This study examined the psychometric properties of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Restructured Clinical Scales (RCSs) in individuals with posttraumatic stress disorder (PTSD) receiving clinical services at Veterans Affairs medical centers. Study 1 included 1,098 men who completed the MMPI-2 and were assessed for a range of psychological disorders via structured clinical interview. Study 2 included 136 women who completed the MMPI-2 and were interviewed with the Clinician Administered Scale for PTSD. The utility of the RCSs was compared to that of the Clinical Scales (CSs) and the Keane PTSD (PK) scale. The RCSs demonstrated good psychometric properties along with patterns of associations with other measures of psychopathology that corresponded to current theory regarding the structure of comorbidity. A notable advantage of the RCSs compared to the MMPI-2 CSs was their enhanced construct validity and clinical utility in the assessment of comorbid internalizing and externalizing psychopathology. The PK scale demonstrated incremental validity in the prediction of PTSD beyond that of the RCSs or CSs.
Minnesota Multiphasic Personality Inventory-2; Restructured Clinical Scales; posttraumatic stress disorder; internalizing; externalizing
Several studies have demonstrated the importance of personality constructs on health behaviors and health status. Having a pessimistic outlook has been related to negative health behaviors and higher mortality. However, the construct has not been well explored in cancer populations.
Survival time of 534 adults, who were diagnosed with lung cancer and had a pessimistic explanatory style, was examined. The patients had completed the Minnesota Multiphasic Personality Inventory (MMPI) approximately 18.2 years prior to receiving their lung cancer diagnosis. MMPI Optimism-Pessimism (PSM) scores were divided into high (60 or more) and low scores (less than 60), and log-rank tests and Kaplan-Meier curves were used to determine survival differences. Multivariate Cox models were used for assessing prognostic values of pessimism along with other known predictors for lung cancer survival outcome. Booting strapping of the survival models was used as a sensitivity analysis.
At the time of lung cancer diagnosis, patients were on average 67 years old; 48% were female; 85% had non-small cell lung cancer (NSCLC); 15% had small cell lung cancer (SCLC); 30% were stage I; 4% were stage II; 31% were stage III/limited; and 35% were stage IV/extensive. Patients who exhibited a non-pessimistic explanatory style survived approximately six months longer than patients classified as having a pessimistic explanatory style.
Among lung cancer patients, those having a pessimistic explanatory style experienced less favorable survival outcome, which may be related to cancer treatment decisions. Further research in this area is warranted.
Explanatory Style; Optimism; Pessimism; Lung Cancer; MMPI; Survival
To examine assessment and treatment profiles of adolescent patients with anorexia nervosa and eating disorder not otherwise specified who received olanzapine as compared with an untreated matched sample.
A retrospective, matched-groups comparison study was completed. Medical files of 86 female patients treated in the eating disorder program at the Children's Hospital of Eastern Ontario were examined. Patients treated with olanzapine were initially identified through chart review and then matched to a diagnosis, age, and, when possible, treatment group that served as the active comparator. Weight gain was examined in a sample of 22 inpatients.
Patients treated with olanzapine displayed greater evidence of psychopathology and medical compromise at the time of first assessment compared with those not treated. Rate of weight gain was not statistically different between groups when olanzapine was started during inpatient admissions. Medication effect on eating disorder cognitions could not be assessed given the presence of multiple confounders relating to treatment. Notable side effects included sedation and dyslipidemia in 56% of patients.
Despite our best attempts at matching olanzapine-treated subjects with a control sample, analysis revealed significant differences between groups, suggesting greater illness severity in those augmented with olanzapine. Given these inherent differences, we were unable to draw any firm conclusions regarding the potential efficacy of olanzapine. Factors associated with the prescription of adjunctive pharmacotherapy in this cohort appear to be linked to illness severity, acuity, and associated comorbidity. The observed side-effect profile indicates the need for more consistent predrug screening and for closer monitoring during treatment.
One hundred and five drug-dependent women in outpatient perinatal addiction treatment were classified by cluster analysis of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) profiles into high and low psychopathology (HP and LP) groups that differed on three validation measures. The HP group (n = 29, 27.6%) had elevations on MMPI-2 Scales F, 2, 4, 6, 7, and 8, while the LP group (n = 76, 72.4%) generated a normal range profile with elevations on Scales F and 4. Psychological outcomes differed by group. HP participants showed reduced alcohol, family, and psychiatric severity, and reduced depressive symptoms, while LP subjects showed reduced drug, self-debasing, and acting-out problems. Data suggest the need for lower intensity services for the majority of the perinatal drug dependent population with LP.
To examine the validity and reliability of a Japanese version of the Symptom Checklist 90 Revised (SCL-90-R (J)).
The English SCL-90-R was translated to Japanese and the Japanese version confirmed by back-translation. To determine the factor validity and internal consistency of the nine primary subscales, 460 people from the community completed SCL-90-R(J). Test-retest reliability was examined for 104 outpatients and 124 healthy undergraduate students. The convergent-discriminant validity was determined for 80 inpatients who replied to both SCL-90-R(J) and the Minnesota Multiphasic Personality Inventory (MMPI).
The correlation coefficients between the nine primary subscales and items were .26 to .78. Cronbach's alpha coefficients were from .76 (Phobic Anxiety) to .86 (Interpersonal Sensitivity). Pearson's correlation coefficients between test-retest scores were from .81 (Psychoticism) to .90 (Somatization) for the outpatients and were from .64 (Phobic Anxiety) to .78 (Paranoid Ideation) for the students. Each of the nine primary subscales correlated well with their corresponding constructs in the MMPI.
We confirmed the validity and reliability of SCL-90-R(J) for the measurement of individual distress. The nine primary subscales were consistent with the items of the original English version.
To identify variables that discriminate needle-sharing among drug abusers, 224 male drug abusers were studied. They had been admitted to a 30-day inpatient drug treatment program over a 19-month period (September 1983 through March 1985). The variables examined were divided into three categories: demographic (age, race, education), personality (Minnesota Multiphasic Personality Inventory [MMPI] scores and MMPI deviant scores), and drug use patterns (drug of choice, use of single or multiple [mixed] drugs, severity of drug use, and place of use). Three variables were identified that discriminated needle-sharers from other drug abusers. Compared with other drug abusers, needle-sharers used more multiple drugs, were more likely to use a "shooting gallery," and had more problems related to drug use. No demographic or personality variables discriminated needle-sharers from nonsharers. The data suggested that needle-sharing is widespread in the drug culture. Needle-sharing was not confined to a particular racial group, educational level, or personality type. These findings can be used to structure education programs about acquired immunodeficiency syndrome (AIDS) for drug abusers. Drug treatment programs appear to provide an important opportunity to educate drug abusers about AIDS and related health issues associated with needle-sharing.
Anorexia nervosa is notoriously difficult to treat, but little is known regarding the relationship of compliance to treatment outcome. We investigated in 41 adolescents who fulfilled DSM-III-R criteria for anorexia nervosa, the relationship between the completion of a standard psychosocial treatment program, subtypes of anorexia nervosa, and outcome as determined by standardized measurements. These adolescents were observed for an average of 32.4 months. Overall, 29 patients (70%) improved considerably, but 10 (24%) were symptomatic, and 2 (5%) remained in poor condition. There were no deaths. Of the 41 patients, 14 (34%) completed our entire treatment program, 15 (37%) received major treatment and failed in the outpatient follow-up phase only, 7 (17%) dropped out of inpatient treatment before its completion, and 5 (12%) refused treatment in our system altogether. Of all the dropouts, 10 received no further treatment. One patient was admitted to hospital elsewhere but again dropped out in the outpatient phase of that program. Seven patients (17%) received further outpatient treatment only, and 9 (22%) received inpatient and outpatient care and seemingly completed their treatment. Treatment completion significantly affected the measures of global clinical functioning and specific psychopathologic features, but only for those patients who completed the initial program. Bulimic patients did considerably worse on follow-up and were less likely to complete treatment. Patients with restricted anorexia nervosa were more likely to complete treatment than those with a bulimic subtype (P = .03). Differential compliance rates in the two subtypes confound the effects of treatment completion and need to be controlled for in future studies. Depression was not associated with noncompliance but, if present, was associated with poor outcome on follow-up and abated in only a third of those in whom it was initially present.
This study examined the association between recollected parental child-rearing strategies and individual differences in self-regulation, socio-emotional adjustment, and psychopathology in early adulthood. Undergraduate participants (N = 286) completed the EMBU – a measure of retrospective accounts of their parents’ child-rearing behaviors – as well as self-report measures of self-regulation and socio-emotional adjustment across the domains of eating disorder symptoms, physically risky behavior, interpersonal problems, personal financial problems, and academic maladjustment. A subset of participants also completed the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF). Parental warmth was found to be related to overall better self-regulation and improved interpersonal and academic adjustment. In contrast, both parental rejection and overcontrol were found to be related to general deficits in self-regulation as well as adjustment difficulties and psychopathology. Parental rejection was most closely related to internalizing clinical presentations like anxiety, depression, and somatization, whereas overcontrol was most aligned with increased hypomanic activation and psychoticism. Mediation analyses demonstrated that the relationships between parental child-rearing strategies and socio-emotional adjustment and psychopathology were partially mediated by self-regulation. Future directions are suggested, including basic and translational research related to better understanding the roles of parental child-rearing and self-regulation in the development of internalizing symptoms, activation, and psychotic symptoms.
Parental child-rearing strategies; EMBU; self-regulation; socio-emotional adjustment; psychopathology; MMPI-2-RF; early adulthood
We previously reported that depressive personality (the scores of hypochondriasis, depression and psychasthenia determined by the Minnesota Multiphasic Personality Inventory (MMPI)) and daily hassles of Graves' disease (GD) patients treated long trem with antithyroid drug (ATD) were significantly higher in a relapsed group than in a remitted group, even in the euthyroid state. The present study aims to examine the relationship among depressive personality, emotional stresses, thyroid function and the prognosis of hyperthyroidism in newly diagnosed GD patients.
Sixty-four untreated GD patients responded to the MMPI for personality traits, the Natsume's Stress Inventory for major life events, and the Hayashi's Daily Life Stress Inventory for daily life stresses before and during ATD treatment.
In the untreated thyrotoxic state, depressive personality (T-scores of hypochondriasis, depression or psychasthenia greater than 60 points in MMPI) were found for 44 patients (69%). For 15 (23%) of these patients, the scores decreased to the normal range after treatment. However, depressive personality persisted after treatment in the remaining 29 patients (46%). Normal scores before treatment were found for 20 patients (31%), and the scores were persistently normal for 15 patients (23%). The remaining 5 patients (8%) had higher depressive personality after treatment. Such depressive personality was not associated with the severity of hyperthyroidism. Serum TSH receptor antibody activity at three years after treatment was significantly (p = 0.0351) greater in the depression group than in the non- depression group. The remission rate at four years after treatment was significantly (p = 0.0305) lower in the depression group than in the non- depression group (22% vs 52%).
The data indicate that in GD patients treated with ATD, depressive personality during treatment reflects the effect of emotional stress more than that of thyrotoxicosis and that it aggravates hyperthyroidism. Psychosomatic therapeutic approaches including antipsychiatric drugs and/or psychotherapy appears to be useful for improving the prognosis of hyperthyroidism.
There has been a relative absence of studies that have examined the neuropsychological profiles of potential lung transplant candidates. Neuropsychological data are presented for 134 patients with end-stage pulmonary disease who were being evaluated as potential candidates for lung transplantation. Neuropsychological test results indicated that a significantly greater proportion of the patients exhibited impaired performances on a number of Selective Reminding Test (SRT) tasks as compared to the expected population frequency distributions for these measures. The highest frequencies of impairment were observed on the SRT’s Immediate Free Recall (46.43%), Long-term Retrieval (41.67%), and Consistent Long-term Retrieval (51.19%) variables. On the Minnesota Multiphasic Personality Inventory-2 (MMPI-2)/Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A), patients’ mean clinical profile revealed elevations on Scales 1 (Hypochondriasis) and 3 (Conversion Hysteria). This profile indicated that they were experiencing an array of symptomatology ranging from somatic complaints to lethargy and fatigue, and that they may have been functioning at a reduced level of efficiency. Findings are discussed in light of patients’ end-stage pulmonary disease and factors possibly contributing to their neuropsychological test performances. Implications for clinical practice and future research are also provided.
Neuropsychology; Neurocognitive; Pulmonary disease; End-stage; Lung transplant
It has been suggested that people who develop Parkinson disease (PD) may have a characteristic premorbid personality. We tested this hypothesis using a large historical cohort study with long follow-up.
We conducted a historical cohort study in the region including the 120-mile radius centered in Rochester, MN. We recruited 7,216 subjects who completed the Minnesota Multiphasic Personality Inventory (MMPI) for research at the Mayo Clinic from 1962 through 1965 and we considered 5 MMPI scales to measure sensation seeking, hypomania, positive emotionality, social introversion, and constraint. A total of 6,822 subjects (94.5% of the baseline sample) were followed over 4 decades either actively (via interview and examination) or passively (via medical records).
During follow-up, 227 subjects developed parkinsonism (156 developed PD). The 3 MMPI scales that we selected to measure the extroverted personality construct (sensation seeking, hypomania, and positive emotionality) did not show the expected pattern of higher scores associated with reduced risk of PD. Similarly, the 2 MMPI scales that we selected to measure the introverted personality construct (social introversion and constraint) did not show the expected pattern of higher scores associated with increased risk of PD. However, higher scores for constraint were associated with an increased risk of all types of parkinsonism pooled together (hazard ratio 1.39; 95% CI 1.06–1.84; p = 0.02).
We suggest that personality traits related to introversion and extroversion do not predict the risk of PD.
= confidence interval;
= hazard ratio;
= Minnesota Multiphasic Personality Inventory;
= MMPI Sensation Seeking Scale;
= Parkinson disease;
= Personality Psychopathology Five Scales.
Twenty-seven Parkinsonism patients and 31 controls, matched for age and verbal IQ, were tested on an objectively scored personality test (Minnesota Multiphasic Personality Inventory) at the beginning of the patients' levodopa therapy and three months later. Patients, but not the controls, were retested after 15 months of levodopa treatment. The patients, all of whom were intact intellectually, obtained MMPI scores indicating moderate depression before beginning levodopa treatment. There was no test evidence to indicate that levodopa significantly increased or decreased the amount of depression in the patients after three or 15 months of levodopa. The patient group, however, significantly increased their Index of Psychopathology (Ip) score after 15 months of levodopa but not after three months.
Unresolved questions in headache research are the roles of drug abuse and psychopathology in headache disorder, especially in chronic daily headache. We investigated the utility of the revised version of the Minnesota Multiphasic Personality Inventory (MMPI-2) for assessing psychopathology in chronic daily headache patients. Chronic headache sufferers gave characteristic responses on Hy (hypochondria), D (depression) and Hs (hysteria) scales which are known as the “neurotic triad”. Although our data suggest that the MMPI profile types do not discriminate between different diagnosis groups and fail to determine whether psychopathological traits predispose to drug abuse, they nonetheless confirm the importance of psychological assessment as an essential step in the decision to seek medical help for headache.
Key words MMPI-2; Chronic daily headache; Personality inventory
OBJECTIVE: To determine the risk of hospitalization and death in relation to preexisting depression and anxiety among patients with cardiovascular disease (CVD).
PATIENTS AND METHODS: The cohort consisted of 799 Olmsted County, MN, residents diagnosed with CVD (myocardial infarction or heart failure) from January 1, 1979, to December 31, 2009, who completed a Minnesota Multiphasic Personality Inventory (MMPI) prior to their event. The MMPI was used to identify depression and anxiety, and participants were followed up for hospitalizations and death during an average of 6.2 years.
RESULTS: Depression and anxiety were identified in 282 (35%) and 210 (26%) participants, respectively. After adjustment, depression and anxiety were independently associated with a 28% (95% confidence interval [CI], 8%-51%) and 26% (95% CI, 3%-53%) increased risk of being hospitalized, respectively. Depression also conferred an increased risk of all-cause mortality of similar magnitude, whereas the hazard ratio for anxiety was not statistically significant. The combined occurrence of depression and anxiety led to a 35% (95% CI, 8%-71%) increase in the risk of hospitalizations.
CONCLUSION: Among patients with CVD, both preexisting depression and anxiety, occurring on average 17 years before the CVD event, independently predict hospitalizations. In addition, the 2 conditions may act synergistically on increasing health care utilization in patients with CVD.
To study the association between several personality traits and all-cause mortality.
We established a historical cohort of 7216 subjects who completed the Minnesota Multiphasic Personality Inventory (MMPI) for research at the Mayo Clinic from 1962 to 1965, and who resided within a 120-mile radius centered in Rochester, MN. A total of 7080 subjects (98.1%) were followed over four decades either actively (via a direct or proxy telephone interview) or passively (via review of medical records or by obtaining their death certificates). We examined the association of pessimistic, anxious, and depressive personality traits (as measured using MMPI scales) with all-cause mortality.
A total of 4634 subjects (65.5%) died during follow-up. Pessimistic, anxious, and depressive personality traits were associated with increased all-cause mortality in both men and women. In addition, we observed a linear trend of increasing risk from the first to the fourth quartile for all three scales. Results were similar in additional analyses considering the personality scores as continuous variables, in analyses combining the three personality traits into a composite neuroticism score, and in several sets of sensitivity analyses. These associations remained significant even when personality was measured early in life (ages 20 to 39 years).
Our findings suggest that personality traits related to neuroticism are associated with an increased risk of all-cause mortality even when they are measured early in life.
personality; mortality; pessimism; anxiety; depression; neuroticism; MMPI
We studied the association of three personality traits related to neuroticism with the subsequent risk of Parkinson’s disease (PD) using a historical cohort study. We included 7,216 subjects who resided within the 120-mile radius centered in Rochester, MN, at the time they completed the Minnesota Multiphasic Personality Inventory (MMPI) for research at the Mayo Clinic from 1962–1965. We considered three MMPI personality scales (pessimistic, anxious, and depressive traits). A total of 6,822 subjects (94.5%) were followed over 4 decades either actively or passively. During follow-up, 227 subjects developed parkinsonism (156 developed PD). An anxious personality was associated with an increased risk of PD (hazard ratio [HR], 1.63; 95% confidence interval [CI], 1.16–2.27). A pessimistic personality trait was also associated with an increased risk of PD but only in men (HR = 1.92; 95% CI = 1.20–3.07). By contrast, a depressive trait was not associated with increased risk. Analyses combining scores from the three personality scales into a composite neuroticism score showed an association of neuroticism with PD (HR = 1.54; 95% CI = 1.10–2.16). The association with neuroticism remained significant even when the MMPI was administered early in life (ages 20–39 years). By contrast, none of the three personality traits was associated with the risk of non-PD types of parkinsonism grouped together. Our long-term historical cohort study suggests that an anxious personality trait may predict an increased risk of PD developing many years later.
Parkinson’s disease; parkinsonism; anxious personality; pessimistic personality; neuroticism; Minnesota Multiphasic Personality Inventory
Patients with left hemisphere disease have been noted to be depressed while those with right hemisphere disease appear indifferent. While patients with left hemisphere disease frequently have a greater cognitive deficit, patients with right hemisphere disease have difficulty in expressing affectively intoned speech. The Minnesota Multiphasic Personality Inventory (MMPI) can demonstrate underlying affective experience and is not dependent on affectively intoned speech. The purpose of this study was to determine whether a difference in affective moods, as assessed by the MMPI, was related to laterality of lesion in patients matched for severity of cognitive and motor dysfunction. Seven of the 16 subjects with left hemisphere dysfunction and none of the eight subjects with right hemisphere dysfunction showed an elevation on the depression scale. This observation not only confirms previous clinical observations but also demonstrates that these asymmetries cannot be ascribed completely to hemisphere-related differences in cognitive deficits or expressive abilities.
The present study evaluated the heritability of personality traits and psychopathology symptoms assessed by the Minnesota Multiphasic Personality Interview 2nd edition (MMPI-2) in a family-based sample selected for alcohol dependence. Participants included 950 probands and 1204 first-degree relatives recruited for the UCSF Family Alcoholism Study. Heritability estimates (h2) for MMPI-2 scales ranged from .25–.49. When alcohol dependence was used as a covariate, heritability estimates remained significant but generally declined. However, when the MMPI-2 scales were used as covariates to estimate the heritability of alcohol dependence, scales measuring antisocial behavior (ASP), depressive symptoms (DEP), and addictive behavior (MAC-R) led to moderate increases in the heritability of alcohol dependence. This suggests that the ASP, DEP, and MAC-R scales may explain some of the non-genetic variance in the alcohol dependence diagnosis in this population when utilized as covariates, and thus may serve to produce a more homogeneous and heritable alcohol dependence phenotype.
alcohol-related disorders; behavioral genetics; heredity; personality; comorbidity
Our purpose was to apply the Minnesota Multiphasic Personality Inventory (MMPI-2) to groups of women with different types of headache and facial pain. 117 women with tension-type headache (TTH), migraine (M), facial pain disorder as somatoform disorder (FP), myogenous facial pain (MP), or temporomandibular joint disorder (TMJ) were given in the Italian version of the MMPI-2. The level of pain was assessed with the visual analogue scale (VAS). A configural analysis of the MMPI profiles was also performed. Data were analysed with one-way ANOVA, chi-square analysis and Pearson's correlation coefficient. FP and TH patients showed the highest scale elevation and TMJ patients the lowest. The TMJ group had the highest prevalence of “coper” configuration and the FP group the lowest. A correlation was found between VAS and MMPI-2 scores for hypochondria, hysteria and paranoia. We conclude that: chronic pain may alter the patient's personality characteristics; patients with facial pain disorder show the highest tendency to neurotism and psychoticism; and in patients with migraine, TTH and MP, the psychological component may vary conspiquously. These factors should be taken into account when selecting the treatment options.
Key words MMPI-2; Headache; Facial pain; Personality traits
We used measures of positive affect and emotional expression to distinguish and better understand veterans with PTSD with symptom overreporting presentation styles. Based on prior research, symptom overreporting was defined as scores greater than eight on the Fp (Infrequency-Psychopathology) scale of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Data were drawn from an archival dataset of 227 combat veteran outpatients. Results were consistent with theory and research on the distinction between negative and positive affect. Major findings indicated that (a) veterans endorsing greater anhedonia had a greater likelihood of being classified as a symptom overreporter (controlling for PTSD symptoms), and (b) compared to non-symptom overreporting veterans, overreporters showed greater congruency in their presentation of diminished positive affect and their expression across self- and clinician-ratings. Our data suggest that diminished positive emotions and their behavioral expression are uniquely associated with veterans’ psychological experiences, providing insight into the nature of symptom overreporters.
This study evaluated the symptoms of post-traumatic stress disorder (PTSD) among North Korean defectors and their level of suicidal ideation and the correlation between these and heart-rate variability (HRV) to explore the possibility of using HRV as an objective neurobiological index of signs of autonomic nervous system disorder.
A total of 32 North Korean defectors (nine men, 23 women) were selected as subjects, and their HRV was measured after they completed the Minnesota Multiphasic Personality Inventory-PTSD (MMPI-PTSD) scale and the Beck Depression Inventory (BDI).
1) Low-frequency (LF)/high-frequency (HF) ratios in the HRV index and MMPI-PTSD scores were correlated (r=0.419, p<0.05), as were BDI item 9 (suicidal ideation) and MMPI-PTSD scores (r=0.600, p<0.01). 2) A regression analysis of LF/HF ratios and MMPI-PTSD scores revealed an R-value of 13.8% (Adj. R2=0.138, F=4.695, p=0.041), and a regression analysis of BDI item 9 and MMPI-PTSD scores showed an R-value of 32.8% (Adj. R2=0.328, F=11.234, p=0.003). In other words, the LF/HF ratio (β=0.419) and BDI item 9 (β=0.600) appear to be risk factors in predicting MMPI-PTSD scores.
The LF/HF ratio, a standard index of autonomic nervous system activity, can be used as an objective neurobiological index to analyze PTSD among North Korean defectors presenting with various mental and physical symptoms, and the approximate level of suicide -ideation can act as a predicting factor for PTSD.
North Korean defectors; Post-traumatic stress disorder; Suicide; Heart rate variability; Depression
There is a dearth of data regarding changes in dietary intake and physical activity over time that lead to inpatient medical treatment for anorexia nervosa (AN). Without such data, more effective nutritional therapies for patients cannot be devised. This study was undertaken to describe changes in diet and physical activity that precede inpatient medical hospitalization for AN in female adolescents. This data can be used to understand factors contributing to medical instability in AN, and may advance rodent models of AN to investigate novel weight restoration strategies. It was hypothesized that hospitalization for AN would be associated with progressive energy restriction and increased physical activity over time. 20 females, 11–19 years (14.3±1.8 years), with restricting type AN, completed retrospective, self-report questionnaires to assess dietary intake and physical activity over the 6 month period prior to inpatient admission (food frequency questionnaire, Pediatric physical activity recall) and 1 week prior (24 hour food recall, modifiable activity questionnaire). Physical activity increased acutely prior to inpatient admission without any change in energy or macronutrient intake. However, there were significant changes in reported micronutrient intake causing inadequate intake of Vitamin A, Vitamin D, and pantothenic acid at 1 week versus high, potentially harmful, intake of Vitamin A over 6 months prior to admission. Subject report of significantly increased physical activity, not decreased energy intake, were associated with medical hospitalization for AN. Physical activity and Vitamin A and D intake should be carefully monitored following initial AN diagnosis, as markers of disease progression as to potentially minimize the risk of medical instability.
Five methods of personality assessment are evaluated to provide guidance for the psychological treatment of patients with chronic back pain. Patient pain drawings, pentothal pain studies, stress score index, psychological testing with the Minnesota Multiphasic Personality Inventory (MMPI) and response to treatment challenge are used as measurements for evaluation. This evaluation gives the treating staff guidelines for individual treatment programs utilizing operant conditioning techniques. Using this approach, three fourths of the severely disabled patients seen have been successfully treated.
In 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.
108 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.
Illness 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.
These 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.
Anorexia nervosa; Eating disorders; Psychosomatic syndromes; Illness denial; Alexithymia
Anorexia nervosa (AN) is a biologically based serious mental disorder with high levels of mortality and disability, physical and psychological morbidity and impaired quality of life. AN is one of the leading causes of disease burden in terms of years of life lost through death or disability in young women. Psychotherapeutic interventions are the treatment of choice for AN, but the results of psychotherapy depend critically on the stage of the illness. The treatment response in adults with a chronic form of the illness is poor and drop-out from treatment is high. Despite the seriousness of the disorder the evidence-base for psychological treatment of adults with AN is extremely limited and there is no leading treatment. There is therefore an urgent need to develop more effective treatments for adults with AN. The aim of the Maudsley Outpatient Study of Treatments for Anorexia Nervosa and Related Conditions (MOSAIC) is to evaluate the efficacy and cost effectiveness of two outpatient treatments for adults with AN, Specialist Supportive Clinical Management (SSCM) and the Maudsley Model of Treatment for Adults with Anorexia Nervosa (MANTRA).
138 patients meeting the inclusion criteria are randomly assigned to one of the two treatment groups (MANTRA or SSCM). All participants receive 20 once-weekly individual therapy sessions (with 10 extra weekly sessions for those who are severely ill) and four follow-up sessions with monthly spacing thereafter. There is also optional access to a dietician and extra sessions involving a family member or a close other. Body weight, eating disorder- related symptoms, neurocognitive and psychosocial measures, and service use data are measured during the course of treatment and across a one year follow up period. The primary outcome measure is body mass index (BMI) taken at twelve months after randomization.
This multi-center study provides a large sample size, broad inclusion criteria and a follow-up period. However, the study has to contend with difficulties directly related to running a large multi-center randomized controlled trial and the psychopathology of AN. These issues are discussed.
Current Controlled Trials ISRCTN67720902 - A Maudsley outpatient study of treatments for anorexia nervosa and related conditions.
Anorexia nervosa; Eating disorder not otherwise specified; Outpatient treatment; Randomized controlled trial; Cost effectiveness