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Background: In recent years, many studies have explored the associations among impulsivity, history of abuse, the emergence of eating disorders with episodes of binge eating (EDBE) and their severity. Nevertheless, factors associated with successful clinical outcomes of EDBE are still unknown. Our study aimed to test the hypothesis that a history of abuse is associated with unsuccessful clinical outcomes of EDBE through an effect mediated by impulsivity., Methods: We assessed patients older than 15 years, 3 months with EDBE at inclusion and at 1 year. Recovery was defined as the absence of eating disorders at 1 year. A mediation analysis was performed by means of structural equation modelling., Results: We included 186 patients in our analyses (54% bulimia nervosa, 29% anorexia nervosa binge eating/purging type and 17% binge-eating disorder); 179 (96%) were female. One-third ( n = 63) of patients reported a history of abuse, and recovery was observed for 20% of the sample ( n = 38). Contrary to our assumption, a history of abuse was not associated with the absence of recovery of EDBE at 1 year. Factors unfavourable for achieving recovery were anxiety disorders (odds ratio [OR] 0.41), vomiting (OR 0.39), physical hyperactivity (OR 0.29), negative urgency and a lack of perseverance (OR 0.85 for both). Only positive urgency was positively associated with recovery (OR 1.25)., Limitations: We excluded 219 patients lost to the 1-year follow-up., Conclusion: Our findings may help to deconstruct the empirical belief that traumatic events may interfere with the successful course of treatment for eating disorders. A high level of positive urgency may be associated with more receptivity to care., Competing Interests: Competing interests: None declared., (© 2023 CMA Impact Inc. or its licensors.)

Objective: Anorexia nervosa (AN) is a complex disease in which obsessive thoughts about body image, shape, or weight are expressed. The intensity of these concerns varies among individuals, and only a few studies have focused on their impact on patients' clinical course when patients are treated on an outpatient basis. Our study aimed to determine whether marked body concerns at inclusion were predictive of the one-year follow-up., Method: Participants (N = 72) were women seeking treatment for AN in a specialized unit for eating disorder management. All participants were assessed at inclusion and at the 1-year follow-up. Clinical outcome was assessed using the Morgan & Russel Outcome Average Score (MROAS), and body concerns were assessed using the Body Shape Questionnaires (BSQ)., Results: Marked body concerns (BSQ score >140) at inclusion were associated with a poorer outcome at the 12-month follow-up (lower MROAS "total score"). Other characteristics at inclusion that were predictive of a poorer outcome at 12 months were as follows: higher severity of ED at inclusion, longer hospitalization during follow-up, and experiencing a lower impact of the illness on school/work life., Discussion: The results confirmed the importance of a multifocal treatment that should address body concerns and motivation to change. Our results also highlighted the necessity of promoting the maintenance of school/work during the treatment course., (© 2021 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Background: The links between impulsivity, a history of abuse, the emergence of eating disorders with episodes of binge eating (EDBE) and their severity have already been assessed, but little is known about clinical predictors of clinical outcome. Our objective was to confirm that a history of abuse might impede the achievement of ED recovery. Methods: Patients seeking treatment for EDBE were assessed at inclusion and one year after. Recovery was defined as the absence of ED at 1 year. Association between history of abuse, impulsivity, other baseline characteristics and recovery were explored by means of univariate and multivariate analyses. Results: Our sample comprised 186 patients, mainly women (96%), who suffered from anorexia nervosa binge-eating/purging type (29%), bulimia nervosa (54%) and binge-eating disorder (17%). Approximately one-third of the sample reported a history of abuse, and ED recovery was achieved for 20% of the sample. We failed to demonstrate that a history of abuse was associated with recovery at 1 year. Factors negatively associated with recovery were: anxiety disorders (OR=0.41, CI95% [0.18-0.97]); vomiting (OR=0.39, CI95% [0.17-0.85]); physical hyperactivity (OR=0.29, CI95% [0.09-0.79]); higher scores of negative urgency and lack of perseverance (OR=0.85 for both, CI95% [0.73-0.99] and CI95% [0.72-0.99] respectively). Only higher score of positive urgency was positively associated with recovery (OR=1.25, CI95% [1.06-1.49]). Conclusions: Our results could help to deconstruct the empirical belief that traumatic events could limit ED recovery. [ABSTRACT FROM AUTHOR]

Concerns about body shape and weight are core diagnostic criteria for eating disorders although intensity varies between patients. Few studies have focused on the clinical differences relative to the intensity of these concerns. Nonetheless, they might have a prognostic value. This study was aimed at identifying the characteristics associated with marked body shape concerns in patients with an eating disorder. Data was collected from a systematic and standardized clinical assessment of outpatients seeking treatment in our department for eating disorders. Only female patients, suffering from anorexia nervosa or bulimia nervosa, and with “no / mild” or “marked” body shape concerns according to the Body Shape Questionnaire, were included for the present study. We focused on sociodemographic characteristics, eating disorder characteristics, axis 1 disorders, types of attachment, self-esteem and dissociation. A multiple logistic regression was performed to identify factors related to “marked” body shape concerns. In our sample (123 participants, with a mean age of 24.3 years [range 16–61]), 56.9% had marked concerns with body shape. Marked body shape concerns were associated with a major depressive episode (OR = 100.3), the use of laxatives (OR = 49.8), a high score on the item “body dissatisfaction” of the Eating Disorders Inventory scale (OR = 1.7), a higher minimum body mass index (OR = 1.73), and a high score on the item “loss of control over behavior, thoughts and emotions” from the dissociation questionnaire (OR = 10.74). These results are consistent with previous studies, and highlight the importance of denial. [ABSTRACT FROM AUTHOR]

Résumé Objectifs L’objectif de l’étude était d’évaluer si l’attachement insécure était associé à des symptômes plus sévères dans l’anorexie mentale. Méthode En nous appuyant sur la théorie de l’attachement développée par Bartholomew et Horowitz, nous avons classé en fonction de leur modalité d’attachement (sécure vs insécure) toutes les patientes souffrant d’anorexie mentale et commençant des soins dans le service d’addictologie du CHU de Nantes. Les scores aux échelles évaluant les préoccupations corporelles (BSQ), l’estime de soi (échelle de Rosenberg) et la gravité de la maladie (échelle de Morgan et Russell) ont ensuite été comparés à l’aide du test de Wilcoxon. Résultats La prévalence d’attachement de type insécure était élevée (82,8 %) dans notre population, avec un score moyen plus élevé pour l’attachement de type préoccupé. Les patientes du groupe insécure ont un profil clinique particulier, marqué par une psychopathologie plus sévère : estime de soi plus basse, préoccupations corporelles plus importantes et score à l’échelle Morgan et Russell inférieur aux patientes du groupe sécure . Discussion Lors de la prise en charge, le thérapeute doit tenir compte des difficultés associées au style d’attachement et engager un travail psychothérapeutique adapté. Objectives The aim of the study is to assess whether insecure attachment based on the model developed by Bartholomew and Horowitz (1991) is associated with more severe symptoms in anorexia nervosa, including self-esteem, personal concerns and disease severity. This attachment-based model, inspired by the theory of Bowlby, is conceptualized on two dimensions: Thoughts of self and thoughts of others. Method Only patients with anorexia nervosa have been taken in the study, with a screening using the Mini International Neuropsychiatric Interview (MINI). Based on Bartholomew and Horowitz attachment theory, all new patients with anorexia nervosa at the Nantes University Hospital addiction service were classified according to their mode of attachment (secure versus insecure) and scores on the Relationship Scales Questionnaire (RSQ). Scores assessing bodily concerns (Body Shape Questionnaire), self-esteem (Rosenberg scale) and disease severity (Morgan-Russell Scale) were then compared with a Wilcoxon test. In addition, we took into account body mass index (BMI), age and type of anorexia because these parameters could affect our variables. Results The prevalence of insecure attachment was high (82.8%) in our sample with a higher value for the preoccupied attachment style. Patients in the insecure group have a particular profile and have a more severe psychopathology: Lower self-esteem, more important bodily concerns and lower scores on Russell and Morgan Scale. Statistical analysis showed no significant difference between the two groups on the variables BMI, age and type of anorexia. Discussion These results highlight the high prevalence of insecure attachment among patients with anorexia nervosa. They also invite clinicians to therapeutic strategies focusing on attachment and how to help these patients to work on their relationship difficulties. [ABSTRACT FROM AUTHOR]

The concept of "food addiction" (FA) has aroused much focus because of evidence for similarities between overeating and substance use disorders (SUDs). However, few studies have explored this concept among the broad spectrum of eating disorders (ED), especially in anorexia nervosa (AN). This study aimed to assess FA prevalence in ED female patients and to determine its associated factors. We recruited a total of 195 adult women with EDs from an ED treatment center. The prevalence of FA diagnosis (Yale Food Addiction Scale) in the whole ED sample was 83.6%; AN restrictive type (AN-R), 61.5%; AN binge-eating/purging type (AN-BP), 87.9%; bulimia nervosa (BN), 97.6%; and binge-eating disorder (BED), 93.3%. The most frequently met criteria of FA were "clinically significant impairment or distress in relation to food", "craving" and "persistent desire or repeated unsuccessful attempts to cut down". An FA diagnosis was independently associated with three variables: presence of recurrent episodes of binge eating, ED severity, and lower interoceptive awareness. In showing an overlap between ED and FA, this study allows for considering EDs, and AN-R in particular, from an "addictive point of view", and thus for designing therapeutic management that draws from those proposed for addictive disorders. [ABSTRACT FROM AUTHOR]