Psychoform and somatoform dissociation in anorexia nervosa: A systematic review.

Dissociation is a debilitating condition often present as comorbidity in patients with eating disorders, but to date only sparse findings are available on this topic. Additionally, very little data exist on the classification of dissociation, namely, psychoform and somatoform, in anorexia nervosa (AN). This review aimed to provide an updated view on the literature about dissociation in AN, with a focus on AN subtypes (i.e., restricter and binge-purging) as well as dissociation type (i.e., psychoform and somatoform), when available. We screened 304 studies, and after title and abstract selection and full-text reading, 29 of them were included in this review. Most of the studies investigated psychoform dissociation, whereas just four publications considered somatoform dissociation. Dissociation resulted to be present in AN more than in healthy controls and in individuals with other psychiatric disorders, and it was related mostly to the binge-purging subtype of AN. Moreover, dissociation was linked to traumatic events, self-harm and negative treatment outcomes, especially in patients affected by the binge-purging subtype of AN. However, results on these matters are scarce and partially discordant. The methodological assessment we performed revealed an overall fair quality of the included studies, although several flaws emerged as well. The present review reported on one hand the relevance of dissociation in AN, but on the other hand the need to stimulate the scientific debate on (a) a deeper investigation of somatoform dissociation in AN and (b) the relationship between dissociation and both clinical severity and treatment response/resistance in AN.

Young Patients with Anorexia Nervosa: The Contribution of Post-Traumatic Stress Disorder and Traumatic Events.

Background and Objectives: Anorexia nervosa (AN) is a complex disorder whose etiopathogenesis involves both biological and environmental factors. The aims of the present study were to retrospectively analyze risk factors in young patients with AN and to assess differences in clinical and eating-related symptoms between patients with and without a diagnosis of post-traumatic stress disorder (PTSD) and with or without a history of acknowledged risk factors. Materials and Methods: Sixty-four patients with AN (<25 years old) were recruited and completed an anamnestic evaluation and the following self-report measures: Eating Disorder Examination Questionnaire (EDE-Q), Childhood Trauma Questionnaire (CTQ), State-Trait Anxiety Inventory (STAI-Y), Beck Depression Inventory (BDI), Life Events Checklist (LEC), and Dissociative Experience Scale (DES). The PTSD diagnosis was assigned according to the Structured Clinical Interview for the DSM-5 (SCID-5). Results: The most frequent risk factors were those associated with relational traumatic events and familiarity for psychiatric disorders. Higher severity of body-related symptoms (i.e., those symptoms impacting on body image and perception and leading to body concerns) emerged in patients with PTSD, versus patients without PTSD diagnosis; however, after controlling for dissociative symptoms, only differences in BMI remained significant. Concerning other risk factors, those with a history of childhood trauma were more depressed than patients without such history and those with familiarity with eating disorders reported more AN-related hospitalizations in the past than those individuals without familiarity. Conclusion: These results suggest the importance of investigating the presence of risk factors and PTSD diagnosis in patients with AN, and to treat post-traumatic symptoms in young patients in order to decrease the risk of developing severe forms of AN. Moreover, a particular focus on those patients with a family member affected by an eating disorder could be of clinical utility.