Abstract
The first aim of our study was to compare the characteristics and comorbidities of patients with eating disorders between those who suffered from a childhood abuse and those who did not. Our second aim was to analyze the differences in the outcome of the psychodynamic therapy between abused and not abused patients. Twenty-six adolescent patients with eating disorders were assessed. Adolescent were evaluated by a single expert psychiatrist by checklists and questionnaires: EDI 3, SCL 90, BIS11, Dissociative Experiences Scale, Global Assessment of Functioning, SCID II, and CTQ-Self control (SF). According to the results of CTQ-SF (cut-off ≥ 8), patients were divided into two groups: those who had experienced a history of abuse and those who had not. They underwent a psychodynamic psychotherapy and were assessed again after 12 months. Eleven patients (42.3%) had a history of abuse according to CTQ score. No significant differences were found in abused and not abused patients in their demographic, clinical, and comorbid characteristics (sex, age, type of eating disorder, comorbid impulse control, personality, and addictive disorders). Abused patients showed a significantly higher score in many scale. The psychotherapeutic intervention in patients with a history of abuse resulted only in a significant decrease in symptom checklist-90 (SCL-90) psychoticism dimension (p < 0.05), whereas in patients with no history of abuse a significant decrease was found for SCL-90 somatization, obsessive-compulsive and phobic anxiety dimensions, the SCL-90 Global Severity Index, the Eating Disorder Inventory-3 interceptive deficits, and the dissociative experience scale. Regarding the first aim of our study, we proved that history of abuse is not significantly related to patient comorbidities. Regarding our second aim, history of abuse was related to patient improvement only for psychotic symptoms; whereas patients who had not experienced an abuse improved in a variety of symptoms. Thus, abuse history can be considered as a negative prognostic factor for patients with eating disorders undergoing dynamic psychotherapy. However, this psychotherapy may have a role in preventing early psychotic disorders in patients with and without an history of abuse.
Highlights
Eating disorders consist of impairment in body image perception and extreme behaviors, such as rejection or desire for food, which debilitate patients in terms of both physical and psychological health.According to the DSM-5, the complete diagnostic class of eating disorders is named “Feeding and Eating Disorders” and lists: anorexia and bulimia, pica, rumination disorder, avoidant/ restrictive food intake disorder, and binge eating disorder [1].In DSM-5, the age of eating disorder onset has been lowered, with a more severe prognosis and the need for a differentiated and complex treatment, which should be specific to developmental disorders of children and adolescents [2]
Eleven patients (42.3%) had a history of abuse according to CTQ score, with respect to subscales high median values were found especially for emotional neglect: emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect; 10 out of 26 patients had a binge eating comorbidity
No significant differences were found between abused and non-abused patients with respect to patients’ characteristics even though, as far as addictive disorders are concerned, a trend was observed with abused patients showing more frequently substance abuse/ dependence and gambling (Table 1)
Summary
In DSM-5, the age of eating disorder onset has been lowered, with a more severe prognosis and the need for a differentiated and complex treatment, which should be specific to developmental disorders of children and adolescents [2]. Previous studies have showed a number of similarities between food addiction and other addictive behaviors including activation of specific brain regions and neurotransmitter systems, disrupted neuronal circuitry, and behavioral indicators of addiction, such as continued use despite negative consequences [3]. Impulsivity and emotional dysregulation (ED) have a fundamental role in food addiction, as well as both of them play salient roles in drug use disorders [4]. Adolescence is the period of onset of personality disorders [5]. Obsessive–compulsive and avoidant personality disorders are frequently associated to eating disorder [6]
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