Interpersonal problems in eating disorders

Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Hauptstrasse 8, Freiburg, Germany.
International Journal of Eating Disorders (Impact Factor: 3.13). 11/2010; 43(7):619-27. DOI: 10.1002/eat.20747
Source: PubMed


Eating disorders are often chronic in nature and lead to a number of problems among which interpersonal issues are suggested to be central. Although research has shown that individuals with disturbed patterns of eating consistently report problems in social interactions, this study is unique in assessing a range of interpersonal problems among patients with all types of eating disorders before and after intensive hospital-based treatment.
A total of 208 patients receiving a primary diagnosis of restrictive anorexia nervosa, bulimia nervosa, or anorexia nervosa of the binge/purging-subtype were included in the study. Eating pathology, symptom severity, and interpersonal patterns were examined before and after treatment.
Patients with eating disorders exhibited a generally nonassertive, submissive interpersonal style, with anorexic patients of the binge/purging-subtype reporting more difficulties with social inhibition and nonaffiliation. These patterns were found to change over the course of treatment with interpersonal problems at intake predictive of greater binge severity at discharge. Furthermore, issues of dominance and social avoidance predicted outcome for specific subgroups of patients.
Results underscore the importance of interpersonal problems in eating disorders and suggest that interpersonal patterns remain a focus of treatment and future research.

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    • "A possible exogenous cause is an excessive level of stress. Different researchers recently suggested the influence of interpersonal problems (Hartmann et al., 2010), chronic stress, and post-traumatic stress on the onset of EDs (Troop et al., 1998; Sassaroli and Ruggiero, 2005; Rojo et al., 2006; Hepp et al., 2007; Lo Sauro et al., 2008). Recent research underlines the role of anxiety and stress in influencing the brain areas involved in the egocentric/allocentric transformation (Vyas et al., 2002; McLaughlin et al., 2007). "
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    ABSTRACT: Clinical psychology is starting to explain eating disorders (ED) as the outcome of the interaction among cognitive, socio-emotional and interpersonal elements. In particular two influential models-the revised cognitive-interpersonal maintenance model and the transdiagnostic cognitive behavioral theory-identified possible key predisposing and maintaining factors. These models, even if very influential and able to provide clear suggestions for therapy, still are not able to provide answers to several critical questions: why do not all the individuals with obsessive compulsive features, anxious avoidance or with a dysfunctional scheme for self-evaluation develop an ED? What is the role of the body experience in the etiology of these disorders? In this paper we suggest that the path to a meaningful answer requires the integration of these models with the recent outcomes of cognitive neuroscience. First, our bodily representations are not just a way to map an external space but the main tool we use to generate meaning, organize our experience, and shape our social identity. In particular, we will argue that our bodily experience evolves over time by integrating six different representations of the body characterized by specific pathologies-body schema (phantom limb), spatial body (unilateral hemi-neglect), active body (alien hand syndrome), personal body (autoscopic phenomena), objectified body (xenomelia) and body image (body dysmorphia). Second, these representations include either schematic (allocentric) or perceptual (egocentric) contents that interact within the working memory of the individual through the alignment between the retrieved contents from long-term memory and the ongoing egocentric contents from perception. In this view EDs may be the outcome of an impairment in the ability of updating a negative body representation stored in autobiographical memory (allocentric) with real-time sensorimotor and proprioceptive data (egocentric).
    Frontiers in Human Neuroscience 05/2014; 8:236. DOI:10.3389/fnhum.2014.00236 · 3.63 Impact Factor
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    • "The measure of received support also does not allow us to determine whether patients responded to items based on their experiences within the treatment context, outside of treatment, or both. In future research, it would be interesting to examine whether certain interpersonal patterns characteristic of AN-BP, such as being cold/distant, socially inhibited, and vindictive/self-centered [19], may lead these patients to lose favour among co-patients and therapists as treatment progresses. "
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    ABSTRACT: Background Individuals with Anorexia Nervosa (AN) are renowned for their poor short- and long-term treatment outcomes. To gain more insight into the reasons for these poor outcomes, the present study compared patients with AN-R (restrictive subtype), AN-BP (binge-purge subtype), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS) over 12 weeks of specialized eating disorders treatment. Eighty-nine patients completed the Eating Disorder Examination- Questionnaire (EDE-Q) and various measures of psychosocial functioning at baseline, and again after weeks 3, 6, 9, and 12 of treatment. Results Multilevel modeling revealed that, over the 12 weeks, patients with AN-BP and AN-R had slower improvements in global eating disorder pathology, shape concerns, and self-compassion than those with EDNOS and BN. Patients with AN-BP had slower improvements in shame, social safeness (i.e., feelings of warmth in one’s relationships), and received social support compared to those with AN-R, BN, and EDNOS. Conclusions These findings support the need for more effective and comprehensive clinical interventions for patients with AN and especially AN-BP. Results also highlight not-yet studied processes that might contribute to the poor outcomes AN patients often face during and after treatment.
    International Journal of Eating Disorders 01/2014; 2(1):2. DOI:10.1186/2050-2974-2-2 · 3.13 Impact Factor
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    • "Although understanding and investigating changes in symptomatology is integral to psychotherapy, focusing solely on symptoms ignores a range of other factors known to influence psychological well-being and quality of life (QoL). Interpersonal problems are associated with many psychological difficulties, including generalized anxiety disorder (GAD, Borkovec, Newman, Pincus, & Lytle, 2002; Eng & Heimberg, 2006), depression (Vittengl, Clark, & Jarrett, 2003; Petty, Sachs-Ericsson, & Joiner, 2004), and eating disorders (Fairburn, Cooper, & Shafran, 2003; Hartmann, Zeeck, & Barrett, 2010; Hopwood, Clarke, & Perez, 2007). Recognizing the importance of accounting for interpersonal functioning in understanding psychological well-being, "
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    ABSTRACT: Integrative models of psychopathology suggest that quality of interpersonal relationships is a key determinant of psychological well-being. However, there is a relative paucity of research evaluating the association between interpersonal problems and psychopathology within cognitive behavioural therapy. Partly, this may be due to lack of brief, well-validated, and easily interpretable measures of interpersonal problems that can be used within clinical settings. The aim of the present study was to evaluate the psychometric properties, factor invariance, and external validity of the Inventory of Interpersonal Problems 32 (IIP-32) across anxiety, depression, and eating disorders. Two treatment-seeking samples with principal anxiety and depressive disorders (AD sample, n = 504) and eating disorders (ED sample, n = 339) completed the IIP-32 along with measures of anxiety, depression, and eating disorder symptoms, as well as quality of life (QoL). The previously established eight-factor structure of the IIP-32 provided the best fit for both the AD and ED groups, and was robustly invariant across the two samples. The IIP-32 also demonstrated excellent external validity against well-validated measures of anxiety, depression, and eating disorder symptoms, as well as QoL. The IIP-32 provides a clinically useful measure of interpersonal problems across emotional and ED.
    British Journal of Clinical Psychology 06/2013; 52(2):129-47. DOI:10.1111/bjc.12005 · 1.90 Impact Factor
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