Aggression Disorder May Up Risk of Substance Abuse

A new study finds that people with intermittent explosive disorder (IED) are at five times greater risk of abusing substances such as alcohol, tobacco, and marijuana than those who don’t display frequent aggressive behavior.

IED is described as a condition marked by frequent physical or verbal outbursts.

Researchers from the University of Chicago analyzed data from more than 9,200 subjects in the National Comorbidity Survey, a national survey of mental health in the United States. They found that as the severity of aggressive behavior increased, so did levels of daily and weekly substance use.

The findings suggest that a history of frequent, aggressive behavior is a risk factor for later substance abuse, and effective treatment of aggression could delay or even prevent substance abuse in young people.

Emil Coccaro, M.D., led the study, which appears in the Journal of Clinical Psychiatry.

The research is relevant as IED affects as many as 16 million Americans, more than bipolar disorder and schizophrenia combined. It is often first diagnosed in adolescents, some of whom are as young as 11, years before substance abuse problems usually develop.

IED runs in families and is thought to have a significant genetic component, although Coccaro said people tend to treat it as a social-behavioral issue instead of as a true neurobiological disorder.

“People don’t see this as a medical problem. They think of it as simply bad behavior they have developed over the course of their lives, but it isn’t. It has significant biology and neuroscience behind it,” said Coccaro.

Previous research has implied that aggressive behavior in IED is due to the presence of other psychiatric disorders, such as anxiety or depression. But the new University of Chicago study found no such relationship.

While substance abuse, like excessive drinking, can clearly make aggressive behavior worse, the onset of IED almost always precedes the development of chronic substance abuse.

Coccaro and his team found that IED preceded substance abuse in 92.5 percent of the cases where subjects developed both disorders.

Coccaro emphasized that early psychological intervention, medication and cognitive therapy are the most effective treatments to prevent, or at least delay, substance abuse problems in adolescents diagnosed with IED.

“What you’re really treating is the emotional dysregulation that leads to aggression,” Coccaro said.

“The earlier you treat this dysregulation, the more likely you are to offset other disorders that come later down the road.”

Source: University of Chicago/EurekAlert

Instagram a Haven for Those with Depression

A new study shows that one way people suffering from depression find solace is in sharing their feelings and experiences on social media sites, especially Instagram.

The new study, from researchers at Drexel University, notes that some users view Instagram as a safe medium for sharing sensitive information about themselves and reaching out for help.

“Physical or mental health and body image concerns are stigmatized, rarely disclosed, and frequently elicit negative responses when shared with others,” according to the researchers. “We found that these disclosures, in addition to deep and detailed stories of one’s difficult experiences, attract positive social support on Instagram.”

The researchers, Andrea Forte, Ph.D., an associate professor, and Nazanin Andalibi, a doctoral candidate in Drexel’s College of Computing & Informatics, said they also observed this sort of self-disclosure and support-seeking behavior among Reddit users. One reason may be that the relative anonymity provided by “throwaway” accounts on the forum allowed users to make sensitive disclosures, ask for and receive help, the researchers noted.

Previous studies had suggested that people avoid sharing their struggles with depression, eating disorders, abuse, mental health challenges, and other sensitive issues, on social networks, such as Facebook — for much the same reason they’d tend to avoid talking about these things in person: Because of the stigma that’s attached to them.

The researchers say their study on Reddit broke new ground in understanding the use of social media in stigmatized and sensitive contexts.

It also pushed them to find how people were using other social media sites to reach out for support.

“At the same time we were studying interactions on Reddit, we were also looking at Instagram because it is one of the most heavily used social media sites and also allows pseudonymous users, in contrary to Facebook that enforces real-name policies,” Andalibi said. “And we wanted to see how people might behave differently on a more image-centric, rather than one that is driven solely by textual posts and comments.”

To investigate their theory, Forte and Andalibi examined the responses to a sample of 800 Instagram posts pulled from more than 95,000 photos tagged with “#depression” that were posted by 24,920 unique users over the course of a month.

The findings indicate that not only are people using Instagram to make sensitive disclosures, but they are also getting mostly positive support from the people who respond to the posts, and little in the way of negative or aggressive comments.

The researchers set out to understand the ways that Instagrammers use pictures, captions, and comments to signal this need to connect. Gathering posts with the “#depression” tag gave them a range of posts in which people were expressing their feelings, talking about their struggles and reaching out for support — both in words and pictures.

To explore the correlation between posts and the responses — comments and “likes” — they receive, Forte and Andalibi organized them into categories based on the type of disclosures in the text and captions, ranging from disclosures seeking some sort of social interaction to those expressing emotion.

They also developed a method for coding the content of images and categorized the types of messages they were expressing, such as concerns about looks, relationship problems, illness, suicidal thoughts, and pictures of food and beverage that were often used to talk about eating disorders.

After gaining an understanding of the general categories of posts that were tagged “#depression” Forte and Andalibi undertook a similar process to categorize the comments on the posts. Then, by using a statistical analysis method, they were able to discover what sorts of responses were most often elicited from particular types of posts.

According to the study, 41 percent of the posts that the researchers examined brought on comments expressing positive social support. They found that “those who value feedback, engage in support seeking, or disclose sensitive concerns, do receive significantly more feedback.”

For example, they noted that posts seeking support and engagement about eating disorders, self-appearance, and relationships are more likely to receive supportive comments — not just “likes” — than the same type of post that is not worded in a way that is seeking support or social engagement. These posts were also more likely to receive comments offering instrumental support, such as how and where to get help, the researchers noted.

“Those in distress or with stigmatized identities often need to express themselves and tell their stories, not only to potentially receive support or find similar others, but also to feel they are expressing themselves candidly, to make sense of their experiences, and to solidify their identities,” the researchers write in the study.

They noticed that the people who were willing to tell the story of their suffering — rather than just posting a picture or implying that they have a problem — seemed to get more supportive comments on their posts, messages like “I know how that feels,” “I have been there,” or “You are strong and beautiful.”

According to the research, people whose posts disclosed an illness received more than twice as many supportive comments as the ones who did not specifically note that they had an illness.

Forte and Andalibi note that psychologists sometimes use visual imagery to help their patients express feelings and experiences that are difficult to put into words. Confirming that images on Instagram can serve a similar function in online social interactions is an important discovery, they add. It means that there are specific corners of social media where people are turning to ask for help — and this is valuable information for professional caregivers who seek to help the suffering, they said.

“The social risks associated with negative disclosures are real, and if people expose themselves to such risk at particularly vulnerable moments, they likely expect some important benefits from doing so,” they said. “Finding social support is critical, and by sharing difficult experiences and emotions, people signal this need to others.”

Another observation the researchers made is that users who post about behaviors such as harming themselves or struggling with an eating disorder tend to receive comments that offer empathetic support and discourage the unhealthy behavior.

For instance, someone who posts about their self-harming behaviors is equally likely to be greeted with comments such as, “I know how it is, it helps to hurt myself too” or “Please don’t hurt yourself. You are strong and you can get through this.” These are surprising observations given the fact that these disclosures could make the users targets for bullying among other negative commentary, according to the researchers.

“Self-harm is a way of coping with extreme negative feelings and gaining control that many keep as a secret, and find isolating. It is possible that finding others who engage or used to engage in the same behavior may be comforting for some,” the researchers said. “Our findings suggest that both kinds of reactions to self-harm disclosures are significant, and shed light on the nuances of these expressions.”

Similarly, users who disclosed eating disorders received comments that discouraged the behavior, offered constructive support, and reinforced a positive self-image, for example, “Please don’t fast or look for any tips. You are beautiful the way you are.”

It is important to note that eating disorder-related disclosures did not receive a significant number of comments that supported the harmful behavior, the researchers pointed out.

“Our findings complicate the concerns and the popular narrative that such online disclosures might encourage eating disorders or are inherently problematic,” Andalibi said.

“Statistically speaking, our findings suggest that when people share content about eating disorders, they do not receive many comments supportive of pro-disease behavior. Is Instagram used as a pro-eating disorder or a pro-self-harm community? We do not know yet. With this study, we are the first to detail the nuances of interactions around these sensitive disclosures.

This is a necessary first step to understanding the impact of these interactions on Instagrammers. How posters perceive these comments, and how these comments and interactions influence their wellbeing and behavior is an important area for further research.”

Instagram recently rolled out a suicide prevention tool that allows users to alert operators when they think someone might be in serious trouble. The operators are able to provide help or connect users with the information they need to find it.

While this is a step in the right direction, it is only the first of many that need to be taken to truly reach these communities of users, Andalibi said.

“Social media platforms like Instagram that people have adopted to connect with ‘similar others’ to share their difficult experiences, and seek and provide support, should explore ways to facilitate safe and supportive connections,” Andalibi said. “Rather than diverting people away from these platforms, or making design decisions that would further stigmatize sensitive disclosures, they should work to foster these communities of support that are arising organically on their platform.”

For Forte and Andalibi, this research represents another step toward more fully understanding how social media is becoming interwoven into the ways people interact and express themselves, particularly in socially stigmatized or otherwise sensitive contexts. While in some ways, it is means for people turn away from external expression and communication with others, by better understanding how people use social networking sites, it can actually uncover very nuanced forms of communication that would not happen elsewhere, they said.

“It is very important to figure out what the needs of certain marginalized or stigmatized populations are, and how we could be more inclusive and considerate when we design social media,” Andalibi said. “The period of thinking online platforms are not ‘real-life’ has passed, and these spaces can have meaningful impact on people’s lives in many ways, so we need to focus on design that can foster support and reduce abuse.”

They suggest that future research could continue to look at the effects of the interactions that result from the sensitive disclosures to figure out if the help and support being offered is having an impact.

Andalibi presented the research at the Association for Computing Machinery’s International Conference on Computer-Supported Cooperative Work and Social Computing in February 2017.

Source: Drexel University

Many Anorexics Need Extended Care for Brain Function

New research discovers that even after weeks of treatment and weight gain, anorexic teenagers need additional time to regain normal brain function.

Researchers at the University of Colorado Anschutz Medical Campus said persistent brain alteration puts teen at risk for possible relapse.

In the study, investigators examined 21 female adolescents before and after treatment for anorexia and found that their brains still had an elevated reward system compared to 21 participants without the eating disorder.

“That means they are not cured,” said Guido Frank, M.D., senior author of the study and associate professor of psychiatry and neuroscience at the University of Colorado School of Medicine.

“This disease fundamentally changes the brain response to stimuli in our environment. The brain has to normalize and that takes time.”

The research has been published in the American Journal of Psychiatry.

Brain scans of anorexia nervosa patients have implicated central reward circuits that govern appetite and food intake in the disease. This study showed that the reward system was elevated when the patients were underweight and remained so once weight was restored.

The neurotransmitter dopamine might be the key, researchers said.

Dopamine mediates reward learning and is suspected of playing a major role in the pathology of anorexia nervosa. Animal studies have shown that food restriction or weight loss enhances dopamine response to rewards.

With that in mind, Frank, an expert in eating disorders, and his colleagues wanted to see if this heightened brain activity would normalize once the patient regained weight.

In the study, adolescent girls who were between 15 and 16 years old underwent a series of reward-learning taste tests while their brains were being scanned.

The results showed that reward responses were higher in adolescents with anorexia nervosa than in those without it. This normalized somewhat after weight gain but still remained elevated.

At the same time, the study showed that those with anorexia had widespread changes to parts of the brain like the insula, which processes taste along with a number of other functions including body self-awareness.

The more severely altered the brain, the harder it was to treat the illness, or in other words, the more severely altered the brain, the more difficult it was for the patients to gain weight in treatment.

“Generalized sensitization of brain reward responsiveness may last long into recovery,” the study said. “Whether individuals with anorexia nervosa have a genetic predisposition for such sensitization requires further study.”

Frank said more studies are also needed to determine if the continued elevated brain response is due to a heightened dopamine reaction to starvation and whether it signals a severe form of anorexia among adolescents that is more resistant to treatment.

In either case, Frank said the biological markers discovered here could be used to help determine the likelihood of treatment success. They could also point the way toward using drugs that target the dopamine reward system.

“Anorexia nervosa is hard to treat. It is the third most common chronic illness among teenage girls with a mortality rate 12 times higher than the death rate for all causes of death for females 15-24 years old,” Frank said.

“But with studies like this we are learning more and more about what is actually happening in the brain. And if we understand the system, we can develop better strategies to treat the disease.”

Source: University of Colorado/EurekAlert

Living With Kids Means Less Sleep for Women, But Not Men

A new study confirms what many women already know: They are sleep deprived, especially if there are children in the house.

Unlike men, a good night’s sleep for women is affected by having children in the house, according to the study, which will be presented at the American Academy of Neurology’s 69th Annual Meeting in Boston, April 22 to 28, 2017.

“I think these findings may bolster those women who say they feel exhausted,” said study author Kelly Sullivan, Ph.D., of Southern University in Statesboro, Ga., and a member of the American Academy of Neurology. “Our study found not only are they not sleeping long enough, they also report feeling tired throughout the day.”

For the study, researchers examined data from a nationwide telephone survey of 5,805 people. Participants were asked how long they slept, with seven to nine hours a day considered optimum and less than six hours considered insufficient. They were also asked how many days they felt tired in the past month.

Researchers looked at age, race, education, marital status, number of children in the household, income, body mass index, exercise, employment, and snoring as possible factors linked to sleep deprivation.

Among the 2,908 women aged 45 years and younger in the study, researchers found the only factor associated with getting enough sleep was having children in the house, with each child increasing the odds of insufficient sleep by nearly 50 percent.

For women under 45, 48 percent of women with children reported getting at least seven hours of sleep, compared to 62 percent of women without children, according to the study’s findings.

No other factors — including exercise, marital status, and education — were linked to how long younger women slept, the researchers noted.

The study also found that not only was living with children associated with how long younger women slept, but also how often they felt tired. Younger women with children reported feeling tired 14 days a month, on average, compared to 11 days for younger women without children in the household, the study discovered.

It also found that having children in the house was not linked to how long men slept.

“Getting enough sleep is a key component of overall health and can impact the heart, mind, and weight,” said Sullivan. “It’s important to learn what is keeping people from getting the rest they need so we can help them work toward better health.”

Source: The American Academy of Neurology

New Study Shows How Dads Bond With Their Kids

A new brain imaging study shows that fathers given the hormone oxytocin show increased activity in brain regions associated with reward and empathy when viewing photos of their toddlers.

“Our findings add to the evidence that fathers, and not just mothers, undergo hormonal changes that are likely to facilitate increased empathy and motivation to care for their children,” said lead author Dr. James Rilling, an Emory University anthropologist and director of the Laboratory for Darwinian Neuroscience.

“They also suggest that oxytocin, known to play a role in social bonding, might someday be used to normalize deficits in paternal motivation, such as in men suffering from postpartum depression.”

According to the researcher, the study is the first to look at the influence of oxytocin and vasopressin, another hormone linked to social bonding, on brain function in fathers.

A growing body of literature shows that an involved father plays a role in reducing child mortality and morbidity, as well as improving social, psychological and educational outcomes, the researcher noted.

But not every father takes a “hands-on” approach to caring for his children.

“I’m interested in understanding why some fathers are more involved in caregiving than others,” Rilling says. “In order to fully understand variation in caregiving behavior, we need a clear picture of the neurobiology and neural mechanisms that support the behavior.”

Researchers have long known that when women go through pregnancy they experience dramatic hormonal changes that prepare them for child rearing. Oxytocin, in particular, was traditionally considered a maternal hormone since it is released into the bloodstream during labor and nursing and facilitates the processes of birth, bonding with the baby, and milk production.

More recently, however, it became clear that men can also undergo hormonal changes when they become fathers, including increases in oxytocin, according to researchers.

Evidence shows that, in fathers, oxytocin facilitates physical stimulation of infants during play, as well as the ability to synchronize their emotions with their children.

To investigate the neural mechanisms involved in oxytocin and paternal behavior, Rilling’s lab used functional Magnetic Resonance Imaging (fMRI) to compare neural activity in men with and without doses of oxytocin, administered through a nasal spray.

The participants in the experiment were all healthy fathers of toddlers, between the ages of one and two.

While undergoing fMRI brain scans, each participant was shown a photo of his child, a photo of a child he did not know, and a photo of an adult he did not know.

When viewing an image of their child, fathers dosed with oxytocin showed significantly increased neural activity in brain systems associated with reward and empathy, compared to placebo.

This heightened activity in the caudate nucleus, dorsal anterior cingulate and visual cortex suggests that doses of oxytocin may augment feelings of reward and empathy in fathers, as well as their motivation to pay attention to their children, according to the study’s findings.

Surprisingly, the study results did not show a significant effect of vasopressin on the neural activity of fathers, contrary to the findings of some previous studies on animals, the researchers noted.

Research in prairie voles, which bond for life, for instance, has shown that vasopressin promotes both pair-bonding and paternal caregiving.

“It could be that evolution has arrived at different strategies for motiving paternal caregiving in different species,” Rilling said.

The study was published in the journal Hormones and Behavior.

Source: Emory University

Parent Training Shows Promise for ADHD Treatment in Japan

A new Japanese research study suggests a parent-training program for attention-deficit hyperactivity disorder might prove to be an effective mainstream behavioral treatment.

Researchers from the Okinawa Institute of Science and Technology (OIST) say the new approach is geared to develop culturally appropriate parent-training programs for Japanese families of children with ADHD.

The study appears in the journal Japanese Psychological Research.

In the proof-of-concept program, researchers found reductions in children’s ADHD symptoms and improvements in parent-child relationships.

International guidelines for the management of ADHD in children recommend approved medications and/or behavioral therapy. However, compared with many Western countries, Japan has fewer pharmacological and behavioral options. The availability of behavioral therapy is further limited by a shortage of trained specialists.

Researchers first recruited Japanese parents of children with ADHD for a pilot study using standard behavioral strategies to see if Japanese parents would be comfortable with the program content, assessment strategies, and group delivery of the program.

Though the researchers did not specify the gender of the parents, only mothers contacted the researchers to participate in the study and five mothers were recruited for the study.

The mothers embraced the group setting, expressing the importance of interacting with other mothers who could understand the challenges of parenting a child with ADHD.

However, they articulated a desire to have more information about the causes of ADHD as well as extra practice using behavioral strategies specifically targeting ADHD. In response, the OIST researchers adapted the New Forest Parenting Programm, with the support of the program originators, for use with Japanese parents.

“It is important that children with ADHD are rewarded with positive praise after engaging in appropriate behaviors,” said Dr. Shizuka Shimabukuro from OIST’s Human Development Neurobiology Unit, who is the driving force behind adapting the NFPP for Japanese families.

“In general, Japanese parents praise their children more sparingly than Western parents. Overcoming this cultural norm can be challenging for many mothers.”

Based on the feedback from the pilot study, researchers in OIST’s Human Development Neurobiology Unit recruited mothers only for the proof-of-concept study.

They modified the program to replace four general parenting strategy sessions with six sessions that were specifically designed for parents of children with ADHD. They also added five extra support sessions to the beginning of the training program to increase mothers’ understanding of ADHD and increase their confidence in participating in the parenting program.

The researchers then conducted a proof-of-concept study with the new extended program, known as the NFPP-Japan, with 17 Japanese mothers, to assess the effects of the program on child behavior, mothers’ well-being, and parenting skills.

Mothers’ reports before and after the program indicated significant reductions in children’s ADHD symptoms, reductions in mothers’ reactivity to their child’s behavioral difficulties, and reductions in the stress they experienced in their roles as parents.

“Because the results of the study are based on self-reports from the mothers, we cannot rule out that the positive results we saw are due to changes in mothers’ perceptions of, or attitudes toward, their child’s behavior,” said Professor Gail Tripp, head of OIST’s Human Development Neurobiology Unit.

“Nevertheless, improving the parent-child relationship is an important step in managing ADHD.”

Future studies of the NFPP-Japan will focus on using objective evaluations of child behavior and the parent child-relationship.

A randomized control trial of the NFPP-Japan is currently underway. If the program proves successful, it might eventually become generally available in Japan as an effective treatment for managing symptoms of ADHD.

Source: Okinawa Institute of Science and Technology

What Motivates Teens to Exercise?

Unless actively involved in sports, many students entering high school drop their activity levels to a minimum, setting the stage for sedentary-related adult diseases. In a new pilot study, researchers set out to investigate what types of energy levels and mindsets tend to prompt __teens to exercise. For example, are __teens more likely to exercise when they are feeling down? Or when they are feeling good and energetic?

The findings show that when it comes to exercise, teens are far too unique in their mindsets and motivations to use a one-size-fits-all intervention.

“You might assume that if you had higher positive affect and felt energetic, you would be more likely to exercise, but we found that this is not true for everyone,” said study leader Dr. Christopher Cushing, assistant professor of clinical child psychology and University of Kansas (KU) Life Span Institute assistant scientist.

“For some of our participants, feeling happy with lots of energy predicted exercise, while for others the relationship was in the opposite direction.”

For the study, 26 adolescents reported their mood and energy four times a day for 20 days with an Android smartphone app developed by the KU research team.

The students were asked to rate positive affect (feeling happy), negative affect (feeling sad) as well as whether and to what degree they felt energetic or fatigued. The researchers then combined those reports with physical activity data collected from an activity tracker that the teens wore 24 hours a day.

Cushing said that this is a big advancement in the field of health behavior.

“If you think about the kind of advice a clinician would want to give to a patient, this study shows that adolescents are too different from each other to rely on a one-size-fits-all recommendation that is typical in practice. We need to know something about the person before giving a standard set of advice.”

A long-term goal of this research is to design an intervention system that would personalize prompts based on each individual’s optimum times to exercise as gleaned from data collected from reported internal states.

Cushing said that they were also able to answer the question of whether adolescents would even want to participate in this kind of study — one that required a lot of time and energy throughout the day. The study got a very high response rate and nearly all of the participants said they would do it again if their physician asked them to in order to better understand their health.

“Teens are willing to do it if they think they’ll learn something about the relationship between how they feel and important health behaviors they are interested in tracking or improving,” he said.

The researchers want to focus on increasing the physical activity of adolescents because high school is a time when most adolescents drop from a pattern of moderate activity to the kind of minimal activity that predisposes them for diseases as adults.

“We want to help them find opportunities for leisure time physical activities outside of the structure of school, and we think it makes sense to do that in a way that is personalized for each adolescent,” said Cushing.

“By the time a person reaches adulthood, patterns of behavior are relatively well-established. We think it is a harder proposition to get an adult off of the couch after they have slipped into a pattern of inactivity than to help an adolescent who is moderately active maintain some of that activity as they age into adulthood.”

The study is published in the Journal of Pediatric Psychology.

Source: University of Kansas, Life Span Institute