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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    • "Such difficulties are thought to be one of the maintaining factors of the disorder (Ohmann et al., 2013; Treasure and Schmidt, 2013). Individuals with AN report experiencing emotions and social interactions as highly problematic, as well as being more likely to report a poor social network and lack of social support than healthy controls (Hartmann et al., 2010; Tchanturia et al., 2012; Tchanturia et al., 2013a; Tiller et al., 1997) and there are also high comorbidity rates between AN and social anxiety, with one study reporting that 20% of their participants with AN also had a comorbid diagnosis of social anxiety (Kaye et al., 2004). Numerous factors are postulated to influence the social difficulties commonly observed in individuals with AN such as attachment style (Jewell et al., In Press; Rommel et al., 2013), dissociation between cognitive and physiological responses (Nandrino et al., 2011), obsessionality and trait anxiety (Castro et al., 2010; Hambrook et al., 2012; Lulé et al., 2014) and avoidance and low tolerance of difficult emotions (Harrison et al., 2011; Oldershaw et al., 2012). "
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    ABSTRACT: This study aimed to investigate emotion expression in a large group of children, adolescents and adults with Anorexia Nervosa (AN), and investigate the associated clinical correlates. One hundred and forty-one participants (AN=66, HC= 75) were recruited and positive and negative film clips were used to elicit emotion expressions. The Facial Activation Coding system (FACES) was used to code emotion expression. Subjective ratings of emotion were collected. Individuals with AN displayed less positive emotions during the positive film clip compared to healthy controls (HC). There was no significant difference between the groups on the Positive and Negative Affect Scale (PANAS). The AN group displayed emotional incongruence (reporting a different emotion to what would be expected given the stimuli, with limited facial affect to signal the emotion experienced), whereby they reported feeling significantly higher rates of negative emotion during the positive clip. There were no differences in emotion expression between the groups during the negative film clip. Despite this individuals with AN reported feeling significantly higher levels of negative emotions during the negative clip. Diminished positive emotion expression was associated with more severe clinical symptoms, which could suggest that these individuals represent a group with serious social difficulties, which may require specific attention in treatment.
    No preview · Article · Dec 2015
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    • "chart 1. continuation author and year country Cia; Barham, 2009 29 Brazil Silva; Murta, 2009 24 Brazil Bolsoni-Silva et al., 2010 25 Brazil Fitzsimmons; Bardone- Cone, 2011 59 USA Toral; Slater, 2007 50 Brazil Sarmento et al., 2010 40 Brazil Aubalat; Marcos, 2012 51 Spain Nilsson et al., 2007 30 Switzerland Arkell; Robinson, 2008 31 London Aime et al., 2008 55 Canada Grilo et al., 2012 41 USA Lam; McHale, 2012 52 USA Hartmann et al., 2010 42 Germain Davey; Chapman, 2009 32 London aims of the study To relate children's socialemotional development to their academic development To present a program of training in social skills for adolescents To evaluate children with behavior or social skill problems To assess the relationship between social support and the ability to resist/avoid eating disorders To obtain a deeper understanding of the factors determining eating habits and how they are formed To investigate emotional and behavioral symptoms in obese adolescents To analyze strategies for dealing with and overcoming eating disorders in adolescents To evaluate the causes of anorexia nervosa To analyze the quality of life of patients with AN To assess dietary history, risk factors and emotional factors in eating disorders To analyze history of BN and behavioral eating disorders, in relation to stress To examine concern about weight during adolescence To relate interpersonal problems with eating disorders Relation between disgust and eating disorders type of article Original article Original article Original article Original article Review of the literature Original article Original article Original article Original article Original article Original article Original article Original article Original article Variables analyzed Social skills and school performance Training of social skills in groups of adolescents Social skills and problems of behavior Anxiety, difficulty of confrontation and eating disorders Eating behavior, nutritional education, trans-theoretical model Social skills and problems of behavior Strategies for confrontation in eating disorders Causes of eating disorders Quality of life, depression and social skills Depression, use of drugs and alcohol, eating disorders, emotions Remission of eating disorders, personal characteristics Concerns with weight and parental relationships Interpersonal problems and eating disorders Disgust and eating disorders it continues chart 1. continuation author and year country Groleau et al., 2012 43 Canada Fox, 2009 26 London Presnell et al., 2009 33 USA Limbert, 2010 34 London Vale et al., 2011 44 Brazil Lavender; Anderson, 2010 45 USA Markey, 2010 46 USA Ioannou; Fox, 2009 35 London "
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    ABSTRACT: The purpose of this study is to provide a review of the literature on the relationship between eating disorders and social skills in adolescents. A search was made on the Medline, SciELO and Lilacs databases, for items combining the terms ‘eating disorders’, ‘anorexia nervosa’, ‘bulimia nervosa’ and ‘food behavior’, with the terms ‘social psychology’ and ‘social isolation’, and with the keywords ‘social competence’, ‘social skill’ and ‘interpersonal relations’. The following were included: studies on adolescents; in Portuguese, English and Spanish; published in the years 2007 through 2012. The search resulted in 63 articles, and 50 were included in this review. The majority of the studies were made in Brazil and the United States. Of the total, 43 were original articles. The studies aimed to understand how emotional state could influence the establishment of eating disorders, interpersonal relationships and peer relationship. The articles also discussed the influence of the media and of society in this process. Based on the analysis of the studies, it was observed that the greater an adolescent’s repertory of social skills, the greater his or her factor of protection against the development of eating disorders.
    Preview · Article · Nov 2015 · Ciencia & saude coletiva
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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).
    Full-text · Article · May 2014 · Frontiers in Human Neuroscience
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