Life events and prodromal symptoms in bulimia nervosa

Background: In clinical samples, bulimia seems to be associated with various dyscontrol behaviours suggesting weakness in impulse control. Population studies of adolescents, however, are needed. We evaluated the association between self-reported bulimic behaviour and a number of dyscontrol behaviours, namely bullying, truancy, excessive drinking and sexual disinhibition among adolescents aged 14–16. This is the first study on bulimia and impulsivity in a large non-selected adolescent population sample. Methods: A self-report questionnaire was administered to a representative population sample of 14- to 16-year-old adolescents (pupils of the 8th and the 9th grades of secondary school in four different regions in Finland). 4,453 girls and 4,334 boys aged 14–16 participated. The participation rate was 85.5%. Results: Bulimic behaviour was associated with bullying, truancy, excessive drinking and sexual disinhibition among both sexes. Odds ratios for bulimic-type eating pathology according to each of these behaviours varied between 1.7 and 4.1. The more dyscontrol behaviours occurred simultaneously, the more likely was bulimic-type eating pathology. Conclusions: There is an association between bulimic behaviour and dyscontrol behaviours in the general population of adolescent girls and boys.

Section: Discussionmentioning

confidence: 99%

“…Management of irritability may be preventive of psychosomatic disorders such as bulimia. Further, in the treatment of bulimia nervosa, management of residual irritable moods may be advisable for a more lasting treatment outcome [35]. …”

Section: Discussionmentioning

confidence: 99%

Bulimia and Impulsive Behaviour in Middle Adolescence

Kaltiala-Heino

Rissanen

Rimpelä

et al. 2002

“…The scale ranges from ‘changes due to environment absent or very rare’ (score 1) via ‘nonspecific factors, such as having someone to talk to, produce limited improvement’ (score 3) to ‘the source of the depression is entirely dependent on certain specific situations, being regularly precipitated or entirely removed according to them’ (score 7). This item was found to sensitively discriminate between different subgroups of depressed patients [26,27,28,29], to be exceedingly common in patients with neurocirculatory asthenia [30] and also in the prodromal phase of bulimia nervosa compared to control subjects [31]. It was thus expected to yield a sensitive measurement of change upon treatment in cyclothymic disorder.…”

Section: Methodsmentioning

confidence: 99%

The Sequential Combination of Cognitive Behavioral Treatment and Well-Being Therapy in Cyclothymic Disorder

Fava

Rafanelli

Tomba

et al. 2011

135

Background: There is a lack of controlled studies of psychological treatment of cyclothymic disorder. The aim of this investigation was to examine the benefits of the sequential combination of cognitive behavioral therapy (CBT) and well-being therapy (WBT) compared to clinical management (CM) in DSM-IV cyclothymic disorder. Methods: Sixty-two patients with DSM-IV cyclothymic disorder were randomly assigned to CBT/WBT (n = 31) or CM (n = 31). Both CBT/WBT and CM consisted of ten 45-min sessions every other week. An independent blind evaluator assessed the patients before treatment, after therapy, and at 1- and 2-year follow-ups. The outcomes included total score of the change version of the Clinical Interview for Depression, and the Mania Scale. All analyses were performed on an intent-to-treat basis. Results: Significant differences were found in all outcome measures, with greater improvements after treatment in the CBT/WBT group compared to the CM group. Therapeutic gains were maintained at 1- and 2-year follow-ups. Conclusions: A sequential combination of CBT and WBT, which addresses both polarities of mood swings and comorbid anxiety, was found to yield significant and persistent benefits in cyclothymic disorder.

“…Subclinical mood disturbances were found to be exceedingly common in the prodromal phase of bulimia nervosa [122,123]. The interview discriminated sensitively between patients and controls on anorexia/strict diet, on ratings of low self-esteem, depressed mood, generalized anxiety, reactivity to social environment, phobic avoidance, irritability, and guilt.…”

Section: Resultsmentioning

confidence: 99%

“…Raffi et al [122,123] found that, in normal subjects, the CID total score was significantly negatively correlated with two dimensions (environmental mastery and positive relations with others) of Ryff’s Psychological Well-Being scales, while no significant correlations were found among remitted patients. In another study [133], persistent residual symptoms, as measured by the modified version of the CID, in remitted patients with panic disorder and agoraphobia were found to be correlated negatively and significantly with well-being subscales, and these correlations were similar also in control subjects.…”

Section: Resultsmentioning

confidence: 99%

The Clinical Interview for Depression: A Comprehensive Review of Studies and Clinimetric Properties

Guidi

Fava

Bech

et al. 2010

Background: A comprehensive assessment of the wide spectrum of depressive symptomatology, particularly in its subclinical forms, is lacking in standard rating scales. There is also an emerging need for instruments that can detect small differences in therapeutic studies and have good sensitivity. The purpose of this paper is to review the clinimetric characteristics of Paykel’s Clinical Interview for Depression (CID) and to examine the results of the studies in which the interview has been used. Methods: Published reports which involved the use of the CID were identified by searching the following electronic databases: Medline, PsychINFO, EMBASE, and Web of Science. A manual search of the literature was also performed. Results: The initial strategies yielded 169 published reports for potential inclusion in the review: 98 are discussed here. The CID has been used extensively in a variety of studies, including descriptive studies, classification by means of factor analysis and cluster analysis, and predictor variables of response to treatment or relapse. The CID has also been used as an outcome measure in several controlled clinical trials and follow-up studies of pharmacotherapy and psychotherapy of affective disorders. It has been shown to be valid and reliable, to discriminate depressives from controls, or different subgroups of depressed patients, and to reflect changes during the course of treatment, particularly when individual symptoms are considered. Conclusions: Evidence from these studies highlights the utility of the CID in clinical research and practice. Its clinimetric characteristics, particularly the broad evaluation of affective symptomatology and the sensitivity to change, make it an instrument of choice in therapeutic trials.