Trastornos de la conducta alimentaria, experiencias adversas vitales e imagen corporal: Una revisión sistemática

Eating disorders, life stressful events and body image: A systematic review Abstract: Our objective was to clarify the relationship between adverse life events and the altered body image in eatingdisorders. We reviewed English and Spanish papers indexed in MEDLINE, PsycINFO and ScienceDirect from the last 10years. We included 16 studies of which 37.5% focus on eating disorders. Sexual abuse, physical abuse, domestic violence,bullying and having experienced multiples adverse life events have been associated with overweight patients and high body dissatisfaction. Emotional abuse has been associated with underweight and body shape concerns. Posttraumatic symptoms and emotion dysregulation have been identified as mediating factors. Eating disorder psychopathology could be the response to a bad regulation of negative emotion coming from different adverse life events and this mechanism could underlie patiens’ body dissatisfaction. Keywords: eating disorders; adverse life events; bulimia nervosa; anorexia nervosa; binge-eating disorder; body image; body dissatisfaction; traumatic events. Resumen: El objetivo de este trabajo es esclarecer la relación entre experiencias adversas vitales y la alteración de la imagen corporal en los trastornos alimentarios. Se han revisado trabajos en inglés y castellano indexados en MEDLINE, PsychoINFO y ScienceDirect en los últimos 10 años. Se han incluido 16 estudios de los cuales, el 37.5% se centra en trastornos de la alimentación. El abuso sexual, el físico, la violencia intrafamiliar, el acoso escolar y la suma de diferentes experiencias adversas vitales identifican pacientes con sobrepeso y alta insatisfacción corporal. El abuso emocional se ha asociado a bajo peso y preocupación entorno a la figura. La relación con la imagen corporal está mediada por clínica postraumática y la desregulación emocional. La clínica alimentaria es una respuesta a un mal manejo de emociones negativas derivadas de diferentes experiencias adversas y este mecanismo podría estar en la base de la insatisfacción corporal de los pacientes. Palabras clave: trastornos de la alimentación; experiencias adversas vitales; bulimia nerviosa; anorexia nerviosa; trastorno de atracón; imagen corporal; insatisfacción corporal; eventos traumáticos.

Digital Storytelling for Bereaved Individuals in a Virtual Setting

An emerging body literature exists highlighting the use of Digital Storytelling as an educational, and/or therapeutic intervention. Authors of this manuscript have studied Digital Storytelling as a narrative bereavement intervention designed to help individuals make meaning of adverse life events, like the death of a family member. Until recently, Digital Storytelling is typically delivered in person. The purpose of this article is to describe the steps to implementing Digital Storytelling as a bereavement intervention in a completely virtual setting, using Zoom technology. Best practices and lessons learned for the virtual delivery of Digital Storytelling are provided.

Financial Scarcity Undermines Health Across the Globe and the Life Course

The gradient between income and health is well established: the lower the income, the poorer the health. However, low income (having few economic resources) may not be enough to characterize economic vulnerability, and financial scarcity (perceiving having insufficient economic resources) may further reduce health. First, analysis of cross-national data (275,000+ participants from 200+ country-years) revealed that financial scarcity was associated with twice the odds of suffering from reduced self-rated health and feelings of unhappiness; this association was observed in ≈90% of the country-years and explained variance over and above income. Second, analysis of national longitudinal data (20,000+ participants over 20 years of assessment) revealed that facing financial scarcity in the course of one’s life decreased self-rated and objective health and increased feelings of depression; again, these effects explained variance over and above income. Two subsidiary findings were obtained: (i) three adverse life events (illness, separation, family conflicts) predicted financial scarcity over the life course, and (ii) self-mastery (a component of sense of control) accounted for the detrimental longitudinal effects of financial scarcity on health. This research suggests that to understand socioeconomic inequality in health, one should consider not only an individual’s quantity of monetary resources but also the perceived sufficiency of these resources.

Chronic and cumulative adverse life events in patients of premature ovarian insufficiency with unknown cause: an exploratory qualitative study

Background Premature ovarian insufficiency (POI) has serious physical and psychological consequences due to estrogen deprivation, leading to increased morbidity and mortality. However, the causes of most POI cases remain unknown (idiopathic POI). Environmental factors play an important role in the occurrence of complex diseases. To explore whether chronic and cumulative adverse life events occur in patients before POI diagnosis. Searching for the potential relative risk factors may find an intervention strategy to prevent POI in young women.Results Forty-three women (mean age=33·8 years) were recruited who were newly- diagnosed with idiopathic POI in a Chinese Ob/Gyn hospital to participate in semi-structured interviews through convenience sampling. The main questions covered by the topic guide were designed to explore adverse life events prior to POI diagnosis. Interviews were audio recorded, transcribed and analyzed thematically. Data were analyzed from June 2019 to August 2020. Among the POI patients, the mean age at diagnosis of POI was 33·8 years (range from 19 to 39 years), and the average time between the onset of irregular menstruation and POI diagnosis was 2.3 years. These patients had a relatively normal menstrual cycle before the diagnosis of POI. A number of stressful life events prior to POI diagnosis were discussed by them as important factors influencing their health and well-being. Four core themes emerged: 1) persistent exposure to workplace stress, 2) persistent exposure to family stress, 3) chronic sleep problem/disturbance existed in patients before POI diagnosis, and 4) participants' general cognition and concerns about POI. Conclusions Persistent exposures to adverse life events related to work stress, family stress and sleep disturbance exist in idiopathic POI patients. In addition, patients and their families generally have incorrect cognition of POI disease and its treatment. Future case-control studies should demonstrate whether chronic and cumulative adverse life events are risk factors of POI disease. Provision of tailored interventions (i.e. preventing or mitigating impact of adverse life events) aimed at high-risk populations is urgently needed to prevent new POI cases and promoting understanding of disease may improve health conditions of POI patients.

Brain tumour related epilepsy with co-existing non epileptic attacks: Characteristics of a clinically challenging cohort

Aims The co-existence of non-epileptic attacks (NEAD) in patients with brain tumour related epilepsy (BTRE) is poorly described. Non epileptic attacks (NEAD) co-occur in up to 30% of patients with epilepsy PWE. Adverse life events are associated with development of NEAD; their co-occurrence in those with BTRE is potentially un-surprising. We sought to characterise the evolution of symptoms in this cohort. Method Clinical trajectories of patients with BTRE and co-existing NEAD were characterised. The diagnosis of NEAD was based on the epilepsy specialist’s observation of attacks and /or capture of attacks on video. Some patients had additional video EEG correlate. Patients had been referred because of persisting symptoms in spite of escalating antiepileptic therapy. Results Of eight patients, six were initially misdiagnosed with escalating seizures. One patient developed NEAD de novo following tumour biopsy, the remaining patients developed NEAD following onset of BTRE. Onset of NEAD was not temporally linked with the diagnosis of a brain tumour. In five patients, NEAD onset occurred when seizures were controlled (< 1 seizure/ month). All patients reported fear of developing uncontrolled seizures as being associated with their symptoms and identified their NEAD as more disabling than their epilepsy. Patients were eventually managed with polytherapy -two found adjunctive clobazam helpful and four were offered antidepressant/ anxiolytic medication. Behavourial strategies including mindfulness were also discussed. At time of last follow up, seven patients had on-going NEAD symptoms in spite of good seizure control. Conclusion NEAD can co-occur with BTRE and should be considered in those with rapidly escalating symptoms in spite of antiepileptic therapy and radiologically stable lesions. Both making the diagnosis of NEAD and providing ongoing support is challenging. These patients require a multidisciplinary approach with support from allied specialties including neuropsychiatry and neuropsychology.

Association Between Schizoid and Aggressive Behaviors in Chinese Adolescents and the Mediating Influences of Childhood Trauma and Adverse Life Events

Background: This study investigated an association between schizoid and aggressive behaviors in Chinese adolescents, and the influences of childhood trauma and adverse life events on this association.Methods: The cross-sectional data of 3094 adolescents aged 12 to 16 years was collected from an epidemiological survey of child and adolescent mental disorders in Hunan Province, China. All these subjects completed the Achenbach’s Child Behavior Checklist, the Childhood Trauma Questionnaire-Short Form, and the Adolescent Self-rating Life Event Checklist. Use independent-sample t-test, Pearson’s correlation analysis, linear regression, mediation analysis and moderation analysis for data analysis.Results: The regression analysis showed that schizoid (βmale = 0.618, βfemale = 0.637, both P < 0.001) and adverse life events (βmale = 0.113, βfemale = 0.057, all P < 0.01) predicted aggressive behaviors. In addition, childhood trauma predicted aggressive behaviors (female: emotional abuse and sexual abuse (β = 0.118 and –0.062, both P < 0.01). Adverse Life events mediated the association between schizoid and aggressive behaviors in male and female adolescents. Emotional neglect in boys, and emotional abuse and sexual abuse in girls mediated the association. Only in female adolescents, the interaction between childhood trauma and life events affected the association between schizoid and aggressive behaviors (P = 0.023).Conclusions: Schizoid are associated with aggressive behaviors in Chinese adolescents. Life events and childhood trauma mediated the association between schizoid and aggressive behaviors, and the interaction between childhood trauma and life events affected girls’ aggressive behaviors. Hence, reducing childhood trauma and adverse life events can reduce the risk of aggressive behaviors in adolescents.

Exploring the Pathogenic Role of Stress in Inflammatory Bowel Disease and its Management

Every organism is constantly adapting to changes happening in the environment. This adaptation helps in maintaining homeostasis. All organisms must adapt at molecular, cellular, physiological, and behavioral levels. Amongst many factors which act as a threat to homeostasis, one of them is stress. The organism has to bring about both physiological and behavioral changes. The various researches in recent years have shown that adverse life events, along with chronic stress, and depression leads to increased likelihood of relapse in patients with quiescent IBD. Many studies of experimental stress in animal models of colitis support this. Till date, the therapeutic successes of stress reduction therapies have not been explored largely. This is also due to methodological difficulties in going ahead with such studies. This paper tries to explore the recent researches in enhancing our understanding of the pathogenic role played by psychological stress in inflammatory bowel disease and focuses our attention on the need for controlled studies on the curative prospective of stress reduction therapies for IBD.

Delayed post-traumatic stress and memory inflation of life-threatening events following a natural disaster: prospective study

Background The causes of delayed post-traumatic stress disorder (PTSD) are debated, and the validity of late-onset PTSD has been questioned. Aims We aimed to examine predictors of delayed PTSD in a community sample of survivors of a natural disaster. Method Norwegian survivors of the 2004 Indian Ocean tsunami (n = 532) responded to a questionnaire at 6 and 24 months post-disaster. The questionnaire measured PTSD symptoms, recalled exposure and immediate stress responses to the disaster, recalled perceived life threat, personality dimensions, social support and other subsequent adverse life events. Results When dichotomising PTSD symptom scores, 331 participants had low and 194 had high PTSD scores (early-onset PTSD) at 6 months. Of those with initially low scores, 43 (13.0%) had high symptom scores (delayed PTSD) at 24 months. The delayed PTSD group had a lower degree of initially assessed threat and witness experiences of death or suffering, lower immediate stress response and higher degree of memory inflation of perceived threat than the early-onset PTSD group. Among those with low PTSD scores at 6 months, onset of delayed PTSD was associated with neuroticism and memory inflation of life threat, but not with the degree of initially assessed disaster exposure or reports of subsequent adverse life events. Conclusions Lack of association between trauma exposure and delayed onset of PTSD symptoms casts doubt on whether the traumatic event is actually the primary causative factor for delayed PTSD. Our findings suggest that delayed PTSD may be a manifestation of personality factors and memory inflation of the severity of an event.