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Objective: The main aim of the present research was to evaluate the coherence of generalized anxiety disorder (GAD) psychopathological pattern, the robustness of its diagnostic criteria, and the clinical utility of considering this disorder as a discrete condition rather than assigning it a dimensional value., Method: The study was designed in a purely naturalistic setting and carried out using a community sample; data from the Sesto Fiorentino Study were reanalyzed., Results: Of the 105 subjects who satisfied the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for the diagnosis of GAD, only 18 (17.1%) had no other comorbid DSM-IV disorder. The most frequent comorbid condition was major depressive disorder (70.4 %). Only 2 of the GAD diagnostic symptoms (excessive worry and muscle tension) showed a specific association with the diagnosis itself, whereas the others, such as feeling wound up, tense, or restless, concentration problems, and fatigue, were found to be more prevalent in major depressive disorder than in GAD., Conclusion: Our study demonstrates that GAD, as defined by DSM-IV criteria, shows a substantial overlap with other DSM-IV diagnoses (especially with mood disorders) in the general population. Furthermore, GAD symptoms are frequent in all other disorders included in the mood/anxiety spectrum. Finally, none of the GAD symptoms, apart from muscle tension, distinguished GAD from patients without GAD., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objectives: The relationship between emotional states and eating behaviors is complex, and emotional eating has been identified as a possible factor triggering binge eating in bulimia nervosa (BN) and binge eating disorder. Few studies considered emotional eating in patients with anorexia nervosa., Methods: The present study evaluated the clinical correlates of emotional eating in 251 eating-disordered (EDs) subjects (70 AN restricting type, 71 AN binge eating/purging type, 110 BN purging type) and in a group of 89 healthy control subjects. Subjects were assessed by means of a clinical interview (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and several self-reported questionnaires, including the Emotional Eating Scale (EES)., Results: No significant differences were found between the 3 EDs groups in terms of EES total score, and all patients with ED showed higher EES scores compared with control subjects. Emotional eating was associated with subjective binge eating in AN binge eating/purging type and with objective binge eating in patients with BN. Among patients with AN restricting type, emotional eating was associated with restraint, but this association was lost when controlling for fear of loss of control over eating, which was the principal determinant of restraint., Conclusion: Emotional eating and fear of loss of control over eating are significantly associated with specific eating attitudes and behaviors, according to the different diagnoses. Emotional eating is a relevant psychopathologic dimension that deserves a careful investigation in both anorectic and bulimic patients., (Copyright © 2012 Elsevier Inc. All rights reserved.)

The aim of this study was to verify the level of expressed emotion (EE) as perceived from patients with an eating disorder (ED). The Italian translation of the Level of Expressed Emotion Scale was administered to 63 female patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of anorexia nervosa, bulimia nervosa, and binge-eating disorder and 63 control subjects, according to a case-control procedure. Patients with ED showed higher level of perceived EE than controls, whereas no significant differences were observed when comparing the 3 patient subgroups. The level of perceived EE was found to be independent of age, person who has been most influential in the patient's life, amount of contacts, and duration of treatment. Different associations between eating disorder psychopathology and EE were found, suggesting a close relationship between the emotional response and tolerance of influential person and the dysfunctional attitudes regarding eating, weight, and body shape., (Copyright 2010 Elsevier Inc. All rights reserved.)

Background: Many obese subjects show relevant psychological distress. The aims of this study were to assess the psychopathological and clinical features of a sample of overweight or obese subjects seeking weight loss treatment and to evaluate the possible, significant associations between the levels of overweight and the specific and general eating disorder psychopathology., Methods: A total of 397 consecutive overweight (body mass index > or =25 kg/m(2)) patients seeking treatment for weight loss at the Outpatient Clinic for Obesity of the University of Florence were studied. The prevalence of binge eating disorder was assessed using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. All subjects were assessed through the self-report version of the Eating Disorder Examination Questionnaire, the Beck Depression Inventory, and the State-Trait Anxiety Inventory., Results: The current prevalence of binge eating disorder was 24.2%; 35% of the subjects were overweight during childhood. High prevalence rates of clinical significant depressive (38%) and anxious (71.5%) symptoms were observed. Binge eating disorder, the severity of specific eating disorder psychopathology, and depressive and anxious symptoms were not associated with the severity of overweight., Conclusions: The severity of the specific and general eating disorder psychopathology does not predict the levels of overweight. A positive association between severe eating disorder psychopathology and clinical depression was observed.

In the last few decades, there has been a long debate on the existence of agoraphobia (AG) without a history of panic attacks (PAs). In the present study, the problem of the relationships between AG and PAs is addressed trough a reevaluation of the cases who had been diagnosed with AG in the community survey of Sesto Fiorentino. Forty-one of the 75 subjects who met the criterion of AG in the Sesto Fiorentino Study were reinterviewed by experienced clinical psychiatrists. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and the Composite International Diagnostic Interview were used to make the diagnoses. The Mobility Inventory for Agoraphobia (MIA) and a specific adjunctive question, "why do/did you avoid?", were used to compare AG subjects with or without PD. Of the 41 subjects with a lifetime history of AG, 12 cases had original diagnosis of AG without PAs and the remaining 29 had PD with AG. After the reassessment, in 10 cases, the criteria for the diagnosis of AG without PAs were confirmed, totaling a lifetime prevalence of 0.4% (confidence interval, 0.2-0.8). Agoraphobia subjects with and without PAs were comparable as regard to sex, age, age of onset, duration of illness, family history for anxiety or mood disorders, MIA scores, number, and type of situations avoided. Thus, AG seems to exist also in absence of a history of PAs, and the one-way relationship between the occurrence of PAs and a following development of AG, postulated by DSM-IV, should be reconsidered for the future classifications.

Current classification systems (ICD-10 and DSM-IV) require a quantitative criterion for differentiating depressive states, suggesting a correlation between the number of symptoms, i.e., the pervasiveness of the syndrome, and the subtype of the illness. All the symptoms (within those contained in the diagnostic lists) are assumed to have comparable value. To investigate the relevance of the number and the type of symptoms reported by 196 patients suffering from depression, we compared the symptoms using independent indicators of severity such as the Clinical Global Index (CGI) and the social functioning subscale of the Global Assessment of Functioning (GAF). A second comparison using the same indicators was made between qualitatively distinct categories of DSM-IV and ICD-10 (i.e., melancholic v nonmelancholic, somatic v nonsomatic, and psychotic v nonpsychotic). There was evidence that increasing numbers of symptoms actually reflect higher levels of severity, but the categorizations that were mainly based on qualitative criteria (e.g., melancholia, somatic syndrome, etc.) usually attained better discrimination compared with those based on the number of symptoms. Moreover, certain symptoms (usually those indicated as endogenous) were more likely to be associated with greater severity and pervasiveness. Finally, the results clearly showed that different symptoms had different weight in establishing the gradient of severity.

Ninety-nine patients with panic disorder (PD) not comorbid with other psychiatric disorders were evaluated for 5 years using a naturalistic prospective design. The probability of achieving full remission, albeit transitory, was 37.5%, whereas 72.8% of cases showed a consistent amelioration. However, among patients with an initial positive outcome, the probability of remaining well was 41.4% after 5 years. When the general course of the disorder during the follow-up period was considered, only 12.12% of the subjects had a complete and stable remission of symptoms, whereas 47.47% had a generally positive but not fully satisfactory amelioration either due to infrequent recurrences of the illness or to chronic continuation of symptoms at a mild level. On the other hand, 40.40% of the subjects reported an overall poor outcome because of the presence of a recurrent pattern of illness (11.11%) or because the periods of well-being did not represent more than 40% of the time being considered (29.29%). Among the predictors taken into consideration, only duration of illness before intake showed a strict relationship with long-term outcome, with patients having a lesser duration of illness at the moment of the index episode showing a significantly better outcome.