Psychotic-like anomalous self-experiences in feeding and eating disorders: Their role in eating psychopathology through the mediation of body uneasiness and embodiment and identity disorders.
anorexia nervosa
bulimia nervosa
clinical staging models
eating disorders
phenomenology
Journal
Early intervention in psychiatry
ISSN: 1751-7893
Titre abrégé: Early Interv Psychiatry
Pays: Australia
ID NLM: 101320027
Informations de publication
Date de publication:
13 Apr 2024
13 Apr 2024
Historique:
revised:
19
02
2024
received:
17
10
2023
accepted:
02
04
2024
medline:
13
4
2024
pubmed:
13
4
2024
entrez:
13
4
2024
Statut:
aheadofprint
Résumé
Psychotic-like anomalous self-experiences (ASEs) are core and early features of schizophrenia spectrum disorders, which have been recently also postulated to underlie embodiment disturbance in feeding and eating disorders (FEDs). The present study was aimed at investigating the interplay between ASEs and specific psychopathology in FED. Ninety persons with Anorexia Nervosa and 41 with Bulimia Nervosa were evaluated with the inventory of psychotic-like anomalous self-experiences (IPASE), identity and eating disorders (IDEA), body uneasiness test (BUT), and eating disorder examination questionnaire (EDE-Q). The same assessment was performed for 92 subjects recruited from the general population. Structural equation modelling was employed to test the role of embodiment/identity disorders in mediating the relationship between ASEs and ED psychopathology. Patients with FED displayed high scores on IPASE, comparable with people with schizophrenia spectrum disorders. A significant correlation was also demonstrated between IPASE, BUT and EDE-Q. All IPASE domains were strongly related to feeling extraneous from one's own body by IDEA. All IPASE domains demonstrated a high relationship with BUT Depersonalization scale. A strong correlation was also reported between total scores of IPASE and IDEA. The mediation model confirmed that ASEs impact on FED symptomatology through the mediation of both embodiment/identity disorders and body image. Anomalous interoceptive processes may represent the first step of a maladaptive process-impairing embodiment, selfhood, and identity in FED. Assessment of ASEs might be a valid tool to identify an early-shared vulnerability of severe disorders characterized by embodiment alterations.
Sections du résumé
BACKGROUND
BACKGROUND
Psychotic-like anomalous self-experiences (ASEs) are core and early features of schizophrenia spectrum disorders, which have been recently also postulated to underlie embodiment disturbance in feeding and eating disorders (FEDs). The present study was aimed at investigating the interplay between ASEs and specific psychopathology in FED.
METHODS
METHODS
Ninety persons with Anorexia Nervosa and 41 with Bulimia Nervosa were evaluated with the inventory of psychotic-like anomalous self-experiences (IPASE), identity and eating disorders (IDEA), body uneasiness test (BUT), and eating disorder examination questionnaire (EDE-Q). The same assessment was performed for 92 subjects recruited from the general population. Structural equation modelling was employed to test the role of embodiment/identity disorders in mediating the relationship between ASEs and ED psychopathology.
RESULTS
RESULTS
Patients with FED displayed high scores on IPASE, comparable with people with schizophrenia spectrum disorders. A significant correlation was also demonstrated between IPASE, BUT and EDE-Q. All IPASE domains were strongly related to feeling extraneous from one's own body by IDEA. All IPASE domains demonstrated a high relationship with BUT Depersonalization scale. A strong correlation was also reported between total scores of IPASE and IDEA. The mediation model confirmed that ASEs impact on FED symptomatology through the mediation of both embodiment/identity disorders and body image.
DISCUSSION
CONCLUSIONS
Anomalous interoceptive processes may represent the first step of a maladaptive process-impairing embodiment, selfhood, and identity in FED. Assessment of ASEs might be a valid tool to identify an early-shared vulnerability of severe disorders characterized by embodiment alterations.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Ministero dell'Università e della Ricerca
ID : PE0000006
Informations de copyright
© 2024 John Wiley & Sons Australia, Ltd.
Références
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596
An, Z., Krug, I., Portingale, J., & Butler, D. (2022). Mirror, mirror, on the wall: During pandemics, how can self‐perception research in people with eating disorders happen at all? Journal of Eating Disorders, 10(1), 89. https://doi.org/10.1186/s40337-022-00608-8
Badoud, D., & Tsakiris, M. (2017). From the body's viscera to the body's image: Is there a link between interoception and body image concerns? Neuroscience and Biobehavioral Reviews, 77, 237–246. https://doi.org/10.1016/j.neubiorev.2017.03.017
Ballerini, M., Magnani, F., Amorosi, S., Dell'Anna, C., Borrelli, D. F., Marchesi, C., Lucarini, V., Castellini, G., & Tonna, M. (2023). Anomalous Self‐Experiences are predictive of social dysfunction in people with schizophrenia. Schizophrenia Research, 266, 116–117. https://doi.org/10.1016/j.schres.2024.02.029
Barrett, L. F., & Simmons, W. K. (2015). Interoceptive predictions in the brain. Nature Reviews Neuroscience, 16(7), 419–429. https://doi.org/10.1038/nrn3950
Becker, A. E. (2004). Television, disordered eating, and young women in Fiji: Negotiating body image and identity during rapid social change. Culture, Medicine and Psychiatry, 28(4), 533–559. https://doi.org/10.1007/s11013-004-1067-5
Blanke, O., Slater, M., & Serino, A. (2015). Behavioral, neural, and computational principles of bodily self‐consciousness. Neuron, 88(1), 145–166. https://doi.org/10.1016/j.neuron.2015.09.029
Bokma, W. A., Batelaan, N. M., Hoogendoorn, A. W., Penninx, B. W., & van Balkom, A. J. (2020). A clinical staging approach to improving diagnostics in anxiety disorders: Is it the way to go? The Australian and New Zealand Journal of Psychiatry, 54(2), 173–184. https://doi.org/10.1177/0004867419887804
Borda, J. P., & Sass, L. A. (2015). Phenomenology and neurobiology of self disorder in schizophrenia: Primary factors. Schizophrenia Research, 169(1–3), 464–473. https://doi.org/10.1016/j.schres.2015.09.024
Burgin, S., Reniers, R., & Humpston, C. (2022). Prevalence and assessment of self‐disorders in the schizophrenia spectrum: A systematic review and meta‐analysis. Scientific Reports, 12(1), 1165. https://doi.org/10.1038/s41598-022-05232-9
Calugi, S., Milanese, C., Sartirana, M., El Ghoch, M., Sartori, F., Geccherle, E., Coppini, A., Franchini, C., & Dalle Grave, R. (2017). The eating disorder examination questionnaire: Reliability and validity of the Italian version. Eating and Weight Disorders: EWD, 22(3), 509–514. https://doi.org/10.1007/s40519-016-0276-6
Carruthers, G. (2008). Types of body representation and the sense of embodiment. Consciousness and Cognition, 17(4), 1302–1316. https://doi.org/10.1016/j.concog.2008.02.001
Cascino, G., Castellini, G., Stanghellini, G., Ricca, V., Cassioli, E., Ruzzi, V., Monteleone, P., & Monteleone, A. M. (2019). The role of the embodiment disturbance in the anorexia nervosa psychopathology: A network analysis study. Brain Sciences, 9(10), 276. https://doi.org/10.3390/brainsci9100276
Cassioli, E., Rossi, E., Castellini, G., Sensi, C., Mancini, M., Lelli, L., Monteleone, A. M., Ricca, V., & Stanghellini, G. (2020). Sexuality, embodiment and attachment style in anorexia nervosa. Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity, 25(6), 1671–1680. https://doi.org/10.1007/s40519-019-00805-6
Castellini, G., Cassioli, E., Rossi, E., Mancini, M., Ricca, V., & Stanghellini, G. (2022). Bridging cognitive, phenomenological and psychodynamic approaches to eating disorders. Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity, 27, 2273–2289. https://doi.org/10.1007/s40519-022-01379-6
Castellini, G., Lo Sauro, C., Mannucci, E., Ravaldi, C., Rotella, C. M., Faravelli, C., & Ricca, V. (2011). Diagnostic crossover and outcome predictors in eating disorders according to DSM‐IV and DSM‐V proposed criteria: A 6‐year follow‐up study. Psychosomatic Medicine, 73(3), 270–279. https://doi.org/10.1097/PSY.0b013e31820a1838
Cicero, D. C., Neis, A. M., Klaunig, M. J., & Trask, C. L. (2017). The inventory of psychotic‐like anomalous self‐experiences (IPASE): Development and validation. Psychological Assessment, 29(1), 13–25. https://doi.org/10.1037/pas0000304
Clark, A. (2013). Whatever next? Predictive brains, situated agents, and the future of cognitive science. The Behavioral and Brain Sciences, 36(3), 181–204. https://doi.org/10.1017/S0140525X12000477
Cuzzolaro, M., Vetrone, G., Marano, G., & Garfinkel, P. E. (2006). The body uneasiness test (BUT): Development and validation of a new body image assessment scale. Eating and Weight Disorders: EWD, 11(1), 1–13. https://doi.org/10.1007/BF03327738
Dorahy, M. J., Nesbit, A., Palmer, R., Wiltshire, B., Cording, J. R., Hanna, D., Seager, L., & Middleton, W. (2023). A comparison between auditory hallucinations, interpretation of voices, and formal thought disorder in dissociative identity disorder and schizophrenia spectrum disorders. Journal of Clinical Psychology, 79(9), 2009–2022. https://doi.org/10.1002/jclp.23522
Fairburn, C. G. (2008). Eating disorders: The transdiagnostic view and the cognitive behavioral theory. In C. G. Fairburn (Ed.), Cognitive behavior therapy and eating disorders (pp. 7–22). Guilford Press.
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41(5), 509–528. https://doi.org/10.1016/s0005-7967(02)00088-8
First, M. B., Williams, J. B. W., Karg, R. S., & Spitzer, R. L. (2016). User's guide for the SCID‐5‐CV structured clinical interview for DSM‐5® disorders: Clinical version (Vol. 158). American Psychiatric Publishing, Inc.
Friston, K. (2010). The free‐energy principle: A unified brain theory? Nature Reviews Neuroscience, 11(2), 127–138. https://doi.org/10.1038/nrn2787
Fuchs, T., & Schlimme, J. E. (2009). Embodiment and psychopathology: A phenomenological perspective. Current Opinion in Psychiatry, 22(6), 570–575. https://doi.org/10.1097/YCO.0b013e3283318e5c
Gallagher, S. (2006). How the body shapes the mind (Illustrated edition). Oxford University Press.
Gallese, V., & Ferri, F. (2014). Psychopathology of the bodily self and the brain: The case of schizophrenia. Psychopathology, 47(6), 357–364. https://doi.org/10.1159/000365638
Gaudio, S., & Riva, G. (2013). Body image in anorexia nervosa: The link between functional connectivity alterations and spatial reference frames. Biological Psychiatry, 73(9), e25–e26. https://doi.org/10.1016/j.biopsych.2012.08.028
Gawęda, Ł., Pionke, R., Arciszewska, A., Prochwicz, K., Frydecka, D., Misiak, B., Cechnicki, A., Cicero, D. C., & Nelson, B. (2019). A combination of self‐disturbances and psychotic‐like experiences. A cluster analysis study on a non‐clinical sample in Poland. Psychiatry Research, 273, 394–401. https://doi.org/10.1016/j.psychres.2019.01.044
Henriksen, M. G., Raballo, A., & Nordgaard, J. (2021). Self‐disorders and psychopathology: A systematic review. The Lancet Psychiatry, 8(11), 1001–1012. https://doi.org/10.1016/S2215-0366(21)00097-3
Henry, M. (2015). Phénoménologie matérielle. Humensis.
Hernández‐García, M., Gómez‐García, M., Sotelo, E., Fernández‐Linsenbarth, I., Andrés‐Olivera, P., de Alarcon‐Gómez, R., Muñoz‐Moreno, M. F., & Molina, V. (2021). Anomalous self‐experiences are related to general cognition deficits in schizophrenia. European Archives of Psychiatry and Clinical Neuroscience, 271(4), 707–712. https://doi.org/10.1007/s00406-020-01213-z
Jacquemot, A. M. M. C., & Park, R. (2020). The role of interoception in the pathogenesis and treatment of anorexia nervosa: A narrative review. Frontiers in Psychiatry, 11, 281. https://doi.org/10.3389/fpsyt.2020.00281
Lin, A., Reniers, R. L. E. P., & Wood, S. J. (2013). Clinical staging in severe mental disorder: Evidence from neurocognition and neuroimaging. The British Journal of Psychiatry, 202(s54), s11–s17. https://doi.org/10.1192/bjp.bp.112.119156
Madeira, L., Carmenates, S., Costa, C., Linhares, L., Stanghellini, G., Figueira, M. L., & Sass, L. (2017). Basic self‐disturbances beyond schizophrenia: Discrepancies and affinities in panic disorder—An empirical clinical study. Psychopathology, 50(2), 157–168. https://doi.org/10.1159/000457803
McGorry, P., Keshavan, M., Goldstone, S., Amminger, P., Allott, K., Berk, M., Lavoie, S., Pantelis, C., Yung, A., Wood, S., & Hickie, I. (2014). Biomarkers and clinical staging in psychiatry. World Psychiatry, 13(3), 211–223. https://doi.org/10.1002/wps.20144
McGrath, J. J., Saha, S., Al‐Hamzawi, A., Alonso, J., Bromet, E. J., Bruffaerts, R., Caldas‐de‐Almeida, J. M., Chiu, W. T., de Jonge, P., Fayyad, J., Florescu, S., Gureje, O., Haro, J. M., Hu, C., Kovess‐Masfety, V., Lepine, J. P., Lim, C. C. W., Mora, M. E. M., Navarro‐Mateu, F., … Kessler, R. C. (2015). Psychotic experiences in the general population: A cross‐national analysis based on 31,261 respondents from 18 countries. JAMA Psychiatry, 72(7), 697–705. https://doi.org/10.1001/jamapsychiatry.2015.0575
Moccia, L., Conte, E., Ambrosecchia, M., Janiri, D., Di Pietro, S., De Martin, V., Di Nicola, M., Rinaldi, L., Sani, G., Gallese, V., & Janiri, L. (2022). Anomalous self‐experience, body image disturbance, and eating disorder symptomatology in first‐onset anorexia nervosa. Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity, 27(1), 101–108. https://doi.org/10.1007/s40519-021-01145-0
Monteleone, A. M., Castellini, G., Ricca, V., Volpe, U., De Riso, F., Nigro, M., Zamponi, F., Mancini, M., Stanghellini, G., Monteleone, P., Treasure, J., & Maj, M. (2017). Embodiment mediates the relationship between avoidant attachment and eating disorder psychopathology. European Eating Disorders Review, 25(6), 461–468. https://doi.org/10.1002/erv.2536
Morrison, A. P., Nothard, S., Bowe, S. E., & Wells, A. (2004). Interpretations of voices in patients with hallucinations and non‐patient controls: A comparison and predictors of distress in patients. Behaviour Research and Therapy, 42(11), 1315–1323. https://doi.org/10.1016/j.brat.2003.08.009
Nelson, B., Li, E., Cicero, D. C., Gawęda, Ł., Hartmann, J. A., Koren, D., Polari, A., Whitford, T. J., & Lavoie, S. (2019). The construct validity of the inventory of psychotic‐like anomalous self‐experiences (IPASE) as a measure of minimal self‐disturbance: Preliminary data. Early Intervention in Psychiatry, 13(3), 686–691. https://doi.org/10.1111/eip.12711
O'Shaughnessy, B. (1998). Proprioception and the body image. In J. L. Bermudez, A. J. Marcel, & N. M. Eilan (Eds.), The body and the self (pp. 175–203). MIT Press. https://philpapers.org/rec/OSHPAT
Parker, A. G., Hetrick, S. E., Jorm, A. F., Mackinnon, A. J., McGorry, P. D., Yung, A. R., Scanlan, F., Stephens, J., Baird, S., Moller, B., & Purcell, R. (2016). The effectiveness of simple psychological and physical activity interventions for high prevalence mental health problems in young people: A factorial randomised controlled trial. Journal of Affective Disorders, 196, 200–209. https://doi.org/10.1016/j.jad.2016.02.043
Parker, A. G., Markulev, C., Rickwood, D. J., Mackinnon, A., Purcell, R., Alvarez‐Jimenez, M., Yung, A. R., McGorry, P., Hetrick, S. E., & Jorm, A. (2019). Improving mood with physical ACTivity (IMPACT) trial: A cluster randomised controlled trial to determine the effectiveness of a brief physical activity behaviour change intervention on depressive symptoms in young people, compared with psychoeducation, in addition to routine clinical care within youth mental health services—A protocol study. BMJ Open, 9(10), e034002. https://doi.org/10.1136/bmjopen-2019-034002
Parnas, J., & Handest, P. (2003). Phenomenology of anomalous self‐experience in early schizophrenia. Comprehensive Psychiatry, 44(2), 121–134. https://doi.org/10.1053/comp.2003.50017
Parnas, J., Møller, P., Kircher, T., Thalbitzer, J., Jansson, L., Handest, P., & Zahavi, D. (2005). EASE: Examination of anomalous self‐experience. Psychopathology, 38(5), 236–258. https://doi.org/10.1159/000088441
R Core Team. (2023). R: A language and environment for statistical computing [Computer software]. https://www.R-project.org
Rasmussen, A. R., Reich, D., Lavoie, S., Li, E., Hartmann, J. A., McHugh, M., Whitford, T. J., & Nelson, B. (2020). The relation of basic self‐disturbance to self‐harm, eating disorder symptomatology and other clinical features: Exploration in an early psychosis sample. Early Intervention in Psychiatry, 14(3), 275–282. https://doi.org/10.1111/eip.12850
Ricoeur, P. (1990). Soi‐même comme un autre. POINTS.
Riva, G., & Gaudio, S. (2018). Locked to a wrong body: Eating disorders as the outcome of a primary disturbance in multisensory body integration. Consciousness and Cognition, 59, 57–59. https://doi.org/10.1016/j.concog.2017.08.006
Ronchi, R., Park, H.‐D., & Blanke, O. (2018). Bodily self‐consciousness and its disorders. Handbook of Clinical Neurology, 151, 313–330. https://doi.org/10.1016/B978-0-444-63622-5.00015-2
Rosen, C., Park, S., Baxter, T., Tufano, M., & Giersch, A. (2023). Sensed presence, attenuated psychosis, and transliminality: At the threshold of consciousness. Psychopathology, 56(5), 359–370. https://doi.org/10.1159/000528572
Rosseel, Y. (2012). lavaan: An R package for structural equation modeling. Journal of Statistical Software, 48, 1–36. https://doi.org/10.18637/jss.v048.i02
Rossi, E., Castellini, G., Cassioli, E., Sensi, C., Mancini, M., Stanghellini, G., & Ricca, V. (2021). The role of embodiment in the treatment of patients with anorexia and bulimia nervosa: A 2‐year follow‐up study proposing an integration between enhanced cognitive behavioural therapy and a phenomenological model of eating disorders. Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity, 26(8), 2513–2522. https://doi.org/10.1007/s40519-021-01118-3
Sartre, J.‐P. (1969). Being and nothingness: An essay on phenomenological ontology (1st ed.). Routledge.
Sass, L. A., & Parnas, J. (2003). Schizophrenia, consciousness, and the self. Schizophrenia Bulletin, 29(3), 427–444. https://doi.org/10.1093/oxfordjournals.schbul.a007017
Schreiber, J. B., Nora, A., Stage, F. K., Barlow, E. A., & King, J. (2006). Reporting structural equation modeling and confirmatory factor analysis results: A review. The Journal of Educational Research, 99(6), 323–338. https://doi.org/10.3200/JOER.99.6.323-338
Stanghellini, G. (2019a). Embodiment and the other's look in feeding and eating disorders. World Psychiatry, 18(3), 364–365. https://doi.org/10.1002/wps.20683
Stanghellini, G. (2019b). The optical‐coenaesthetic disproportion in feeding and eating disorders. European Psychiatry: The Journal of the Association of European Psychiatrists, 58, 70–71. https://doi.org/10.1016/j.eurpsy.2019.02.005
Stanghellini, G., Ballerini, M., & Mancini, M. (2019). The optical‐coenaesthetic disproportion hypothesis of feeding and eating disorders in the light of neuroscience. Frontiers in Psychiatry, 10, 630. https://doi.org/10.3389/fpsyt.2019.00630
Stanghellini, G., Castellini, G., Brogna, P., Faravelli, C., & Ricca, V. (2012). Identity and eating disorders (IDEA): A questionnaire evaluating identity and embodiment in eating disorder patients. Psychopathology, 45(3), 147–158. https://doi.org/10.1159/000330258
Stanghellini, G., Trisolini, F., Castellini, G., Ambrosini, A., Faravelli, C., & Ricca, V. (2015). Is feeling extraneous from one's own body a core vulnerability feature in eating disorders? Psychopathology, 48(1), 18–24. https://doi.org/10.1159/000364882
Todd, J., Cardellicchio, P., Swami, V., Cardini, F., & Aspell, J. E. (2021). Weaker implicit interoception is associated with more negative body image: Evidence from gastric‐alpha phase amplitude coupling and the heartbeat evoked potential. Cortex, 143, 254–266. https://doi.org/10.1016/j.cortex.2021.07.006
Tozzi, F., Thornton, L. M., Klump, K. L., Fichter, M. M., Halmi, K. A., Kaplan, A. S., Strober, M., Woodside, D. B., Crow, S., Mitchell, J., Rotondo, A., Mauri, M., Cassano, G., Keel, P., Plotnicov, K. H., Pollice, C., Lilenfeld, L. R., Berrettini, W. H., Bulik, C. M., & Kaye, W. H. (2005). Symptom fluctuation in eating disorders: Correlates of diagnostic crossover. The American Journal of Psychiatry, 162(4), 732–740. https://doi.org/10.1176/appi.ajp.162.4.732
Trask, C. L., Matsui, M. M., Cohn, J. R., Klaunig, M. J., & Cicero, D. C. (2021). Anomalous self‐experiences in cognition are negatively associated with neurocognitive functioning in schizophrenia. Cognitive Neuropsychiatry, 26(5), 307–320. https://doi.org/10.1080/13546805.2021.1935225
Uhlhaas, P. J., Davey, C. G., Mehta, U. M., Shah, J., Torous, J., Allen, N. B., Avenevoli, S., Bella‐Awusah, T., Chanen, A., Chen, E. Y. H., Correll, C. U., Do, K. Q., Fisher, H. L., Frangou, S., Hickie, I. B., Keshavan, M. S., Konrad, K., Lee, F. S., Liu, C. H., … Wood, S. J. (2023). Towards a youth mental health paradigm: A perspective and roadmap. Molecular Psychiatry, 1–11, 3171–3181. https://doi.org/10.1038/s41380-023-02202-z
Verduijn, J., Milaneschi, Y., van Hemert, A. M., Schoevers, R. A., Hickie, I. B., Penninx, B. W. J. H., & Beekman, A. T. F. (2015). Clinical staging of major depressive disorder: An empirical exploration. The Journal of Clinical Psychiatry, 76(9), 2953. https://doi.org/10.4088/JCP.14m09272
Wickham, H., François, R., Henry, L., Müller, K., & RStudio. (2021). dplyr: A grammar of data manipulation (1.0.7) [Computer software]. https://CRAN.R-project.org/package=dplyr
Zahavi, D. (2005). Subjectivity and selfhood: Investigating the first‐person perspective. The MIT Press. https://doi.org/10.7551/mitpress/6541.001.0001
Zahavi, S., & Gallagher, D. (2020). The phenomenological mind (3rd ed.). Routledge. https://doi.org/10.4324/9780429319792