consent both for the protocol and for the publication.Results: The treatment was well-tolerated. Depressive symptoms only slightly improved; however, patients' binge episodes remitted completely, which was a serendipitous finding. BED symptomatology complete remission lasted up to 12 weeks follow-up.Discussion: This is the first study regarding iTBS use in BED in comorbidity with BD-II. Further research is still needed to assess the efficacy of this technique in BED treatment.

Compensatory Belief in Health Behavior Management: A Concept Analysis

PurposeThis study aimed to identify the exact definition of the concept of compensatory belief (CB) and to help clinicians and caregivers to distinguish patients who tend to form such beliefs.MethodsThis study is a conceptual analysis based on the strategy of Walker and Avant (2014). We retrieved studies from existing literature using databases such as PubMed, CINAHL, Wiley, and Web of Science, and extracted information from the results. No date limitations were applied.ResultsA total of 35 articles were sourced for data extraction. The identified attributes of CB were as follows: cognitive coping strategy, pleasure without guilt, compensatory behaviors, automatic motivated self-regulatory process, and implicit cognition. The observed antecedents were: failure to resist desire, reluctance, a conflicting motivational state, seeking appropriate balance, and self-image maintenance. The consequences of CB were lower health-related intentions, justification of unhealthy choices, relief from cognitive dissonance, continued existence of conflict feeling, and poor long-term health.ConclusionCompensatory belief stems from motivational dissonance or confliction. Despite causing feelings of pleasure and relief, it can negatively impact long-term health. Although CB is crucial to establish healthy behaviors, it is easily ignored in medical work.

Recurrent episodes of binging and purging

Bulimia nervosa (BN) is an eating disorder that consists of recurrent binging episodes and inappropriate compensatory behaviors. Binge eating is defined as eating a large amount of food within a discrete time period accompanied by a sense of lack of control over eating during the episode. Examples of inappropriate compensatory behaviors include self-induced vomiting, fasting, excessive exercise, and laxative or diuretic misuse. Additionally, patients with BN experience body image disturbance, where their self-evaluation is unduly affected by weight and body shape concerns. Bulimia nervosa typically begins in late adolescence or young adulthood. Patients either are typically of normal weight or are overweight. Physical examination and laboratory findings are typically normal; however, medical complications can include electrolyte disturbances, cardiac arrhythmia, and dental caries. Fluoxetine and other selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat BN. A nutritional consultation is another important component of care. Finally, cognitive behavioral therapy (CBT) and family therapy are the psychotherapies of choice.

Healthy Communication Partners Modify Their Speech When Conversing With Individuals With Parkinson's Disease

Purpose For individuals with Parkinson's disease (PD), conversational interactions can be challenging. Efforts to improve the success of these interactions have largely fallen on the individual with PD. Successful communication, however, involves contributions from both the individual with PD and their communication partner. The current study examines whether healthy communication partners naturally engage in different acoustic–prosodic behavior (speech compensations) when conversing with an individual with PD and, further, whether such behavior aids communication success. Method Measures of articulatory precision, speaking rate, and pitch variability were extracted from the speech of healthy speakers engaged in goal-directed dialogue with other healthy speakers (healthy–healthy dyads) and with individuals with PD (healthy–PD dyads). Speech compensations, operationally defined as significant differences in healthy speakers' acoustic–prosodic behavior in healthy–healthy dyads versus healthy–PD dyads, were calculated for the three speech behaviors. Finally, the relationships between speech behaviors and an objective measure of communicative efficiency were examined. Results Healthy speakers engaged in speech characterized by greater articulatory precision and slower speaking rate when conversing with individuals with PD relative to conversations with other healthy individuals. However, these adaptive speech compensations were not predictive of communicative efficiency. Conclusions Evidence that healthy speakers naturally engage in speech compensations when conversing with individuals with PD is novel, yet consistent with findings from studies with other populations in which conversation can be challenging. In the case of PD, these compensatory behaviors did not support communication outcomes. While preliminary in nature, the results raise important questions regarding the speech behavior of healthy communication partners and provide directions for future work.

Gender-Dependent Associations of Anxiety and Depression Symptoms With Eating Disorder Psychopathology in a Representative Population Sample

Background: Evidence shows that anxiety and depressive disorders play an important role in eating disorder behavior. However, given the epidemiology of eating disorders, there is a need to investigate potentially gender-specific connections.Method: This study tested the associations of anxiety and depression symptoms with eating disorder symptoms and behaviors and explored whether they differed between men and women. Within a population-representative survey (N = 2,510; ages 14–94), participants completed measures of depression symptoms (PHQ-2), anxiety symptoms (GAD-2), and eating disorder symptoms (EDE-Q8). We conducted linear regression analyses of the EDE-Q8 sum score and General Linear Models on the three behaviors overeating, binge eating, and compensatory behaviors (self-induced vomiting/use of laxatives/excessive exercising).Results: Depression and anxiety symptoms were related to more eating disorder symptoms in men and women (irrespective of BMI, age, and income). The association of depression and eating disorder symptoms was slightly stronger in women. Overeating was more common in men and in depressed individuals, whereas compensatory behaviors were more common among anxious individuals, especially anxious women.Conclusion: The study extends previous research by using gender-specific methods in a representative sample. It indicates similarities and differences between men and women regarding disordered eating on a population level.

The Effect of Concerns About COVID-19 on Anxiety, Stress, Parental Burnout, and Emotion Regulation: The Role of Susceptibility to Digital Emotion Contagion

Background and aims: The COVID-19 pandemic has caused social and economic turmoil, which has led to enormous strain for many families. Past work with pandemic outbreaks suggests that media attention can increase anxiety and compensatory behaviors. Social isolation can lead to increase in online communication and parents who use social media may be affected by other people's emotions online through what is known as digital emotion contagion (DEC). The current study aimed to examine the role of DEC in the relationship between stress, concern about COVID-19, parental burnout and emotion regulation (ER).Methods: In April 2020, an online survey was advertised in Social Media Parenting Groups and published on FIU Psychology online research system SONA. Data were analyzed using correlational analysis, linear and multiple linear regression, and moderation analysis.Results: Concern about COVID-19 predicted stress, depression, and parental burnout. Susceptibility to DEC significantly increased the impact of stress on parental burnout. Having relatives infected with COVID-19 increased the effect of DEC on parental burnout. A higher level of ER buffered the relationship between emotion contagion and concern about COVID-19.Conclusion: These findings suggest that susceptibility to digital emotion contagion may have a negative effect on parents. Digital emotion contagion may increase parental burnout and is tied to stress.

Epilogue

Opening to further reflection, the epilogue recalls Franz Neumann’s 1954 arguments that anxiety arises in response to economic and cultural threats to identity and status, often paralyzing political participation. In times of disillusionment and social unrest, anxiety precipitates unreflective responses, including adherence to “caesaristic movements,” grounded on “false concreteness” or social prejudices. Another great observer of the rise of authoritarian movements, Hermann Broch, ties anxiety to our embodied ego’s existence in its world, to its self-enhancement, and to responses to perceived threats. When confronted with dangers to its self-expansion, anxiety, panic, and compensatory behaviors aiming at sadistic “over-satisfactions” (Superbefriedigungen) ensue. These responses can be seen in individuals and in the groups and movements they form. Together, these authors strongly support the book’s argument for abiding with anxiety and approaching it with a certain existential knowledge—of oneself and one’s circumstances.

Interoceptive insular cortex participates in sensory processing of gastrointestinal malaise and associated behaviors

The insular cortex plays a central role in the perception and regulation of bodily needs and emotions. Its modular arrangement, corresponding with different sensory modalities, denotes a complex organization, and reveals it to be a hub that is able to coordinate autonomic and behavioral responses to many types of stimuli. Yet, little is known about the dynamics of its electrical activity at the neuronal level. We recorded single neurons in behaving rats from the posterior insula cortex (pIC), a subdivision considered as a primary interoceptive cortex, during gastrointestinal (GI) malaise, a state akin to the emotion of disgust in humans. We found that a large proportion of pIC neurons were modulated during the rodent compensatory behaviors of lying on belly (LOB) and Pica. Furthermore, we demonstrated that LOB was correlated with low-frequency oscillations in the field potentials and spikes at the theta (8 Hz) band, and that low-frequency electrical microstimulation of pIC elicited LOB and Pica. These findings demonstrate that pIC neurons play a critical role in GI malaise perception, and that the pIC influences the expression of behaviors that alleviate GI malaise. Our model provides an accessible approach at the single cell level to study innate emotional behaviors, currently elusive in humans.