Is anorexia nervosa a neuropsychological disease?

Evidence for central nervous system, and more particularly cortical, etiology of anorexia nervosa is reviewed. Topics covered are neuropsychiatric comorbidity, inheritance patterns, the neurobiology of body-image disturbance and of the eating function, perinatal and alcoholic insult to the brain, neurochemical and neuroelectric disturbance, anatomic and metabolic brain imaging, and neuropsychological impairment. It is concluded that there is indeed an important neuropsychological etiological dimension to anorexia nervosa. The profile most frequently associated with anorexia nervosa is right posterior hypometabolism, followed by right anterior hypermetabolism, both associated with right-sided abnormal electroencephalogram spiking. It is also proposed that bulimia consists of a positive neurological subtype and that restricting anorexia represents a negative neurological subtype. Priorities for further research into anorexia nervosa are specified to include twin adoption studies, brain electrical topography studies, postmortem histological studies, and experimentally inspired neuropsychological studies.     

APPARENT COVARIATION BETWEEN CHILD HABIT DISORDERS: EFFECTS OF SUCCESSFUL TREATMENT FOR THUMB SUCKING ON UNTARGETED CHRONIC HAIR PULLING

We evaluated the effects of aversive taste treatment of thumb sucking on untreated trichotillomania (habitual hair pulling) in two children who chronically pulled their hair and sucked their thumbs. A combination of withdrawal and nonconcurrent multiple baseline designs showed that, concomitant with the successful treatment of thumb sucking, hair pulling was also eliminated. The results suggest an efficient method for changing behaviors that are difficult to treat directly.     

Comments on Hughes and Sussman''s time-sharing study of cerebral laterality in language-disordered and normal children

M. Hughes and H. M. Sussman (1983, Brain and Language, 19, 48-64) suggest that the time-sharing paradigm "does not serve as an adequate behavioral index for language lateralization in children." The merits of this conclusion are considered and general interpretative issues regarding manual interference in dual-task/time-sharing studies are discussed.     

Issues in diagnosing anxiety disorders

Research progress in the anxiety disorders is predicated on a useful classification system. In this paper, we review the reliability and validity data for theDiagnostic and Statistical Manual of Mental Disorders, 3rd ed. (DSM-III) anxiety disorders and discuss the salient issues associated with both the conceptualization of anxiety disorders and the diagnostic criteria offered in the DSM-III. It is concluded that the diagnostic reliability for these disorders is, overall, satisfactory. A dearth of validity data, however, hinders progress in both the diagnosis and the treatment of the anxiety disorders. Nevertheless, the DSM-III work group has proposed several changes in the diagnostic criteria for the anxiety disorders. We find some of these proposed changes helpful in that they clarify current diagnostic criteria; changes in diagnostic criteria that alter the basic classification schema, however, seem to be premature.Preparation of this paper was supported in part by MIMH Research Grant 1368.On sabbatical leave from Indiana State University.     

Psychopathology in anxiety disorders

Complaints of anxiety, often meetingDiagnostic and Statistical Manual of Mental Disorders, 3rd ed. (DSM-III), criteria for anxiety disorder, are among the most common problems presenting to health practitioners. In spite of the frequency of anxiety and anxiety disorders, little is known about the basic psychopathology of these conditions that would lead to the development of more efficient and effective treatments and possible preventive efforts. Recently, there has been an increase in research on the psychopathology of anxiety disorders from biological, psychological, and social perspectives. The National Institute of Mental Health's Clinical Research Branch sponsored a 2-day workshop of investigators representing diverse research approaches to discuss emerging issues and research practices within the anxiety disorders. Discussions centered on a review of the general areas of classification, phenomenology, and etiology. A selective summary of this workshop is presented along with recommendations for specific research directions.     

Conceptual,methodological, and clinical issues in the assessment of anxiety disorders

Many conceptual, methodological, and clinical issues remain unresolved in the assessment of anxiety disorders. Despite the prevalence, incidence, chronicity, and severity of anxiety disorders, research efforts and funding have fallen behind with regard both to other disorders and to addressing critical issues in the field. The primary objective of this paper is to provide a scientific critique regarding a number of often ignored yet salient considerations in anxiety-disorders assessment. Critical analyses of and recommendations regarding the multidimensional nature of anxiety, comorbidity, uniformity myths, synchrony, normative comparisons, psychometric properties of measures, and treatment integrity are offered. Finally, promising areas of clinical research are presented to enhance further the current understanding of the complexities inherent in assessing anxiety disorders.Preparation of this paper was supported in part by NIMH Grant MH36299.     

The importance of assessing treatment integrity: An example in the anxiety disorders

One purpose of this investigation was to examine the importance of assessing treatment integrity in a study evaluating a treatment for specific anxiety disorders. Three subjects, two social phobics and one simple phobic, received self-instruction training (Phase I) followed by exposure and self-instruction training (Phase II) in a multiple baseline across subjects design. All subjects were assessed during a pretreatment baseline and throughout treatment using measures of treatment integrity and measures of change in phobic severity. Improvement took place at different times for different subjects. Measures of treatment integrity, which consisted of monitoring of self-statements as well as practice outside the session, indicated that treatment was not always received as intended and that improvement was correlated with practice. The usefulness of measures of treatment integrity in both clinical and research settings is highlighted.     

Création de l’Échelle de Distorsions Cognitives pour adultes (EDC-A) : étude des propriétés psychométriques en population générale et association avec l’anxiété et la dépression

IntroductionCognitive distortions contribute to the maintenance of inappropriate cognitive schemas and play a role in the emergence of pathologies such as anxiety and depression. We developed the Cognitive Distortion Scale for Adults in order to identify distortions in individuals’ reasoning. The main objectives of this study were: (1) to study the psychometric properties of the Cognitive Distortion Scale for Adults, (2) to identify cognitive distortions associated with anxiety and depression in the general population.MethodThe study involved 916 participants (151 men and 765 women) aged 18 to 85-years. The participants completed the Cognitive Distortion Scale for Adults. The tool presents 42 mini scenarios with a daily life situation and a proposition concerning a cognitive distortion. Participants must give their degree of agreement (0 to 10) with this one. Seven cognitive distortions are operationalized (dichotomous reasoning, disqualification of one of the poles, arbitrary focusing, omission of the neutral, requalification in the other pole, maximization and minimization). They also completed the Hospital Anxiety and Depression Scale. Both scales were available online on the Internet. The total duration of the test was approximately 10 minutes. A group of 35 participants completed the two scale 15 days apart.ResultsThe sub-dimensions of EDC-A obtain Cronbach alphas higher than .65 and EDC-A has a coherent factor structure. The scale has good temporal stability. Anxiety is predicted by dichotomous reasoning, disqualification of one of the poles, arbitrary focusing and maximization. Depression is predicted by dichotomous reasoning, arbitrary focusing, omission of the neutral and requalification in the other pole. Anxiety and depression are associated with negative cognitive distortions in reasoning. However, depression is also associated with positive cognitive distortions. Subjects with depression produce more varied cognitive distortions than subjects with anxiety.DiscussionThe Cognitive Distortion Scale for Adults shows promising psychometric properties. Further studies will need to be conducted to confirm these results. Anxiety would be related to biased information treatment of negative information, whereas depression would be related to more comprehensive biased information treatment, both negative and positive information. Anxiety would be related to suboptimal functioning of reasoning abilities; depression would be more characterized by a structural deficit of reasoning abilities.