Association between Food Addiction, dysfunctional eating ... · Association between Food Addiction, dysfunctional eating patterns and Early Maladaptive Schemas. Mariantonietta Fabbricatore

Association between Food Addiction, dysfunctionaleating patterns and Early Maladaptive Schemas.

Mariantonietta Fabbricatorea,b, Claudio Imperatoria, Antonella Serena Ferracanea, Anna Contardia,b, Marco Innamoratia,b.aUniversità Europea di Roma, Psychology Dpt, Roma ItalybIstituto Skinner, Scuola di Specializzazione in Psicoterapia Cognitivo Comportamentale, Roma, Italy

INTRODUZIONE� La Schema therapy è oggi considerata un approccio

terapeutico supplementare alla CBT per identificare e trattare problematiche psicologiche croniche, definite Early Maladaptive Schemas o Schemi MaladattiviPrecoci (EMSs). Recenti ricerche hanno evidenziato la presenza di EMSs nei disturbi alimentari.

La Schema Therapy (ST) è un approccio terapeutico relativamente recente messo a punto da Young et al nel 2003 per trattare disturbi di Axis I and Axis II. Secondo questo modello Schemi maladattivi precoci stabili e durevoli rappresentano il nucleo o cuore di disturbi cronici di Axis I and Axis II (Young et al., 2003).

Il termine schema deriva dalla teoria della elaborazione dell’informazione, che sostiene che l’informazione è classificata o ordinata nella memoria umana per temi. (Williams et al., 1997; Vonk, 1999). L’idea è che le esperienze sono immagazzinate nella nostra memoria autobiografica per mezzo di schemi fin dai primi anni di vita. (Zajonc, 1980,Conway and Pleydell-Pearce, 2000). Queste strutture comprendono percezioni sensoriali, esperienze, emozioni, ed il significato attribuito ad essi, in tal modo le esperienze precoci di vita sono immagazzinate ad un livello non verbale. (Freeman, 1981; Greenberg and Safran, 1989; Christianson and Engelberg, 1999; Young, 2005; Rijkeboer and Huntjens, 2007).

Gli schemi così originati agiscono come un filtro che l’individuo usa per ordinare, interpretare e fare previsioni sul mondo. Carr and Francis (2010) hanno messo in evidenza che EMSs mediano la relazione tra esperienze avverse dell’infanzia e psicopatologia nella vita adulta. Gli EMSs sono considerati egosintonici. Gli EMSs sono attivati da eventi emozionali e l’individuo può passare dall’uno all’altro molto rapidamente.

Schema Therapy for Emotional Dysregulation: Theoretical Implication and Clinical Applications

H. Dadomo, A. Gregorucci, I. Giardini, E. Ugolini, A. Carmelita, M. PanzeriFront Psychol. 2016; 7: 1987

� A CBT-derived new approach called Schema Therapy (ST), that integrates theory and techniques from psychodynamic and emotion focused therapy, holds the promise to fill this gap in cognitive literature. In this model, psychopathology is viewed as the interaction between the innate temperament of the child and the early experiences of deprivation or frustration of the subject’s basic needs. This deprivation may lead to develop early maladaptive schemas (EMS), and maladaptive Modes. In the present paper we point out that EMSs and Modes are associated with either dysregulated emotions or with dysregulatory strategies that produce and maintain problematic emotional responses. Thanks to a special focus on the therapeutic relationship and emotion focused-experiential techniques, this approach successfully treats severe emotional dysregulation.

Journal of Eating Disorders (2015) 3:41 DOI 10.1186/s40337-015-0082-y

Schema modes in eating disorders compared to a community sampleDaniel Talbot1†, Evelyn Smith1*†, Alethea Tomkins1, Robert Brockman3 and Susan Simpson2

A total of forty seven women with eating disorders and 89 women from the community participated in this study. Eating disorder diagnosis was determined by a clinician treating the eating disorder and was confirmed on the basis of Body Mass Index (BMI) and the Eating Disorder Examination Questionnaire (EDE-Q). The Schema Mode Inventory (SMI) was used to explore the association between schema modes and eating disorder diagnostic status.Results: A series t-tests revealed that when compared to the community sample, the ED group scored significantly higher on 10 out of 12 maladaptive schema modes, and significantly lower on both adaptive schema modes. A series of planned contrasts revealed that the AN, BN, and OSFED groups each scored significantly higher than the community sample group in the majority of maladaptive schema modes, with slight variations between groups. Further, AN, BN, and OSFED groups each scored significantly lower than the community sample group for the two SMI scores categorized as adaptive. All Cohen’s d that reached significance ranged 0.55-2.24.Conclusions: The current study shows a tendency for females with eating disorders to rely on maladaptive schema modes more frequently, and more adaptive schema modes less frequently compared to a community sample. These findings provide

initial empirical support for a schema mode model of eating disorders.

Does schema therapy change schemas and symptoms? A systematic review across mental health disorders.

Taylor CD, Bee P, Haddok GPsychol Psychother. 2016 Dec 30. doi:10.1111/papt.12112

� Schema therapy was first applied to individuals with borderline personality disorder (BPD) over 20 years ago, and more recent work has suggested efficacy across a range of disorders. The present review aimed to systematically synthesize evidence for the efficacy and effectiveness of schema therapy in reducing early maladaptive schema (EMS) and improving symptoms as applied to a range of mental health disorders in adults including BPD, other personality disorders, eating disorders, anxiety disorders, and post-traumatic stress disorder.

A narrative review of schemas and schemas therapyoutcomes in the eating disorders

Pugh M. Clin Psychol Rev. 2015 Jul;39:30-41

� Whilst cognitive-behavioural therapy has demonstrated efficacy in the treatment of eating disorders, therapy outcomes and current conceptualizations still remain inadequate. In light of these shortcomings there has been growing interest in the utility of schema therapy applied to eating pathology. Treatment outcomes also indicate that schema therapy, the schema-mode approach, and associated techniques are promising interventions for complex eating disorders.

Psychotherapy for transdiagnostic binge eating: A randomized controlled trial of cognitive-behavioural therapy, appetite-focused

cognitive-behavioural therapy, and schema therapy.McIntosh VV1, Jordan J2, Carter JD3, Frampton CM4, McKenzie JM4, Latner JD5, Joyce

PR4.Psychiatry Res. 2016 Jun30;240:412-20.

� Cognitive-behavioural therapy (CBT) is the recommended treatment for binge eating, yet many individuals do not recover, and innovative new treatments have been called for. The current study compares traditional CBT with two augmented versions of CBT; schema therapy, which focuses on early life experiences as pivotal in the history of the eating disorder; and appetite-focused CBT, which emphasises the role of recognising and responding to appetite in binge eating. 112 women with transdiagnostic DSM-IV binge eating were randomized to the three therapies. Therapy consisted of weekly sessions for six months, followed by monthly sessions for six months. Primary outcome was the frequency of binge eating. Secondary and tertiary outcomes were other behavioural and psychological aspects of the eating disorder, and other areas of functioning. No differences among the three therapy groups were found on primary or other outcomes. Across groups, large effect sizes were found for improvement in binge eating, other eating disorder symptoms and overall functioning. Schema therapy and appetite-focused CBT are likely to be suitable alternative treatments to traditional CBT for binge eating.

Early maladaptive schemas and body mass index in subgroups of eating disorders: a differential association.

Unoka Z1, Tölgyes T, Czobor P.Compr Psychiatry. 2007 Mar-Apr; 48(2):199-204

� The findings of this study indicate that EMSs based on Young's conceptualization of EMS, as measured by the Young Schema Questionnaire, differ significantly among eating disorder subgroups defined by the phenomenological approach used by the DSM-IV diagnoses. These results are consistent with the notion that dysfunctional cognitions may play an important role in the development and maintenance of the symptoms that underlie the DSM-IV classification of the eating disorder subtypes.

SCOPO della RICERCA� Lo scopo di questo studio è stato quello di esaminare

l’associazione tra pattern alimentari disfunzionali e EMSs al fine di identificare quali specifici schemi maladattivi fossero associati a pattern alimentari disfunzionali, quali la Food Addiction (FA), l’obesità e il Binge eating (BE).

Incorporating food addiction into disordered eating: the disordered eating food addiction nutrition guide (DEFANG).Wiss DA1, Brewerton TD2.Eat Weight Disord. 2017 Mar;22(1):49-59. doi: 10.1007/s40519-016-0344-y. Epub 2016 Dec 10.

1Nutrition in Recovery LLC, 8549 Wilshire Blvd. #646, Beverly Hills, CA, 90211, USA. [email protected].

2Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA.

Although not formally recognized by the DSM-5, food addiction (FA) has been well described in the scientific literature. FA has emerged as a clinical entity that is recognized within the spectrum of disordered eating, particularly in patients with bulimia nervosa, binge-eating disorder and/or co-occurring addictive disorders and obesity. Integrating the concept of FA into the scope of disordered eating has been challenging for ED treatment professionals, since there is no well-accepted treatment model. The confusion surrounding the implications of FA, as well as the impact of the contemporary Westernized diet, may contribute to poor treatment outcomes. The purpose of this review is twofold. The first is to briefly explore the relationships between EDs and addictions, and the second is to propose a new model of conceptualizing and treating EDs that incorporates recent data on FA. Since treatment for EDs should vary based on individual assessment and diagnosis, the Disordered Eating Food Addiction Nutrition Guide (DEFANG) is presented as a tool for framing treatment goals and helping patients achieve sustainable recovery.

OBIETTIVILo studio si è concentrato su due diversi obiettivi:

1. Valutare l’associazione tra pattern alimentari disfunzionali (FA, sovrappeso, obesità, BE) e EMSs

2. Studiare la correlazione tra FA e EMSs controllando alcune variabili confondenti spesso associate alla FA come l’ansia e la depressione e BE.

MATERIALE e METODO� Hanno partecipato allo studio 62 donne reclutate tra

novembre 2015 e gennaio 2016 in un centro medico romano specializzato nel trattamento dell’obesità e dei disturbi alimentari.

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MATERIALE e METODO� Tutti i partecipanti, dopo aver completato una scheda

sociodemografica, hanno compilato una batteria di test psicometrici composta da:

� Yale Food Addiction Scale (YFAS)

� Young Schema Questionnaire YSQ (L-3)

� Hospital Anxiety and Depression Scale (HADS),

� Binge Eating Scale (BES).

Analisi statistica� Tutte le analisi sono state eseguite con lo“Statistical Package for the

Social Sciences” (SPSS 19.0; IBM, Armonk, NY, USA).

� L’associazione tra le variabili è stata misurata attraverso il coefficienter

di Pearson. Le variabili significativamente associate conla FA sono state

inserite come covariante in una regressione parziale controllando per il

livello di Binge eating, ansia e depressione.

RISULTATI� BMI è risultato rispettivamente</= 25 in 16% dei

pazienti, >25 in 43,5% e >30 in 38,7%. FA è stata rilevata in 19,4% dei casi e il BE in 25,8%.

� I risultati della ricerca hanno evidenziato solo una minima correlazione tra obesità EMSs mentre nei pazienti con FA è stata rilevata una forte associazione con particolari EMSs soprattutto di abbandono e di isolamento sociale/alienazione.

RISULTATI� I pazienti con BE hanno mostrato EMSs

simili ai pazienti con FA ma differivano per il minor grado di associazione.

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RISULTATI� La correlazione parziale ci ha permesso di analizzare

l’associazione «esclusiva» tra schemi e FA, controllando cioè per altre variabili potenzialmente disturbanti (Depressione, ansia, binge eating)

� La FA è risultata positivamente associata con: Abbandono/instabilità; isolamento sociale\alienazione; Deprivazione emotiva; Inadeguatezza e vergogna; Fallimento; Dipendenza\incompetenza; Sottomissione; Inibizione emotiva; Autosacrificio; Insufficiente self-control; Negatività\pessimismo; Punizione.

DISCUSSIONE� Questo studio ha evidenziato un’associazione tra

particolari EMSs e FA e BE.

� Tuttavia la FA sembra essere più fortemente associata con specifici EMSs rispetto al BE.

� E’ stata rilevata solo una minima correlazione tra obesità EMSs.

CONCLUSIONI� In conclusione i risultati della ricerca sono in accordo

con l’opinione che EMSs possono rivestire un ruolo specifico in pazienti con disturbi alimentari complessi quali FA e BE, suggerendo l’idea che questi casi potrebbero trarre beneficio dalla applicazione della Schema Therapy.