Psychosomatic syndromes and anorexia nervosa

Abstract

BackgroundIn spite of the role of some psychosomatic factors as alexithymia, mood intolerance, and somatization in both pathogenesis and maintenance of anorexia nervosa (AN), few studies have investigated the prevalence of psychosomatic syndromes in AN. The aim of this study was to use the Diagnostic Criteria for Psychosomatic Research (DCPR) to assess psychosomatic syndromes in AN and to evaluate if psychosomatic syndromes could identify subgroups of AN patients.Methods108 AN inpatients (76 AN restricting subtype, AN-R, and 32 AN binge-purging subtype, AN-BP) were consecutively recruited and psychosomatic syndromes were diagnosed with the Structured Interview for DCPR. Participants were asked to complete psychometric tests: Body Shape Questionnaire, Beck Depression Inventory, Eating Disorder Inventory–2, and Temperament and Character Inventory. Data were submitted to cluster analysis.ResultsIllness denial (63%) and alexithymia (54.6%) resulted to be the most common syndromes in our sample. Cluster analysis identified three groups: moderate psychosomatic group (49%), somatization group (26%), and severe psychosomatic group (25%). The first group was mainly represented by AN-R patients reporting often only illness denial and alexithymia as DCPR syndromes. The second group showed more severe eating and depressive symptomatology and frequently DCPR syndromes of the somatization cluster. Thanatophobia DCPR syndrome was also represented in this group. The third group reported longer duration of illness and DCPR syndromes were highly represented; in particular, all patients were found to show the alexithymia DCPR syndrome.ConclusionsThese results highlight the need of a deep assessment of psychosomatic syndromes in AN. Psychosomatic syndromes correlated differently with both severity of eating symptomatology and duration of illness: therefore, DCPR could be effective to achieve tailored treatments.

Cost-effectiveness of focal psychodynamic therapy and enhanced cognitive–behavioural therapy in out-patients with anorexia nervosa

“…However, a recent study used the EQ-5D-3L in in-patients with severe AN (Abbate-Daga et al 2014). In this study, patients' quality of life improved during hospitalization with a mean index score of 0.70 at hospital discharge (Abbate-Daga et al 2014). In our study, we also observed increases towards the end of treatment, but at the end of the 1-year follow-up, the index scores had decreased below the respective baseline values in each group.…”

“…As the validity of the EQ-5D-3L in eating disorders has not been determined we decided to use QALYs only in a sensitivity analysis. However, a recent study used the EQ-5D-3L in in-patients with severe AN (Abbate-Daga et al 2014). In this study, patients' quality of life improved during hospitalization with a mean index score of 0.70 at hospital discharge (Abbate-Daga et al 2014).…”

The Clinical Utility of the Diagnostic Criteria for Psychosomatic Research: A Review of Studies

“…In a study on anorexia nervosa (AN) patients [22] , mostly subjects with restricted-type AN, almost half of the patients had DCPR illness denial, associated with lower intensity of problems in body mass index, eating behaviors, and beliefs. A quarter of the restricted-type AN patients had high global severity in terms of body mass index, behaviors, thoughts, and DCPR conditions (high rates of alexithymia, demoralization, health anxiety, and irritable mood, ranging from 85 to 100%).…”

The Relationship between Alexithymia and Intolerance of Uncertainty in Anorexia Nervosa

“…Alexithymia represents the inability to identify, label and describe emotions coupled with difficulties in discriminating between internal states and bodily sensations [11]. Patients affected by AN are likely to show higher alexithymia levels than healthy controls [12,13,14], thus highlighting a suboptimal ability to identify and communicate affective states. …”