Impulsivity and Eating Disorders: Clinical Correlates and Therapy Approaches Fernando Fernández-Aranda

Transcription

1 Impulsivity and Eating Disorders: Clinical Correlates and Therapy Approaches Fernando Fernández-Aranda Professor University Barcelona, Head of Eating Disorders Unit Head of Group CIBEROBN University Hospital of Bellvitge, Barcelona, SPAIN

2 Impulsive-compulsive Spectrum Disorders Food Addicti on OCD AN-R AN-BP BN Gambling Disorders BDD Kleptomanía ADH D Other ICDs Compulsive buying

3 Comorbidity and Eating Disorders Anxiety 64-71% Affective 20-83% Personal ity 27-77% ED ICD 9-18% Substance Use 7-69%

4 Impulse related disorders and Eating disorders In individuals with IRD and ED, higher impulsivity has been associated with: Specific disorder subtypes Severity of symptoms Greater comorbidity Genetic and biochemical factors Poorer psychological functioning Altered executive functions Less effective coping strategies Poorer treatment outcome

5 Impulse related disorders and Shared Vulnerabilities Probst & van Eimeren: Curr Neurol Neurosci Rep (2013) 13:386

6 Impulse related disorders and Shared Vulnerabilities

7 Impulse related disorders and Shared Vulnerabilities Probst & van Eimeren: Curr Neurol Neurosci Rep (2013) 13:386

8 Impulse related disorders and Shared Vulnerabilities 591 participants (194 HC, 178 GD, 113 OB, 106 SUD) Mallorqui-Bague et al., Plos One (2016), 30-09

9 Impulse related disorders and Shared Vulnerabilities Probst & van Eimeren: Curr Neurol Neurosci Rep (2013) 13:386

10 Shared features underlying ED with comorbid Impulse related disorders Higher Impulsivity Lower tolerance to frustration More difficulties to cope with stress. Difficulties for regulating emotions. Comorbid Axis II (PD-cluster B) and Axis I (Affective dis + Anx. Dis.) Low capacity for future planning Shared personality traits and reward sensitivity Shared biological vulnerabilities (dopaminergic, seritoninergic pathways).

11 Prevalence for lifetime and current Substance use in European ED Instead of Eating ED=879 ED HC HC= OR OR OR OR Tobacco Alcohol Drugs A+D 7 Krug et al. Drug and Alcohol Dependence;2008;97:

12 Impulse Control Disorders and Eating Disorders

13 Impulse control disorders in Eating Disorders

14 Jimenez-Murcia. Comprehensive Psychiatry;2013;

15 Emotion Regulation and ED Difficulties in Emotion Regulation Scale (DERS; Gratz and Roemer, 2004) (Hervas & Jodar Clínica y Salud, 2008, vol. 19 n. 2 - Págs ) Wolz et al., Front. Psychol., 30 June 2015

16 Impulse Related disorders and Eating Disorders BN-CB=50 BN+CB= 49 GD=53 CB=36 HC=50

17 Results Comparison of general psychopathology (measured by SCL90R) between the groups

18 Results Comparison of personality traits (measured by TCI-R) between the groups

19 ADHD and ED 43 AN 95 BN EDNOS 13 BED 82 HC

20 Therapy strategies in ED with comorbid Impulse related disorders Although studies have showed overlap between ED and Impulse related disorders, etiology and shared vulnerabilities, limited research is available about the treatment of these comorbid conditions. In the few studies where this topic is being specifically addressed, two therapy strategies are being considered: Individual therapy vs. Integrated therapy strategies. Symptom oriented vs. non-symptom oriented therapies.

21 Therapy strategies in ED with comorbid Impulse related disorders Symptom oriented strategies: Transdiagnostic CBT (self-monitoring, behavioural management of symptoms, coping with irrational beliefs, problem solving strategies, cues exposure..) CBT + pharmacological therapy Dialectical Behavior Therapy Motivational therapy Non-symptom oriented strategies: Emotional regulation Mindfulness/CFT Neurocognitive training

22 Techniques used in ED with high Impulsivity Emotional regulation: Self-regulation skills (self-soothing, imagery, distracting, meditation, self-awareness). Stress management and self-control strategies (relaxation, biofeedback, breathing techniques). Behavioral/cognitive area: Delay of response Planning skills Cognitive remediation strategies

23 CBT Outpatient GT 16 WEEKLY SESSIONS 90 MIN. DURATION 7-10 PATIENTS CBT- Group therapy: Learning self-monitoring and structured meal patterns. Motivational interviewing Awareness of the binging-escaping from problems vicious circle Cognitive reestructuring Problem solving Achievement of behav. goals Response prevention strategies

24 Group Therapy for Bulimia nerviosa/bed BN-P: 327 BN-NP: 40 BED: 87

25 Results Response to treatment (completers) BNP BNNP BED , , Full-rem Partial-rem Non-resp Agüera et al., BMC Psychiatry.

26 Results Dropout from treatment BNP BNNP BED Yes

27 Limitations of Therapy in ED with comorbid Impulse related disorders Higher relapses and drop-out rates Lower motivation and therapy adherence Poorer prognosis (basically due to higher severity, dysfunctional personality traits and additional comorbid Axis I and II disorders). Lower social support and higher isolation. More medical complications and higher mortality rates. Impulsive traits seem to be difficult to be modified.

28 ANTECEDENTES PlayMancer: A European Serious Gaming 3D Environment E. Kalapanidas C. Davarakis T. Ganchev O. Kocsis C. Breiteneder H. Kaufmann J. Jacobsen J. Krabbe T. Lam T. Raguin M. Vollenbroek R. Huis in 't Veld Konstantas, D. M. Ben Moussa S. Jimenez-Murcia K. Gunnard, J. Santamaría A. Soto F. Fernandez-Aranda ICT - INFORMATION AND COMMUNICATION TECHNOLOGIES- FP7-ICT

29 Enhanced CBT for BN (plus Serious Video Game) Fernandez-Aranda y cols, 2012 Mental Health Fagundo et al., 2013 European Eat. Dis. Rev., 21:6 Fagundo et al., 2014 JMIR, 2014,16(8):e183.21:6

30 Keywords: Bellvitge Playmancer YouTube

31 Enhanced CBT for BN (plus Serious Video Game) CBT+ SVG: 20 CBT-SVG: 18 Fernandez-Aranda et al., 2015 Cyberpsychology

32 Treatment of VGT before CBT and influence on binge/ vomiting episodes Giner-Bartolomé et al., 2015 Frontiers Psychology

33 Enhanced CBT for TRI (plus Serious Video Game)

34 Diseminación I Publicaciones internacionales 2 Proyectos FIS 1 Proyecto PM7 2 Premios: 2011 Mejores ideas DM Best European Serios VG For health

35 RETOS FUTUROS e-estesia: APP PARA REGULACION EMOCIONAL PSI R Euros

36 Challenges for the next decade in the management of Eating Disorder Chronicity and aging in ED Impulsivity and how to deal with emotions and perfectionism SUD/Comorbities and ED: a comprehensive approach? Lifetime obesity and ED: categorical vs. dimensional How to deal with drop-out

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39 Ačiū! Spasibo!