Traumatic events and post-traumatic symptoms in anorexia nervosa.

Background: Traumatic Events (TEs) are often seen as risk factors not only for the development of eating disorders (EDs) but also for their impact on the severity of clinical presentation and psychiatric comorbidities. Objective: This study aimed to assess the prevalence and time of occurrence of TEs in the two subtypes of anorexia nervosa (AN; restricting [RAN] and binge-purging [BPAN]) and to investigate differences in TEs (number, type, frequency) as well as clusters of post-traumatic symptoms and emotional dysregulation between the two groups. Method: Seventy-seven hospitalized women were recruited and divided into two subgroups according to their AN subtype. Participants completed the following self-reported measures: Eating Disorder Inventory-2 (EDI-2), Life Events Checklist (LEC), Impact of Events Scale-Revised (IES-R) and the Difficulties in Emotion Regulation Scale (DERS). Results: A higher occurrence of TEs was found in patients with BPAN than in those with RAN. In particular, there were significantly more women in the BPAN group than in the RAN group who had been sexually assaulted. Exposure to TEs happened before the onset of illness in most patients, regardless of the AN subtype. Finally, the BPAN group had significantly higher scores in terms of post-traumatic symptoms and emotional dysregulation than RAN patients. Conclusions: Patients with BPAN showed a higher occurrence of TEs, post-traumatic symptom clusters, and emotional dysregulation than those with RAN. These findings are of interest as treatments could benefit from trauma-informed interventions for those affected by AN, and particularly for those with the binge-purging subtype.

Antecedentes: Los Eventos Traumáticos (ETs) con frecuencia se ven como factor de riesgo no solo para el desarrollo de los Trastornos de la conducta alimentaria (EDs por sus siglas en inglés) sino tambien por su impacto en la severidad de la presentación clínica y las comorbilidades psiquiátricas.Objetivo: Este estudio tuvo como objetivo evaluar la prevalencia y tiempo de ocurrencia de los ETs en dos subtipos de anorexia nervosa (AN; restrictiva [RAN por sus siglas en ingles] y purga compulsiva [BPAN por sus siglas en ingles) e investigar las diferencias en los ETs (número, tipo, frecuencia) así como también los grupos de síntomas postraumáticos y desregulación emocional entre los dos tipos. Método: Se reclutaron setenta y siete mujeres hospitalizadas y se dividieron en dos subgrupos de acuerdo al subtipo de AN. Las participantes completaron las siguientes medidas de auto-reporte: El Inventario de Trastornos alimentarios-2 (EDI-2), la Lista de Chequeo de Eventos Vitales (LEC), la Escala Revisada del Impacto de los Eventos (IES-R) y la Escala de Dificultades de la regulación Emocional (DERS).Resultados: Se encontró una mayor ocurrencia de ETs en pacientes con BPAN que en aquellas con RAN. En particular, hubo significativamente más mujeres en el grupo de BPAN que en el grupo de RAN que habían tenido abuso sexual. La exposición a los ETs sucedió antes del inicio de la enfermedad en la mayoría de las pacientes, independientemente del subtipo de AN. Finalmente, el grupo BPAN tenía significativamente puntajes más altos en términos de síntomas postraumáticos y desregulación emocional que las pacientes RAN.Conclusiones: Las pacientes con BPAN mostraron una mayor ocurrencia de ETs, grupos de síntomas postraumáticos, y desregulación emocional que aquellas con RAN. Estos hallazgos son de interés ya que los tratamientos podrían beneficiarse de las intervenciones informadas en trauma para aquellas afectadas por AN y en particular para aquellas con el subtipo purga compulsiva.

Adlerian parental counseling in eating disorders: preliminary data of a controlled clinical trial.

OBJECTIVE: Counseling interventions for parents with a daughter affected by an eating disorder (ED) may represent a useful and cost-effective tool to improve patients' compliance to treatment and overall outcome. The present study evaluates the outcome of Adlerian Parental Counseling (APC) on individuals affected by ED and their parents. METHODS: We assessed 114 patients whose parents underwent APC and 44 individuals whose parents did not receive this intervention. All patients received multimodal treatment and were assessed at intake and at a 6-month follow-up. Patients were assessed using: the first scale and the improvement scale (GI) of the Clinical Global Impression (CGI) and the Family Assessment Device (FAD). Parents underwent APC and completed several psychometric tests: Attachment Style Questionnaire, State-Trait Anger Expression Inventory, Symptom Questionnaire, and Family Assessment Device. RESULTS: The GI of the ED group whose parents received APC significantly improved when compared with baseline. Moreover, the improvement was significantly greater for the APC group with respect to the non-APC group if the initial CGI score was considered. After counseling, mothers displayed poorer FAD scores, but their sense of inadequacy, their anxiety symptoms and their preoccupation with relationships improved. Fathers improved their social trust and reduced introverted anger. APC reduced the differences as regards family functioning perception among family members. CONCLUSION: Parents reported a subjective improvement in psychopathology scales and a better fine-tuning of their perception of family dynamics with those of their daughters and husband. The improvement in family dynamics along with the motivational effect of parents' participation in counseling may have positively influenced the outcome of the multimodal treatment. Moreover, this intervention could also have been helpful for those with a severe ED.

Exploring personality clusters among parents of ED subjects. Relationship with parents' psychopathology, attachment, and family dynamics.

BACKGROUND: Eating disorders are some of the most difficult mental disorders to treat and manage. Family interacts with genetic dispositions and other pathogenic factors, and may influence the outburst, development and outcome of EDs. The present study explores with a cluster analysis the personality traits of parents of ED subjects. METHODS: One-hundred-eight mothers and 104 fathers were tested with Temperament Character Inventory (TCI), Eating Disorder Inventory-2 (EDI-2), State-Trait Anger Expression Inventory (STAX), Family Assessment Device (FAD), Attachment Style Questionnaire (ASQ), Symptom Questionnaire (SQ), Psychological Well-Being scales (PWB). The cluster distribution of parents based on personality traits was explored. Parents' clusters TCI scores were compared as regards personality, psychopathology, attachment and family features. Cross distribution of temperament and character clusters in mothers and fathers, among couples and ED diagnoses of the daughters was explored. RESULTS: Two clusters of mothers and fathers were identified with temperament clustering. Character traits led to two mothers and three fathers clusters. Mothers temperament cluster 1 (MTC1) correspond to a explosive/adventurous profile, MTC2 to a cautious/passive-dependent profile. Fathers temperament cluster 1 (FTC1) was explosive/methodic, FTC2 was independent/methodic. Character clustering distinguished very immature mothers (MCC1) and majority (65%) of character mature mothers with low self-transcendence (MCC2). A third of fathers was severely immature (FCC1), a third impaired as regards relationships (poor cooperativeness and self-transcendence; FCC2), and one third character mature fathers with low self-transcendence (FCC3). Each cluster evidences specific psychopathology and attachment characteristics. FTC1 was more frequently associated with character immaturity. No significant clusters' cross correlation was found in parental couples. CONCLUSION: Parents' clusters analyze in depth the univocal picture of prototypical mothers and fathers of EDs. Parents not disturbed as regards personality traits are not exceptions. Since EDs are multifactor disorders family dynamics related to parents' personality may be very relevant or even marginal in their pathogenesis. Conversely, parenting may be negatively influenced by relatively marginal personality malfunctions of parents. The clustering approach to the complexity of personality-related dynamics of ED families improves the picture of ED parents. Psychoeducational, counseling and psychotherapeutic family interventions should consider the specific underlying personality of parents.