Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-10T11:34:05.381Z Has data issue: false hasContentIssue false
  • English
  • Français

Insight in eating disorders: clinical and cognitive correlates

Published online by Cambridge University Press:  07 January 2011

G. Konstantakopoulos ,
K. Tchanturia ,
S. A. Surguladze  and
A. S. David
G. Konstantakopoulos*
Affiliation:
Section of Cognitive Neuropsychiatry, Institute of Psychiatry, King's College, London, UK First Department of Psychiatry, Athens University Medical School, Greece
K. Tchanturia
Affiliation:
Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, King's College, London, UK
S. A. Surguladze
Affiliation:
Section of Cognitive Neuropsychiatry, Institute of Psychiatry, King's College, London, UK
A. S. David
Affiliation:
Section of Cognitive Neuropsychiatry, Institute of Psychiatry, King's College, London, UK
*
*Address for correspondence: G. Konstantakopoulos, M.D., Section of Cognitive Neuropsychiatry, Institute of Psychiatry, King's College London, 16 De Crespigny Park, London SE5 8AF, UK. (Email: george.konstantakopoulos@kcl.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The aim of this study was to explore the extent of lack of insight and its components in eating disorders (EDs) and to investigate the relationship between insight and clinical and cognitive characteristics in this group.

Method

Seventy-five participants were enrolled in the study: 25 with anorexia nervosa (AN), 15 with bulimia nervosa (BN) and 35 healthy controls (HC). Insight was assessed with a modified version of the Schedule for the Assessment of Insight for EDs (SAI-ED) and multi-dimensional scaling (MDS) analysis was used to clarify the internal structure of the scale. Neuropsychological tests included the Trail Making Test (TMT), the Brixton Test and a Verbal Fluency Task.

Results

Only a subgroup of AN patients (24%) had severe impairment of insight. Patients with the restricting type of AN (AN-R) had poorer overall insight than patients with the binge-purge type of the disorder (AN-B/P). More of the ED patients displayed a deliberate denial of illness rather than a lack of awareness of the illness. A regression model revealed that only performance in part B of the TMT (TMT-B) was a moderate predictor of insight level. No association was found between insight and other cognitive or clinical variables.

Conclusions

Impaired insight is a significant feature of some ED patients. Insight in EDs seems to be partially dependent on intact mental flexibility.

Keywords

Anorexia nervosabulimia nervosadenial of illnessinsightset shifting
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 9 , September 2011 , pp. 1951 - 1961
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aleman, A, Agrawal, N, Morgan, KD, David, AS (2006). Insight in psychosis and neuropsychological function: meta-analysis. British Journal of Psychiatry 189, 204–212.CrossRefGoogle ScholarPubMed
Alonso, P, Menchon, JM, Segalas, C, Jaurrieta, N, Jimenez-Murcia, S, Cardoner, N, Labad, J, Real, E, Pertusa, A, Vallejo, J (2008). Clinical implications of insight assessment in obsessive-compulsive disorder. Comprehensive Psychiatry 49, 305–312.CrossRefGoogle ScholarPubMed
Bizeul, C, Sadowsky, N, Rigaud, D (2001). The prognostic value of initial EDI scores in anorexia nervosa patients: a prospective follow-up study of 5-10 years. Eating Disorder Inventory. European Psychiatry 16, 232–238.CrossRefGoogle ScholarPubMed
Borg, I, Groenen, PJF (1997). Modern Multidimensional Scaling: Theory and Applications. Springer Verlag: New York.CrossRefGoogle Scholar
Brett-Jones, J, Garety, P, Hemsley, D (1987). Measuring delusional experiences: a method and its application. British Journal of Clinical Psychology 26, 257–265.CrossRefGoogle ScholarPubMed
Bruch, H (1973). Eating Disorders: Obesity, Anorexia Nervosa, and the Person Within. Basic Books: Houston, TX.Google Scholar
Burgess, PW, Shallice, T (1997). The Hayling and Brixton Tests. Thames Valley Test Company, Ltd: Bury St Edmunds, UK.Google Scholar
Casper, RC, Halmi, KA, Goldberg, SC, Eckert, ED, Davis, JM (1979). Disturbances in body image estimation as related to other characteristics and outcome in anorexia nervosa. British Journal of Psychiatry 134, 60–66.CrossRefGoogle ScholarPubMed
Casper, RC, Heller, W (1991). ‘La douce indifference’ and mood in anorexia nervosa: neuropsychological correlates. Progress in Neuropsychopharmacology and Biological Psychiatry 15, 15–23.CrossRefGoogle ScholarPubMed
Catapano, F, Perris, F, Fabrazzo, M, Cioffi, V, Giacco, D, De Santis, V, Maj, M (2010). Obsessive-compulsive disorder with poor insight: a three-year prospective study. Progress in Neuro-Psychopharmacology and Biological Psychiatry 34, 323–330.CrossRefGoogle ScholarPubMed
Couturier, JL, Lock, J (2006). Denial and minimization in adolescents with anorexia nervosa. International Journal of Eating Disorders 39, 212–216.CrossRefGoogle ScholarPubMed
David, A, Buchanan, A, Reed, A, Almeida, O (1992). The assessment of insight in psychosis. British Journal of Psychiatry 161, 599–602.CrossRefGoogle ScholarPubMed
David, A, van Os, J, Jones, P, Harvey, I, Foerster, A, Fahy, T (1995). Insight and psychotic illness. Cross-sectional and longitudinal associations. British Journal of Psychiatry 167, 621–628.CrossRefGoogle ScholarPubMed
David, AS (1990). Insight and psychosis. British Journal of Psychiatry 156, 798–808.CrossRefGoogle ScholarPubMed
David, AS (2004). The clinical importance of insight: an overview. In Insight and Psychosis (ed. Amador, X. F. and David, A. S.), pp. 359–392. Oxford University Press: Oxford.CrossRefGoogle Scholar
Dias, VV, Brissos, S, Carita, AI (2008). Clinical and neurocognitive correlates of insight in patients with bipolar I disorder in remission. Acta Psychiatrica Scandinavica 117, 28–34.CrossRefGoogle ScholarPubMed
Drake, RJ, Lewis, SW (2003). Insight and neurocognition in schizophrenia. Schizophrenia Research 62, 165–173.CrossRefGoogle ScholarPubMed
Eckert, ED, Goldberg, SC, Halmi, KA, Casper, RC, Davis, JM (1982). Depression in anorexia nervosa. Psychological Medicine 12, 115–122.CrossRefGoogle ScholarPubMed
Eisen, JL, Phillips, KA, Coles, ME, Rasmussen, SA (2004). Insight in obsessive compulsive disorder and body dysmorphic disorder. Comprehensive Psychiatry 45, 10–15.CrossRefGoogle ScholarPubMed
Fisher, M, Schneider, M, Burns, J, Symons, H, Mandel, FS (2001). Differences between adolescents and young adults at presentation to an eating disorders program. Journal of Adolescent Health 28, 222–227.CrossRefGoogle Scholar
Ghaemi, SN, Rosenquist, KJ (2004). Insight in mood disorders: an empirical and conceptual review. In Insight and Psychosis (ed. Amador, X. F. and David, A. S.), pp. 101–115. Oxford University Press: Oxford.Google Scholar
Gilleen, J, Greenwood, K, David, AS (2010). Anosognosia in schizophrenia and other neuropsychiatric disorders: similarities and differences. In The Study of Anosognosia (ed. Prigatano, G. P.), pp. 255–290. Oxford University Press: New York.Google Scholar
Godart, NT, Perdereau, F, Rein, Z, Berthoz, S, Wallier, J, Jeammet, P, Flament, MF (2007). Comorbidity studies of eating disorders and mood disorders. Critical review of the literature. Journal of Affective Disorders 97, 37–49.CrossRefGoogle ScholarPubMed
Goldberg, SC, Halmi, KA, Eckert, ED, Casper, RC, Davis, JM, Roper, M (1979). Attitudinal dimensions in anorexia nervosa. Journal of Psychiatric Research 15, 239–251.CrossRefGoogle ScholarPubMed
Greenfeld, DG, Anyan, WR, Hobart, M, Quinlan, DM, Plantes, M (1991). Insight into illness and outcome in anorexia nervosa. International Journal of Eating Disorders 10, 101–109.3.0.CO;2-7>CrossRefGoogle Scholar
Halmi, KA (1974). Anorexia nervosa: demographic and clinical features in 94 cases. Psychosomatic Medicine 36, 18–26.CrossRefGoogle ScholarPubMed
Halmi, KA, Goldberg, SC, Casper, RC, Eckert, ED, Davis, JM (1979). Pretreatment predictors of outcome in anorexia nervosa. British Journal of Psychiatry 134, 71–78.CrossRefGoogle ScholarPubMed
Hatch, A, Madden, S, Kohn, MR, Clarke, S, Touyz, S, Gordon, E, Williams, LM (2010). In first presentation adolescent anorexia nervosa, do cognitive markers of underweight status change with weight gain following a refeeding intervention? International Journal of Eating Disorders 43, 295–306.CrossRefGoogle ScholarPubMed
Hodgson, RJ, Rachman, S (1977). Obsessional-compulsive complaints. Behaviour Research and Therapy 15, 389–395.CrossRefGoogle ScholarPubMed
Holliday, J, Tchanturia, K, Landau, S, Collier, D, Treasure, J (2005). Is impaired set-shifting an endophenotype of anorexia nervosa? American Journal of Psychiatry 162, 2269–2275.CrossRefGoogle ScholarPubMed
Iqbal, Z, Birchwood, M, Chadwick, P, Trower, P (2000). Cognitive approach to depression and suicidal thinking in psychosis. 2. Testing the validity of a social ranking model. British Journal of Psychiatry 177, 522–528.CrossRefGoogle ScholarPubMed
Kemmler, G, Holzner, B, Kopp, M, Dunser, M, Greil, R, Hahn, E, Sperner-Unterweger, B (2002). Multidimensional scaling as a tool for analysing quality of life data. Quality of Life Research 11, 223–233.CrossRefGoogle ScholarPubMed
Kemp, R, David, A (1997). Insight and compliance. In Treatment Compliance and the Therapeutic Alliance (ed. Blackwell, B.), pp. 61–84. Harwood: Amsterdam.Google Scholar
Kravariti, E, Morris, RG, Rabe-Hesketh, S, Murray, RM, Frangou, S (2003). The Maudsley early onset schizophrenia study: cognitive function in adolescents with recent onset schizophrenia. Schizophrenia Research 61, 137–148.CrossRefGoogle ScholarPubMed
Kruskal, JP, Wish, M (1978). Multidimensional Scaling. Sage: Newbury Park, CA.CrossRefGoogle Scholar
Lasègue, C (1964). De l'anorexie hysterique (1873). In Evolution of Psychosomatic Concepts. Anorexia Nervosa: A Paradigm (ed. Kaufman, R. M. and Heiman, M.), pp. 141–155. International Universities Press: New York.Google Scholar
Lena, SM, Fiocco, AJ, Leyenaar, JK (2004). The role of cognitive deficits in the development of eating disorders. Neuropsychology Review 14, 99–113.CrossRefGoogle ScholarPubMed
Lezak, MD, Howieson, DB, Loring, DW (2004). Neuropsychological Assessment. Oxford University Press: New York.Google Scholar
Lochner, C, Hemmings, SM, Kinnear, CJ, Niehaus, DJ, Nel, DG, Corfield, VA, Moolman-Smook, JC, Seedat, S, Stein, DJ (2005). Cluster analysis of obsessive-compulsive spectrum disorders in patients with obsessive-compulsive disorder: clinical and genetic correlates. Comprehensive Psychiatry 46, 14–19.CrossRefGoogle ScholarPubMed
Mintz, AR, Dobson, KS, Romney, DM (2003). Insight in schizophrenia: a meta-analysis. Schizophrenia Research 61, 75–88.CrossRefGoogle ScholarPubMed
Morgan, HG, Russell, GFM (1975). Value of family background and clinical features as predictors of long-term outcome in anorexia nervosa: four-year follow-up study of 41 patients. Psychological Medicine 5, 355–371.CrossRefGoogle ScholarPubMed
Morgan, KD, David, AS (2004). Neuropsychological studies of insight in patients with psychotic disorders. In Insight and Psychosis (ed. Amador, X. F. and David, A. S.), pp. 177–193. Oxford University Press: Oxford.CrossRefGoogle Scholar
Nelson, HE, Willison, JW (1991). The National Adult Reading Test. NFER, Nelson: Windsor, UK.Google Scholar
Newton, T, Butler, N, Slade, P (1988). Denial of symptoms and self-report in eating disorders. British Review of Bulimia and Anorexia Nervosa 2, 55–59.Google Scholar
Pyne, JM, Bean, D, Sullivan, G (2001). Characteristics of patients with schizophrenia who do not believe they are mentally ill. Journal of Nervous and Mental Disease 189, 146–153.CrossRefGoogle Scholar
Reitan, R (1958). Validity of the Trail Making Test as an indicator of organic brain damage. Perceptual and Motor Skills 8, 271–276.CrossRefGoogle Scholar
Roberts, ME, Tchanturia, K, Stahl, D, Southgate, L, Treasure, J (2007). A systematic review and meta-analysis of set-shifting ability in eating disorders. Psychological Medicine 37, 1075–1084.CrossRefGoogle ScholarPubMed
Roberts, ME, Tchanturia, K, Treasure, JL (2010). Exploring the neurocognitive signature of poor set-shifting in anorexia and bulimia nervosa. Journal of Psychiatric Research 44, 964–970.CrossRefGoogle ScholarPubMed
Saccomani, L, Savoini, M, Cirrincione, M, Vercellino, F, Ravera, G (1998). Long-term outcome of children and adolescents with anorexia nervosa: study of comorbidity. Journal of Psychosomatic Research 44, 565–571.CrossRefGoogle ScholarPubMed
Sanz, M, Constable, G, Lopez-Ibor, I, Kemp, R, David, AS (1998). A comparative study of insight scales and their relationship to psychopathological and clinical variables. Psychological Medicine 28, 437–446.CrossRefGoogle ScholarPubMed
Schmidt, U, Treasure, J (2006). Anorexia nervosa: valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. British Journal of Clinical Psychology 45, 343–366.CrossRefGoogle ScholarPubMed
Serpell, L, Treasure, J, Teasdale, J, Sullivan, V (1999). Anorexia nervosa: friend or foe? International Journal of Eating Disorders 25, 177–186.3.0.CO;2-D>CrossRefGoogle ScholarPubMed
Southgate, L, Tchanturia, K, Treasure, J (2006). Neuropsychological studies in eating disorders: a review. In Eating Disorders: New Research (ed. Swain, P. I.), pp. 1–69. Nova Science Publishers: New York.Google Scholar
Steinglass, J, Walsh, BT (2006). Habit learning and anorexia nervosa: a cognitive neuroscience hypothesis. International Journal of Eating Disorders 39, 267–275.CrossRefGoogle ScholarPubMed
Steinglass, JE, Eisen, JL, Attia, E, Mayer, L, Walsh, BT (2007). Is anorexia nervosa a delusional disorder? An assessment of eating beliefs in anorexia nervosa. Journal of Psychiatric Practice 13, 65–71.CrossRefGoogle ScholarPubMed
Steinhausen, HC (1986). Attitudinal dimensions in adolescent anorexic patients: an analysis of the Goldberg Anorectic Attitude Scale. Journal of Psychiatric Research 20, 83–87.CrossRefGoogle ScholarPubMed
Steinhausen, HC (2002). The outcome of anorexia nervosa in the 20th century. American Journal of Psychiatry 159, 1284–1293.CrossRefGoogle ScholarPubMed
Steinhausen, HC, Weber, S (2009). The outcome of bulimia nervosa: findings from one-quarter century of research. American Journal of Psychiatry 166, 1331–1341.CrossRefGoogle ScholarPubMed
Sunday, SR, Halmi, KA, Einhorn, A (1995). The Yale-Brown-Cornell Eating Disorder Scale: a new scale to assess eating disorder symptomatology. International Journal of Eating Disorders 18, 237–245.3.0.CO;2-1>CrossRefGoogle Scholar
Swinbourne, JM, Touyz, SW (2007). The co-morbidity of eating disorders and anxiety disorders: a review. European Eating Disorders Review 15, 253–274.CrossRefGoogle ScholarPubMed
Tchanturia, K, Anderluh, MB, Morris, RG, Rabe-Hesketh, S, Collier, DA, Sanchez, P, Treasure, JL (2004 a). Cognitive flexibility in anorexia nervosa and bulimia nervosa. Journal of the International Neuropsychological Society 10, 513–520.CrossRefGoogle ScholarPubMed
Tchanturia, K, Campbell, IC, Morris, R, Treasure, J (2005). Neuropsychological studies in anorexia nervosa. International Journal of Eating Disorders 37, S72–S76; discussion S87–S89.CrossRefGoogle ScholarPubMed
Tchanturia, K, Morris, RG, Anderluh, MB, Collier, DA, Nikolaou, V, Treasure, J (2004 b). Set shifting in anorexia nervosa: an examination before and after weight gain, in full recovery and relationship to childhood and adult OCPD traits. Journal of Psychiatric Research 38, 545–552.CrossRefGoogle ScholarPubMed
Tchanturia, K, Morris, RG, Surguladze, S, Treasure, J (2002). An examination of perceptual and cognitive set shifting tasks in acute anorexia nervosa and following recovery. Eating and Weight Disorders 7, 312–315.CrossRefGoogle ScholarPubMed
Tenconi, E, Santonastaso, P, Degortes, D, Bosello, R, Titton, F, Mapelli, D, Favaro, A (2010). Set-shifting abilities, central coherence, and handedness in anorexia nervosa patients, their unaffected siblings and healthy controls: exploring putative endophenotypes. World Journal of Biological Psychiatry 11, 813–823.CrossRefGoogle ScholarPubMed
Vanderdeycken, W, Vanderlinden, J (1983). Denial of illness and the use of self-reporting measures in anorexia nervosa patients. International Journal of Eating Disorders 2, 101–107.3.0.CO;2-U>CrossRefGoogle Scholar
Vandereycken, W (2006 a). Denial of illness in anorexia nervosa – a conceptual review: Part 1. Diagnostic significance and assessment. European Eating Disorders Review 14, 341–351.CrossRefGoogle Scholar
Vandereycken, W (2006 b). Denial of illness in anorexia nervosa – a conceptual review: Part 2. Different forms and meanings. European Eating Disorders Review 14, 352–368.CrossRefGoogle Scholar
Vandereycken, W, Van Humbeeck, I (2008). Denial and concealment of eating disorders: a retrospective survey. European Eating Disorders Review 16, 109–114.CrossRefGoogle ScholarPubMed
Varga, M, Magnusson, A, Flekkoy, K, David, AS, Opjordsmoen, S (2007). Clinical and neuropsychological correlates of insight in schizophrenia and bipolar I disorder: does diagnosis matter? Comprehensive Psychiatry 48, 583–591.CrossRefGoogle ScholarPubMed
Varga, M, Magnusson, A, Flekkoy, K, Ronneberg, U, Opjordsmoen, S (2006). Insight, symptoms and neurocognition in bipolar I patients. Journal of Affective Disorders 91, 1–9.CrossRefGoogle ScholarPubMed
Viglione, V, Muratori, F, Maestro, S, Brunori, E, Picchi, L (2006). Denial of symptoms and psychopathology in adolescent anorexia nervosa. Psychopathology 39, 255–260.CrossRefGoogle ScholarPubMed
Vitousek, K, Watson, S, Wilson, GT (1998). Enhancing motivation for change in treatment-resistant eating disorders. Clinical Psychology Review 18, 391–420.CrossRefGoogle ScholarPubMed
Vitousek, KB, Daly, J, Heiser, C (1991). Reconstructing the internal world of the eating-disordered individual: overcoming denial and distortion in self-report. International Journal of Eating Disorders 10, 647–666.3.0.CO;2-T>CrossRefGoogle Scholar
Zigmond, AS, Snaith, RP (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 67, 361–370.CrossRefGoogle ScholarPubMed