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An innovative approach for the assessment of mood disturbances in patients with eating disorders

Published online by Cambridge University Press:  15 April 2019

Lucia Tecuta ,
Giovanni Andrea Fava Open the ORCID record for Giovanni Andrea Fava [Opens in a new window]  and
Elena Tomba
Lucia Tecuta
Affiliation:
Department of Psychology, University of Bologna, Bologna, Italy
Giovanni Andrea Fava*
Affiliation:
Department of Psychology, University of Bologna, Bologna, Italy Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA
Elena Tomba
Affiliation:
Department of Psychology, University of Bologna, Bologna, Italy
*
*Address correspondence to: Giovanni A. Fava, MD, Department of Psychology, University of Bologna, Viale Berti Pichat, 5, 40127Bologna, Italy, Phone: +39-051-2091339, Fax: +39-051-243086. (E-mail: [email protected])
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Abstract

Objective.

Assessment of mood in eating disorders (EDs) has important clinical implications, but the current standard psychiatric classification (DSM-5) has limitations. The aim of the current study is to broaden the evaluation of depressive symptomatology by providing a comprehensive and innovative assessment approach in EDs through instruments that capture clinical phenomena of demoralization, subclinical distress, and psychological well-being.

Methods.

Seventy-nine patients who met diagnostic criteria for EDs of the Diagnostic and Statistical Manual of Mental Disorders – Fifth edition (DSM-5) were evaluated for depressive symptoms through Paykel’s Clinical Interview for Depression, the Structured Clinical Interview for DSM-5 for major depressive episode and persistent depressive disorder, and the Diagnostic Criteria for Psychosomatic Research (DCPR) interview for demoralization. Further, self-report inventories encompassing psychological well-being and distress were used.

Results.

Guilt, abnormal reactivity to social environment, and depressed mood were the most common depressive symptoms in the sample. DSM-defined depressive disorders were found in 55.7% of patients. The DCPR-demoralization criteria identified an additional 20.3% of the sample that would have been undetected with DSM criteria. Both DSM and DCPR diagnostic categories were associated with compromised psychological well-being and distress. Demoralization, unlike depression, was not associated with the severity of ED symptomatology.

Conclusion.

The findings indicate that a standard psychiatric approach, DSM-5-based, captures only a narrow part of the spectrum of mood disturbances affecting patients with EDs. A broadened clinimetric assessment unravels the presence of demoralization and yields clinical distinctions that may entail prognostic and therapeutic differences among patients who would be otherwise simply labeled as depressed.

Keywords

Demoralizationdepressioneating disorderspsychological well-being
Type
Original Research
Information
CNS Spectrums , Volume 25 , Issue 1 , February 2020 , pp. 71 - 78
Copyright
© Cambridge University Press 2019

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Footnotes

The authors would like to thank the therapists and the collaborators of the Eating Disorder Clinics “Centro Gruber” (Bologna, Italy) and “Residenza Gruber” (Bologna, Italy), in particular Dr Donatella Ballardini, MD, Dr Romana Schumann, PsyD, and Dr Anna Franco, PsyD, for assistance in participant recruitment and data gathering.

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