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Sample records for anorexia nervosa co-occurring

  1. Severe anorexia nervosa, co-occurring major depressive disorder and electroconvulsive therapy as maintenance treatment: a case report

    PubMed Central

    2009-01-01

    Introduction It is difficult to treat patients who, in addition to having severe anorexia nervosa, also have severe symptoms of major depressive disorder and a tendency for impulsive acting out behaviour. Our case report considers the feasibility of maintenance electroconvulsive therapy in such complicated cases. Case presentation This is a case report of a woman with anorexia nervosa and co-morbid severe major depressive disorder who was treated with electroconvulsive therapy as a maintenance treatment. The maintenance electroconvulsive therapy was conducted without immediate complications. It had a positive effect on the patient's depressive symptoms and lability and her general wellbeing, although some cognitive deficits were observed. Conclusion The maintenance electroconvulsive therapy seemed to support recovery in a case of refractory anorexia nervosa and a tendency for labile mood. The symptoms of co-occurring major depressive disorder were partly relieved and maintenance electroconvulsive therapy had some positive effect on weight gain. PMID:20062609

  2. [Anorexia nervosa].

    PubMed

    Herzog, W; Friederich, H C; Wild, B; Löwe, B; Zipfel, S

    2006-08-01

    Anorexia nervosa differs distinctly from other psychogenic eating disorders. Well known for the past 300 years, anorexia occurs consistently and is one of the most serious illnesses to be found for a certain age group. Three-quarters of the patients are healed or improve their condition long-term; one-quarter has a chronic course frequently including somatic complications and death. Because of the long healing process as well as the extensive chronification and complication rate, an individual treatment plan should be set up at the beginning of therapy to allow for a long-term structure of the course of therapy. Depending on the severity, phase and co-morbidity, inpatient and ambulant therapies are indicated. Depending on the duration of therapy, adequate weight (BMI > 15 kg/m2), good motivation, and lack of complications, an ambulant therapy is justified. Inpatient treatment is multimodal corresponding to the multifactorial etiology of anorexia nervosa. Weight gain is an important primary goal of therapy and a prerequisite for a conflict oriented, ambulant psychotherapy to be carried on after inpatient treatment. Ambivalent psychotherapy motivation and the necessity of symptom orientation demand technical modification both for inpatient as well as ambulant psychotherapy.

  3. Blindness and anorexia nervosa.

    PubMed

    McFarlane, A C

    1989-06-01

    Two cases of anorexia nervosa in blind patients are reported. They demonstrate that blind children experience many developmental problems which are thought to be important in the etiology of anorexia nervosa. Similarly, blind children are unusually susceptible to misperceive their body size and weight. The apparent absence of a strong association between congenital blindness and anorexia nervosa challenges the presumed aetiological link between disturbed body image and identity diffusion, and anorexia nervosa.

  4. Anorexia nervosa.

    PubMed

    Treasure, Janet; Zipfel, Stephan; Micali, Nadia; Wade, Tracey; Stice, Eric; Claudino, Angélica; Schmidt, Ulrike; Frank, Guido K; Bulik, Cynthia M; Wentz, Elisabet

    2015-11-26

    Anorexia nervosa (AN) is a psychiatric condition characterized by severe weight loss and secondary problems associated with malnutrition. AN predominantly develops in adolescence in the peripubertal period. Without early effective treatment, the course is protracted with physical, psychological and social morbidity and high mortality. Despite these effects, patients are noted to value the beliefs and behaviours that contribute to their illness rather than regarding them as problematic, which interferes with screening, prevention and early intervention. Involving the family to support interventions early in the course of the illness can produce sustained changes; however, those with a severe and/or protracted illness might require inpatient nursing support and/or outpatient psychotherapy. Prevention programmes aim to moderate the overvaluation of 'thinness' and body dissatisfaction as one of the proximal risk factors. The low prevalence of AN limits the ability to identify risk factors and to study the timing and sex distribution of the condition. However, genetic profiles, premorbid features, and brain structures and functions of patients with AN show similarities with other psychiatric disorders and contrast with obesity and metabolic disorders. Such studies are informing approaches to address the neuroadaptation to starvation and the other various physical and psychosocial deficits associated with AN. This Primer describes the epidemiology, diagnosis, screening and prevention, aetiology, treatment and quality of life of patients with AN.

  5. Anorexia nervosa and culture.

    PubMed

    Simpson, K J

    2002-02-01

    Anorexia nervosa is currently considered a disorder confined to Western culture. Its recent identification in non-Western societies and different subcultures within the Western world has provoked a theory that Western cultural ideals of slimness and beauty have infiltrated these societies. The biomedical definition of anorexia nervosa emphasizes fat-phobia in the presentation of anorexia nervosa. However, evidence exists that suggests anorexia nevosa can exist without the Western fear of fatness and that this culturally biased view of anorexia nervosa may obscure health care professionals' understanding of a patient's own cultural reasons for self-starvation, and even hinder their recovery.

  6. Anorexia Nervosa

    MedlinePlus

    ... fact sheet (PDF, 832 KB) Related information Binge eating disorder fact sheet Bulimia nervosa fact sheet What is ... when I realized my daughter, Jen, had an eating disorder. Jen has always been a picky eater. But ...

  7. Predisposition Factors in Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Nagel, K. L.; Jones, Karen H.

    1992-01-01

    Reviews literature concerned with investigating psychiatric disturbances and genetic variables hypothesized as predisposing factors in etiology of anorexia nervosa. Gives particular emphasis to research which discusses association between anorexia nervosa and depression. Reviews psychopharmacological evidence and family genetics studies. Offers…

  8. Predisposition Factors in Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Nagel, K. L.; Jones, Karen H.

    1992-01-01

    Reviews literature concerned with investigating psychiatric disturbances and genetic variables hypothesized as predisposing factors in etiology of anorexia nervosa. Gives particular emphasis to research which discusses association between anorexia nervosa and depression. Reviews psychopharmacological evidence and family genetics studies. Offers…

  9. Anorexia Nervosa and Bulimia.

    ERIC Educational Resources Information Center

    Csapo, Marg

    1987-01-01

    The article reviews the literature on anorexia nervosa, with or without bulimia, and presents a comprehensive picture of this eating disorder, focusing on terminology, historical references, prevalence, prognosis, classification, diagnostic criteria, physical and psychological characteristics, evolution of the disability, etiology, treatment, and…

  10. Anorexia Nervosa and Bulimia.

    ERIC Educational Resources Information Center

    Csapo, Marg

    1987-01-01

    The article reviews the literature on anorexia nervosa, with or without bulimia, and presents a comprehensive picture of this eating disorder, focusing on terminology, historical references, prevalence, prognosis, classification, diagnostic criteria, physical and psychological characteristics, evolution of the disability, etiology, treatment, and…

  11. Anorexia nervosa. A review.

    PubMed

    Tamburrino, M B; McGinnis, R A

    2002-12-01

    Anorexia nervosa is an illness characterized by significant weight loss, amenorrhea, distorted body image and a relentless pursuit of thinness. The disorder affects primarily young women between the ages of 13 and 20, and is more commonly seen in westernized countries. Although the incidence is relatively rare, affecting approximately 0.5 to 1.0% of younger women in the United States, medical complications can be severe, and long-term mortality rates may approach 20%. Recent studies indicate that subclinical eating disorders occur in at least 5% of women and up to 1/3 of females among special populations such as athletes and insulin-dependent diabetics. The etiology of eating disorders is not known, but there are psychosocial and biological influences. Malnutrition associated with anorexia nervosa can affect nearly every organ system in the body, with cardiac complications responsible for 50% of the deaths in anorexia nervosa. More recent brain studies suggest that grey matter volume deficits may persist after refeeding. Subclinical anorexia nervosa in athletes is associated with premature fractures and long-term osteopenia. Early complications, such as retinopathy, are increasingly seen in female diabetics who have disordered eating patterns. Well-designed empirical trials of treatment with psychotherapy and psychopharmacology are very limited. There is some evidence that family therapy may be more effective than individual therapy in younger anorectics who have been ill less than 3 years. The most promising finding in medication treatment suggests that fluoxetine may help prevent relapse in the weight restored anorectic.

  12. Case 39: Anorexia nervosa

    USDA-ARS?s Scientific Manuscript database

    Anorexia nervosa is a disease affecting primarily young women who have distorted body images. Although their weight is less than 30 percent under ideal body weight, they see themselves as overweight. Anorectics often use diuretic and laxative agents to accomplish their weight loss. Patients with bul...

  13. [Pharmacotherapy for anorexia nervosa and bulimia nervosa].

    PubMed

    Greetfeld, M; Cuntz, U; Voderholzer, U

    2012-01-01

    Psychotherapy is the treatment of choice for both anorexia nervosa and for bulimia nervosa. However, many patients are also treated by pharmaceutical drugs. For the clinician it is difficult to choose pharmacotherapy, because the drugs may not be licensed, because of pharmacodynamic problems due to underweight or purging behaviour, or because of comorbidity. The present review summarises the current knowledge on pharmacotherapy for anorexia nervosa and bulimia nervosa considering the available guidelines. In general, the knowledge based on studies is insufficient for anorexia nervosa. Up to now, there is no proof of efficacy for any antidepressant or atypical antipsychotic with respect to weight gain; atypical antipsychotics may be helpful for ruminating or excessive motor hyperactivity. For bulimia nervosa antidepressants are the pharmacotherapy of first choice. Long-term effects, however, are still unknown. © Georg Thieme Verlag KG Stuttgart · New York.

  14. Dopamine and anorexia nervosa.

    PubMed

    Södersten, P; Bergh, C; Leon, M; Zandian, M

    2016-01-01

    We have suggested that reduced food intake increases the risk for anorexia nervosa by engaging mesolimbic dopamine neurons, thereby initially rewarding dieting. Recent fMRI studies have confirmed that dopamine neurons are activated in anorexia nervosa, but it is not clear whether this response is due to the disorder or to its resulting nutritional deficit. When the body senses the shortage of nutrients, it rapidly shifts behavior toward foraging for food as a normal physiological response and the mesolimbic dopamine neurons may be involved in that process. On the other hand, the altered dopamine status of anorexics has been suggested to result from a brain abnormality that underlies their complex emotional disorder. We suggest that the outcomes of the treatments that emerge from that perspective remain poor because they target the mental symptoms that are actually the consequences of the food deprivation that accompanies anorexia. On the other hand, a method that normalizes the disordered eating behavior of anorexics results in much better physiological, behavioral, and emotional outcomes. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. [Franz Kafka's anorexia nervosa].

    PubMed

    Fichter, M M

    1988-07-01

    The evidence for the hypothesis that the poet Franz Kafka had suffered from an atypical anorexia nervosa is presented. Kafka was slim and underweight throughout his life and showed an ascetic attitude and abjuration of physical enjoyment and pleasure (fasting, vegetarianism, sexual abstinence, emphasis on physical fitness). The analysis is mainly based on Kafka's own descriptions in his letters, diaries, and literary work. Kafka was achievement oriented, reported many sadomasochistic fantasies, and had an anancastic (obsessive-compulsive) depressive personality. In addition there is evidence for a disturbed psychosexual and gender identity development. Our results concerning Kafka's psychopathology do not question his genius as a poet.

  16. [Biomarkers for anorexia nervosa].

    PubMed

    Sjøgren, Jan Magnus

    2017-01-16

    Biomarkers for anorexia nervosa (AN) which reflect the pathophysiology and relate to the aetiology of the disease, are warranted and could bring us one step closer to targeted treatment of AN. Some leads may be found in the biochemistry which often is found disturbed in AN, although normalization in many aspects is seen at recovery from undernutrition. Recent genome-wide association studies support that genetic factors play a role in the pathophysiology of AN, of which some are independent of BMI-related mechanisms. In this review, an update on blood-based biomarkers of AN is presented.

  17. Anorexia Nervosa: Sociocultural Factors and Treatment.

    ERIC Educational Resources Information Center

    Williams, Jennifer

    This paper examines how the epidemiological findings of anorexia nervosa lead theorists to speculate a correlation between sociocultural factors and the development of anorexia nervosa. A section on the essential features of anorexia nervosa identifies five primary characteristics of anorexia: (1) severe weight loss; (2) a disturbance of body…

  18. Osteoporosis in anorexia nervosa: a brittle future?

    PubMed

    Katzman, D K

    2003-02-01

    Anorexia nervosa commonly occurs during adolescence, a critical period for the acquisition of peak bone mass. Osteopenia is an early and serious complication associated with anorexia nervosa. Whether the osteopenia observed in adolescents with anorexia nervosa is reversible is unknown. The possible mechanisms for the osteopenia observed in adolescents with anorexia nervosa are complex and poorly understood. The purpose of this paper is to review a number of the identified factors that influence the attainment of peak bone mass in anorexia nervosa and to examine the best treatment options for optimizing skeletal mineralization in adolescents with anorexia nervosa.

  19. Medical Complications of Anorexia Nervosa and Bulimia.

    PubMed

    Westmoreland, Patricia; Krantz, Mori J; Mehler, Philip S

    2016-01-01

    Anorexia nervosa and bulimia nervosa are serious psychiatric illnesses related to disordered eating and distorted body images. They both have significant medical complications associated with the weight loss and malnutrition of anorexia nervosa, as well as from the purging behaviors that characterize bulimia nervosa. No body system is spared from the adverse sequelae of these illnesses, especially as anorexia nervosa and bulimia nervosa become more severe and chronic. We review the medical complications that are associated with anorexia nervosa and bulimia nervosa, as well as the treatment for the complications. We also discuss the epidemiology and psychiatric comorbidities of these eating disorders.

  20. Bone health in anorexia nervosa

    PubMed Central

    Misra, Madhusmita; Klibanski, Anne

    2013-01-01

    Purpose of review Anorexia nervosa is associated with low bone mineral density (BMD), concerning for an increased risk of fractures, and decreased bone accrual in adolescents, concerning for suboptimal peak bone mass. This review discusses causes of impaired bone health in anorexia nervosa and potential therapeutic strategies. Recent findings Low BMD in anorexia nervosa is consequent to decreased lean mass, hypogonadism, low insulin-like growth factor-1 (IGF-1), relative hypercortisolemia and alterations in hormones impacted by energy availability. Weight gain causes some improvement in bone accrual, but not to the extent observed in controls, and vitamin D supplementation does not increase BMD. Oral estrogen is not effective in increasing BMD, likely from IGF-1 suppressive effects. In contrast, transdermal estrogen replacement is effective in increasing bone accrual in adolescents with anorexia nervosa, although not to the extent seen in controls. Recombinant human IGF-1 increases bone formation in adolescents, and with oral estrogen increases BMD in adults with anorexia nervosa. Bisphosphonates increase BMD in adults, but not in adolescents, and should be used cautiously given their long half-life. Summary Further investigation is necessary to explore therapies for low BMD in anorexia nervosa. Weight gain is to be encouraged. Transdermal estrogen in adolescents, and bisphosphonates in adults, have a potential therapeutic role. PMID:21897220

  1. Adolescent Eating Disorder: Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Muuss, Rolf E.

    1985-01-01

    Examines anorexia nervosa, an eating disorder seen with increasing frequency, especially among adolescent girls. Presents five theories about causation, discusses early characteristics, typical family patterns, physical and medical characteristics, social adjustment problems, and society's contribution to anorexia. Describes course of the…

  2. Adolescent Eating Disorder: Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Muuss, Rolf E.

    1985-01-01

    Examines anorexia nervosa, an eating disorder seen with increasing frequency, especially among adolescent girls. Presents five theories about causation, discusses early characteristics, typical family patterns, physical and medical characteristics, social adjustment problems, and society's contribution to anorexia. Describes course of the…

  3. ["Pro Ana": Psychodynamic References for Anorexia Nervosa].

    PubMed

    Siefert, Linda

    2017-02-01

    "Pro Ana": Psychodynamic References for Anorexia Nervosa The internet-based phenomenon "Pro Ana" refers to the eating disorder anorexia nervosa in a positive way. To understand what the phenomenon "Pro Ana" represents, the websites are used as a starting point of the current analysis. Based on these results, similarities and differences between "Pro Ana" and the eating disorder anorexia nervosa are discussed. Furthermore psychodynamic references for anorexia nervosa are derived and finally their importance for treatment motivation will be considered.

  4. Does anorexia nervosa resemble an addiction?

    PubMed

    Barbarich-Marsteller, Nicole C; Foltin, Richard W; Walsh, B Timothy

    2011-09-01

    Anorexia nervosa is a severe psychiatric disorder characterized by unrelenting self-starvation and life-threatening weight loss. The relentlessness with which individuals with anorexia nervosa pursue starvation and in some cases exercise despite the negative physical, emotional, and social consequences parallels features of addictive disorders. From a clinical perspective, individuals with anorexia nervosa behave similarly to individuals with substance abuse by narrowing their behavioral repertoire so that weight loss, restricting food intake, and excessive exercise interfere with other activities in much the same way that substance abuse does. However, fundamental differences exist between anorexia nervosa and substance abuse that suggest anorexia nervosa is not an addiction in and of itself.

  5. Anorexia Nervosa and Bone

    PubMed Central

    Misra, Madhusmita; Klibanski, Anne

    2014-01-01

    Anorexia nervosa (AN) is a condition of severe low weight that is associated with low bone mass, impaired bone structure and reduced bone strength, all of which contribute to increased fracture risk., Adolescents with AN have decreased rates of bone accrual compared with normal-weight controls, raising addition concerns of suboptimal peak bone mass and future bone health in this age group. Changes in lean mass and compartmental fat depots, hormonal alterations secondary to nutritional factors contribute to impaired bone metabolism in AN. The best strategy to improve bone density is to regain weight and menstrual function. Oral estrogen-progesterone combinations are not effective in increasing bone density in adults or adolescents with AN, and transdermal testosterone replacement is not effective in increasing bone density in adult women with AN. However, physiologic estrogen replacement as transdermal estradiol with cyclic progesterone does increase bone accrual rates in adolescents with AN to approximate that in normal-weight controls, leading to a maintenance of bone density Z-scores. A recent study has shown that risedronate increases bone density at the spine and hip in adult women with AN. However, bisphosphonates should be used with great caution in women of reproductive age given their long half-life and potential for teratogenicity, and should be considered only in patients with low bone density and clinically significant fractures when non-pharmacological therapies for weight gain are ineffective. Further studies are necessary to determine the best therapeutic strategies for low bone density in AN. PMID:24898127

  6. Reproductive issues in anorexia nervosa

    PubMed Central

    Hoffman, Elizabeth R; Zerwas, Stephanie C; Bulik, Cynthia M

    2011-01-01

    Despite a high prevalence of menstrual irregularities, women with anorexia nervosa are becoming pregnant. The physical and psychological demands of pregnancy and motherhood can represent an immense challenge for women already struggling with the medical and psychological stress of an eating disorder. This article summarizes key issues related to reproduction in women with anorexia nervosa, highlighting the importance of preconception counseling, adequate gestational weight gain, and sufficient pre- and post-natal nutrition. Postpartum issues including eating disorder symptom relapse, weight loss, breastfeeding, and risk of perinatal depression and anxiety are also discussed. PMID:22003362

  7. [Gender role and anorexia nervosa].

    PubMed

    Behar, R

    1992-06-01

    The gender role is defined; its physiognomy, adopted by women since the occurrence of the Industrial Revolution, and the intricate status that characterizes the present feminine role are described. Finally, a psychosocial approach of anorexia nervosa is made. This disorder is considered as a paradigm of the present ambiguity of the femininity concept likely to become a transactional phenomenon between sexual identities.

  8. Adolescent Boys and Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Romeo, Felicia

    1994-01-01

    Notes that there has been steady increase in reported incidence of male adolescents with anorexia nervosa, from approximately 5% in 1985 to as much as 10% in 1987. Considers role of educators and counselors in early identification of this disorder, noting that young anorectic males have better prognosis for recovery if they receive treatment in…

  9. Adolescent Boys and Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Romeo, Felicia

    1994-01-01

    Notes that there has been steady increase in reported incidence of male adolescents with anorexia nervosa, from approximately 5% in 1985 to as much as 10% in 1987. Considers role of educators and counselors in early identification of this disorder, noting that young anorectic males have better prognosis for recovery if they receive treatment in…

  10. An introduction to anorexia nervosa and bulimia nervosa.

    PubMed

    Murphy, Beverley; Manning, Yvonne

    2003-12-17

    Nurses may come into contact with patients who have anorexia nervosa and bulimia nervosa. The authors discuss the signs and symptoms of these illnesses and outline treatment options for patients with eating disorders.

  11. Treatments of medical complications of anorexia nervosa and bulimia nervosa.

    PubMed

    Mehler, Philip S; Krantz, Mori J; Sachs, Katherine V

    2015-01-01

    Inherent to anorexia nervosa and bulimia nervosa are a plethora of medical complications which correlate with the severity of weight loss or the frequency and mode of purging. Yet, the encouraging fact is that most of these medical complications are treatable and reversible with definitive care and cessation of the eating-disordered behaviours. Herein, these treatments are described for both the medical complications of anorexia nervosa and those which are a result of bulimia nervosa.

  12. Endocrine consequences of anorexia nervosa.

    PubMed

    Misra, Madhusmita; Klibanski, Anne

    2014-07-01

    Anorexia nervosa is prevalent in adolescents and young adults, and endocrine changes include hypothalamic amenorrhoea; a nutritionally acquired growth-hormone resistance leading to low concentrations of insulin-like growth factor-1 (IGF-1); relative hypercortisolaemia; decreases in leptin, insulin, amylin, and incretins; and increases in ghrelin, peptide YY, and adiponectin. These changes in turn have harmful effects on bone and might affect neurocognition, anxiety, depression, and the psychopathology of anorexia nervosa. Low bone-mineral density (BMD) is particularly concerning, because it is associated with changes in bone microarchitecture, strength, and clinical fractures. Recovery leads to improvements in many--but not all--hormonal changes, and deficits in bone accrual can persist. Oestrogen-replacement therapy, primarily via the transdermal route, increases BMD in adolescents, although catch-up is incomplete. In adults, oral oestrogen--combined with recombinant human IGF-1 in one study and bisphosphonates in another--increased BMD, but not to the normal range. More studies are necessary to investigate the optimum therapeutic approach in patients with, or recovering from, anorexia nervosa. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. Anorexia Nervosa/Bulimia: The Teenager's Dilemma.

    ERIC Educational Resources Information Center

    Thompson, G. Sue

    Anorexia nervosa and bulimia are currently being studied with great intensity by the medical profession. Anorexia nervosa was first described in the medical literature in 1868, but was considered a rarity until the late 1930's. Bulimia was not identified in the medical literature until 1979. Recent studies suggest that approximately five percent…

  14. Anorexia nervosa with herpes simplex encephalitis

    PubMed Central

    George, G. C. W.

    1981-01-01

    Studies of patients suffering from anorexia nervosa appear to show an increased immunity to certain infections, as well as immunological deficiencies. This is the report of a patient with anorexia nervosa who developed herpes simplex encephalitis, a condition associated with lowered immunological defence mechanisms. PMID:7301681

  15. Anorexia Nervosa/Bulimia: The Teenager's Dilemma.

    ERIC Educational Resources Information Center

    Thompson, G. Sue

    Anorexia nervosa and bulimia are currently being studied with great intensity by the medical profession. Anorexia nervosa was first described in the medical literature in 1868, but was considered a rarity until the late 1930's. Bulimia was not identified in the medical literature until 1979. Recent studies suggest that approximately five percent…

  16. Anorexia Nervosa: Treatment in the Family Context.

    ERIC Educational Resources Information Center

    Levitt, Dana Heller

    2001-01-01

    One form of treatment for anorexia nervosa that continues to be developed is family therapy. In the following article, anorexia nervosa and its prevalence are defined, theories of its development are discussed, and family therapy interventions that have been applied to the treatment of the disorder are outlined. (Contains 15 references.) (GCP)

  17. Action Monitoring and Perfectionism in Anorexia Nervosa

    ERIC Educational Resources Information Center

    Pieters, Guido L. M.; de Bruijn, Ellen R. A.; Maas, Yvonne; Hulstijn, Wouter; Vandereycken, Walter; Peuskens, Joseph; Sabbe, Bernard G.

    2007-01-01

    To study action monitoring in anorexia nervosa, behavioral and EEG measures were obtained in underweight anorexia nervosa patients (n=17) and matched healthy controls (n=19) while performing a speeded choice-reaction task. Our main measures of interest were questionnaire outcomes, reaction times, error rates, and the error-related negativity ERP…

  18. Action Monitoring and Perfectionism in Anorexia Nervosa

    ERIC Educational Resources Information Center

    Pieters, Guido L. M.; de Bruijn, Ellen R. A.; Maas, Yvonne; Hulstijn, Wouter; Vandereycken, Walter; Peuskens, Joseph; Sabbe, Bernard G.

    2007-01-01

    To study action monitoring in anorexia nervosa, behavioral and EEG measures were obtained in underweight anorexia nervosa patients (n=17) and matched healthy controls (n=19) while performing a speeded choice-reaction task. Our main measures of interest were questionnaire outcomes, reaction times, error rates, and the error-related negativity ERP…

  19. Anorexia Nervosa: Treatment in the Family Context.

    ERIC Educational Resources Information Center

    Levitt, Dana Heller

    2001-01-01

    One form of treatment for anorexia nervosa that continues to be developed is family therapy. In the following article, anorexia nervosa and its prevalence are defined, theories of its development are discussed, and family therapy interventions that have been applied to the treatment of the disorder are outlined. (Contains 15 references.) (GCP)

  20. Treating Anorexia Nervosa in the Couple Context

    PubMed Central

    Bulik, Cynthia M; Baucom, Donald H.; Kirby, Jennifer S.

    2012-01-01

    Anorexia nervosa is a serious mental illness that affects women and men of all ages. Despite the gravity of its chronic morbidity, risk of premature death, and societal burden, the evidence base for its treatment—especially in adults—is weak. Guided by the finding that family-based interventions confer benefit in the treatment of anorexia nervosa in adolescents, we developed a cognitive-behavioral couple-based intervention for adults with anorexia nervosa who are in committed relationships that engages both the patient and her/his partner in the treatment process. This article describes the theoretical rationale behind the development of Uniting Couples in the treatment of Anorexia nervosa (UCAN), practical considerations in delivering the intervention, and includes reflections from the developers on the challenges of working with couples in which one member suffers from anorexia nervosa. Finally, we discuss future applications of a couple-based approach to the treatment of adults with eating disorders. PMID:22904599

  1. Measuring Severity and Change in Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Piazza, Eugene; And Others

    1983-01-01

    Describes the State of Mind (SOM) Questionnaire, which measures severity and change of clinical state in anorexia nervosa. A study of 42 anorexia patients and 4 control groups showed a strong correlation between depression as measured by the Beck Depression Inventory and the Anorexia Scale, which comprise the SOM. (JAC)

  2. Measuring Severity and Change in Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Piazza, Eugene; And Others

    1983-01-01

    Describes the State of Mind (SOM) Questionnaire, which measures severity and change of clinical state in anorexia nervosa. A study of 42 anorexia patients and 4 control groups showed a strong correlation between depression as measured by the Beck Depression Inventory and the Anorexia Scale, which comprise the SOM. (JAC)

  3. Executive functions in anorexia nervosa.

    PubMed

    Jáuregui-Lobera, Ignacio

    2014-03-01

    The pathophysiologic mechanisms that account for the development and persistence of anorexia nervosa (AN) remain unclear. With respect to the neuropsychological functioning, the executive functions have been reported to be altered, especially cognitive flexibility and decision-making processes. The aim of this study was to review the current state of the neuropsychological studies focused on anorexia nervosa, especially those highlighting the executive functions. This was done by means of a searching process covering three relevant electronic databases, as well as an additional search on references included in the analysed papers. Eventually we have to mention other published reviews and a hand-search. Comparing AN patients and healthy controls the results remain controversial and so remains the comparison of different eating disorders with respect to the neuropsychological dysfunction. The role of variables such as depression, anxiety and obsessionality needs to be clarified. There seems to be some base to state that some commonalities exist in the so-called extreme weight conditions (anorexia, obesity). The link between neuropsychological dysfunction in AN and biomarkers remains unclear. The role of neuropsychological deficits in AN, as initial factors or simply as mere consequences, remains unclear too. The link between the body image disturbances and the neuropsychological dysfunction needs to be clarified. The similarities between the AN neuropsychological dysfunction and that found in other mental disorders may be considered up to date as a mere approach. The same applies to the relationship between the AN patients' neuropsychological performance and personality or gender. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  4. Anorexia Nervosa and Bulimia: A Research Review.

    ERIC Educational Resources Information Center

    Sweeten, Mary K.

    1985-01-01

    The eating disorders called anorexia nervosa and bulimia are examined in terms of their symptomatology, etiology, and treatment, and in terms of how the extension home economist or teacher can help. Resources for additional information or help are listed. (CT)

  5. Anorexia Nervosa, Obesity and Bone Metabolism

    PubMed Central

    Misra, Madhusmita; Klibanski, Anne

    2014-01-01

    Anorexia nervosa and obesity are conditions at the extreme ends of the nutritional spectrum, associated with marked reductions versus increases respectively in body fat content. Both conditions are also associated with an increased risk for fractures. In anorexia nervosa, body composition and hormones secreted or regulated by body fat content are important determinants of low bone density, impaired bone structure and reduced bone strength. In addition, anorexia nervosa is characterized by increases in marrow adiposity and decreases in cold activated brown adipose tissue, both of which are related to low bone density. In obese individuals, greater visceral adiposity is associated with greater marrow fat, lower bone density and impaired bone structure. In this review, we discuss bone metabolism in anorexia nervosa and obesity in relation to adipose tissue distribution and hormones secreted or regulated by body fat content. PMID:24079076

  6. Anorexia Nervosa: Adolescent Starvation by Choice.

    ERIC Educational Resources Information Center

    Gilbert, Evelyn H.; DeBlassie, Richard R.

    1984-01-01

    Discusses anorexia nervosa in terms of symptoms, characteristics of patients, family relationship, and modes of treatment. Suggests that a combination of psychological and medical treatment is more effective than behavior modification. (JAC)

  7. Jane: A Case Study in Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Willingham, Barbara

    1988-01-01

    The article reports the case history of a 15-year-old Australian girl with anorexia nervosa. Information is also given on prevalence, causes, definitions, and treatments including hospitalization, co-therapy, psychotherapy, behavior modification, family therapy, and counseling. (DB)

  8. Adolescence, Sexual Conflict, and Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Romeo, Felicia F.

    1984-01-01

    Suggests that the high incidence of anorexia nervosa in adolescent girls may be related to developmental sexual pressure. Symptoms appear with the onset of puberty and are related to physiological and psychological changes. (JAC)

  9. Anorexia Nervosa: Adolescent Starvation by Choice.

    ERIC Educational Resources Information Center

    Gilbert, Evelyn H.; DeBlassie, Richard R.

    1984-01-01

    Discusses anorexia nervosa in terms of symptoms, characteristics of patients, family relationship, and modes of treatment. Suggests that a combination of psychological and medical treatment is more effective than behavior modification. (JAC)

  10. Anorexia Nervosa and Bulimia: A Research Review.

    ERIC Educational Resources Information Center

    Sweeten, Mary K.

    1985-01-01

    The eating disorders called anorexia nervosa and bulimia are examined in terms of their symptomatology, etiology, and treatment, and in terms of how the extension home economist or teacher can help. Resources for additional information or help are listed. (CT)

  11. Jane: A Case Study in Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Willingham, Barbara

    1988-01-01

    The article reports the case history of a 15-year-old Australian girl with anorexia nervosa. Information is also given on prevalence, causes, definitions, and treatments including hospitalization, co-therapy, psychotherapy, behavior modification, family therapy, and counseling. (DB)

  12. Treatment of Adolescents with Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Patel, Dilip R.; Pratt, Helen D.; Greydanus, Donald E.

    2003-01-01

    Reviews research on the treatment of adolescents with anorexia nervosa, including the general approach, treatment setting, treatment of medical complications, nutritional management, psychopharmacotherapy, psychotherapy, treatment efficacy and outcome studies, comparison studies, and prevention programs. (EV)

  13. Adolescence, Sexual Conflict, and Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Romeo, Felicia F.

    1984-01-01

    Suggests that the high incidence of anorexia nervosa in adolescent girls may be related to developmental sexual pressure. Symptoms appear with the onset of puberty and are related to physiological and psychological changes. (JAC)

  14. Treatment of Adolescents with Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Patel, Dilip R.; Pratt, Helen D.; Greydanus, Donald E.

    2003-01-01

    Reviews research on the treatment of adolescents with anorexia nervosa, including the general approach, treatment setting, treatment of medical complications, nutritional management, psychopharmacotherapy, psychotherapy, treatment efficacy and outcome studies, comparison studies, and prevention programs. (EV)

  15. Biological Aspects of Anorexia Nervosa and Bulimia Nervosa.

    ERIC Educational Resources Information Center

    Kaplan, Allan S.; Woodside, D. Blake

    1987-01-01

    Reviews biological factors relevant to the understanding of anorexia nervosa and bulimia nervosa. Considers the physical presentation of these disorders; the medical complications of starvation, binging, and purging; and the cognitive and behavioral effects of starvation. Reviews neurophysiological and neurochemical aspects of these illnesses and…

  16. Biological Aspects of Anorexia Nervosa and Bulimia Nervosa.

    ERIC Educational Resources Information Center

    Kaplan, Allan S.; Woodside, D. Blake

    1987-01-01

    Reviews biological factors relevant to the understanding of anorexia nervosa and bulimia nervosa. Considers the physical presentation of these disorders; the medical complications of starvation, binging, and purging; and the cognitive and behavioral effects of starvation. Reviews neurophysiological and neurochemical aspects of these illnesses and…

  17. [Anorexia nervosa and bulimia nervosa. Psychological considerations for its treatment].

    PubMed

    Barriguete Meléndez, J Armando; Rojo, Luis; Emmelhainz, Marisa

    2004-11-01

    It is presented the current perspectives in the study and treatment of the eating disorders, in specific: anorexia nervosa and bulimia nervosa, epidemiology, and the interface among the different medical specialties, nutrition and sciences of the behavior, the diagnostic approaches, instruments and current therapeutic models.

  18. Pretreatment predictors of outcome in anorexia nervosa.

    PubMed

    Halmi, K A; Goldberg, S C; Casper, R C; Eckert, E D; Davis, J M

    1979-01-01

    The relationship of selected pretreatment characteristics to weight gain during treatment was examined in 81 anorexia nervosa patients. Good prognostic indicators correlating positively with weight gain were: no previous hospitalizations for anorexia nervosa, a great amount of overactivity before treatment, less denial of illness, less psychosexual immaturity and the admission to feeling hunger. A perinatal history of delivery complications was associated with the poor outcome predictor of prior hospitalizations.

  19. Understanding the 'Anorexic Voice' in Anorexia Nervosa.

    PubMed

    Pugh, Matthew; Waller, Glenn

    2016-07-20

    In common with individuals experiencing a number of disorders, people with anorexia nervosa report experiencing an internal 'voice'. The anorexic voice comments on the individual's eating, weight and shape and instructs the individual to restrict or compensate. However, the core characteristics of the anorexic voice are not known. This study aimed to develop a parsimonious model of the voice characteristics that are related to key features of eating disorder pathology and to determine whether patients with anorexia nervosa fall into groups with different voice experiences. The participants were 49 women with full diagnoses of anorexia nervosa. Each completed validated measures of the power and nature of their voice experience and of their responses to the voice. Different voice characteristics were associated with current body mass index, duration of disorder and eating cognitions. Two subgroups emerged, with 'weaker' and 'stronger' voice experiences. Those with stronger voices were characterized by having more negative eating attitudes, more severe compensatory behaviours, a longer duration of illness and a greater likelihood of having the binge-purge subtype of anorexia nervosa. The findings indicate that the anorexic voice is an important element of the psychopathology of anorexia nervosa. Addressing the anorexic voice might be helpful in enhancing outcomes of treatments for anorexia nervosa, but that conclusion might apply only to patients with more severe eating psychopathology. Copyright © 2016 John Wiley & Sons, Ltd.

  20. The Enigmatic Persistence of Anorexia Nervosa

    PubMed Central

    Walsh, B. Timothy

    2014-01-01

    Objective In this review, based on recent advances in cognitive neuroscience, the author presents a formulation in which the marked persistence of anorexia nervosa can be usefully understood as a well-ingrained maladaptive habit. Method The author reviewed the relevant literature on the development and course of anorexia nervosa and interpreted critical features in light of developments in cognitive neuroscience. Results Anorexia nervosa is a well characterized disorder with remarkable persistence both across history and among affected individuals. Food restriction, the salient behavioral feature of the disorder, often begins innocently but gradually takes on a life of its own. Over time, it becomes highly entrenched and resistant to change through either psychological or pharmacological treatment. Cognitive neuroscience has described two related but distinct processes that underlie the acquisition of new patterns of behavior, namely, action-outcome and stimulus-response learning. It is likely that both processes are engaged in the development of anorexia nervosa and that stimulus-response learning (that is, habit formation) is critical to the persistence of the dieting behavior. Conclusions The formulation of the dieting behavior characteristic of anorexia nervosa as a well-entrenched habit provides a basis for understanding the striking persistence of this disorder. This model helps explain the resistance of anorexia nervosa to interventions that have established efficacy in related disorders and implies that addressing the dieting behavior is critical, especially early in the course of the illness, before it has become ingrained. PMID:23429750

  1. Endocrine abnormalities in anorexia nervosa.

    PubMed

    Lawson, Elizabeth A; Klibanski, Anne

    2008-07-01

    Anorexia nervosa (AN) is a psychiatric disease associated with notable medical complications and increased mortality. Endocrine abnormalities, including hypogonadotropic hypogonadism, hypercortisolemia, growth hormone resistance and sick euthyroid syndrome, mediate the clinical manifestations of this disease. Alterations in anorexigenic and orexigenic appetite-regulating pathways have also been described. Decreases in fat mass result in adipokine abnormalities. Although most of the endocrine changes that occur in AN represent physiologic adaptation to starvation, some persist after recovery and might contribute to susceptibility to AN recurrence. In this Review, we summarize key endocrine alterations in AN, with a particular focus on the profound bone loss that can occur in this disease. Although AN is increasingly prevalent among boys and men, the disorder predominantly affects girls and women who are, therefore, the focus of this Review.

  2. The problem of anorexia nervosa.

    PubMed

    Boris, H N

    1984-01-01

    In anorexia nervosa the pain of hunger or, alternatively (in bulemia), of glut recalls Freud's aphorism that the man with toothache cannot fall in love. But object longing remains and stimulates such envy that the anorectic must project her wishes; she is not be found wanting. The use of projection, in turn, complicates self-other boundaries, with the result that she experiences not only people but even food as overpowering. This, then, excites more envy, indeed an envy so ruinous that self-starvation or compulsive evacuations are employed additionally to make reparation. Because all of this condenses into Less is More, the anorexic poses particular problems for analytic treatment, which is the subject of a companion paper.

  3. New Insights in Anorexia Nervosa

    PubMed Central

    Gorwood, Philip; Blanchet-Collet, Corinne; Chartrel, Nicolas; Duclos, Jeanne; Dechelotte, Pierre; Hanachi, Mouna; Fetissov, Serguei; Godart, Nathalie; Melchior, Jean-Claude; Ramoz, Nicolas; Rovere-Jovene, Carole; Tolle, Virginie; Viltart, Odile; Epelbaum, Jacques

    2016-01-01

    Anorexia nervosa (AN) is classically defined as a condition in which an abnormally low body weight is associated with an intense fear of gaining weight and distorted cognitions regarding weight, shape, and drive for thinness. This article reviews recent evidences from physiology, genetics, epigenetics, and brain imaging which allow to consider AN as an abnormality of reward pathways or an attempt to preserve mental homeostasis. Special emphasis is put on ghrelino-resistance and the importance of orexigenic peptides of the lateral hypothalamus, the gut microbiota and a dysimmune disorder of neuropeptide signaling. Physiological processes, secondary to underlying, and premorbid vulnerability factors—the “pondero-nutritional-feeding basements”- are also discussed. PMID:27445651

  4. Endocrine Consequences of Anorexia Nervosa

    PubMed Central

    Misra, Madhusmita; Klibanski, Anne

    2014-01-01

    Summary Anorexia nervosa (AN) is prevalent in adolescents and young adults, and endocrine changes include hypothalamic amenorrhea, a nutritionally acquired growth hormone resistance with low insulin like growth factor-1 (IGF-1), relative hypercortisolemia, decreases in leptin, insulin, amylin and incretins, and increases in ghrelin, PYY and adiponectin. These changes in turn have deleterious effects on bone, and may affect neurocognition, anxiety, depression and eating disorder psychopathology. Low bone density is particularly concerning; clinical fractures occur and changes in both bone microarchitecture and strength estimates have been reported. Recovery causes improvement of many, but not all, hormonal changes, and deficits in bone accrual may persist despite recovery. Physiologic, primarily transdermal, estrogen replacement increases bone density in adolescents, although catch-up is incomplete. In adults, oral estrogen co-administered with rhIGF-1 in one study, and bisphosphonates in another increased bone density, though not to normal. More studies are necessary to determine the optimal therapeutic approach in AN. PMID:24731664

  5. Bone Metabolism in Anorexia Nervosa

    PubMed Central

    Fazeli, Pouneh K.; Klibanski, Anne

    2014-01-01

    Anorexia nervosa (AN), a psychiatric disorder predominantly affecting young women, is characterized by self-imposed chronic nutritional deprivation and distorted body image. AN is associated with a number of medical co-morbidities including low bone mass. The low bone mass in AN is due to an uncoupling of bone formation and bone resorption, which is the result of hormonal adaptations aimed at decreasing energy expenditure during periods of low energy intake. Importantly, the low bone mass in AN is associated with a significant risk of fractures and therefore treatments to prevent bone loss are critical. In this review, we discuss the hormonal determinants of low bone mass in AN and treatments that have been investigated in this population. PMID:24419863

  6. [Endocrine abnormalities in anorexia nervosa].

    PubMed

    Lanfranco, F; Gianotti, L; Destefanis, S; Arvat, E; Ghigo, E; Camanni, F

    2003-06-01

    Anorexia nervosa is a syndrome with multifactorial etiology in which several genetic, biologic, psychological and social factors are involved. Patients affected by anorexia nervosa (AN) may develop multiple endocrine abnormalities, e.g. amenorrhea, hypothalamus-pituitary-adrenal axis hyperactivity, low T3 syndrome and peculiar changes of somatotroph axis function. These endocrine abnormalities are also found after prolonged starvation and may represent an adaptive response developed in order to save energy and proteins. It is still a matter of debate whether these endocrine changes are etiologic or secondary. In fact, several evidences suggest the existence in AN of hypothalamus functional alterations, which may be involved in the development and maintenance of the food intake disorder; on the other hand, the increased CRH secretion seems to be secondary to malnutrition as well as GH hypersecretion coupled to low IGF-I levels; the latter is a common finding in AN, as well as in other undernutrition and malabsorption conditions, type 1 diabetes mellitus, liver cirrhosis and catabolic states. Hypothalamic amenorrhea, which is one of the diagnostic criteria for AN, is not linked only to the reduction of body weight but reflects also deep alterations of gonadotropin secretory pattern. Low T3 syndrome is frequently found in AN; on the other hand, an iodide-induced hypothyroidism is quite uncommon. T3 reduction in AN seems to be an adaptive response to prolonged starvation; however the presence of a simultaneous central dysregulation cannot be excluded. Finally, AN patients frequently show defects in urinary concentration or dilution with inappropriate secretion of antidiuretic hormone, which may be due to intrinsic defects in the neurohypophysis or to abnormalities of its regulatory afferent neurons.

  7. Epidemiology of anorexia nervosa in Japanese adolescents.

    PubMed

    Hotta, Mari; Horikawa, Reiko; Mabe, Hiroyo; Yokoyama, Shin; Sugiyama, Eiko; Yonekawa, Tadato; Nakazato, Masamitsu; Okamoto, Yuri; Ohara, Chisato; Ogawa, Yoshihiro

    2015-01-01

    No epidemiologic survey examining eating disorders in Japan has been done at a national level since 1992. The prevalence of anorexia nervosa, as assessed by questionnaires to hospitals, is thought to be underestimated because patients with anorexia nervosa tend to avoid consultations. In conformity with the School Health and Safety Act of Japan, schools are required to have physicians perform a medical examination of students every year. The teachers in charge of health education and school physicians determine the height, weight, and health condition, and examine the medical records of each student. Therefore, we as members of the Survey Committee for Eating Disorders of the Japanese Ministry of Health, Labour, and Welfare conducted an epidemiologic survey using questionnaires sent to schools in seven prefectures to determine the current prevalence of anorexia nervosa among adolescents. We sent a questionnaire to elementary, junior high, and senior high schools. Questionnaires contained items on the number of students, patients with anorexia nervosa in each grade who were diagnosed by specialists, and students who the school physician strongly suspected to have anorexia nervosa but who did not undergo a clinical examination in a medical institution. We found patients of both sexes with anorexia nervosa aged 9-10 years in elementary schools. The point prevalence of anorexia nervosa for girls, including strongly suspected cases, in the three grades of junior high school and three grades of senior high school were 0-0.17 %, 0-0.21 %, 0.17-0.40 %, 0.05-0.56 %, 0.17-0.42 % and 0.09-0.43 %, respectively. We also confirmed a prominent sex difference in the prevalence of anorexia nervosa. The prevalence of boys was one third that of girls in some prefectures. One third to one half of diagnosed and strongly suspected students with anorexia nervosa had not received medical consultation or treatment. Although the prevalence of anorexia nervosa had regional differences

  8. Intracranial germ cell tumor mimicking anorexia nervosa.

    PubMed

    Andreu Martínez, F J; Martínez Mateu, J M

    2006-12-01

    We report on a case of a 23 year-old female diagnosed as having a germ-cell tumour located in the sellar region. The patient referred anorexia, psychic disorders, weight loss of 15 kilograms and secondary amenorrhea during the previous three years. This is the reason why the patient was diagnosed as having anorexia nervosa. Subsequently, the patient presented some endocrine dysfunction. MRI revealed the existence of a lesion located in suprasellar and hypothalamic regions. This case shows that the presence of intracranial tumours next to the hypothalamus must be borne in mind as a rare but real possibility in cases of anorexia nervosa, specially in those non-typical cases.

  9. "Fasting Girls": Reflections on Writing the History of Anorexia Nervosa

    ERIC Educational Resources Information Center

    Brumberg, Joan Jacobs

    1986-01-01

    Reflects on the history of anorexia nervosa among adolescent ("fasting") girls, suggesting that its psychodynamics have changed over time. Focuses on the social and cultural processes by which anorexia nervosa became a disease. Argues for a conception of anorexia nervosa that incorporates culture as well as biomedical and psychological…

  10. "Fasting Girls": Reflections on Writing the History of Anorexia Nervosa

    ERIC Educational Resources Information Center

    Brumberg, Joan Jacobs

    1986-01-01

    Reflects on the history of anorexia nervosa among adolescent ("fasting") girls, suggesting that its psychodynamics have changed over time. Focuses on the social and cultural processes by which anorexia nervosa became a disease. Argues for a conception of anorexia nervosa that incorporates culture as well as biomedical and psychological…

  11. Olfaction in child and adolescent anorexia nervosa.

    PubMed

    Schecklmann, Martin; Pfannstiel, Christoph; Fallgatter, Andreas J; Warnke, Andreas; Gerlach, Manfred; Romanos, Marcel

    2012-06-01

    Previous studies indicate disturbed olfactory functions in anorexia nervosa with presumable relationship to the clinical symptom of food aversion and weight loss. However, these studies are in part limited due to inadequately matched control samples, insufficient exclusion criteria, complex interactions of the olfactory and trigeminal system, and the lack of regard to co-morbidity and medication. Thus, we investigated olfactory function in 26 female adolescent patients with anorexia nervosa and 23 healthy controls matched for age, gender, handedness, and intelligence. No significant group differences were identified. Controlling for co-morbid disorders, psychopharmacological treatment, and depressivity revealed superior olfactory identification performance in the "pure" anorexia nervosa group (n = 15) in contrast to the controls. Superior identification may be mediated by increased attentional processes towards food stimuli in patients with anorexia nervosa. Effects of co-morbidity and medication highlight the role of neurobiological factors in the etiology of anorexia nervosa. Furthermore, as other neuropsychiatric disorders such as Parkinson's disease or attention deficit hyperactivity disorder show distinct olfactory function patterns, olfaction may be suitable as phenotypic marker with potential relevance for (differential) diagnosis in neuropsychiatric disorders.

  12. Obesity and sexually selected anorexia nervosa.

    PubMed

    Lozano, George A

    2008-12-01

    Anorexia nervosa is diagnosed by drastic weight loss, a fear of gaining weight, a distorted body image, and, in women, three consecutive episodes of amenorrhea. It is often associated with a compulsive need for exercise, a bright outlook on life, and a high level of competitiveness. It afflicts primarily young women in higher socioeconomic strata who are highly competitive and otherwise overachievers. There are three adaptive explanations for anorexia nervosa: the reproductive suppression, the fleeing famine and the pseudo-female hypotheses. Here I present a novel hypothesis, the age-related obesity hypothesis. It posits that the otherwise normal tendency by women to seek a youthful appearance can become maladaptive and lead to anorexia nervosa in environments in which thinness becomes the primary indicator of youth, such as in modern industrialized societies. This hypothesis explains the aforementioned associated features of anorexia nervosa, and its increasing prevalence in western societies. The hypothesis generates several testable predictions: (1) Prevalence of anorexia nervosa across societies should be related to the degree to which thinness is an indicator of youth in a population. (2) Conversely, perceptions of the weight-age relationship should differ among populations depending on the prevalence of anorexia nervosa. (3) Anorectic individuals, or those with the propensity to develop the disease, should have a biased perception of the weight-age relationship. (4) Experimental manipulation of individuals' perception of the weight-age relationship should affect weight concerns, particularly among anorectic or at-risk individuals. Should the hypothesis be supported it might be used to screen at-risk individuals. Furthermore, it would call for more integrative public health programs that take a comprehensive approach encompassing both obesity and anorexia.

  13. [Masculine anorexia nervosa: realities and perspectives].

    PubMed

    Chambry, Jean; Corcos, Maurice; Guilbaud, Olivier; Jeammet, Phillipe

    2002-05-01

    Since its description by Morton in 1694, masculine anorexia nervosa has been the subject of much debate. For many, two questions remain unanswered: does anorexia nervosa, as described in girls, exist in boys? - if so, is it the same disease? We analyzed the data in the literature which demonstrate a lower incidence than in the female population, although estimates are probable low due to underdiagnosis. The behavioral aspects suggest a similarity between masculine and feminine anorexia nervosa although the pure restrictive forms of anorexia are more rare in boys. There are however a few differences. Affected boys, according to Crips and Burns (1990), are heavier than girls at onset of the disorder but present a lower body weight during certain periods of the disease. Excessive physical activity is more frequent as is excessive intellectual involvement (Margo, 1987). The problem of amenorrhea, on/off periods, is not present in the male form. Testosterone and sexual function decline gradually, in parallel with the state of malnutrition (Anersen, 1990). The patient does not have particular difficulty discussing sexual relations but does exhibit a poor level of experience and mental representations. Contact with the opposite sex is rare and the fantastic life is generally very limited. The frequency of homosexual behavior would lie between 25% (Herzog, 1984) and 58% (Schneider and Agras, 1987), which is higher than in the female anorexia population (Herzog, 1984). This observation raises the question concerning the relationship between masculine mental anorexia nervosa and fragile sexual identity.

  14. Self-forgiveness in anorexia nervosa and bulimia nervosa.

    PubMed

    Watson, Michelle J; Lydecker, Janet A; Jobe, Rebecca L; Enright, Robert D; Gartner, Aubrey; Mazzeo, Suzanne E; Worthington, Everett L

    2012-01-01

    This study investigated whether low levels of self-forgiveness were associated with eating disorder symptomatology. Participating women (N = 51) had diagnoses of anorexia nervosa, bulimia nervosa, or no eating disorder diagnosis. They completed 3 measures of self-forgiveness. Women with eating disorders had lower levels of self-forgiveness compared with control participants. Results suggest that incorporating self-forgiveness interventions into current eating disorder treatments should be evaluated in future research as they might enhance clinical outcomes.

  15. Hematological complications in anorexia nervosa

    PubMed Central

    De Filippo, E; Marra, M; Alfinito, F; Di Guglielmo, M L; Majorano, P; Cerciello, G; De Caprio, C; Contaldo, F; Pasanisi, F

    2016-01-01

    Background/objectives: Anemia, leukopenia and, although less frequently, thrombocytopenia are possible hematological complications of anorexia nervosa considered strictly secondary to chronic malnutrition. This is a retrospective study on the prevalence of these disorders in a large cohort of 318 female patients with AN (20.4±5.6 years, body mass index (BMI) 15.9±1.6 kg/m2), recruited in the Outpatient Unit for Malnutrition secondary to Eating Disorders at the Department of Clinical Medicine and Surgery, Federico II University Hospital, since February 1991 to December 2012. Subjects/methods: Patients were studied on an outpatient basis after obtaining medical history, clinical examination, routine hematobiochemical and endocrine tests, electrocardiography, psychiatric interview and bioelectrical impedance analysis and, in particular, phase angle determination. All patients with other comorbidities, in particular with mean corpuscular volume <80 fl, were excluded for suspected genetic alteration in the synthesis of hemoglobin. Results: Hematologic data showed that 16.7% of patients had anemia, 7.9% neutropenia and 8.9% thrombocytopenia. These abnormalities were strictly related to the duration of illness (P=0.028), and to protein energy malnutrition, in particular, BMI and phase angle (P<0.001). Conclusions: Our study offers description of the incidence of hematologic defects in a selected and large sample of AN female patients, suggesting that its incidence is related to the degree and duration of protein energy malnutrition. PMID:27436150

  16. Serotonin neurotransmission in anorexia nervosa.

    PubMed

    Haleem, Darakhshan Jabeen

    2012-09-01

    Patients with anorexia nervosa (AN) show extreme dieting weight loss, hyperactivity, depression/anxiety, self-control, and behavioral impulsivity. 5-Hydroxytryptamine (5-HT; serotonin) is involved in almost all the behavioral changes observed in AN patients. Both genetic and environmental factors contribute toward the pathogenesis of AN. It is a frequent disorder among adolescent girls and young women and starts as an attempt to lose weight to look beautiful and attractive. Failure to see the turning point when fasting becomes unreasonable leads to malnutrition and AN. Tryptophan, the precursor of serotonin and an essential amino acid, is only available in the diet. It is therefore likely that excessive diet restriction and malnutrition decrease brain serotonin stores because the precursor is less available to the rate-limiting enzyme of 5-HT biosynthesis, which normally exists unsaturated with its substrate. Evidence shows that diet restriction-induced exaggerated feedback control over 5-HT synthesis and the smaller availability of tryptophan decreases serotonin neurotransmission at postsynaptic sites, leading to hyperactivity, depression, and behavioral impulsivity. A compensatory upregulation of postsynaptic 5-HT-1A receptors and hypophagic serotonin receptors may be involved in anxiety and suppression of appetite. It is suggested that tryptophan supplementation may improve pharmacotherapy in AN.

  17. Anorexia nervosa--diagnosis, aetiology, and treatment.

    PubMed

    Hartman, D

    1995-12-01

    The aetiology, assessment and treatment of anorexia nervosa are reviewed in the light of the classical accounts of Morton, Lasègue and Gull. The core symptoms are deliberate weight loss, disturbed body image and amenorrhoea, and complications may include cardiac failure, electrolyte disturbances, hypothermia and osteoporosis. Common clinical findings are described. Disturbed brain serotonin activity is implicated in the aetiology of anorexia nervosa, but there is little support for the use of pharmacological treatments. Psychological theories of aetiology are discussed with reference to Bruch, Crisp, Palazzoli and Minuchin: the common theme is the reaction of the patient and her family to the physical and social changes of puberty. Individual and/or family psychotherapy is seen as central to the treatment of anorexia nervosa, and the relevant clinical research is reviewed. The roles of general practitioners, general psychiatrists and eating disorder specialists are discussed in the light of recent consensus treatment guidelines.

  18. [Neuropsychological performance in anorexia and bulimia nervosa].

    PubMed

    Bühren, Katharina; Holtkamp, Kristian; Herpertz-Dahlmann, Beate; Konrad, Kerstin

    2008-11-01

    Anorexia nervosa and Bulimia nervosa are common chronic psychiatric diseases afflicting in particular female adolescents. During the acute phase of starvation a number of hormonal, neuropsychological and cerebral morphological changes occur. Some of these abnormalities are only partly reversible. Psychiatric comorbidities complicate the clinical picture and aggravate appropriate therapeutic interventions. The following review describes in detail the neuropsychological impairments in eating disorders, potential factors influencing cognitive performance, and resulting implications for clinical every day life.

  19. Measuring severity and change in anorexia nervosa.

    PubMed

    Piazza, E; Rollins, N; Lewis, F S

    1983-01-01

    The State of Mind Questionnaire measures severity and change of clinical state in anorexia nervosa. Its two parts, the Beck Depression Inventory and the Anorexia scale correlate highly with each other. Test scores of hospitalized anorectic patients are significantly higher than scores of normal controls. Both test scores correlate positively with clinical Global Severity Ratings. Serial test scores reflect changes in emotional state. The significance of depression as an important feature of the syndrome is discussed.

  20. Diagnostic Crossover in Anorexia Nervosa and Bulimia Nervosa: Implications for DSM-V

    PubMed Central

    Eddy, Kamryn T.; Dorer, David J.; Franko, Debra L.; Tahilani, Kavita; Thompson-Brenner, Heather; Herzog, David B.

    2011-01-01

    Objective The Diagnostic and Statistical Manual of Mental Disorders (DSM) is designed primarily as a clinical tool. Yet high rates of diagnostic “crossover” among the anorexia nervosa subtypes and bulimia nervosa may reflect problems with the validity of the current diagnostic schema, thereby limiting its clinical utility. This study was designed to examine diagnostic crossover longitudinally in anorexia nervosa and bulimia nervosa to inform the validity of the DSM-IV-TR eating disorders classification system. Method A total of 216 women with a diagnosis of anorexia nervosa or bulimia nervosa were followed for 7 years; weekly eating disorder symptom data collected using the Eating Disorder Longitudinal Interval Follow-Up Examination allowed for diagnoses to be made throughout the follow-up period. Results Over 7 years, the majority of women with anorexia nervosa experienced diagnostic crossover: more than half crossed between the restricting and binge eating/purging anorexia nervosa subtypes over time; one-third crossed over to bulimia nervosa but were likely to relapse into anorexia nervosa. Women with bulimia nervosa were unlikely to cross over to anorexia nervosa. Conclusions These findings support the longitudinal distinction of anorexia nervosa and bulimia nervosa but do not support the anorexia nervosa subtyping schema. PMID:18198267

  1. Psychosomatic syndromes and anorexia nervosa

    PubMed Central

    2013-01-01

    Background In spite of the role of some psychosomatic factors as alexithymia, mood intolerance, and somatization in both pathogenesis and maintenance of anorexia nervosa (AN), few studies have investigated the prevalence of psychosomatic syndromes in AN. The aim of this study was to use the Diagnostic Criteria for Psychosomatic Research (DCPR) to assess psychosomatic syndromes in AN and to evaluate if psychosomatic syndromes could identify subgroups of AN patients. Methods 108 AN inpatients (76 AN restricting subtype, AN-R, and 32 AN binge-purging subtype, AN-BP) were consecutively recruited and psychosomatic syndromes were diagnosed with the Structured Interview for DCPR. Participants were asked to complete psychometric tests: Body Shape Questionnaire, Beck Depression Inventory, Eating Disorder Inventory–2, and Temperament and Character Inventory. Data were submitted to cluster analysis. Results Illness denial (63%) and alexithymia (54.6%) resulted to be the most common syndromes in our sample. Cluster analysis identified three groups: moderate psychosomatic group (49%), somatization group (26%), and severe psychosomatic group (25%). The first group was mainly represented by AN-R patients reporting often only illness denial and alexithymia as DCPR syndromes. The second group showed more severe eating and depressive symptomatology and frequently DCPR syndromes of the somatization cluster. Thanatophobia DCPR syndrome was also represented in this group. The third group reported longer duration of illness and DCPR syndromes were highly represented; in particular, all patients were found to show the alexithymia DCPR syndrome. Conclusions These results highlight the need of a deep assessment of psychosomatic syndromes in AN. Psychosomatic syndromes correlated differently with both severity of eating symptomatology and duration of illness: therefore, DCPR could be effective to achieve tailored treatments. PMID:23302180

  2. Case reports of anorexia nervosa and caffeinism.

    PubMed

    Sours, J A

    1983-02-01

    Many patients with anorexia nervosa drink large quantities of beverages containing caffiene--e.g., coffee and diet cola--which have few calories and suppress the appetite while increasing energy. The author describes the clinical aspects of caffeinism in two such patients.

  3. The School Counselor and Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Hendrick, Susan S.

    1984-01-01

    Provides information on identification and treatment of anorexia nervosa. Recommends that school counselors take responsibility with this problem by (1) informing themselves through reading; (2) initiating an inservice training with a local expert on eating disorders; and (3) begin conducting a short-term "weight problems" group in the…

  4. Eco-Systemic Analysis of Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Sheppy, Margarette I.; And Others

    1988-01-01

    Tested eco-systemic approach to understanding of anorexia nervosa. Compared 30 anorexics and parents to 34 matched control subjects and parents. Found that, compared to controls, families of anorexics were less supportive, helpful, and committed to each other. Family interactions perceived by anorexics were characterized by overprotective,…

  5. Family Patterns Associated with Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Grigg, Darryl N.; And Others

    1989-01-01

    Used family systems perspective to explore familial transactional patterns related to anorexia nervosa among 22 families with an anorexic child and 22 matched control families. Identified 7 family groups with unique family dynamics differentiating one from another. With no single family pattern characterizing families of anorexics, results…

  6. The Physical Educator and Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Romeo, Felicia F.

    1984-01-01

    The physical education teacher is in an advantageous position to observe a student who may have anorexia nervosa. Severe weight loss, hyperactivity, body image delusion, and amenorrhea are symptoms of this behavior disorder. Implications for the physical education teacher and athletic coach are offered. (DF)

  7. Personality and Treatment Effectiveness in Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Skoog, Dagna K.; And Others

    1984-01-01

    Compared pre- and posttreatment Minnesota Multiphasic Personality Inventory profiles of female inpatients (N=12) with anorexia nervosa. Results showed change after treatment, and found that pretreatment profiles obtained at a different hospital were remarkably similar, which suggests a common constellation of personality characteristics in…

  8. Anorexia Nervosa: Its Symptoms and Possible Cures.

    ERIC Educational Resources Information Center

    Bingaman, David E.

    This document presents a definition and description of anorexia nervosa as a disorder that occurs predominantly in girls and that can affect 1 out of every 250 girls between the ages of 12 and 18 years. The existence of a distorted mental body image among anorexics is discussed and symptoms of the disorder are described, including amenorrhea…

  9. Pellagra: a rare complication of anorexia nervosa.

    PubMed

    Jagielska, Gabriela; Tomaszewicz-Libudzic, Elzbieta Celina; Brzozowska, Agata

    2007-10-01

    Pellagra is a potentially fatal, nutritional disease with cutaneous, gastrointestinal, and neuropsychiatric manifestations. Because of the diversity of pellagra's signs and symptoms, diagnosis is difficult without an appropriate index of suspicion. A case of pellagra in a 14-year-old girl with anorexia nervosa is presented. Signs and symptoms of pellagra were resolved after niacin therapy and dietary treatment.

  10. Anorexia Nervosa: Its Symptoms and Possible Cures.

    ERIC Educational Resources Information Center

    Bingaman, David E.

    This document presents a definition and description of anorexia nervosa as a disorder that occurs predominantly in girls and that can affect 1 out of every 250 girls between the ages of 12 and 18 years. The existence of a distorted mental body image among anorexics is discussed and symptoms of the disorder are described, including amenorrhea…

  11. Family Patterns Associated with Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Grigg, Darryl N.; And Others

    1989-01-01

    Used family systems perspective to explore familial transactional patterns related to anorexia nervosa among 22 families with an anorexic child and 22 matched control families. Identified 7 family groups with unique family dynamics differentiating one from another. With no single family pattern characterizing families of anorexics, results…

  12. The School Counselor and Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Hendrick, Susan S.

    1984-01-01

    Provides information on identification and treatment of anorexia nervosa. Recommends that school counselors take responsibility with this problem by (1) informing themselves through reading; (2) initiating an inservice training with a local expert on eating disorders; and (3) begin conducting a short-term "weight problems" group in the…

  13. Personality and Treatment Effectiveness in Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Skoog, Dagna K.; And Others

    1984-01-01

    Compared pre- and posttreatment Minnesota Multiphasic Personality Inventory profiles of female inpatients (N=12) with anorexia nervosa. Results showed change after treatment, and found that pretreatment profiles obtained at a different hospital were remarkably similar, which suggests a common constellation of personality characteristics in…

  14. The Physical Educator and Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Romeo, Felicia F.

    1984-01-01

    The physical education teacher is in an advantageous position to observe a student who may have anorexia nervosa. Severe weight loss, hyperactivity, body image delusion, and amenorrhea are symptoms of this behavior disorder. Implications for the physical education teacher and athletic coach are offered. (DF)

  15. Juvenile Anorexia Nervosa: Family Therapy's Natural Niche

    ERIC Educational Resources Information Center

    Fishman, H. Charles

    2006-01-01

    Juvenile Anorexia Nervosa (AN) is a severe problem both in terms of presenting symptomatology and its tendency toward chronicity. Researchers have consistently shown that family-based approaches are superior to individual approaches for the treatment of juvenile AN. This article addresses the capacity deficit of trained family therapists to treat…

  16. Male Anorexia Nervosa: A New Focus.

    ERIC Educational Resources Information Center

    Crosscope-Happel, Cindy; Hutchins, David E.; Getz, Hildy G.; Hayes, Gerald L.

    2000-01-01

    Although anorexia nervosa affects over one million males yearly, it is often misdiagnosed or overlooked by mental health and medical practitioners. This article brings the problem to the forefront and outlines features that are unique to these males. Greater recognition of the disorder can lead to more accurate diagnoses and, subsequently, better…

  17. Juvenile Anorexia Nervosa: Family Therapy's Natural Niche

    ERIC Educational Resources Information Center

    Fishman, H. Charles

    2006-01-01

    Juvenile Anorexia Nervosa (AN) is a severe problem both in terms of presenting symptomatology and its tendency toward chronicity. Researchers have consistently shown that family-based approaches are superior to individual approaches for the treatment of juvenile AN. This article addresses the capacity deficit of trained family therapists to treat…

  18. Male Anorexia Nervosa: A New Focus.

    ERIC Educational Resources Information Center

    Crosscope-Happel, Cindy; Hutchins, David E.; Getz, Hildy G.; Hayes, Gerald L.

    2000-01-01

    Although anorexia nervosa affects over one million males yearly, it is often misdiagnosed or overlooked by mental health and medical practitioners. This article brings the problem to the forefront and outlines features that are unique to these males. Greater recognition of the disorder can lead to more accurate diagnoses and, subsequently, better…

  19. The role of socialization in male anorexia nervosa: two cases.

    PubMed

    Halperin, E N

    1996-01-01

    Social isolation, competitiveness and self-defeating masochism are the major themes in male and female Anorexia Nervosa. A relationship is seen between Anorexia Nervosa and Perversions, where there is a preconscious reenactment of traumatic situations. This dynamic of competition and masochism is described in two cases of male anorexia and seen as part of many other cases.

  20. Anorexia Nervosa in Chinese Adolescents: Does Culture Make a Difference?

    ERIC Educational Resources Information Center

    Lai, Kelly Y. C.

    2000-01-01

    Reports on clinical and psychosocial characteristics of 16 Chinese adolescents from Hong Kong with anorexia nervosa. Over 80% of these patients expressed a fear of fatness. Against the background of increasing Westernization of Hong Kong society, anorexia is taking on a Western pattern, in congruence with the notion that anorexia nervosa is a…

  1. Anorexia Nervosa in Chinese Adolescents: Does Culture Make a Difference?

    ERIC Educational Resources Information Center

    Lai, Kelly Y. C.

    2000-01-01

    Reports on clinical and psychosocial characteristics of 16 Chinese adolescents from Hong Kong with anorexia nervosa. Over 80% of these patients expressed a fear of fatness. Against the background of increasing Westernization of Hong Kong society, anorexia is taking on a Western pattern, in congruence with the notion that anorexia nervosa is a…

  2. Narrative art inquiry and anorexia nervosa.

    PubMed

    Craig, Jennifer

    Narrative art inquiry is a new qualitative research methodology. It is different from the narrative approaches used by some nurse investigators because the study's findings are presented in the form of creative writing. In this article the author describes narrative art inquiry using material from research that used this approach to study anorexia nervosa. The author believes that narrative art inquiry has a wider application and could be used to study other types of psychological illness and physiological distress.

  3. Behavioral neuroendocrinology and treatment of anorexia nervosa.

    PubMed

    Södersten, P; Nergårdh, R; Bergh, C; Zandian, M; Scheurink, A

    2008-10-01

    Outcome in anorexia nervosa remains poor and a new way of looking at this condition is therefore needed. To this aim, we review the effects of food restriction and starvation in humans. It is suggested that body weight remains stable and relatively low when the access to food requires a considerable amount of physical activity. In this condition, the human homeostatic phenotype, body fat content is also low and as a consequence, the synthesis and release of brain neurotransmitters are modified. As an example, the role of neuropeptide Y is analyzed in rat models of this state. It is suggested that the normal behavioral role of neuropeptide Y is to facilitate the search for food and switch attention from sexual stimuli to food. Descriptive neuroendocrine studies on patients with anorexia nervosa have not contributed to the management of the patients and the few studies in which hormones have been administered have, at best, reversed an endocrine consequence secondary to starvation. In a modified framework for understanding the etiology and treatment of anorexia nervosa it is suggested that the condition emerges because neural mechanisms of reward and attention are engaged. The neural neuropeptide Y receptor system may be involved in the maintenance of the behavior of eating disorder patients because the localization of these receptors overlaps with the neural systems engaged in cue-conditioned eating in limbic and cortical areas. The eating behavior of patients with anorexia nervosa, and other eating disorders as well, is viewed as a cause of the psychological changes of the patients. Patients are trained to re-learn normal eating habits using external support and as they do, their symptoms, including the psychological symptoms, dissolve.

  4. Endocrine Dysregulation in Anorexia Nervosa Update

    PubMed Central

    2011-01-01

    Context: Anorexia nervosa is a primary psychiatric disorder with serious endocrine consequences, including dysregulation of the gonadal, adrenal, and GH axes, and severe bone loss. This Update reviews recent advances in the understanding of the endocrine dysregulation observed in this state of chronic starvation, as well as the mechanisms underlying the disease itself. Evidence Acquisition: Findings of this update are based on a PubMed search and the author's knowledge of this field. Evidence Synthesis: Recent studies have provided insights into the mechanisms underlying endocrine dysregulation in states of chronic starvation as well as the etiology of anorexia nervosa itself. This includes a more complex understanding of the pathophysiologic bases of hypogonadism, hypercortisolemia, GH resistance, appetite regulation, and bone loss. Nevertheless, the etiology of the disease remains largely unknown, and effective therapies for the endocrine complications and for the disease itself are lacking. Conclusions: Despite significant progress in the field, further research is needed to elucidate the mechanisms underlying the development of anorexia nervosa and its endocrine complications. Such investigations promise to yield important advances in the therapeutic approach to this disease as well as to the understanding of the regulation of endocrine function, skeletal biology, and appetite regulation. PMID:21976742

  5. Binge eating as a meaningful experience in bulimia nervosa and anorexia nervosa: a qualitative analysis.

    PubMed

    Eli, Karin

    2015-12-01

    Clinical studies describe binge eating as a reaction to hunger, negative affect, or the need to dissociate. However, little is known about the meanings that women with bulimia nervosa and anorexia nervosa associate with binge eating. To examine how women with anorexia nervosa and bulimia nervosa interpret their experiences of binge eating. Sixteen women who engaged in binge eating and had been diagnosed with anorexia nervosa, bulimia nervosa, or their subclinical variants were interviewed about their experiences of eating disorder. Interview data were analyzed using phenomenologically-informed thematic analysis. Participants described binge eating as a practice through which the self experiences a sense of release, and existential emptiness is replaced by overwhelming fullness. Meaningful experiences of release and fullness are central to binge eating in bulimia nervosa and anorexia nervosa, and may contribute to the long-term maintenance of this practice.

  6. Special Issue: Outcome of Anorexia Nervosa with Teenage Onset.

    ERIC Educational Resources Information Center

    Casper, Regina C., Ed.

    1996-01-01

    The articles of this special issue report on studies of the outcomes of treatment of adolescent anorexia nervosa. These studies leave no doubt about the mortality risk and debilitating nature of chronic anorexia nervosa, but they do suggest that the prognosis, given expert treatment, is favorable for the most part. (SLD)

  7. Death Related Themes in Anorexia Nervosa: A Practical Exploration.

    ERIC Educational Resources Information Center

    Russell, Janice; And Others

    1990-01-01

    Explored death-related themes in psychodynamic etiology of anorexia nervosa by comparing anorexic adolescent patients (n=28) to age-matched controls (n=238). Results suggest that death-related themes are of significance in the understanding and management of anorexia nervosa. (Author/ABL)

  8. [Anorexia nervosa and its consequences on bone: a therapeutic challenge].

    PubMed

    Trombetti, Andrea; Richert, Laura; Rizzoli, René

    2007-06-13

    It has been estimated that osteoporosis is present in 20 to 50% of women with anorexia nervosa, with an increased fracture risk particularly at non vertebral sites. Thus, bone loss is a major clinical concern in anorexia nervosa patients, justifying systematic evaluation. However, evidence-based therapeutic options are limited.

  9. Anorexia Nervosa: A Misdiagnosis of the Adolescent Male.

    ERIC Educational Resources Information Center

    Svec, Henry

    1987-01-01

    Discusses rarity of anorexia nervosa among male population with primary reference to differences from female symptomatology. Presents case which implies that anorexia nervosa in the male may be a marker for other more severe pathology. Presents findings which suggest a diagnostic strategy based on familial, behavioral, environmental, educational,…

  10. Special Issue: Outcome of Anorexia Nervosa with Teenage Onset.

    ERIC Educational Resources Information Center

    Casper, Regina C., Ed.

    1996-01-01

    The articles of this special issue report on studies of the outcomes of treatment of adolescent anorexia nervosa. These studies leave no doubt about the mortality risk and debilitating nature of chronic anorexia nervosa, but they do suggest that the prognosis, given expert treatment, is favorable for the most part. (SLD)

  11. Death Related Themes in Anorexia Nervosa: A Practical Exploration.

    ERIC Educational Resources Information Center

    Russell, Janice; And Others

    1990-01-01

    Explored death-related themes in psychodynamic etiology of anorexia nervosa by comparing anorexic adolescent patients (n=28) to age-matched controls (n=238). Results suggest that death-related themes are of significance in the understanding and management of anorexia nervosa. (Author/ABL)

  12. Anorexia Nervosa: A Misdiagnosis of the Adolescent Male.

    ERIC Educational Resources Information Center

    Svec, Henry

    1987-01-01

    Discusses rarity of anorexia nervosa among male population with primary reference to differences from female symptomatology. Presents case which implies that anorexia nervosa in the male may be a marker for other more severe pathology. Presents findings which suggest a diagnostic strategy based on familial, behavioral, environmental, educational,…

  13. Symptoms, Causes and Possible Treatment of Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Odebunmi, Akin

    This document provides research findings, a discussion of etiology, case studies, and treatment approaches for anorexia nervosa. The research findings classify the anorexic patient by sex, age, presenting characteristics, socioeconomic status, premorbid personality, and cultural and familial characteristics. The etiology of anorexia nervosa is…

  14. A longitudinal investigation of mortality in anorexia nervosa and bulimia nervosa.

    PubMed

    Franko, Debra L; Keshaviah, Aparna; Eddy, Kamryn T; Krishna, Meera; Davis, Martha C; Keel, Pamela K; Herzog, David B

    2013-08-01

    OBJECTIVE Although anorexia nervosa has a high mortality rate, our understanding of the timing and predictors of mortality in eating disorders is limited. The authors investigated mortality in a long-term study of patients with eating disorders. METHOD Beginning in 1987, 246 treatment-seeking female patients with anorexia nervosa or bulimia nervosa were interviewed every 6 months for a median of 9.5 years to obtain weekly ratings of eating disorder symptoms, comorbidity, treatment participation, and psychosocial functioning. From January 2007 to December 2010 (median follow-up of 20 years), vital status was ascertained with a National Death Index search. RESULTS Sixteen deaths (6.5%) were recorded (lifetime anorexia nervosa, N=14; bulimia nervosa with no history of anorexia nervosa, N=2). The standardized mortality ratio was 4.37 (95% CI=2.4-7.3) for lifetime anorexia nervosa and 2.33 (95% CI=0.3-8.4) for bulimia nervosa with no history of anorexia nervosa. Risk of premature death among patients with lifetime anorexia nervosa peaked within the first 10 years of follow-up, resulting in a standardized mortality ratio of 7.7 (95% CI=3.7-14.2). The standardized mortality ratio varied by duration of illness and was 3.2 (95% CI=0.9-8.3) for patients with lifetime anorexia nervosa for 0 to 15 years (4/119 died), and 6.6 (95% CI=3.2-12.1) for those with lifetime anorexia nervosa for >15 to 30 years (10/67 died). Multivariate predictors of mortality included alcohol abuse, low body mass index, and poor social adjustment. CONCLUSIONS These findings highlight the need for early identification and intervention and suggest that a long duration of illness, substance abuse, low weight, and poor psychosocial functioning raise the risk for mortality in anorexia nervosa.

  15. Anorexia nervosa and bulimia nervosa: brains, bones and breeding.

    PubMed

    Starr, Taylor B; Kreipe, Richard E

    2014-05-01

    Recent research has modified both the conceptualization and treatment of eating disorders. New diagnostic criteria reducing the "not otherwise specified" category should facilitate the early recognition and treatment of anorexia nervosa (AN) and bulimia nervosa (BN). Technology-based studies identify AN and BN as "brain circuit" disorders; epidemiologic studies reveal that the narrow racial, ethnic and income profile of individuals no longer holds true for AN. The major organs affected long term-the brain and skeletal system-both respond to improved nutrition, with maintenance of body weight the best predictor of recovery. Twin studies have revealed gene x environment interactions, including both the external (social) and internal (pubertal) environments of boys and of girls. Family-based treatment has the best evidence base for effectiveness for younger patients. Medication plays a limited role in AN, but a major role in BN. Across diagnoses, the most important medicine is food.

  16. Social support in patients with anorexia nervosa and bulimia nervosa.

    PubMed

    Tiller, J M; Sloane, G; Schmidt, U; Troop, N; Power, M; Treasure, J L

    1997-01-01

    To investigate the social support networks of patients with anorexia nervosa (AN) and bulimia nervosa (BN). Social support was measured using the Significant Others Scale for 44 patients with AN, 81 patients with BN, and 86 polytechnic students. Eating disorder patients had smaller social networks than the students. AN patients were significantly less likely than BN patients to have a spouse or partner as a support figure. Both AN and BN patients reported less actual emotional and practical support than students. AN patients perceived their social support to be adequate, whereas BN patients were dissatisfied with their support. Patients set lower ideals for support than the students. Social support was not correlated with duration of illness. AN and BN patients have deficient social networks. In BN patients there is disturbance in both the size and perceived adequacy of social relationships.

  17. Intellectual function in patients with anorexia nervosa and bulimia nervosa.

    PubMed

    Weider, Siri; Indredavik, Marit Saebø; Lydersen, Stian; Hestad, Knut

    2014-01-01

    This study aimed to examine cognitive function in individuals with anorexia nervosa (AN) and bulimia nervosa (BN) on the basis of IQ measures, indexes and subtests of the Wechsler Adult Intelligence Scale – Third Edition (WAIS-III). A total of 41 patients with AN, 40 patients with BN and 40 healthy controls (HC), matched for sex, age and education, were recruited consecutively to complete the WAIS-III. The AN group showed a significantly lower performance than the HC group on most global measures and on eight of the 13 administered subtests. Minor differences in verbal function were detected between the BN group and the HC group. The patients with eating disorders showed normal intellectual functions compared with the normative population. However, the AN group displayed a consistently lower performance than the matched HC group, which performed above normative means. The BN group performed at a level between that of the AN and HC groups.

  18. Sexual function of women suffering from anorexia nervosa and bulimia nervosa.

    PubMed

    Gonidakis, Fragiskos; Kravvariti, Vasilliki; Varsou, Eleftheria

    2015-01-01

    The cross-sectional study aimed at examining the sexual function of young adult women suffering from eating disorders. The authors interviewed 53 women (26 with anorexia nervosa and 27 with bulimia nervosa) and 58 female students. Each participant was administered the Female Sexual Function Index, the Eating Attitudes Test, the Body Shape Questionnaire, and the Beck Depression Inventory. Comparisons among the 3 groups showed that patients with anorexia nervosa scored lower in each Female Sexual Function Index subscale than did healthy controls. There was no significant difference between bulimia nervosa and healthy controls. Sexual functionality of patients with anorexia nervosa was correlated only with body mass index (r = 0.5, p =.01). Sexual functionality of patients with bulimia nervosa was correlated only with the Beck Depression Inventory (r = -0.4, p =.03) Patients with anorexia nervosa had more disturbed sexual function than did controls. Sexual function can be related to the level of starvation and symptoms of depression.

  19. [Anorexia nervosa: study method and sleep analysis].

    PubMed

    Cervera, S; Zapata, R; Gual, P; Quintanilla, B

    1989-01-01

    By studying anorexia nervosa with an Integrated Inventory and the quality and the quantity of sleep applying Hauri's scale for the analysis of dream contents, the sleeping habits of 50 anorexic patients who were under treatment have been studied. The results show that sleep in these patients is similar and sometimes better in quantity and quality than those in the control group. Their dreams are characterized by an almost total absence of sexual, aggressive and alimentary contents, and that reality, active participation, unpleasant feelings and sensory-perceptive elements are predominant.

  20. An overview of anorexia nervosa in males.

    PubMed

    Wooldridge, Tom; Lytle, Pauline Polly

    2012-01-01

    This article presents an integrative overview of existing research on anorexia nervosa (AN) in adolescent males. AN is commonly thought of as a female disorder. Even though as much as 25% of the clinical population is male, research on AN in males is limited. Additionally, most conceptualizations of male AN emphasize a single etiological factor and, therefore, produce treatments that fail to address it as a global phenomenon. In contrast, an integrative understanding that incorporates research on the familial, biological, cultural, and psychodynamic elements involved in male AN encourages treatment that comprehensively addresses the disorder.

  1. Endocrinology of anorexia nervosa in young people: recent insights.

    PubMed

    Singhal, Vibha; Misra, Madhusmita; Klibanski, Anne

    2014-02-01

    Anorexia nervosa is among the most prevalent chronic medical conditions in young adults. It has acute as well as long-term consequences, some of which, such as low bone mineral density (BMD), are not completely reversible even after weight restoration. This review discusses our current understanding of endocrine consequences of anorexia nervosa. Anorexia nervosa is characterized by changes in multiple neuroendocrine axes including acquired hypogonadotropic hypogonadism, growth hormone resistance with low insulin-like growth factor-1 (likely mediated by fibroblast growth factor-1), relative hypercortisolemia, alterations in adipokines such as leptin, adiponectin and resistin, and gut peptides including ghrelin, PYY and amylin. These changes in turn contribute to low BMD. Studies in anorexia nervosa have demonstrated abnormalities in bone microarchitecture and strength, and an association between increased marrow fat and decreased BMD. One study in adolescents reported an improvement in BMD following physiologic estrogen replacement, and another in adults demonstrated improved BMD following risedronate administration. Brown adipose tissue is reduced in anorexia nervosa, consistent with an adaptive response to the energy deficit state. Anorexia nervosa is associated with widespread physiologic adaptations to the underlying state of undernutrition. Hormonal changes in anorexia nervosa affect BMD adversely. Further investigation is underway to optimize therapeutic strategies for low BMD.

  2. Endocrinology of anorexia nervosa in young people: recent insights

    PubMed Central

    Singhal, Vibha; Misra, Madhusmita; Klibanski, Anne

    2014-01-01

    Purpose of review Anorexia nervosa is among the most prevalent chronic medical conditions in young adults. It has acute as well as long-term consequences, some of which, such as low bone mineral density (BMD), are not completely reversible even after weight restoration. This review discusses our current understanding of endocrine consequences of anorexia nervosa. Recent findings Anorexia nervosa is characterized by changes in multiple neuroendocrine axes including acquired hypogonadotropic hypogonadism, growth hormone resistance with low insulin-like growth factor-1 (likely mediated by fibroblast growth factor-1), relative hypercortisolemia, alterations in adipokines such as leptin, adiponectin and resistin, and gut peptides including ghrelin, PYY and amylin. These changes in turn contribute to low BMD. Studies in anorexia nervosa have demonstrated abnormalities in bone microarchitecture and strength, and an association between increased marrow fat and decreased BMD. One study in adolescents reported an improvement in BMD following physiologic estrogen replacement, and another in adults demonstrated improved BMD following risedronate administration. Brown adipose tissue is reduced in anorexia nervosa, consistent with an adaptive response to the energy deficit state. Summary Anorexia nervosa is associated with widespread physiologic adaptations to the underlying state of undernutrition. Hormonal changes in anorexia nervosa affect BMD adversely. Further investigation is underway to optimize therapeutic strategies for low BMD. PMID:24275621

  3. Applying neurobiology to the treatment of adults with anorexia nervosa.

    PubMed

    Hill, Laura; Peck, Stephanie Knatz; Wierenga, Christina E; Kaye, Walter H

    2016-01-01

    Anorexia nervosa is a severe, biologically based brain disorder with significant medical complications. It is critical that new, effective treatments are developed to interrupt the persistent course of the illness due to the medical and psychological sequelae. Several psychosocial, behavioral and pharmacologic interventions have been investigated in adult anorexia nervosa; however, evidence shows that their impact is weak and treatment effects are generally small. This paper describes a new neurobiological anorexia nervosa model that shifts focus from solely external influences, such as social and family, to include internal influences that integrate genetic and neurobiological contributions, across the age span. The model serves as a theoretical structure for a new, five-day treatment, outlined in this paper, targeting anorexia nervosa temperament, which integrates neurobiological dimensions into evidence-based treatment interventions. The treatment is in two phases. Phase I is a five day, 40 hour treatment for anorexia nervosa adults. Phase II is the follow-up and is currently being developed. Preliminary qualitative acceptability data on 37 adults with anorexia nervosa and 60 supports (e.g., spouses, parents, aunts, friends, partners, children of anorexia nervosa adults) are promising from Phase I. Clients with anorexia nervosa and their supports report that learning neurobiological facts improved their understanding of the illness and helped equip them with better tools to manage anorexia nervosa traits and symptoms. In addition, nutritional knowledge changed significantly. This is the first neurobiologically based, five-day treatment for adults with anorexia nervosa and their supports. It is a new model that outlines underlying genetic and neurobiological contributions to anorexia nervosa that serves as a foundation to treat both traits and symptoms. Preliminary qualitative findings are promising, with both clients and supports reporting that the

  4. Complications of pre-operative anorexia nervosa in bariatric surgery.

    PubMed

    Shear, Matthew; DeFilippis, Ersilia M

    2015-01-01

    It is important to recognise that patients who seek weight loss surgery may have a history of restrictive eating or anorexia nervosa. The following case report describes a woman with a history of anorexia nervosa who underwent Roux-en-Y gastric bypass surgery. Her eating disorder symptoms subsequently reappeared and were largely resistant to treatment. To the best of our knowledge, this is the first case report of a bariatric surgery patient with a prior history of anorexia nervosa. Further research is required to determine how best to select patients for weight loss surgery.

  5. [Pseudo-myasthenic myopathy in a woman with anorexia nervosa].

    PubMed

    Dupond, J-L; Meaux-Ruault, N; Hafsaoui, C; Gil, H; Curlier, E; Fery-Blanco, C; Magy-Bertrand, N

    2007-11-01

    Skeletal myopathy, although foreseeable in severe malnutrition, has been rarely reported in patients with anorexia nervosa. We report a case of oculo-oropharyngeal myopathy mimicking myasthenia in a 42-year-old woman with an history of anorexia nervosa, completely reversible after refeeding with carbohydrate diet, mainly chocolate. Nutritional myopathies are not well known and therefore rarely looked for in patients with anorexia nervosa. Classical presentation is a myogenic syndrome with severe type 2 fibre atrophy and biochemical characteristics similar to Mac Ardle's disease. A clinical form mimicking myasthenia gravis has never been reported. Refeeding programme leads to total recovery within a few days.

  6. Self-focused Attention in Anorexia Nervosa

    PubMed Central

    Zucker, Nancy; Wagner, H. Ryan; Merwin, Rhonda; Bulik, Cynthia M.; Moskovich, Ashley; Keeling, Lori; Hoyle, Rick

    2015-01-01

    Objective The clinical presentation of anorexia nervosa (AN) is characterized by preoccupation with body experience, intrusive concerns regarding shape, and pathological fears of weight gain. These symptoms are suggestive of unrelenting self-focused attention. No research to date has characterized self-focused attention (SFA) in AN nor examined neurocognitive features that may facilitate an excessive, rigid, or sustained focus on one’s appearance. Method This study examined SFA, body image disturbance, and executive functioning in women with current anorexia nervosa (AN-C; n = 24), a history of AN who were weight-restored at the time of the study weight-restored (WR; n = 19), and healthy controls (n = 24). Results Private and public SFA were highest among WR and lowest among AN-C. Shape concerns were negatively correlated with SFA, especially among AN-C, after controlling for depression and social anxiety symptoms. Discussion Lower levels of SFA among AN-C were unexpected and suggest the acute state of AN may lessen pathological self-focus, negatively reinforcing symptoms. In addition, body image concerns may distract from general SFA. Deficits in executive attention may explain these findings, as each one unit increase in perseverative errors among AN-C participants was associated with an almost one-half unit decrease in public SFA. PMID:24899215

  7. Anorexia nervosa: treatment expectations - a qualitative study.

    PubMed

    Paulson-Karlsson, Gunilla; Nevonen, Lauri

    2012-01-01

    Anorexia nervosa is a serious illness with a high mortality rate, a poor outcome, and no empirically supported treatment of choice for adults. Patients with anorexia nervosa strive for thinness in order to obtain self-control and are ambivalent toward change and toward treatment. In order to achieve a greater understanding of patients' own understanding of their situation, the aim of this study was to examine the expectations of potential anorexic patients seeking treatment at a specialized eating-disorder unit. A qualitative study design was used. It comprised 15 women between 18 and 25 years of age waiting to be assessed before treatment. The initial question was, "What do you expect, now that you are on the waiting list for a specialized eating-disorder unit?" A content analysis was used, and the text was coded, categorized according to its content, and further interpreted into a theme. FROM THE RESULTS EMERGED THREE MAIN CATEGORIES OF WHAT PARTICIPANTS EXPECTED: "treatment content," "treatment professionals," and "treatment focus." The overall theme, "receiving adequate therapy in a collaborative therapeutic relationship and recovering," described how the participants perceived that their expectations could be fulfilled. Patients' expectations concerning distorted thoughts, eating behaviors, a normal, healthy life, and meeting with a professional with knowledge and experience of eating disorders should be discussed before treatment starts. In the process of the therapeutic relationship, it is essential to continually address patients' motivations, in order to understand their personal motives behind what drives their expectations and their desire to recover.

  8. Body checking behaviors in anorexia nervosa.

    PubMed

    Calugi, Simona; El Ghoch, Marwan; Dalle Grave, Riccardo

    2017-01-24

    The study aimed to assess the trajectories of change in body checking over time and the change in eating disorder and general psychopathology in patients with anorexia nervosa treated with inpatient enhanced cognitive behavioral therapy (CBT-E). Sixty-six adult patients with anorexia nervosa were recruited from consecutive referrals to a community-based eating disorder clinic. Body mass index, Eating Disorder Examination, Brief Symptom Inventory, and Body Checking Questionnaire (BCQ) scores were recorded at admission (T0), end of treatment (T1), and 6- and 12-month follow-ups (T2 and T3, respectively). The BCQ was also administered at a single time point to an age-matched healthy female comparison participants group (N = 182). In comparison with comparison participants, patients had higher global BCQ scores at T0. However, mean patient scores for global BCQ administered at T1, T2, and T3 were significantly lower than that measured at baseline in the comparison participants group. The change in BCQ was significantly associated to short- and long-term improvements in eating disorder and general psychopathology. The association between change in body checking and the trajectories of change of eating disorder psychopathology supports the potential usefulness of the CBT-E strategy for reducing shape and weight concerns by addressing body checking.

  9. Perioperative management of severe anorexia nervosa.

    PubMed

    Hirose, K; Hirose, M; Tanaka, K; Kawahito, S; Tamaki, T; Oshita, S

    2014-02-01

    As the prevalence of anorexia nervosa (AN) increased, surgery in severe AN patients also increased in the 2000s. We experienced a surgical case of a patient with severe AN, showing an extremely low BMI of 8.6 kg m(-2). We investigated the problems associated with this case and propose criteria to manage severe AN. We endeavour to report on the perioperative management of rare and severe symptoms and surgical indications of severely malnourished patients. All published reports were identified through comprehensive searches using PubMed, BioMedLib, and the Japan Medical Abstracts Society with the following terms and keywords: 'anorexia nervosa', 'eating disorder', 'hypoglycaemia', 'leucocytopaenia', 'gelatinous bone marrow', 'surgery', and 'operation'. In cases of AN with a BMI under 13 kg m(-2), marked hypoglycaemia, leucocytopaenia <3.0×10(9) litre(-1), or both, potentially fatal complications frequently occur. Accordingly, patients need strict nutritional support to avoid re-feeding syndrome until surgery. During the course of anaesthesia, careless loading of glucose or catecholamine may lead to disturbance of electrolytes or fatal arrhythmia. Intensive care and early feeding as soon as possible after surgery are important to prevent surgical site infection. Although not many perioperative cases of AN have been reported, clinicians must be aware of the danger and the causes of mortality in critical cases. Thus, the decision to undertake surgery must be taken carefully and close perioperative coordination among physicians, surgeons, psychiatrists, anaesthesiologists, and intensivists is essential.

  10. Altered cortical excitability in anorexia nervosa.

    PubMed

    Khedr, E M; El Fetoh, N A; El Bieh, E; Ali, A M; Karim, A A

    2014-09-01

    Recent EEG and positron emission tomography (PET) studies have reported hyperactivation of the right hemisphere in anorexia nervosa (AN). The aim of the present study was to test this notion by examining cortical excitability in subjects with AN using transcranial magnetic stimulation (TMS). We investigated thirteen patients meeting the DSM IV diagnostic criteria for AN and 14 controls age and sex matched. Each subject was assessed clinically using the Eating Disorder Inventory (EDI), the Eating Attitude Test (EAT) and Beck's Depression Inventory (BDI-II). TMS measures involved resting and active motor thresholds (RMT, AMT) as well as motor evoked potentials (MEP), cortical silent period duration (CSP), transcallosal inhibition (TCI), and short latency intracortical inhibition (SICI) of the first dorsal interosseous muscle (FDI) were assessed. Cortical esophageal MEP latencies (CL) were also recorded. The RMT and MEP onset latency of the FDI and the esophagus as well as duration of the TCI were significantly reduced in anorexic patients compared to the control group. There were no significant differences neither in AMT nor CSP between patients and controls. Moreover, we found significant negative correlations between the EAT scores and RMT, and TCI duration. Although anorexic patients had significantly higher BDI score, there was no correlation between it and cortical excitability. Anorexic individuals are characterized by pathologically increased motor and esophageal cortical excitability that significantly correlates with clinical symptoms of anorexia nervosa. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  11. Diagnosed Anxiety Disorders and the Risk of Subsequent Anorexia Nervosa: A Danish Population Register Study.

    PubMed

    Meier, Sandra M; Bulik, Cynthia M; Thornton, Laura M; Mattheisen, Manuel; Mortensen, Preben B; Petersen, Liselotte

    2015-11-01

    Anxiety disorders and anorexia nervosa are frequently acknowledged to be highly comorbid conditions, but still, little is known about the clinical and aetiological cohesion of specific anxiety diagnoses and anorexia nervosa. Using the comprehensive Danish population registers, we aimed to determine the risk of anorexia nervosa in patients with register-detected severe anxiety disorders. We also explored whether parental psychopathology was associated with offspring's anorexia nervosa. Anxiety disorders increased the risk of subsequent anorexia nervosa, with the highest risk observed in obsessive-compulsive disorder. Especially, male anxiety patients were at an increased risk for anorexia nervosa. Furthermore, an increased risk was observed in offspring of fathers with panic disorder. A diagnosis of an anxiety disorder, specifically obsessive-compulsive disorder, constitutes a risk factor for subsequent diagnosis of anorexia nervosa. These observations support the notion that anxiety disorders and anorexia nervosa share etiological mechanisms and/or that anxiety represents one developmental pathway to anorexia nervosa.

  12. The Treatment of Anorexia Nervosa and Bulimia: A Multidimensional Group Approach.

    ERIC Educational Resources Information Center

    Richards, P. Scott

    This paper defines the eating disorders of anorexia nervosa, bulimia, and bulimia nervosa, a bulimic subtype of anorexia nervosa. The diagnosis of these disorders is discussed and similarities and differences among the three disorders are reviewed. Etiological factors are considered and current trends in treatment of anorexia nervosa, bulimia, and…

  13. The Treatment of Anorexia Nervosa and Bulimia: A Multidimensional Group Approach.

    ERIC Educational Resources Information Center

    Richards, P. Scott

    This paper defines the eating disorders of anorexia nervosa, bulimia, and bulimia nervosa, a bulimic subtype of anorexia nervosa. The diagnosis of these disorders is discussed and similarities and differences among the three disorders are reviewed. Etiological factors are considered and current trends in treatment of anorexia nervosa, bulimia, and…

  14. Physical activity in patients with anorexia nervosa.

    PubMed

    Achamrah, Najate; Coëffier, Moïse; Déchelotte, Pierre

    2016-05-01

    Anorexia nervosa (AN) is often associated with physical hyperactivity. Recent studies have established links between anorexia and hyperactivity, suggesting the existence of commonalities in neural pathways. How physical activity should be managed during the clinical care of patients with anorexia remains controversial. This review first focuses on the implication of hyperactivity in the pathophysiology of AN. Hyperactivity during refeeding of patients with AN has been associated with increased energy needs to achieve weight gain, poorer clinical outcome, longer hospitalization, and increased psychiatric comorbidity. This typically leads to the prescription of bed rest. However, current knowledge suggests that preserving some kind of physical activity during refeeding of patients with AN should be safe and beneficial for the restoration of body composition, the preservation of bone mineral density, and the management of mood and anxiety. In the absence of standardized guidelines, it is suggested here that physical activity during refeeding of patients with AN should be personalized according to the physical and mental status of each patient. More research is needed to assess whether programmed physical activity may be a beneficial part of the treatment of AN.

  15. Recovery from anorexia nervosa: a Durkheimian interpretation.

    PubMed

    Garrett, C J

    1996-11-01

    Attempts to explain "eating disorders" in contemporary western society have concentrated on aetiology at the expense of resolution. Most "recovered" anorectics, however, question medical definitions of "anorexia nervosa" and clinical criteria for recovery. This article refers to a study of 32 people at different stages of the recovery process, to reconceptualize the problem in sociological terms. Durkheim's account of asceticism offers a fresh interpretive framework in which anorexia and recovery are understood as the negative and positive phases respectively of a ritual of self-transformation. In western culture, where appropriate myths and rituals of re-incorporation are not readily available following a period of symbolic fasting, it is not surprising that recovery from anorexia is not automatic. Participants in this study referred to anorexia as a spiritual quest and for them recovery involved a re-discovery (or creation) of a threefold connection: inner, with others and with "nature". These connections are, for them, the defining features of spirituality. The negative phase of the ritualistic quest (anorexia) involves a confrontation with the inevitability of death as a condition of the positive phase (recovery) in which people actively choose life. This new theoretical approach provides a non-medicalized understanding of anorexia and simultaneously enables a re-interpretation of the fasting of medieval women saints. Recent scholarship in this area is re-evaluated to demonstrate that the continuity between asceticism and anorexia lies in the use of food as a metaphorical attempt to confront the universal problem of one's own mortality. In certain historical situations, asceticism served a socially valuable symbolic purpose. In contemporary society, however, this meaning is no longer available. Instead, it is recovery which constitutes the active and metaphorical "rebellion" against forces of social control. Finally, the work of Van Gennep is used to explore

  16. Anorexia Nervosa: Why Do Some People Starve Themselves?

    ERIC Educational Resources Information Center

    Chng, Chwee Lye

    1983-01-01

    Written for the school and/or community health professional, this article defines anorexia nervosa, discusses its prevalence, causes, symptoms, and treatment, and draws implications about health education's role in its prevention and treatment. (Author/CJ)

  17. Anorexia Nervosa: The More It Grows, the More It Starves.

    ERIC Educational Resources Information Center

    Oldis, Katherine O.

    1986-01-01

    Presents a bibliography of books on anorexia nervosa that are appropriate for young adults. Includes fiction, autobiographies, informational books, and books on the related topics of bulimia, bulimarexia, and therapy. (EL)

  18. Anorexia Nervosa: The More It Grows, the More It Starves.

    ERIC Educational Resources Information Center

    Oldis, Katherine O.

    1986-01-01

    Presents a bibliography of books on anorexia nervosa that are appropriate for young adults. Includes fiction, autobiographies, informational books, and books on the related topics of bulimia, bulimarexia, and therapy. (EL)

  19. Anorexia Nervosa: Why Do Some People Starve Themselves?

    ERIC Educational Resources Information Center

    Chng, Chwee Lye

    1983-01-01

    Written for the school and/or community health professional, this article defines anorexia nervosa, discusses its prevalence, causes, symptoms, and treatment, and draws implications about health education's role in its prevention and treatment. (Author/CJ)

  20. Bradycardia: an important physical finding in anorexia nervosa.

    PubMed

    Portilla, Maria G

    2011-03-01

    Cardiovascular complications are common in patients with anorexia nervosa, an eating disorder resulting in severe malnutrition that affects multiple organ systems. Sinus bradycardia is the most common cardiovascular physical finding and the most common arrhythmia in patients with anorexia nervosa. It is important to appreciate the significance of sinus bradycardia in this clinical setting because it may be associated with sudden death, especially in the presence of other arrhythmias or EKG abnormalities, such as prolongation of the QTc interval. Since sinus bradycardia can occur in up to 95% of patients with anorexia nervosa, its clinical correlation with more lethal arrhythmias cannot be overemphasized. Physicians must be aware of the common cardiac findings on the physical examination of a patient with anorexia nervosa in order to refer those patients to tertiary care centers for treatment by eating disorder specialists.

  1. Could dopamine agonists aid in drug development for anorexia nervosa?

    PubMed

    Frank, Guido K W

    2014-01-01

    Anorexia nervosa is a severe psychiatric disorder most commonly starting during the teenage-years and associated with food refusal and low body weight. Typically there is a loss of menses, intense fear of gaining weight, and an often delusional quality of altered body perception. Anorexia nervosa is also associated with a pattern of high cognitive rigidity, which may contribute to treatment resistance and relapse. The complex interplay of state and trait biological, psychological, and social factors has complicated identifying neurobiological mechanisms that contribute to the illness. The dopamine D1 and D2 neurotransmitter receptors are involved in motivational aspects of food approach, fear extinction, and cognitive flexibility. They could therefore be important targets to improve core and associated behaviors in anorexia nervosa. Treatment with dopamine antagonists has shown little benefit, and it is possible that antagonists over time increase an already hypersensitive dopamine pathway activity in anorexia nervosa. On the contrary, application of dopamine receptor agonists could reduce circuit responsiveness, facilitate fear extinction, and improve cognitive flexibility in anorexia nervosa, as they may be particularly effective during underweight and low gonadal hormone states. This article provides evidence that the dopamine receptor system could be a key factor in the pathophysiology of anorexia nervosa and dopamine agonists could be helpful in reducing core symptoms of the disorder. This review is a theoretical approach that primarily focuses on dopamine receptor function as this system has been mechanistically better described than other neurotransmitters that are altered in anorexia nervosa. However, those proposed dopamine mechanisms in anorexia nervosa also warrant further study with respect to their interaction with other neurotransmitter systems, such as serotonin pathways.

  2. Could Dopamine Agonists Aid in Drug Development for Anorexia Nervosa?

    PubMed Central

    Frank, Guido K. W.

    2014-01-01

    Anorexia nervosa is a severe psychiatric disorder most commonly starting during the teenage-years and associated with food refusal and low body weight. Typically there is a loss of menses, intense fear of gaining weight, and an often delusional quality of altered body perception. Anorexia nervosa is also associated with a pattern of high cognitive rigidity, which may contribute to treatment resistance and relapse. The complex interplay of state and trait biological, psychological, and social factors has complicated identifying neurobiological mechanisms that contribute to the illness. The dopamine D1 and D2 neurotransmitter receptors are involved in motivational aspects of food approach, fear extinction, and cognitive flexibility. They could therefore be important targets to improve core and associated behaviors in anorexia nervosa. Treatment with dopamine antagonists has shown little benefit, and it is possible that antagonists over time increase an already hypersensitive dopamine pathway activity in anorexia nervosa. On the contrary, application of dopamine receptor agonists could reduce circuit responsiveness, facilitate fear extinction, and improve cognitive flexibility in anorexia nervosa, as they may be particularly effective during underweight and low gonadal hormone states. This article provides evidence that the dopamine receptor system could be a key factor in the pathophysiology of anorexia nervosa and dopamine agonists could be helpful in reducing core symptoms of the disorder. This review is a theoretical approach that primarily focuses on dopamine receptor function as this system has been mechanistically better described than other neurotransmitters that are altered in anorexia nervosa. However, those proposed dopamine mechanisms in anorexia nervosa also warrant further study with respect to their interaction with other neurotransmitter systems, such as serotonin pathways. PMID:25988121

  3. Recovery From Anorexia Nervosa and Bulimia Nervosa at 22-Year Follow-Up.

    PubMed

    Eddy, Kamryn T; Tabri, Nassim; Thomas, Jennifer J; Murray, Helen B; Keshaviah, Aparna; Hastings, Elizabeth; Edkins, Katherine; Krishna, Meera; Herzog, David B; Keel, Pamela K; Franko, Debra L

    2017-02-01

    The course of eating disorders is often protracted, with fewer than half of adults achieving recovery from anorexia nervosa or bulimia nervosa. Some argue for palliative management when duration exceeds a decade, yet outcomes beyond 20 years are rarely described. This study investigates early and long-term recovery in the Massachusetts General Hospital Longitudinal Study of Anorexia and Bulimia Nervosa. Females with DSM-III-R/DSM-IV anorexia nervosa or bulimia nervosa were assessed at 9 and at 20 to 25 years of follow-up (mean [SD] = 22.10 [1.10] years; study initiated in 1987, last follow-up conducted in 2013) via structured clinical interview (Longitudinal Interval Follow-Up Evaluation of Eating Disorders [LIFE-EAT-II]). Seventy-seven percent of the original cohort was re-interviewed, and multiple imputation was used to include all surviving participants from the original cohort (N = 228). Kaplan-Meier curves estimated recovery by 9-year follow-up, and McNemar test examined concordance between recovery at 9-year and 22-year follow-up. At 22-year follow-up, 62.8% of participants with anorexia nervosa and 68.2% of participants with bulimia nervosa recovered, compared to 31.4% of participants with anorexia nervosa and 68.2% of participants with bulimia nervosa by 9-year follow-up. Approximately half of those with anorexia nervosa who had not recovered by 9 years progressed to recovery at 22 years. Early recovery was associated with increased likelihood of long-term recovery in anorexia nervosa (odds ratio [OR] = 10.5; 95% CI, 3.77-29.28; McNemar χ²₁ = 31.39; P < .01) but not in bulimia nervosa (OR = 1.0; 95% CI, 0.49-2.05; McNemar χ²₁ = 0; P = 1.0). At 22 years, approximately two-thirds of females with anorexia nervosa and bulimia nervosa were recovered. Recovery from bulimia nervosa happened earlier, but recovery from anorexia nervosa continued over the long term, arguing against the implementation of palliative care for most individuals with eating

  4. Lay theories of anorexia nervosa: a discourse analytic study.

    PubMed

    Benveniste, J; Lecouteur, A; Hepworth, J

    1999-01-01

    Previous studies on lay theories of anorexia nervosa have examined the 'accuracy' of lay knowledge, and the identification of factors by family and friends that would encourage early interventions (Huon, Brown, & Morris, 1988, 7, 239-252; Murray, Touyz, & Beumont, 1990, 9, 87-93). In contrast to these approaches, we examine lay theories of anorexia nervosa using a critical psychology perspective. We argue that the use of a discourse analysis methodology enables the examination of the construction of lay theories through dominant concepts and ideas. Ten semi-structured interviews with five women and five men aged between 15 and 25 years were carried out. Participants were asked questions about three main aspects of anorexia nervosa: aetiology, treatment and relationship to gender. Each interview was analysed in terms of the structure, function and variability of discourse. Three discourses: sociocultural, individual and femininity, are discussed in relation to the interview questions. We conclude that, in this study, lay theories of anorexia nervosa were structured through key discourses that maintained a separation between sociocultural aspects of anorexia nervosa and individual psychology. This separation exists in dominant psychomedical conceptualizations of anorexia nervosa, reinforcing the concept that it is a form of psychopathology.

  5. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa.

    PubMed

    Harrington, Brian C; Jimerson, Michelle; Haxton, Christina; Jimerson, David C

    2015-01-01

    Eating disorders are life-threatening conditions that are challenging to address; however, the primary care setting provides an important opportunity for critical medical and psychosocial intervention. The recently published Diagnostic and Statistical Manual of Mental Disorders, 5th ed., includes updated diagnostic criteria for anorexia nervosa (e.g., elimination of amenorrhea as a diagnostic criterion) and for bulimia nervosa (e.g., criterion for frequency of binge episodes decreased to an average of once per week). In addition to the role of environmental triggers and societal expectations of body size and shape, research has suggested that genes and discrete biochemical signals contribute to the development of eating disorders. Anorexia nervosa and bulimia nervosa occur most often in adolescent females and are often accompanied by depression and other comorbid psychiatric disorders. For low-weight patients with anorexia nervosa, virtually all physiologic systems are affected, ranging from hypotension and osteopenia to life-threatening arrhythmias, often requiring emergent assessment and hospitalization for metabolic stabilization. In patients with frequent purging or laxative abuse, the presence of electrolyte abnormalities requires prompt intervention. Family-based treatment is helpful for adolescents with anorexia nervosa, whereas short-term psychotherapy, such as cognitive behavior therapy, is effective for most patients with bulimia nervosa. The use of psychotropic medications is limited for anorexia nervosa, whereas treatment studies have shown a benefit of antidepressant medications for patients with bulimia nervosa. Treatment is most effective when it includes a multidisciplinary, teambased approach.

  6. Time trends in age at onset of anorexia nervosa and bulimia nervosa.

    PubMed

    Favaro, Angela; Caregaro, Lorenza; Tenconi, Elena; Bosello, Romina; Santonastaso, Paolo

    2009-12-01

    This study aims to explore the time trends in age at onset of anorexia nervosa and bulimia nervosa. The sample was composed of 1,666 anorexia nervosa subjects and 793 bulimia nervosa subjects (according to DSM-IV criteria) without previous anorexia nervosa consecutively referred to our outpatient unit in the period between 1985 and 2008. Time trends in illness onset were analyzed according to the year of birth of subjects. In both anorexia nervosa and bulimia nervosa, age at onset showed a significant decrease according to year of birth. A regression model showed a significant independent effect of socioeconomic status, age at menarche, and number of siblings in predicting age at onset lower than 16 years. Age at onset of anorexia nervosa and bulimia nervosa is decreasing in younger generations. The implications of our findings in terms of long-term outcome remain to be understood. Biologic and sociocultural factors explaining this phenomenon need to be explored in future studies. Copyright 2009 Physicians Postgraduate Press, Inc.

  7. Neuropsychological function in patients with anorexia nervosa or bulimia nervosa.

    PubMed

    Weider, Siri; Indredavik, Marit Saebø; Lydersen, Stian; Hestad, Knut

    2015-05-01

    This study explored the neuropsychological performance of patients diagnosed with anorexia nervosa (AN) or bulimia nervosa (BN) compared with healthy controls (HCs). An additional aim was to investigate the effect of several possible mediators on the association between eating disorders (EDs) and cognitive function. Forty patients with AN, 39 patients with BN, and 40 HCs who were comparable in age and education were consecutively recruited to complete a standardized neuropsychological test battery covering the following cognitive domains: verbal learning and memory, visual learning and memory, speed of information processing, visuospatial ability, working memory, executive function, verbal fluency, attention/vigilance, and motor function. The AN group scored significantly below the HCs on eight of the nine measured cognitive domains. The BN group also showed inferior performance on six cognitive domains. After adjusting for possible mediators, the nadir body mass index (lowest lifetime BMI) and depressive symptoms explained all findings in the BN group. Although this adjustment reduced the difference between the AN and HC groups, the AN group still performed worse than the HCs regarding verbal learning and memory, visual learning and memory, visuospatial ability, working memory, and executive functioning. Patients with EDs scored below the HCs on several cognitive function measures, this difference being most pronounced for the AN group. The nadir BMI and depressive symptoms had strong mediating effects. Longitudinal studies are needed to identify the importance of weight restoration and treatment of depressive symptoms in the prevention of a possible cognitive decline. © 2014 Wiley Periodicals, Inc.

  8. [Anesthesia in patients with anorexia nervosa and bulimia nervosa].

    PubMed

    Zenker, J; Hagenah, U; Rossaint, R

    2010-03-01

    Eating disorders are typical diseases of adolescence and early adulthood. About 1-3% of female juveniles suffer from anorexia nervosa (AN) or bulimia nervosa (BN). Today AN is still the psychiatric disease with the highest mortality rate. The peri-operative mortality rate of patients suffering from AN is in the range up to 15%. The beginning of AN is a lingering process and the majority of patients show increasingly restrictive eating habits ending in cachexia. Patients are obsessed by the predominant idea of being obese in spite of having a significant underweight. Patients suffering from bulimia break the strict regimen by eating enormous amounts of high calorie food. Such eating attacks are followed by weight reducing measures, mostly vomiting. Most of the physical changes caused by AN are due to starvation and loss of weight. The most significant medical complications are alterations of the cardiovascular system accompanied by decreasing contractility of the heart, bradycardia, electrocardiographic changes as well as disequilibrium of electrolytic and water balance. Most of these symptoms can be reversed by putting on weight.

  9. Set shifting deficit in anorexia nervosa.

    PubMed

    Steinglass, Joanna E; Walsh, B Timothy; Stern, Yaakov

    2006-05-01

    Anorexia nervosa (AN) is a severe mental illness characterized in part by rigid thinking and ritualized behaviors involving eating and weight. Cognitive rigidity may play a role in the perpetuation of symptoms, and may provide information as to important brain-based abnormalities. Neuropsychological studies of patients with AN have shown cognitive dysfunction, but few have focused on cognitive flexibility. This study assessed set shifting in patients with AN, as a measure of cognitive flexibility. In this study, 15 patients with AN were compared with 11 healthy controls using a neuropsychological battery including the Wisconsin Card Sort Test (WCST). While patients with AN did not differ from controls on 5 measures of neuropsychological function, they made significantly more perseverative errors on the WCST, indicating a problem in set shifting. This finding suggests that patients with AN have a specific neurocognitive abnormality that may play a role in the development and persistence of this disorder.

  10. [Anorexia nervosa in boys and men].

    PubMed

    Ziora, Katarzyna; Oświecimska, Joanna; Szalecki, Mieczysław; Geisler, Gabriela; Broll-Waśka, Katarzyna; Kwiecień, Jarosław; Gorczyca, Piotr; Lukasik, Maria; Franiczek, Waldemar; Stojewska, Małgorzata; Dyduch, Antoni

    2006-01-01

    Anorexia nervosa (AN) is thought to appear predominantly in girls and young women. Twenty years ago the incidence of AN was considered as 1 boy to 10-15 girls. Recent data suggest that the girls to boys rate is 4:1. The most frequently AN in boys begins during puberty. Boys and young men reluctantly apply for help to medical professionals trying to hide their symptoms. The diagnosis of AN is established and the treatment is being performed only when they suffer from a marked loss of weight or a severe depression with suicidal thoughts. We report seven male patients with AN and review the differences in a course of this disease between male and female patients.

  11. [Eating disorders: anorexia nervosa, bulimia, binge eating].

    PubMed

    Langenbach, M; Huber, M

    2003-06-01

    We present an overview of three different eating disorders which seem to have an increasing prevalence, especially among young women between 12 and 20 years of age. Anorexia and bulimia nervosa are "threshold disorders" which usually become manifest for the first time during the transition from childhood to early adult life. Eating disorders are chronic disorders and often take a course of 6 or more years. Remission, improvements and symptom change can be expected even after many years of the disorder. Psychiatric comorbidity which occurs in more than 50% of eating disordered patients is of prime importance for prognosis. Depression, anxiety disorders, obsessive-compulsive disorders, and personality disorders are most common. There is a variety of complex in- and outpatient treatments with different components which have to be chosen according to the individual case.

  12. [The therapeutic challenge of anorexia nervosa].

    PubMed

    Jeammet, P

    1992-01-25

    Anorexia nervosa represents a typical paradox of adolescence. This paradox drives the adolescent to refuse what he fears he would need too much: this need seems threatening because it would make him dependent on the object of satisfaction which seems alienating to him. Thus, he becomes alienated to his refusal, which worsens the underlying need and increases the refusal. The life of the anorectic is centered on a passion for food and fear of bulimia. In fact, food focuses a greater "appetite" for recognition and to be the centre of attention. Beyond, and with, curing of the symptom, the treatment, by means of the weight contract, tends to resolve this paradox in which the anorectic tries to enclose us. To take up the challenge, the treatment must create the conditions for the emergence of pleasure in desiring what they need, without anxiety about their autonomy.

  13. Cognitive processing of emotions in anorexia nervosa.

    PubMed

    Torres, Sandra; Guerra, Marina Prista; Lencastre, Leonor; Roma-Torres, António; Brandão, Isabel; Queirós, Cristina; Vieira, Filipa

    2011-01-01

    This study attempts to explore the cognitive processing of emotions in anorexia nervosa (AN), based on the study of emotions felt and the assessment of meta-emotional abilities. Eighty patients with AN and a control group of 80 healthy female participants were screened for anxiety, depression and alexithymia and completed an experimental task designed to analyse the emotional experience and meta-emotional abilities. Despite presenting higher levels of alexithymia, participants with AN demonstrated they were able to imagine emotions in hypothetical situations and to identify and label them. The group of patients with AN revealed feeling more intense and internally based negative emotions in comparison with the control group, but this emotional pattern tends to occur in situations associated with food and weight. Findings on meta-emotional abilities suggested no global deficit in emotional processing, but rather, specific sensitivities pertaining to situations relevant to AN. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.

  14. Impaired social cognition in anorexia nervosa patients

    PubMed Central

    Hamatani, Sayo; Tomotake, Masahito; Takeda, Tomoya; Kameoka, Naomi; Kawabata, Masashi; Kubo, Hiroko; Tada, Yukio; Tomioka, Yukiko; Watanabe, Shinya; Ohmori, Tetsuro

    2016-01-01

    Background The purpose of this study was to investigate the characteristics of social cognition in patients with anorexia nervosa (AN). Methods Eighteen female patients with AN (mean age =35.4±8.6 years) and 18 female healthy controls (HC) (mean age =32.8±9.4 years) participated in the study. Their social cognition was assessed with the Social Cognition Screening Questionnaire (SCSQ). Results The results showed that total score of the SCSQ and scores of theory of mind and metacognition were significantly lower in AN group than those in HC group. Moreover, significant differences in theory of mind, metacognition, and total score of the SCSQ remained when the effects of depression, anxiety, and starvation were eliminated statistically. Conclusion These results suggest that patients with AN may have difficulty inferring other people’s intention and also monitoring and evaluating their own cognitive activities. Therefore, these features may explain some aspects of the pathology of AN. PMID:27785029

  15. [The level of self-esteem in patients with anorexia nervosa].

    PubMed

    Talarczyk, M; Rajewski, A

    2001-01-01

    The aim of this work was to measure the self-acceptance level in patients with anorexia nervosa. The obtained results indicate that patients with anorexia nervosa have lower self-acceptance level in comparison with the control group.

  16. Anorexia nervosa and bulimia nervosa: A meta-analysis of executive functioning.

    PubMed

    Hirst, Rayna B; Beard, Charlotte L; Colby, Katrina A; Quittner, Zoe; Mills, Brent; Lavender, Jason M

    2017-08-26

    Research investigating the link between eating disorder (ED) diagnosis and executive dysfunction has had conflicting results, yet no meta-analyses have examined the overall association of ED pathology with executive functioning (EF). Effect sizes were extracted from 32 studies comparing ED groups (27 of anorexia nervosa, 9 of bulimia nervosa) with controls to determine the grand mean effect on EF. Analyses included effects for individual EF measures, as well as an age-based subgroup analysis. There was a medium effect of ED diagnosis on executive functioning, with bulimia nervosa demonstrating a larger effect (Hedges's g=-0.70) than anorexia nervosa (g=-0.41). Within anorexia nervosa studies, subgroup analyses were conducted for age and diagnostic subtype. The effect of anorexia nervosa on EF was largest in adults; however, subgroup differences for age were not significant. Anorexia and bulimia nervosa are associated with EF deficits, which are particularly notable for individuals with bulimia nervosa. The present analysis includes recommendations for future studies regarding study design and EF measurement. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. "Holy anorexia"-relevant or relic? Religiosity and anorexia nervosa among Finnish women.

    PubMed

    Sipilä, Pyry; Harrasova, Gulnara; Mustelin, Linda; Rose, Richard J; Kaprio, Jaakko; Keski-Rahkonen, Anna

    2017-04-01

    Since medieval times, an association between religiosity and anorexia nervosa has been suggested, but few systematic studies exist. This study examines in a nationwide setting whether personal or family religiosity is associated with lifetime anorexia nervosa among women in adolescence and early adulthood. Women (N = 2,825) from the 1975 to 1979 birth cohorts of Finnish twins were screened for lifetime DSM-5 anorexia nervosa (N = 92). Parental religiosity was assessed by self-report when the women were aged 16 years. The women self-reported their religiosity at ages 16 and 22 to 27 years. Parental religiosity did not increase the risk of lifetime anorexia nervosa, and neither did religiosity of the women themselves in adolescence. In early adulthood, a J-shaped curve was compatible with the data, indicating increased risk both at low and high levels of religiosity, but this result was statistically non-significant. Religiosity was weakly negatively correlated with body dissatisfaction. There was some suggestive evidence for socioregional variation in the association of religiosity with lifetime anorexia nervosa. In this first population study to directly address religiosity and anorexia nervosa, no evidence was found for a significant association of religiosity with anorexia nervosa either at the personal or family level. Some regional differences are possible. A modest protective association of religiosity with body dissatisfaction is also possible. Despite compelling case descriptions of "holy anorexia," religiosity does not appear to be a central factor in the development of anorexia nervosa in Finland, a highly secularized Christian country. © 2017 Wiley Periodicals, Inc.

  18. Anorexia nervosa among teenage girls: Emerging or prevalent?

    PubMed

    Hisam, Aliya; Rahman, Mahmood Ur; Mashhadi, Syed Fawad

    2015-01-01

    To find out frequency of anorexia nervosa (AN) among teenage girls (TG) and to find out the knowledge and practice regarding anorexia nervosa among teenage girls. A cross sectional study was conducted at higher secondary public school, Rawalpindi from June 2013 till December 2013. A sample of 100 female students of the age group 13-19 years were inducted by systematic sampling technique. Mixed pretested questionnaire was filled after informed verbal consent. Data was entered and analysed using SPSS version 20. Participants mean age was 15.81 ± 1.323 years. Mean weight, mean height and mean body mass index were found to be 50.34 ± 10.445 kg, 160.14 ± 7.846 cm and 19.675 ± 4.1477 kg/m(2) respectively. Anorexia nervosa was found in 42 (42%) teenage girls while 58 (58%) were not having anorexia nervosa. Sufficient knowledge and positive practice were found to be present in 57 (57%) and 49 (49%) respectively. Statistically no significant association was found between KP and AN (p=0.73). Anorexia nervosa is an emerging health concern in Pakistan. Anorexia prevalent behaviour was observed in almost half of the teenage girls.

  19. Anorexia nervosa among teenage girls: Emerging or prevalent?

    PubMed Central

    Hisam, Aliya; Rahman, Mahmood Ur; Mashhadi, Syed Fawad

    2015-01-01

    Objectives: To find out frequency of anorexia nervosa (AN) among teenage girls (TG) and to find out the knowledge and practice regarding anorexia nervosa among teenage girls. Methods: A cross sectional study was conducted at higher secondary public school, Rawalpindi from June 2013 till December 2013. A sample of 100 female students of the age group 13-19 years were inducted by systematic sampling technique. Mixed pretested questionnaire was filled after informed verbal consent. Data was entered and analysed using SPSS version 20. Results: Participants mean age was 15.81 ± 1.323 years. Mean weight, mean height and mean body mass index were found to be 50.34 ± 10.445 kg, 160.14 ± 7.846 cm and 19.675 ± 4.1477 kg/m2 respectively. Anorexia nervosa was found in 42 (42%) teenage girls while 58 (58%) were not having anorexia nervosa. Sufficient knowledge and positive practice were found to be present in 57 (57%) and 49 (49%) respectively. Statistically no significant association was found between KP and AN (p=0.73). Conclusion: Anorexia nervosa is an emerging health concern in Pakistan. Anorexia prevalent behaviour was observed in almost half of the teenage girls. PMID:26870084

  20. Comorbidity of anxiety disorders with anorexia and bulimia nervosa.

    PubMed

    Kaye, Walter H; Bulik, Cynthia M; Thornton, Laura; Barbarich, Nicole; Masters, Kim

    2004-12-01

    A large and well-characterized sample of individuals with anorexia nervosa and bulimia nervosa from the Price Foundation collaborative genetics study was used to determine the frequency of anxiety disorders and to understand how anxiety disorders are related to state of eating disorder illness and age at onset. Ninety-seven individuals with anorexia nervosa, 282 with bulimia nervosa, and 293 with anorexia nervosa and bulimia were given the Structured Clinical Interview for DSM-IV Axis I Disorders and standardized measures of anxiety, perfectionism, and obsessionality. Their ratings on these measures were compared with those of a nonclinical group of women in the community. The rates of most anxiety disorders were similar in all three subtypes of eating disorders. About two-thirds of the individuals with eating disorders had one or more lifetime anxiety disorder; the most common were obsessive-compulsive disorder (OCD) (N=277 [41%]) and social phobia (N=134 [20%]). A majority of the participants reported the onset of OCD, social phobia, specific phobia, and generalized anxiety disorder in childhood, before they developed an eating disorder. People with a history of an eating disorder who were not currently ill and never had a lifetime anxiety disorder diagnosis still tended to be anxious, perfectionistic, and harm avoidant. The presence of either an anxiety disorder or an eating disorder tended to exacerbate these symptoms. The prevalence of anxiety disorders in general and OCD in particular was much higher in people with anorexia nervosa and bulimia nervosa than in a nonclinical group of women in the community. Anxiety disorders commonly had their onset in childhood before the onset of an eating disorder, supporting the possibility they are a vulnerability factor for developing anorexia nervosa or bulimia nervosa.

  1. Cognitive-Behavioural Therapy for Individuals with Bulimia Nervosa and a Co-Occurring Substance Use Disorder

    PubMed Central

    Sysko, Robyn; Hildebrandt, Tom

    2010-01-01

    A significant percentage of individuals with bulimia nervosa (BN) also can be diagnosed with a co-occurring substance use disorder (SUD). Although studies have addressed the frequency of overlap between the disorders, etiology and shared personality traits, limited research is available about the treatment of these comorbid patients. Adapting cognitive-behaviour therapy (CBT) to serve as an integrated treatment for patients with both BN and a SUD is a viable option, as studies of CBT suggest that this form of treatment is efficacious for both disorders independently. The shared strategies in CBT for BN and SUDs facilitate the development of a combined treatment for individuals with both disorders with the addition of modules designed to address some common features of these disorders, such as motivation, difficulty with interpersonal relationships, reward sensitivity and impulsivity. Future research should begin to evaluate the efficacy of an integrated CBT in treating individuals with BN and a SUD. PMID:19130465

  2. Wait Not, Want Not: Factors Contributing to the Development of Anorexia Nervosa and Bulimia Nervosa.

    ERIC Educational Resources Information Center

    Murray, Trish

    2003-01-01

    The purpose of this literature review is to examine prevalence and incident rates of both anorexia nervosa and bulimia nervosa. In addition, this article will review the psychological and sociological factors that contribute to the development and maintenance of an eating disorder. Finally, different treatment approaches will be discussed in…

  3. Wait Not, Want Not: Factors Contributing to the Development of Anorexia Nervosa and Bulimia Nervosa.

    ERIC Educational Resources Information Center

    Murray, Trish

    2003-01-01

    The purpose of this literature review is to examine prevalence and incident rates of both anorexia nervosa and bulimia nervosa. In addition, this article will review the psychological and sociological factors that contribute to the development and maintenance of an eating disorder. Finally, different treatment approaches will be discussed in…

  4. Measurement of daily activity in restrictive type anorexia nervosa.

    PubMed

    Harris, Ann M; McAlpine, Donald E; Shirbhate, Rashmi; Manohar, Chinmay U; Levine, James A

    2008-04-01

    The assessment of daily activity in patients with restrictive type anorexia nervosa is limited by an absence of accurate and precise technology. We wanted to test a daily activity detecting device named, the physical activity monitoring system (PAMS). Women participants with restrictive type anorexia nervosa (n = 8, 36 +/- 11 years, 17 +/- 2 kg/m(2)) and healthy women participants (n = 8, 30 +/- 11 years, 27 +/- 7 kg/m(2)) were asked to lie, sit, and stand motionless, and walk at 0.5, 1.0, 1.5, 2.0, 2.5, and 3.0 mph while wearing PAMS. For all restrictive type anorexia nervosa and healthy participants, body posture was correctly detected for all measurements (300/300). There was excellent correlation of an individual's body acceleration with walking velocity and walking energy expenditure (r(2) > .99). The PAMS technology could serve as a tool for lending insight into the pathophysiology of restrictive type anorexia nervosa; and potentially measuring compliance with activity recommendations for medical professionals treating individuals with restrictive type anorexia nervosa. Copyright 2007 by Wiley Periodicals, Inc.

  5. Total body water and total body potassium in anorexia nervosa

    SciTech Connect

    Dempsey, D.T.; Crosby, L.O.; Lusk, E.; Oberlander, J.L.; Pertschuk, M.J.; Mullen, J.L.

    1984-08-01

    In the ill hospitalized patient with clinically relevant malnutrition, there is a measurable decrease in the ratio of the total body potassium to total body water (TBK/TBW) and a detectable increase in the ratio of total exchangeable sodium to total exchangeable potassium (Nae/Ke). To evaluate body composition analyses in anorexia nervosa patients with chronic uncomplicated semistarvation, TBK and TBW were measured by whole body K40 counting and deuterium oxide dilution in 10 females with stable anorexia nervosa and 10 age-matched female controls. The ratio of TBK/TBW was significantly (p less than 0.05) higher in anorexia nervosa patients than controls. The close inverse correlation found in published studies between TBK/TBW and Nae/Ke together with our results suggest that in anorexia nervosa, Nae/Ke may be low or normal. A decreased TBK/TBW is not a good indicator of malnutrition in the anorexia nervosa patient. The use of a decreased TBK/TBW ratio or an elevated Nae/Ke ratio as a definition of malnutrition may result in inappropriate nutritional management in the patient with severe nonstressed chronic semistarvation.

  6. The endocrine manifestations of anorexia nervosa: mechanisms and management.

    PubMed

    Schorr, Melanie; Miller, Karen K

    2017-03-01

    Anorexia nervosa is a psychiatric disorder characterized by altered body image, persistent food restriction and low body weight, and is associated with global endocrine dysregulation in both adolescent girls and women. Dysfunction of the hypothalamic-pituitary axis includes hypogonadotropic hypogonadism with relative oestrogen and androgen deficiency, growth hormone resistance, hypercortisolaemia, non-thyroidal illness syndrome, hyponatraemia and hypooxytocinaemia. Serum levels of leptin, an anorexigenic adipokine, are suppressed and levels of ghrelin, an orexigenic gut peptide, are elevated in women with anorexia nervosa; however, levels of peptide YY, an anorexigenic gut peptide, are paradoxically elevated. Although most, but not all, of these endocrine disturbances are adaptive to the low energy state of chronic starvation and reverse with treatment of the eating disorder, many contribute to impaired skeletal integrity, as well as neuropsychiatric comorbidities, in individuals with anorexia nervosa. Although 5-15% of patients with anorexia nervosa are men, only limited data exist regarding the endocrine impact of the disease in adolescent boys and men. Further research is needed to understand the endocrine determinants of bone loss and neuropsychiatric comorbidities in anorexia nervosa in both women and men, as well as to formulate optimal treatment strategies.

  7. Subjective experience of sensation in anorexia nervosa.

    PubMed

    Zucker, Nancy L; Merwin, Rhonda M; Bulik, Cynthia M; Moskovich, Ashley; Wildes, Jennifer E; Groh, Jennifer

    2013-06-01

    The nature of disturbance in body experience in anorexia nervosa (AN) remains poorly operationalized despite its prognostic significance. We examined the relationship of subjective reports of sensitivity to and behavioral avoidance of sensory experience (e.g., to touch, motion) to body image disturbance and temperament in adult women currently diagnosed with AN (n = 20), women with a prior history of AN who were weight restored (n = 15), and healthy controls with no eating disorder history (n = 24). Levels of sensitivity to sensation and attempts to avoid sensory experience were significantly higher in both clinical groups relative to healthy controls. Sensory sensitivity was associated with body image disturbance (r(56) = .51, p < .0001), indicating that body image disturbance increased with increased global sensitivity to sensation. Sensory sensitivity was also negatively and significantly correlated with lowest BMI (r(2) = -.32, p < .001), but not current BMI (r(2) = .03, p = .18), and to the temperament feature of harm avoidance in both clinical groups. We discuss how intervention strategies that address sensitization and habituation to somatic experience via conditioning exercises may provide a new manner in which to address body image disturbance in AN. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. The Significance of Bradycardia in Anorexia Nervosa

    PubMed Central

    Yahalom, Malka; Spitz, Marcelo; Sandler, Ludmila; Heno, Nawaf; Roguin, Nathan; Turgeman, Yoav

    2013-01-01

    Anorexia nervosa (AN) is a life-threatening condition, with a significant risk for death, due to cardiovascular complications. It is characterized by abnormal eating behavior and has the highest mortality rate of all psychiatric disorders. It has been associated with bradycardia (a heart rate [HR] of less than 60 beats per minute) (up to 95%), hypotension, mitral valve prolapse, and heart failure. The diagnosis of AN can be elusive, and more than half of all cases are undetected. The purpose of this study was to raise and improve awareness to the possible diagnosis of AN in adolescent and young adult patients with weight loss displaying bradycardia and new cardiac disorders. Clinical characteristics, HR, and electrocardiographic data of 23 consecutive patients (20 females) with AN and of 10 young adults (8 females) without AN, between the years 2006 and 2009, were recorded and summarized. At presentation 16/23 (69.6%) showed HR < 50 bpm. The mean lowest HR of all patients was 44 ± 6 (range 26 to 68) bpm. No patient needed pacemaker therapy. Bradycardia in young adults, especially females with weight loss, should raise the possible diagnosis of AN, so it can be treated early in-time, and thus prevent premature death. PMID:24436590

  9. Neurocircuitry of limbic dysfunction in anorexia nervosa.

    PubMed

    Lipsman, Nir; Woodside, D Blake; Lozano, Andres M

    2015-01-01

    Anorexia Nervosa (AN) is a serious psychiatric condition marked by firmly entrenched and maladaptive behaviors and beliefs about body, weight and food, as well as high rates of psychiatric comorbidity. The neural roots of AN are now beginning to emerge, and appear to be related to dysfunctional, primarily limbic, circuits driving pathological thoughts and behaviors. As a result, the significant physical symptoms of AN are increasingly being understood at least partially as a result of abnormal or dysregulated emotional processing. This paper reviews the nature of limbic dysfunction in AN, and how structural and functional imaging has implicated distinct emotional and perceptual neural circuits driving AN symptoms. We propose that top-down and bottom-up influences converge on key limbic modulatory structures, such as the subcallosal cingulate and insula, whose normal functioning is critical to affective regulation and emotional homeostasis. Dysfunctional activity in these structures, as is seen in AN, may lead to emotional processing deficits and psychiatric symptoms, which then drive maladaptive behaviors. Modulating limbic dysregulation may therefore be a potential treatment strategy in some AN patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. [Anorexia nervosa - from a neuroscience perspective].

    PubMed

    Kappel, Viola; van Noort, Betteke; Ritschel, Franziska; Seidel, Maria; Ehrlich, Stefan

    2014-01-01

    Anorexia nervosa is a frequent disorder especially among adolescent girls and young women, with high morbidity, mortality, and relapse rates. To date, no single therapeutic approach has proved to be superior to others (Herpertz et al., 2011). It remains unclear how its etiology and pathology are encoded within cognitive, neural, and endocrinological processes that modulate important mechanisms in appetitive processing and weight regulation. Yet, several trait characteristics have been identified in AN which might reflect predisposing factors. Further, altered levels of neuropeptides and hormones that regulate appetite and feeding behavior have been found during both the acute and the recovered state, pointing to dysfunctional mechanisms in AN that persist even after malnutrition has ceased. Researchers are also hoping that brain imaging techniques will allow for a more detailed investigation of the neural basis of reward and punishment sensitivity that appears to be altered in AN. The integration and extension of recent findings in these areas will hopefully provide a more comprehensive understanding of the disorder and hence enable the development of more effective treatments.

  11. Deep-brain stimulation for anorexia nervosa.

    PubMed

    Wu, Hemmings; Van Dyck-Lippens, Pieter Jan; Santegoeds, Remco; van Kuyck, Kris; Gabriëls, Loes; Lin, Guozhen; Pan, Guihua; Li, Yongchao; Li, Dianyou; Zhan, Shikun; Sun, Bomin; Nuttin, Bart

    2013-01-01

    Anorexia nervosa (AN) is a complex and severe, sometimes life-threatening, psychiatric disorder with high relapse rates under standard treatment. After decades of brain-lesioning procedures offered as a last resort, deep-brain stimulation (DBS) has come under investigation in the last few years as a treatment option for severe and refractory AN. In this jointly written article, Sun et al. (the Shanghai group) report an average of 65% increase in body weight in four severe and refractory patients with AN after they underwent the DBS procedure (average follow-up: 38 months). All patients weighed greater than 85% of expected body weight and thus no longer met the diagnostic criteria of AN at last follow-up. Nuttin et al. (the Leuven group) describe other clinical studies that provide evidence for the use of DBS for AN and further discuss patient selection criteria, target selection, and adverse event of this evolving therapy. Preliminary results from the Shanghai group and other clinical centers showed that the use of DBS to treat AN may be a valuable option for weight restoration in otherwise-refractory and life-threatening cases. The nature of this procedure, however, remains investigational and should not be viewed as a standard clinical treatment option. Further scientific investigation is essential to warrant the long-term efficacy and safety of DBS for AN. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Improving therapeutics in anorexia nervosa with tryptophan.

    PubMed

    Haleem, Darakhshan Jabeen

    2017-06-01

    A growing body of evidence suggests that our diet is an important contributing factor in the development, management and prevention of a number of psychiatric illnesses. Tryptophan, an essential amino acid, is the sole precursor of neurotransmitter 5-hydroxytryptamine (5-HT; serotonin). Administration of tryptophan can boost serotonin neurotransmission to produce therapeutically important effects in serotonin deficiency disorders. Anorexia nervosa (AN) an eating disorder associated with high levels of psychiatric comorbidity including psychosis, hyperactivity, depression and anxiety has highest lethality of all psychiatric illnesses. Evidence suggests that excessive dieting and food restriction can decrease brain tryptophan and serotonin in AN patients to precipitate depression, psychosis and hyperactivity. There are currently no FDA approved pharmacological treatments available for AN patients; antidepressants and antipsychotics, largely used to treat associated psychiatric comorbidities are also not very effective. The aim of this non-systematic review article is to evaluate and document a potential importance of tryptophan supplementation in improving therapeutics in AN patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Emotional processing following recovery from anorexia nervosa.

    PubMed

    Oldershaw, Anna; DeJong, Hannah; Hambrook, David; Broadbent, Hannah; Tchanturia, Kate; Treasure, Janet; Schmidt, Ulrike

    2012-11-01

    Evidence suggests that poor emotional processing perpetuates anorexia nervosa (AN); however, emotional processing following recovery and interactions between aspects of processing remain unknown. This study examined beliefs about emotions, emotional tolerance and avoidance and emotion suppression to preserve relationships in recovered AN patients. It also explored whether beliefs about emotion are related to emotional avoidance. A cross-sectional between-groups design was employed. Currently ill (n = 40), recovered AN patients (n = 24) and a sample of healthy controls (n = 48) completed measures of clinical and demographic background in addition to the Beliefs About Emotions, Distress Tolerance and Silencing the Self emotional processing questionnaires. Recovered and healthy control groups were comparable (except for higher externalised self-perception in recovered participants) and both had better emotional processing than current AN patients. Beliefs about emotions correlated with level of emotional avoidance. This study demonstrates functional levels of emotional processing following recovery from AN. It substantiates models proposing that maladaptive beliefs about emotions link to emotional avoidance and supports inclusion of these factors as treatment foci. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.

  14. Altered orienting of attention in anorexia nervosa.

    PubMed

    Dalmaso, Mario; Castelli, Luigi; Franchetti, Lorena; Carli, Lorenza; Todisco, Patrizia; Palomba, Daniela; Galfano, Giovanni

    2015-09-30

    The study of cognitive processes in anorexia nervosa (AN) is largely unexplored, although recent evidence suggests the presence of impairments in both social cognition and attention processing. Here we investigated AN patients' ability to orient attention in response to social and symbolic visual stimuli. AN patients and matched controls performed a task in which gaze and pointing gestures acted as social directional cues for spatial attention. Arrows were also included as symbolic cue. On each trial, a centrally-placed cue appeared oriented rightwards or leftwards. After either 200 or 700ms, a lateralized neutral target (a letter) requiring a discrimination response appeared in a location either spatially congruent or incongruent with the directional cue. Controls showed a reliable orienting irrespective of both temporal interval and cue type. AN patients showed a reliable orienting at both temporal intervals only in response to pointing gestures. Both gaze and arrow cues failed to orient attention at the short temporal interval, that is when attention is under reflexive control, whereas a reliable orienting emerged at the long temporal interval. These results provide preliminary evidence of altered reflexive orienting of attention in AN patients that does not extend to body-related cues such as pointing gestures.

  15. Set Shifting Among Adolescents with Anorexia Nervosa

    PubMed Central

    Fitzpatrick, Kathleen Kara; Darcy, Alison; Colborn, Danielle; Gudorf, Caroline; Lock, James

    2012-01-01

    Objective Set shifting difficulties are documented for adults with anorexia nervosa (AN). However, AN typically onsets in adolescents and it is unclear if set-shifting difficulties are a result of chronic AN or present earlier in its course. This study examined whether adolescents with short duration AN demonstrated set shifting difficulties compared to healthy controls (HC). Method Data on set shifting collected from the Delis-Kaplan Executive Functioning System (DKEFS) and Wisconsin Card Sort Task (WCST) as well as eating psychopathology were collected from 32 adolescent inpatients with AN and compared to those from 22 HCs. Results There were no differences in set-shifting in adolescents with AN compared to HCs on most measures. Conclusion The findings suggest that set-shifting difficulties in AN may be a consequence of AN. Future studies should explore set-shifting difficulties in a larger sample of adolescents with the AN to determine if there is sub-set of adolescents with these difficulties and determine any relationship of set-shifting to the development of a chronic from of AN. PMID:22692985

  16. Saccadic Eye Movements in Anorexia Nervosa

    PubMed Central

    Phillipou, Andrea; Rossell, Susan Lee; Gurvich, Caroline; Hughes, Matthew Edward; Castle, David Jonathan; Nibbs, Richard Grant; Abel, Larry Allen

    2016-01-01

    Background Anorexia Nervosa (AN) has a mortality rate among the highest of any mental illness, though the factors involved in the condition remain unclear. Recently, the potential neurobiological underpinnings of the condition have become of increasing interest. Saccadic eye movement tasks have proven useful in our understanding of the neurobiology of some other psychiatric illnesses as they utilise known brain regions, but to date have not been examined in AN. The aim of this study was to investigate whether individuals with AN differ from healthy individuals in performance on a range of saccadic eye movements tasks. Methods 24 females with AN and 25 healthy individuals matched for age, gender and premorbid intelligence participated in the study. Participants were required to undergo memory-guided and self-paced saccade tasks, and an interleaved prosaccade/antisaccade/no-go saccade task while undergoing functional magnetic resonance imaging (fMRI). Results AN participants were found to make prosaccades of significantly shorter latency than healthy controls. AN participants also made an increased number of inhibitory errors on the memory-guided saccade task. Groups did not significantly differ in antisaccade, no-go saccade or self-paced saccade performance, or fMRI findings. Discussion The results suggest a potential role of GABA in the superior colliculus in the psychopathology of AN. PMID:27010196

  17. Testosterone administration in women with anorexia nervosa.

    PubMed

    Miller, K K; Grieco, K A; Klibanski, A

    2005-03-01

    Anorexia nervosa (AN) is complicated by severe bone loss, cognitive function deficits, and a high prevalence of major depression. We hypothesized that bone formation would increase and depressive symptoms and spatial cognition would improve with short-term physiological testosterone administration. We randomized 33 women with AN and relative testosterone deficiency to transdermal testosterone (Intrinsa, Procter and Gamble Pharmaceuticals, Cincinnati, OH), 150 mug, 300 mug, or placebo, for 3 wk. At baseline, free testosterone correlated with L4 bone density (r = 0.51, P < 0.001), body mass index (r = 0.39, P = 0.02), depressive symptoms (r = -0.44, P = 0.02), and spatial cognition (r = 0.45, P = 0.04). C-terminal propeptide of type 1 collagen levels were higher during testosterone administration than placebo (P = 0.03). The change in propeptide of type 1 collagen correlated with change in free testosterone over 3 wk (r = 0.50, P = 0.02). Osteocalcin and bone-specific alkaline phosphatase did not change. Depressed patients receiving testosterone improved from severely depressed to moderately depressed; the placebo group was unchanged (P = 0.02). Spatial cognition improved in the testosterone group, compared with placebo (P = 0.0015). Therefore, short-term low-dose testosterone may improve depressive symptoms and spatial cognition in women with AN. Low-dose testosterone may also prevent decreased bone formation in AN, but because testosterone did not affect all markers of bone formation studied, further data are needed.

  18. Emotion coupling and regulation in anorexia nervosa.

    PubMed

    Fox, John R E; Smithson, Emily; Baillie, Sarah; Ferreira, Nuno; Mayr, Ingrid; Power, Michael J

    2013-01-01

    The present study sought to investigate emotion regulation strategies in people with anorexia nervosa (AN) and whether the theoretical concept of 'emotion coupling' between anger and disgust could help to explain some of the specific eating disorder symptomatology in people with AN. This 'emotion coupling' hypothesis was tested using a mood induction procedure within laboratory conditions, where individuals with AN (n = 22) were matched with control participants (n = 19). Participants completed a bank of different measures prior to the study, and these included measures of eating pathology, core beliefs about the self and others, and emotion regulation strategies. Within the experimental part of this study, anger, disgust and body size estimation were measured prior to and after an anger induction procedure (i.e., a repeated measures design). People with AN demonstrated a significantly more internal-dysfunctional way to regulate their emotional states, when compared with matched controls. Within the 'emotional coupling' part of the study, participants showed a significant increase in levels of disgust and body size estimation following an anger induction when compared with matched controls. The significance of these results was considered in the light of the new Schematic, Propositional, Analogical and Associative Representation Systems in eating disorders model. Copyright © 2012 John Wiley & Sons, Ltd.

  19. Altered Implicit Category Learning in Anorexia Nervosa

    PubMed Central

    Shott, Megan E.; Filoteo, J. Vincent; Jappe, Leah M.; Pryor, Tamara; Maddox, W. Todd; Rollin, Michael D.H.; Hagman, Jennifer O.; Frank, Guido K.W.

    2012-01-01

    Objective Recent research has identified specific cognitive deficits in patients with anorexia nervosa (AN), including impairment in executive functioning and attention. Another such cognitive process, implicit category learning has been less studied in AN. This study examined whether implicit category learning is impaired in AN. Method Twenty-one women diagnosed with AN and 19 control women (CW) were administered an implicit category learning task in which they were asked to categorize simple perceptual stimuli (Gabor patches) into one of two categories. Category membership was based on a linear integration (i.e., an implicit task) of two stimulus dimensions (orientation and spatial frequency of the stimulus). Results AN individuals were less accurate on implicit category learning relative to age-matched CW. Model-based analyses indicated that, even when AN individuals used the appropriate (i.e., implicit) strategy they were still impaired relative to CW who also used the same strategy. In addition, task performance in AN patients was worse the higher they were in self-reported novelty seeking and the lower they were in sensitivity to punishment. Conclusions These results indicate that AN patients have implicit category learning deficits, and given this type of learning is thought to be mediated by striatal dopamine pathways, AN patients may have deficits in these neural systems. The finding of significant correlations with novelty seeking and sensitivity to punishment suggests that feedback sensitivity is related to implicit learning in AN. PMID:22201300

  20. Subjective Experience of Sensation in Anorexia Nervosa

    PubMed Central

    Zucker, Nancy L.; Merwin, Rhonda M.; Bulik, Cynthia M.; Moskovich, Ashley; Wildes, Jennifer; Groh, Jennifer

    2013-01-01

    The nature of disturbance in body experience in anorexia nervosa (AN) remains poorly operationalized despite its prognostic significance. We examined the relationship of subjective reports of sensitivity to and behavioral avoidance of sensory experience (e.g., to touch, motion) to body image disturbance and temperament in adult women currently diagnosed with AN (n=20), women with a prior history of AN who were weight restored (n=15), and healthy controls with no eating disorder history (n=24). Levels of sensitivity to sensation and attempts to avoid sensory experience were significantly higher in both clinical groups relative to healthy controls. Sensory sensitivity was associated with body image disturbance (r(56) = .51, p < .0001), indicating that body image disturbance increased with increased global sensitivity to sensation. Sensory sensitivity was also negatively and significantly correlated with lowest BMI (r2 = −.32, p < .001), but not current BMI (r2 = .03, p = .18), and to the temperament feature of harm avoidance in both clinical groups. We discuss how intervention strategies that address sensitization and habituation to somatic experience via conditioning exercises may provide a new manner in which to address body image disturbance in AN. PMID:23523866

  1. Saccadic Eye Movements in Anorexia Nervosa.

    PubMed

    Phillipou, Andrea; Rossell, Susan Lee; Gurvich, Caroline; Hughes, Matthew Edward; Castle, David Jonathan; Nibbs, Richard Grant; Abel, Larry Allen

    2016-01-01

    Anorexia Nervosa (AN) has a mortality rate among the highest of any mental illness, though the factors involved in the condition remain unclear. Recently, the potential neurobiological underpinnings of the condition have become of increasing interest. Saccadic eye movement tasks have proven useful in our understanding of the neurobiology of some other psychiatric illnesses as they utilise known brain regions, but to date have not been examined in AN. The aim of this study was to investigate whether individuals with AN differ from healthy individuals in performance on a range of saccadic eye movements tasks. 24 females with AN and 25 healthy individuals matched for age, gender and premorbid intelligence participated in the study. Participants were required to undergo memory-guided and self-paced saccade tasks, and an interleaved prosaccade/antisaccade/no-go saccade task while undergoing functional magnetic resonance imaging (fMRI). AN participants were found to make prosaccades of significantly shorter latency than healthy controls. AN participants also made an increased number of inhibitory errors on the memory-guided saccade task. Groups did not significantly differ in antisaccade, no-go saccade or self-paced saccade performance, or fMRI findings. The results suggest a potential role of GABA in the superior colliculus in the psychopathology of AN.

  2. Mammillary body volume abnormalities in anorexia nervosa.

    PubMed

    Khalsa, Sahib S; Kumar, Rajesh; Patel, Vandan; Strober, Michael; Feusner, Jamie D

    2016-10-01

    Several case reports of Wernicke's Encephalopathy in anorexia nervosa (AN) caused by thiamine deficiency have described mammillary body (MB) injury, but systematic studies are lacking. Here we evaluated whether underweight and weight-restored individuals with AN demonstrate evidence of abnormal MB morphology, via retrospective examination of a previously collected data set. Using standard-resolution T1-weighted magnetic resonance imaging at 3 Tesla, we measured MB volume and fornix area in a cross-sectional study of 12 underweight AN, 20 weight-restored AN, and 30 age- and sex-matched healthy comparisons. Because of the small size of these structures, a manual tracing approach was necessary to obtain accurate measurements. A blinded expert rater manually traced MB and fornix structures in each participant. We observed significantly smaller MB volumes in the underweight AN group. However, the weight-restored AN group exhibited significantly larger MB volumes. The right fornix was smaller in the weight-restored AN group only. These findings suggest the possibility that MB volume and fornix area could represent potential biomarkers of acute weight loss and restoration, respectively. Verification of this finding through prospective studies evaluating MB morphology, cognition, and thiamine levels longitudinally across individual illness trajectories might be warranted. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:920-929). © 2016 Wiley Periodicals, Inc.

  3. Concurrence of anorexia nervosa and Noonan syndrome.

    PubMed

    Arvaniti, Aikaterini; Samakouri, Maria; Keskeridou, Flora; Veletza, Stavroula

    2014-01-01

    Noonan syndrome (NS) is a genetic disease inherited in an autosomal dominant mode; it presents significant genetic heterogeneity and varying penetrance. Mutations have been identified in several genes, and they account for 75% of all known cases. The majority of reported mutations are localized on PTPN11 gene, which encodes the non-receptor type protein tyrosine phosphatase SHP-2. Diagnosis, however, is mainly established after clinical examination. Anorexia nervosa (AN) is an eating disorder characterized by fear of gaining weight, refusal to maintain normal body weight and distorted perceptions of body image or body shape. AN is independently predicted by female sex and feeding problems in childhood, whereas NS symptoms include feeding difficulties. No comorbidity between NS and AN has been reported to date. The authors reported the case of a 38-year-old female patient with AN who met the van der Burgt criteria for NS with confirmed (a) comorbidity of AN and NS and (b) the absence of the most common mutation in PTPN11 and presence of a novel T > A transversion within intron 8-9. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.

  4. Compulsivity in anorexia nervosa: a transdiagnostic concept.

    PubMed

    Godier, Lauren R; Park, Rebecca J

    2014-01-01

    The compulsive nature of weight loss behaviors central to anorexia nervosa (AN), such as relentless self-starvation and over-exercise, has led to the suggestion of parallels between AN and other compulsive disorders such as obsessive-compulsive disorder (OCD) and addictions. There is a huge unmet need for effective treatments in AN, which has high rates of morbidity and the highest mortality rate of any psychiatric disorder, yet a grave paucity of effective treatments. Viewing compulsivity as a transdiagnostic concept, seen in various manifestations across disorders, may help delineate the mechanisms responsible for the persistence of AN, and aid treatment development. We explore models of compulsivity that suggest dysfunction in cortico-striatal circuitry underpins compulsive behavior, and consider evidence of aberrancies in this circuitry across disorders. Excessive habit formation is considered as a mechanism by which initially rewarding weight loss behavior in AN may become compulsive over time, and the complex balance between positive and negative reinforcement in this process is considered. The physiological effects of starvation in promoting compulsivity, positive reinforcement, and habit formation are also discussed. Further research in AN may benefit from a focus on processes potentially underlying the development of compulsivity, such as aberrant reward processing and habit formation. We discuss the implications of a transdiagnostic perspective on compulsivity, and how it may contribute to the development of novel treatments for AN.

  5. Participatory action research for women with anorexia nervosa.

    PubMed

    Nicholls, Daniel; Fogarty, Sarah; Hay, Phillipa; Ramjan, Lucie Michelle

    2016-05-01

    To discuss the application of the principles of participatory action research (PAR) in a project that developed and evaluated a mentor-mentee support programme for women with anorexia nervosa. A programme was developed and implemented in which mentors and mentees participated in workshops, social activities and focus groups that sought to support and develop resilience for those experiencing anorexia nervosa. PAR principles were mirrored in the programme, paying respect to the views and needs of each participant, an open trajectory to possible conclusions and a continuous feedback cycle. Mentees had a sense of empowerment, ownership of the programme and hope that recovery was possible. It allowed their voices to be heard and provided them with belief they could begin new relationships and friendships. The principles of PAR suited a project aimed at developing self-determination and resilience in women with anorexia nervosa. PAR would be readily transferable to a number of mental health settings where empowerment is of paramount concern.

  6. Nocturnal nasogastric refeeding for hospitalized adolescent boys with anorexia nervosa.

    PubMed

    Silber, Tomas J; Robb, Adelaide S; Orrell-Valente, Joan K; Ellis, Nathan; Valadez-Meltzer, Adela; Dadson, Michele J

    2004-12-01

    Boys with anorexia nervosa have nutritional needs exceeding those of their female counterparts. For many males with anorexia nervosa, oral refeeding alone may result in low discharge weight, a critical risk factor in relapse. This study compared the short-term outcomes of oral refeeding (OR) and a combination of OR with supplemental nocturnal nasogastric refeeding (NNGR) in a sample of hospitalized boys. This was a retrospective chart review with a cohort design. Subjects were partitioned into: The OR group (n = 8, mean age = 14.9, SD = 1.7) and the OR + NNGR group (n = 6, mean age = 13.8, SD = 2.0). The NNGR group had greater increase in weight and Body Mass Index. Their average length of hospitalization was also shorter. Nocturnal nasogastric refeeding, complementing oral refeeding, should be considered as an alternative initial therapy for weight restoration in males with anorexia nervosa.

  7. Biased Interpretation of Ambiguous Social Scenarios in Anorexia Nervosa.

    PubMed

    Cardi, Valentina; Turton, Robert; Schifano, Sylvia; Leppanen, Jenni; Hirsch, Colette R; Treasure, Janet

    2017-01-01

    Patients with anorexia nervosa experience increased sensitivity to the risk of social rejection. The aims of this study were to assess the interpretation of ambiguous social scenarios depicting the risk of rejection and to examine the relationship between interpretation biases and clinical symptoms. Thirty-five women with anorexia nervosa and 30 healthy eaters completed clinical questionnaires, alongside a sentence completion task. This task required participants to generate completions to ambiguous social scenarios and to endorse their best completion. Responses were rated as being negative, neutral or positive. Patients endorsed more negative interpretations and fewer neutral and positive interpretations compared with healthy eaters. The frequency of endorsed negative interpretations correlated with depression, anxiety and fear of weight gain and body disturbance. A negative interpretation bias towards social stimuli is present in women with anorexia nervosa and correlates with clinical symptoms. Interventions aimed at reducing this bias could improve illness prognosis. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

  8. Psychopharmacotherapy of anorexia nervosa, bulimia nervosa and binge-eating disorder

    PubMed Central

    Kruger, S; Kennedy, SH

    2000-01-01

    Pharmacotherapy for anorexia nervosa is considered to be of limited efficacy. However, many studies suffer methodological limitations, and the utility of newer drugs in the treatment of anorexia has not been examined yet. Although there have been more fruitful investigations on the efficacy of medication in the management of bulimia nervosa, there are still many unresolved issues regarding the optimal management of partial remission during the acute treatment phase and the intensity and duration of pharmacotherapy to achieve optimal prophylaxis. Selective serotonin reuptake inhibitors (SSRIs) control the binge urges in binge-eating disorder, but more trials are required to investigate the utility of SSRIs and other agents in maintenance treatment. We review the current status of psychopharmacotherapy for anorexia nervosa, bulimia nervosa and binge-eating disorder and evaluate the merits of newer agents in the treatment of these disorders. PMID:11109300

  9. Gastrointestinal comorbidities which complicate the treatment of anorexia nervosa.

    PubMed

    Mascolo, Margherita; Geer, Bashir; Feuerstein, Joshua; Mehler, Philip S

    2017-01-01

    Patients with anorexia nervosa often voice a multitude of symptoms in regards to their gastrointestinal tract. These complaints can complicate the treatment of their eating disorder as they distract attention from the important goal of weight restoration. Moreover, the restricting of certain food groups also makes the task of weight restoration substantially more difficult, or may result in binging. Therefore a working knowledge of common gastrointestinal comorbidities, such as celiac disease, irritable bowel syndrome, inflammatory bowel disease, and gastroparesis, is useful when treating a patient who has anorexia nervosa.

  10. Retrospective Maternal Report of Early Eating Behaviors in Anorexia Nervosa

    PubMed Central

    Dellava, Jocilyn E.; Trace, Sara E.; Strober, Michael; Thornton, Laura M.; Klump, Kelly L.; Brandt, Harry; Crawford, Steve; Fichter, Manfred M.; Halmi, Katherine A.; Johnson, Craig; Kaplan, Allan S.; Mitchell, James E.; Treasure, Janet; Woodside, D. Blake; Berrettini, Wade H.; Kaye, Walter H.; Bulik, Cynthia M.

    2012-01-01

    This exploratory study assessed whether maternal recall of childhood feeding and eating practices differed across anorexia nervosa (AN) subtypes. Participants were 325 women from the Genetics of Anorexia Nervosa study whose mothers completed a childhood feeding and eating questionnaire. Multinomial logistic regression analyses were used to predict AN subtype from measures related to childhood eating: (a) infant feeding (breastfed, feeding schedule, age of solid food introduction), (b) childhood picky eating (picky eating before age one and between ages one and five), and (c) infant gastrointestinal problems (vomiting and colic). Results revealed no significant differences in retrospective maternal report of childhood feeding and eating practices among AN subtypes. PMID:21830261

  11. [Anorexia nervosa in German medical literature 1900 to 1945. The role of anorexia nervosa in the origin of psychosomatic medicine].

    PubMed

    Habermas, T

    1992-01-01

    German-language publications on anorexia nervosa and Simmonds' disease from between 1900 and 1945 are reviewed in order to trace factors inherent in medical thinking which have mostly hindered German-language medicine in understanding anorexia nervosa. It is demonstrated that a) the few German-language physicians who did describe central and possible characteristics of a.n. (weight-phobia, overactivity, bulimia, self-induced vomiting) were enabled to do so by valuing detailed clinical description, also of psychic characteristics, and an interest in the neuroses; b) the concept of anorexia nervosa was better known than previously assumed, though largely misunderstood; c) typical diagnostic misinterpretations led to typical biases in the description of the syndrome; d) in Germany more than in other countries a.n. was confounded with Simmonds' disease; and e) in addition to other factors, one reason for this lay in the 'holistic' ideal of psychosomatic medicine in the 1930s.

  12. Osteopenia and bone fractures in a man with anorexia nervosa and hypogonadism

    SciTech Connect

    Rigotti, N.A.; Neer, R.M.; Jameson, L.

    1986-07-18

    Women with anorexia nervosa have reduced skeletal mass. Both anorexia and osteopenia are less common in men. We describe a 22-year-old man with anorexia nervosa and severe osteopenia involving both cortical and trabecular bone who developed a pelvic fracture and multiple vertebral compression fractures. He was found to have secondary hypogonadotropic hypogonadism that was reversible with weight gain. This case illustrates the need to consider osteopenia as a potential complication of anorexia nervosa in males as well as females.

  13. Do Mortality Rates in Eating Disorders Change over Time? A Longitudinal Look at Anorexia Nervosa and Bulimia Nervosa

    PubMed Central

    Franko, Debra L.; Keshaviah, Aparna; Eddy, Kamryn T.; Krishna, Meera; Davis, Martha C.; Keel, Pamela K.; Herzog, David B.

    2014-01-01

    Objective Although anorexia nervosa has a high mortality rate, our understanding of the timing and predictors of mortality in eating disorders is limited. The authors investigated mortality in a long-term study of patients with eating disorders. Method Beginning in 1987, 246 treatment-seeking women with anorexia nervosa or bulimia nervosa were interviewed every 6 months for a median of 9.5 years to obtain weekly ratings of eating disorder symptoms, comorbidity, treatment participation, and psychosocial functioning. From January 2007 to December 2010 (median follow-up of 20 years), vital status was ascertained with a National Death Index search. Results Sixteen deaths (6.5%) were recorded (lifetime anorexia nervosa, N=14; bulimia nervosa with no history of anorexia nervosa, N=2). The standardized mortality ratio was 4.37 [95% CI=2.4-7.3] for lifetime anorexia nervosa and 2.33 [95% CI=0.3-8.4] for bulimia nervosa with no history of anorexia nervosa. Risk of premature death among women with lifetime anorexia nervosa peaked within the first 10 years of follow-up resulting in a standardized mortality ratio of 7.7 [95% CI=3.7-14.2]. The standardized mortality ratio varied by duration of illness and was 3.2 [95% CI=0.9-8.3] for women with lifetime anorexia nervosa for 0-15 years (4/119 died), and 6.6 [95% CI=3.2-12.1] for women with lifetime anorexia nervosa for >15-30 years (10/67 died). Multivariate predictors of mortality included alcohol abuse (p<0.0001), low body mass index (p=0.0005), and poor social adjustment (p=0.0090). Conclusions These findings highlight the need for early identification and intervention and suggest that a long duration of illness, substance abuse, low weight, and/or poor psychosocial functioning raise the risk for mortality in anorexia nervosa. PMID:23771148

  14. Daily Patterns of Anxiety in Anorexia Nervosa: Associations with Eating Disorder Behaviors in the Natural Environment

    PubMed Central

    Lavender, Jason M.; De Young, Kyle P.; Wonderlich, Stephen A.; Crosby, Ross D.; Engel, Scott G.; Mitchell, James E.; Crow, Scott J.; Peterson, Carol B.; Le Grange, Daniel

    2015-01-01

    The role of anxiety has been emphasized in etiological/maintenance models of anorexia nervosa. This study identified daily patterns of anxiety in anorexia nervosa and examined the likelihood of the occurrence of eating disorder behaviors in each trajectory, the daily temporal distribution of eating disorder behaviors in each trajectory, and the extent to which the tendency to exhibit particular anxiety trajectories was associated with baseline diagnostic and trait-level personality variables. Women with full or subthreshold anorexia nervosa (N = 118) completed a two-week ecological momentary assessment (EMA) protocol during which they reported on a variety of behavioral and affective variables, including anxiety and eating disorder behaviors. Using latent growth mixture modeling to classify EMA days (N = 1526) based on anxiety ratings, seven distinct daily anxiety trajectories were identified. Overall differences between trajectories were found for rates of binge eating, self-induced vomiting, body checking, skipping meals, and dietary restriction. Further, distinct daily temporal distributions of eating disorder behaviors were found across the trajectories, with peaks in the probability of behaviors frequently coinciding with high levels of anxiety. Finally, traits of personality pathology (affective lability, self-harm, social avoidance, and oppositionality) and the presence of a co-occurring mood disorder were both found to be associated with the tendency to experience particular daily anxiety trajectories (e.g., Stable High anxiety). Findings support the presence of within-person variability in daily anxiety patterns in anorexia nervosa and also provide evidence for an association between these anxiety patterns and eating disorder behaviors. PMID:23647124

  15. Daily patterns of anxiety in anorexia nervosa: associations with eating disorder behaviors in the natural environment.

    PubMed

    Lavender, Jason M; De Young, Kyle P; Wonderlich, Stephen A; Crosby, Ross D; Engel, Scott G; Mitchell, James E; Crow, Scott J; Peterson, Carol B; Le Grange, Daniel

    2013-08-01

    The role of anxiety has been emphasized in etiological/maintenance models of anorexia nervosa. This study identified daily patterns of anxiety in anorexia nervosa and examined the likelihood of the occurrence of eating disorder behaviors in each trajectory, the daily temporal distribution of eating disorder behaviors in each trajectory, and the extent to which the tendency to exhibit particular anxiety trajectories was associated with baseline diagnostic and trait-level personality variables. Women with full or subthreshold anorexia nervosa (N = 118) completed a 2-week ecological momentary assessment (EMA) protocol during which they reported on a variety of behavioral and affective variables, including anxiety and eating disorder behaviors. Using latent growth mixture modeling to classify EMA days (N = 1,526) based on anxiety ratings, we identified 7 distinct daily anxiety trajectories. Overall differences between trajectories were found for rates of binge eating, self-induced vomiting, body checking, skipping meals, and dietary restriction. Furthermore, distinct daily temporal distributions of eating disorder behaviors were found across the trajectories, with peaks in the probability of behaviors frequently coinciding with high levels of anxiety. Finally, traits of personality pathology (affective lability, self-harm, social avoidance, and oppositionality) and the presence of a co-occurring mood disorder were found to be associated with the tendency to experience particular daily anxiety trajectories (e.g., stable high anxiety). Findings support the presence of within-person variability in daily anxiety patterns in anorexia nervosa and also provide evidence for an association between these anxiety patterns and eating disorder behaviors.

  16. Gut Dysbiosis in Patients with Anorexia Nervosa.

    PubMed

    Morita, Chihiro; Tsuji, Hirokazu; Hata, Tomokazu; Gondo, Motoharu; Takakura, Shu; Kawai, Keisuke; Yoshihara, Kazufumi; Ogata, Kiyohito; Nomoto, Koji; Miyazaki, Kouji; Sudo, Nobuyuki

    2015-01-01

    Anorexia nervosa (AN) is a psychological illness with devastating physical consequences; however, its pathophysiological mechanism remains unclear. Because numerous reports have indicated the importance of gut microbiota in the regulation of weight gain, it is reasonable to speculate that AN patients might have a microbial imbalance, i.e. dysbiosis, in their gut. In this study, we compared the fecal microbiota of female patients with AN (n = 25), including restrictive (ANR, n = 14) and binge-eating (ANBP, n = 11) subtypes, with those of age-matched healthy female controls (n = 21) using the Yakult Intestinal Flora-SCAN based on 16S or 23S rRNA-targeted RT-quantitative PCR technology. AN patients had significantly lower amounts of total bacteria and obligate anaerobes including those from the Clostridium coccoides group, Clostridium leptum subgroup, and Bacteroides fragilis group than the age-matched healthy women. Lower numbers of Streptococcus were also found in the AN group than in the control group. In the analysis based on AN subtypes, the counts of the Bacteroides fragilis group in the ANR and ANBP groups and the counts of the Clostridium coccoides group in the ANR group were significantly lower than those in the control group. The detection rate of the Lactobacillus plantarum subgroup was significantly lower in the AN group than in the control group. The AN group had significantly lower acetic and propionic acid concentrations in the feces than the control group. Moreover, the subtype analysis showed that the fecal concentrations of acetic acid were lower in the ANR group than in the control group. Principal component analysis confirmed a clear difference in the bacterial components between the AN patients and healthy women. Collectively, these results clearly indicate the existence of dysbiosis in the gut of AN patients.

  17. Gait analysis in anorexia and bulimia nervosa.

    PubMed

    Cimolin, Veronica; Galli, Manuela; Vismara, Luca; Vimercati, Sara Laura; Precilios, Helmer; Cattani, Laila; Fabris De Souza, Shirley; Petroni, Maria Letizia; Capodaglio, Paolo

    2013-09-13

    Anorexia (AN) and Bulimia Nervosa (BN) are two common eating disorders, which appear to share some reduced motor capacities, such as a reduced balance. The presence and the extent of other motor disorders have not been investigated in a comprehensive way. The aim of this study was to quantify gait pattern in AN and BN individuals in order to ascertain possible differences from the normality range and provide novel data for developing some evidence-based rehabilitation strategies. Nineteen AN patients (age 30.16+9.73) and 20 BN patients (age 26.8+8.41) were assessed with quantitative 3D computerized Gait Analysis. Results were compared with a group of healthy controls (CG; 30.7+5.6). AN and BN patients were characterized by different gait strategies compared to CG. Spatio-temporal parameters indicated shorter step length, with AN showing the shortest values. AN walked slower than BN and CG. As for kinematics, AN and BN showed a nonphysiologic pattern at pelvis and hip level on the sagittal and frontal plane, with BN yielding the most abnormal values. Both AN and BN patients were characterized by high ankle plantar flexion capacity at toe-off when compared to CG. As for ankle kinetics, both AN and BN showed physiologic patterns. Stiffness at hip level was close to CG in both pathologic groups; at the ankle level, stiffness was significantly decreased in both groups, with AN displaying lower values. Both AN and BN were characterized by an altered gait pattern compared to CG. Biomechanical differences were evident mainly at pelvis and hip level. Loss of lean mass may lead to musculoskeletal adaptation, ultimately causing alterations in the gait pattern.

  18. Taste Reward Circuitry Related Brain Structures Characterize Ill and Recovered Anorexia Nervosa and Bulimia Nervosa

    PubMed Central

    Frank, Guido K.; Shott, Megan E.; Hagman, Jennifer O.; Mittal, Vijay A.

    2013-01-01

    Objective The pathophysiology of the eating disorder anorexia nervosa remains obscure, but structural brain alterations could be functionally important biomarkers. Here we assessed taste pleasantness and reward sensitivity in relation to brain structure, which might be related to food avoidance commonly seen in eating disorders. Method We used structural magnetic resonance brain imaging to study gray and white matter volumes in individuals with restricting type currently ill (n = 19) or recovered-anorexia nervosa (n = 24), bulimia nervosa (n= 19) and healthy control women (n=24). Results All eating disorder groups showed increased gray matter volume of the medial orbitofrontal cortex (gyrus rectus). Manually tracing confirmed larger gyrus rectus volume, and predicted taste pleasantness across all groups. The analyses also indicated other morphological differences between diagnostic categories: Ill and recovered-anorexia nervosa had increased right, while bulimia nervosa had increased left antero-ventral insula gray matter volumes compared to controls. Furthermore, dorsal striatum volumes were reduced in recovered-anorexia and bulimia nervosa, and predicted sensitivity to reward in the eating disorder groups. The eating disorder groups also showed reduced white matter in right temporal and parietal areas when compared to healthy controls. Notably, the results held when controlling for a range of covariates (e.g., age, depression, anxiety, medications). Conclusion Brain structure in medial orbitofrontal cortex, insula and striatum is altered in eating disorders and suggests altered brain circuitry that has been associated with taste pleasantness and reward value. PMID:23680873

  19. Anorexia Nervosa and Bulimia: Questions and Answers for School Personnel.

    ERIC Educational Resources Information Center

    Mallick, M. Joan

    1984-01-01

    School personnel can have a vital role in the early detection and treatment of anorexia nervosa and bulimia by understanding certain signs and symptoms. This article provides specific information about early detection, approaches to use when confronting the student, and methods to facilitate treatment. (Author/DF)

  20. Bulimia and Anorexia Nervosa in Dental and Dental Hygiene Curricula.

    ERIC Educational Resources Information Center

    Gross, Karen B. W.; And Others

    1990-01-01

    Dentists and dental hygienists are in a unique position to identify an eating disorder patient from observed oral manifestations and to refer the patient for psychological therapy. The inclusion of information on general and oral complications of bulimia and anorexia nervosa in dental and dental hygiene curriculum was examined. (MLW)

  1. A Primary Prevention Program to Reduce Bulimia and Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Cullari, Salvatore; Redmon, William K.

    This paper presents a theoretical model for a primary prevention program for bulimia and anorexia nervosa to be used with adolescents and young women considered most at risk of developing these eating disorders. Characteristics of potential anorexics and bulimics are identified to aid in the selection of target groups for the program. It is…

  2. Anorexia Nervosa in Adolescence and Maudsley Family-Based Treatment

    ERIC Educational Resources Information Center

    Hurst, Kim; Read, Shelly; Wallis, Andrew

    2012-01-01

    Anorexia nervosa is a serious psychiatric disorder that usually occurs in adolescence. The course of the illness can be protracted. Current empirical evidence suggests that the Maudsley Family-Based Treatment (MFBT) is efficacious for adolescents. MFBT empowers parents as a crucial treatment resource to assist in their child's recovery. The…

  3. Striatal dopamine type 2 receptor availability in anorexia nervosa

    PubMed Central

    Broft, Allegra; Slifstein, Mark; Osborne, Joseph; Kothari, Paresh; Morim, Simon; Shingleton, Rebecca; Kenney, Lindsay; Vallabhajosula, Shankar; Attia, Evelyn; Martinez, Diana; Walsh, B. Timothy

    2016-01-01

    The neurobiology of anorexia nervosa remains incompletely understood. Here we utilized PET imaging with the radiotracer [11C]raclopride to measure striatal dopamine type 2 (D2) receptor availability in patients with anorexia nervosa. 25 women with anorexia nervosa who were receiving treatment in an inpatient program participated, as well as 25 control subjects. Patients were scanned up to two times with the PET tracer [11C]raclopride: once while underweight, and once upon weight restoration. Control subjects underwent one PET scan. In the primary analyses, there were no significant differences between underweight patients (n=21) and control subjects (n=25) in striatal D2 receptor binding potential. Analysis of subregions (sensorimotor striatum, associative striatum, limbic striatum) did not reveal differences between groups. In patients completing both scans (n=15), there were no detectable changes in striatal D2 receptor binding potential after weight restoration. In this sample, there were no differences in striatal D2 receptor binding potential between patients with anorexia nervosa and control subjects. Weight restoration was not associated with a change in striatal D2 receptor binding. These findings suggest that disturbances in reward processing in this disorder are not attributable to abnormal D2 receptor characteristics, and that other reward-related neural targets may be of greater relevance. PMID:26272038

  4. Neural mechanisms supporting maladaptive food choices in anorexia nervosa.

    PubMed

    Foerde, Karin; Steinglass, Joanna E; Shohamy, Daphna; Walsh, B Timothy

    2015-11-01

    People routinely make poor choices, despite knowledge of negative consequences. The authors found that individuals with anorexia nervosa, who make maladaptive food choices to the point of starvation, engaged the dorsal striatum more than healthy controls when making choices about what to eat, and that activity in fronto-striatal circuits was correlated with their actual food consumption in a meal the next day.

  5. Bulimia and Anorexia Nervosa in Dental and Dental Hygiene Curricula.

    ERIC Educational Resources Information Center

    Gross, Karen B. W.; And Others

    1990-01-01

    Dentists and dental hygienists are in a unique position to identify an eating disorder patient from observed oral manifestations and to refer the patient for psychological therapy. The inclusion of information on general and oral complications of bulimia and anorexia nervosa in dental and dental hygiene curriculum was examined. (MLW)

  6. The role of pharmacotherapy in anorexia nervosa and bulimia.

    PubMed

    Tolstoi, L G

    1989-11-01

    The purpose of this article is to review the basic pharmacology and the role of drugs that are used to treat anorexia nervosa and bulimia. The pharmacological treatment of eating disorders is based upon theoretical principles. The theoretical models include: (a) an illness secondary to other psychiatric disorders, (b) a disorder in the hypothalamic control of food intake, (c) a disorder of hypothalamic endocrine regulation, (d) a syndrome secondary to depressive illness, and (e) a disorder in the hypothalamic regulation of food intake. Theoretical models a, b, and c govern the choice of drug therapy for anorexia nervosa, and models d and e govern the choice of drug therapy for bulimia. Drugs used to treat anorexia nervosa and bulimia include tricyclic antidepressants and lithium carbonate. Chlorpromazine, metoclopramide, cyproheptadine, and clomiphene citrate have also been prescribed for the treatment of anorexia nervosa. Monoamine oxidase inhibitors are commonly prescribed to treat bulimia. Fenfluramine has the potential to be of therapeutic value in patients with bulimia. Although drug therapy plays a limited role in the treatment of eating disorders, drugs are commonly prescribed. Therefore, the nutritionist should be familiar with the basic pharmacology and the side effects related to drug therapy.

  7. Some personality characteristics of patients with anorexia nervosa.

    PubMed

    Smart, D E; Beumont, P J; George, G C

    1976-01-01

    Twenty-two female patients with anorexia nervosa were assessed by means of objective personality testing. The EPI, Leyton Obsessional Inventory, Cattell's 16 PF and Raven's Matrices were used for this purpose. The personality profile that emerged was of a highly neurotic and introverted person with moderately severe obsessional features and average intelligence.

  8. An Outcome Study of Anorexia Nervosa in an Adolescent Unit.

    ERIC Educational Resources Information Center

    Jenkins, M. E.

    1987-01-01

    Adolescent girls (N=21) treated for anorexia nervosa in a hospital operating a strict refeeding program were examined 3 years after treatment. Outcome was considered good for 10 girls, intermediate for 4 girls, and poor for 5 girls. Found lack of separation from parents at follow-up. Discusses relevance of findings to treatment approach and to…

  9. Determinants of Adolescent Obesity: A Comparison with Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Brone, Ronald J.; Fisher, Celia B.

    1988-01-01

    Comparison of childhood and adolescent obesity and anorexia nervosa reveals etiological similarities between the two conditions, particularly regarding family interactional patterns. In both cases, family enmeshment and overprotectiveness resulted in a poor sense of identity and effectiveness. Some children, while compliant and dependent in…

  10. A Psychoeducational Approach in the Treatment of Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Cotugno, Albert J.

    1980-01-01

    Anorexia nervosa exists as a clinical entity with significant ego disturbances which appear as primary features. Noneating and accompanying weight loss are often secondary features of the disturbance. The psychoeducational approach is most valuable because it integrates the psychological view with educational goals. (Author)

  11. Humanistic Approaches to the Understanding and Treatment of Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Dittmar, Helga; Bates, Brian

    1987-01-01

    Summarizes some attempts to understand the causes and consequent treatments of anorexia nervosa from the viewpoints of psychoanalytically informed, family, existential and feminist psychology. These perspectives, which focus on the individual experience of the anorexic, leave many questions unanswered, but provide fresh frameworks from which to…

  12. Outpatient Treatment of Primary Anorexia Nervosa in Adult Males.

    ERIC Educational Resources Information Center

    Ziesat, Harold A., Jr.; Ferguson, James M.

    1984-01-01

    Describes three cases of adult-onset primary anorexia nervosa in males. For each case, the history and diagnostic patterns are considered, followed by a discussion of the course of outpatient treatment. The therapy was multimodal and included elements of behavioral contingency management, cognitive therapy, and dynamic psychotherapy. (JAC)

  13. A Comparative Analysis of Personality Organization in Juvenile Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Strober, Michael

    1981-01-01

    To identify distinguishing features of personality associated with anorexia nervosa in adolescence, the Cattell High School Personality Questionnaire responses of 50 anorectics were compared with matched groups of depressed and antisocial adolescent females. Results indicated that anorectics displayed greater conformity, neurotic anxieties,…

  14. Anorexia Nervosa in Adolescence and Maudsley Family-Based Treatment

    ERIC Educational Resources Information Center

    Hurst, Kim; Read, Shelly; Wallis, Andrew

    2012-01-01

    Anorexia nervosa is a serious psychiatric disorder that usually occurs in adolescence. The course of the illness can be protracted. Current empirical evidence suggests that the Maudsley Family-Based Treatment (MFBT) is efficacious for adolescents. MFBT empowers parents as a crucial treatment resource to assist in their child's recovery. The…

  15. [Neurofeedback in the Treatment of Anorexia Nervosa: a Case Report].

    PubMed

    Lackner, N; Unterrainer, H F; Skliris, D; Wood, G; Dunitz-Scheer, M; Wallner-Liebmann, S J; Scheer, P J Z; Neuper, C

    2016-02-01

    Anorexia nervosa has been related to alterations in brain activity in terms of hyperactive EEG patterns. This case report illustrates the principles and results of a five-week neurofeedback treatment in a 29-year-old woman suffering from anorexia nervosa. A neurofeedback protocol to enhance alpha activity (8 - 12 Hz) was developed and conducted additionally to the standardized treatment for eating disorders in training sessions twice a week. Pre- and post-test measurements included resting state EEG measurements and a psychological test battery. The results show improvements from pre- to post-test in eating disorder psychopathology including psychological wellbeing, emotional competence, and eating behavior traits. In addition, a decrease in theta power (4 - 7 Hz), a well-known trait marker of anorexia nervosa, was measured. However, our data should be interpreted with caution because this is a single case study. Nevertheless, this report documents the practicability and method of neurofeedback as treatment adjunct in eating disorders from the clinical perspective. Although the use of neurofeedback in the treatment of anorexia nervosa is recommended in literature, empirical studies are still lacking. Randomized controlled trials to evaluate short- and long-term effects of neurofeedback are needed. © Georg Thieme Verlag KG Stuttgart · New York.

  16. Striatal dopamine type 2 receptor availability in anorexia nervosa.

    PubMed

    Broft, Allegra; Slifstein, Mark; Osborne, Joseph; Kothari, Paresh; Morim, Simon; Shingleton, Rebecca; Kenney, Lindsay; Vallabhajosula, Shankar; Attia, Evelyn; Martinez, Diana; Timothy Walsh, B

    2015-09-30

    The neurobiology of anorexia nervosa remains incompletely understood. Here we utilized PET imaging with the radiotracer [(11)C]raclopride to measure striatal dopamine type 2 (D2) receptor availability in patients with anorexia nervosa. 25 women with anorexia nervosa who were receiving treatment in an inpatient program participated, as well as 25 control subjects. Patients were scanned up to two times with the PET tracer [(11)C]raclopride: once while underweight, and once upon weight restoration. Control subjects underwent one PET scan. In the primary analyses, there were no significant differences between underweight patients (n=21) and control subjects (n=25) in striatal D2 receptor binding potential. Analysis of subregions (sensorimotor striatum, associative striatum, limbic striatum) did not reveal differences between groups. In patients completing both scans (n=15), there were no detectable changes in striatal D2 receptor binding potential after weight restoration. In this sample, there were no differences in striatal D2 receptor binding potential between patients with anorexia nervosa and control subjects. Weight restoration was not associated with a change in striatal D2 receptor binding. These findings suggest that disturbances in reward processing in this disorder are not attributable to abnormal D2 receptor characteristics, and that other reward-related neural targets may be of greater relevance. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. Depression and Anorexia Nervosa of Persons with Down Syndrome.

    ERIC Educational Resources Information Center

    Szymanski, Ludwik S.; Biederman, Joseph

    1984-01-01

    Manifestations of depression in three adults wth Down syndrome, one of whom also exhibited anorexia nervosa, are described. Overall findings indicate that major depression in Down syndrome may be more frequent than previously assumed and that it can be diagnosed with standard diagnostic criteria, modified according to the patient's developmental…

  18. Anorexia Nervosa: An Overview for the School Counselor.

    ERIC Educational Resources Information Center

    Nufrio, Ronald M.

    Anorexia nervosa is a serious eating disorder which affects thousands of people every year. Ninety-five percent of all anorexics are females with the peak age of onset between 14 and 18. While anorexics fit into no specific stereotype, high-risk candidates are often perfectionists and model children who exhibit self-doubt, high conformity,…

  19. Anorexia Nervosa: An Overview for the School Counselor.

    ERIC Educational Resources Information Center

    Nufrio, Ronald M.

    Anorexia nervosa is a serious eating disorder which affects thousands of people every year. Ninety-five percent of all anorexics are females with the peak age of onset between 14 and 18. While anorexics fit into no specific stereotype, high-risk candidates are often perfectionists and model children who exhibit self-doubt, high conformity,…

  20. An adolescent with chronic giardiasis mimicking anorexia nervosa.

    PubMed

    Thomas Iv, Lewis J; Zweig, Alex P; Tosh, Aneesh K

    2014-01-01

    A 13-year-old Hispanic female presented with symptoms of abdominal pain, amenorrhea, and unintentional weight loss of 11 kg. Preliminary investigation yielded no immediate causes, and an initial differential included inflammatory bowel disease (IBD), celiac disease, as well as viral, bacterial, or parasitic gastrointestinal infection. Evaluation of these potential diagnoses yielded negative results; thus, the team thought that the patient may be suffering from anorexia nervosa. The patient was discharged to outpatient care, and was treated in our adolescent health clinic, where repeat laboratory testing yielded a positive Giardia-antigen test. The patient was placed on metronidazole, rapidly gained weight, and resumed menstruation soon after. The final diagnosis was chronic giardiasis. Chronic giardiasis is a rare and enigmatic disease that presents with many symptoms similar to chronic gastrointestinal disorders (e.g. IBD and celiac disease) and anorexia nervosa. Practitioners involved in the diagnosis and treatment of anorexia nervosa should be aware of this disorder and include it in differential diagnoses of patients presenting with anorexia nervosa symptoms.

  1. What People with Anorexia Nervosa Need to Know about Osteoporosis

    MedlinePlus

    ... is an eating disorder characterized by an irrational fear of weight gain. People with anorexia nervosa believe that they are overweight ... sources of calcium include low-fat dairy products; dark green, leafy ... ensure that people get adequate amounts of calcium each day, especially ...

  2. Directives in anorexia nervosa: use of the "Ulysses Agreement".

    PubMed

    Davidson, H; Birmingham, C L

    2003-09-01

    The course of anorexia nervosa frequently has episodes of exacerbation during which motivation and insight are reduced, cognition is impaired and treatment resistance is increased. Formalizing a directive to be used during these episodes when the patient has greater motivation and insight is one way of reducing treatment resistance. We describe a form of directive, called the "Ulysses Agreement".

  3. A Psychoeducational Group Approach for Individuals Recovering from Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Kapp, Lisa

    Although in-depth, long-term group psychotherapy is a beneficial therapeutic experience for adolescent females suffering from anorexia nervosa, these clients are notoriously resistant to treatment and to long-term, open-ended group settings. This dissidence may stem from a motivational deficiency toward changing their eating patterns and…

  4. Anorexia nervosa with massive pulmonary air leak and extraordinary propagation.

    PubMed

    Jensen, V M; Støving, R K; Andersen, P E

    2017-02-07

    A rare case combining pneumothorax, pneumomediastinum, pneumopericardium, pneumoperitoneum, pneumorrhachis, air in retroperitoneum and extensive subcutaneous emphysema simultaneously in a severely anorectic male with BMI 9.2 (22.8 kg) and multiple vomitings is presented. This unusual condition was treated successfully with conservative medical approach in a specialized somatic unit for anorexia nervosa.

  5. The Impact of Childhood Sexual Abuse in Anorexia Nervosa

    ERIC Educational Resources Information Center

    Carter, Jacqueline C.; Bewell, Carmen; Blackmore, Elizabeth; Woodside, D. Blake

    2006-01-01

    Objective: The aim of this study was to examine the impact of childhood sexual abuse (CSA) on clinical characteristics and premature termination of treatment in anorexia nervosa (AN). Method: The participants were 77 consecutive patients with AN admitted to an inpatient eating disorders unit. The patients were assessed in terms of eating disorder…

  6. Psychiatric Comorbidities among Female Adolescents with Anorexia Nervosa

    ERIC Educational Resources Information Center

    Salbach-Andrae, Harriet; Lenz, Klaus; Simmendinger, Nicole; Klinkowski, Nora; Lehmkuhl, Ulrike; Pfeiffer, Ernst

    2008-01-01

    This study investigated current comorbid Axis I diagnoses associated with Anorexia Nervosa (AN) in adolescents. The sample included 101 female adolescents treated at a psychiatric unit for primary DSM-IV diagnoses of AN. 73.3% of the AN patients were diagnosed as having a current comorbidity of at least one comorbid Axis I diagnosis, with no…

  7. Perceived Personality Traits of Individuals with Anorexia Nervosa

    ERIC Educational Resources Information Center

    Watters, Jessica E.; Malouff, John M.

    2012-01-01

    Background: Prior research has found evidence of a general negative personality stereotype for individuals who have anorexia nervosa (AN). Methods: This study examined the expected personality characteristics of individuals with AN using the Five-Factor Model of personality to allow identification of specific personality traits that are part of…

  8. Psychiatric Comorbidities among Female Adolescents with Anorexia Nervosa

    ERIC Educational Resources Information Center

    Salbach-Andrae, Harriet; Lenz, Klaus; Simmendinger, Nicole; Klinkowski, Nora; Lehmkuhl, Ulrike; Pfeiffer, Ernst

    2008-01-01

    This study investigated current comorbid Axis I diagnoses associated with Anorexia Nervosa (AN) in adolescents. The sample included 101 female adolescents treated at a psychiatric unit for primary DSM-IV diagnoses of AN. 73.3% of the AN patients were diagnosed as having a current comorbidity of at least one comorbid Axis I diagnosis, with no…

  9. The Impact of Childhood Sexual Abuse in Anorexia Nervosa

    ERIC Educational Resources Information Center

    Carter, Jacqueline C.; Bewell, Carmen; Blackmore, Elizabeth; Woodside, D. Blake

    2006-01-01

    Objective: The aim of this study was to examine the impact of childhood sexual abuse (CSA) on clinical characteristics and premature termination of treatment in anorexia nervosa (AN). Method: The participants were 77 consecutive patients with AN admitted to an inpatient eating disorders unit. The patients were assessed in terms of eating disorder…

  10. Nutritional adequacy of dietary intake in women with anorexia nervosa

    USDA-ARS?s Scientific Manuscript database

    Background: Understanding nutrient intake of anorexia nervosa (AN) patients is essential for the establishment of dietary treatment. Design: Women, aged 19 to 30 years, with both restricting and binge purge types of AN, participating in an ecological momentary assessment study, completed three nonc...

  11. Perceived Personality Traits of Individuals with Anorexia Nervosa

    ERIC Educational Resources Information Center

    Watters, Jessica E.; Malouff, John M.

    2012-01-01

    Background: Prior research has found evidence of a general negative personality stereotype for individuals who have anorexia nervosa (AN). Methods: This study examined the expected personality characteristics of individuals with AN using the Five-Factor Model of personality to allow identification of specific personality traits that are part of…

  12. An Outcome Study of Anorexia Nervosa in an Adolescent Unit.

    ERIC Educational Resources Information Center

    Jenkins, M. E.

    1987-01-01

    Adolescent girls (N=21) treated for anorexia nervosa in a hospital operating a strict refeeding program were examined 3 years after treatment. Outcome was considered good for 10 girls, intermediate for 4 girls, and poor for 5 girls. Found lack of separation from parents at follow-up. Discusses relevance of findings to treatment approach and to…

  13. Anorexia Nervosa--Parents in Crisis--The Parent Group.

    ERIC Educational Resources Information Center

    Hueth, Colleen Kirkpatrick

    Parents who live with and deal with anorexia nervosa in a daughter often find themselves in crisis. The parent group is one response to that crisis. This study surveyed 30 Montana treatment centers, the 13 Montana AA high schools, and the 12 Montana colleges, universities, and junior colleges to determine what, if any, parent groups existed and…

  14. Anorexia Nervosa: Analysis of Trabecular Texture with CT.

    PubMed

    Tabari, Azadeh; Torriani, Martin; Miller, Karen K; Klibanski, Anne; Kalra, Mannudeep K; Bredella, Miriam A

    2016-10-31

    Purpose To determine indexes of skeletal integrity by using computed tomographic (CT) trabecular texture analysis of the lumbar spine in patients with anorexia nervosa and normal-weight control subjects and to determine body composition predictors of trabecular texture. Materials and Methods This cross-sectional study was approved by the institutional review board and compliant with HIPAA. Written informed consent was obtained. The study included 30 women with anorexia nervosa (mean age ± standard deviation, 26 years ± 6) and 30 normal-weight age-matched women (control group). All participants underwent low-dose single-section quantitative CT of the L4 vertebral body with use of a calibration phantom. Trabecular texture analysis was performed by using software. Skewness (asymmetry of gray-level pixel distribution), kurtosis (pointiness of pixel distribution), entropy (inhomogeneity of pixel distribution), and mean value of positive pixels (MPP) were assessed. Bone mineral density and abdominal fat and paraspinal muscle areas were quantified with quantitative CT. Women with anorexia nervosa and normal-weight control subjects were compared by using the Student t test. Linear regression analyses were performed to determine associations between trabecular texture and body composition. Results Women with anorexia nervosa had higher skewness and kurtosis, lower MPP (P < .001), and a trend toward lower entropy (P = .07) compared with control subjects. Bone mineral density, abdominal fat area, and paraspinal muscle area were inversely associated with skewness and kurtosis and positively associated with MPP and entropy. Texture parameters, but not bone mineral density, were associated with lowest lifetime weight and duration of amenorrhea in anorexia nervosa. Conclusion Patients with anorexia nervosa had increased skewness and kurtosis and decreased entropy and MPP compared with normal-weight control subjects. These parameters were associated with lowest lifetime weight

  15. Effectiveness of individualized, integrative outpatient treatment for females with anorexia nervosa and bulimia nervosa.

    PubMed

    Freudenberg, Cara; Jones, Rebecca A; Livingston, Genvieve; Goetsch, Virginia; Schaffner, Angela; Buchanan, Linda

    2016-01-01

    The effectiveness of an individualized outpatient program was investigated in the treatment of bulimia nervosa (BN) and anorexia nervosa (AN). Participants included 151 females who received outpatient eating disorder treatment in the partial hospitalization program, the intensive outpatient program, or a combination of the two programs. Outcome measures included the Eating Disorder Inventory (EDI-2), Beck Depression Inventory (BDI-II), frequency of binge eating and purging, and mean body weight. Findings included significant increases in weight for the AN group, reductions in binge eating frequency for the BN group, and reductions in EDI-2 and BDI-II scores and purging frequency for both groups. This study provides preliminary support for the efficacy of a multimodal program for the treatment of both anorexia nervosa and bulimia nervosa.

  16. Thoughts about eating, weight and shape in anorexia nervosa and bulimia nervosa.

    PubMed

    Cooper, M J; Fairburn, C G

    1992-09-01

    Concurrent verbalisation and a self-report questionnaire were used to investigate self-statements in patients with anorexia nervosa, patients with bulimia nervosa, two groups of dieters and non-dieting controls. Thoughts were collected while subjects performed three behavioural tasks, looking at themselves in a full-length mirror, weighing themselves and eating a chocolate covered mint. Both groups of patients had more negative thoughts related to eating, weight and shape than those in the three control groups. In addition, patients with anorexia nervosa showed a greater concern with eating while patients with bulimia nervosa showed a greater concern with weight and appearance. Differences were found between the patients and non-dieting controls using both methods but the self-report questionnaire was less sensitive than concurrent verbalisation to differences between the patients and dieters. Implications of the findings for cognitive-behavioural treatments of the two disorders are discussed.

  17. Altered reward processing in women recovered from anorexia nervosa.

    PubMed

    Wagner, Angela; Aizenstein, Howard; Venkatraman, Vijay K; Fudge, Julie; May, J Christopher; Mazurkewicz, Laura; Frank, Guido K; Bailer, Ursula F; Fischer, Lorie; Nguyen, Van; Carter, Cameron; Putnam, Karen; Kaye, Walter H

    2007-12-01

    Individuals with anorexia nervosa are known to be ascetic and able to sustain self-denial of food as well as most comforts and pleasures in life. Building on previous findings of altered striatal dopamine binding in anorexia nervosa, the authors sought to assess the response of the anterior ventral striatum to reward and loss in this disorder. Striatal responses to a simple monetary reward task were investigated using event-related functional magnetic resonance imaging. To avoid the confounding effects of malnutrition, the authors compared 13 healthy comparison women and 13 women who had recovered from restricting-type anorexia nervosa and had 1 year of normal weight and regular menstrual cycles, without binge eating or purging. Recovered women showed greater hemodynamic activation in the caudate than comparison women. Only the recovered women showed a significant positive relationship between trait anxiety and the percentage change in hemodynamic signal in the caudate during either wins or losses. In contrast, in the anterior ventral striatum, comparison women distinguished positive and negative feedback, whereas recovered women had similar responses to both conditions. Individuals who have recovered from anorexia nervosa may have difficulties in differentiating positive and negative feedback. The exaggerated activation of the caudate, a region involved in linking action to outcome, may constitute an attempt at "strategic" (as opposed to hedonic) means of responding to reward stimuli. The authors hypothesize that individuals with anorexia nervosa have an imbalance in information processing, with impaired ability to identify the emotional significance of a stimulus but increased traffic in neurocircuits concerned with planning and consequences.

  18. Readiness to Recover in Adolescent Anorexia Nervosa: Prediction of Hospital Admission

    ERIC Educational Resources Information Center

    Ametller, L.; Castro, J.; Serrano, E.; Martinez, E.; Toro, J.

    2005-01-01

    Objectives: To determine if motivation to change in anorexia nervosa during treatment is a predictor of hospitalisation in adolescent patients. Method: The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ), the Eating Disorders Inventory-2 (EDI-2) and the Beck Depression Inventory (BDI) were administered to a group of 70 anorexia nervosa…

  19. Readiness to Recover in Adolescent Anorexia Nervosa: Prediction of Hospital Admission

    ERIC Educational Resources Information Center

    Ametller, L.; Castro, J.; Serrano, E.; Martinez, E.; Toro, J.

    2005-01-01

    Objectives: To determine if motivation to change in anorexia nervosa during treatment is a predictor of hospitalisation in adolescent patients. Method: The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ), the Eating Disorders Inventory-2 (EDI-2) and the Beck Depression Inventory (BDI) were administered to a group of 70 anorexia nervosa…

  20. Initial assessment and early treatment options for anorexia nervosa and bulimia nervosa.

    PubMed

    Powers, P S

    1996-12-01

    This article presents the essential aspects of assessment of patients with anorexia nervosa or bulimia nervosa. The evaluation of the athlete with a suspected eating disorder is described. The choice of appropriate type and site of treatment is discussed. Throughout the article there is an emphasis on methods that can be useful in assisting the patient to acknowledge his or her illness and participate in treatment. The need to focus simultaneously on psychological and relationship issues and nutritional status is stressed.

  1. Anorexia nervosa and bulimia nervosa - a psychotherapeutic cognitive-constructivist approach.

    PubMed

    Abreu, Cristiano Nabuco de; Cangelli Filho, Raphael

    2017-06-01

    Of the eating disorders, anorexia nervosa and bulimia nervosa are the ones that have made adolescent patients-often females and aged younger and younger-seek for help. This help is provided through a multidisciplinary treatment involving psychiatrists, psychologists and dietists. Psychotherapy has shown to be an efficient component for these patients' improvement. The present article aims at presenting a proposal of psychotherapeutic treatment based on a cognitive-constructivist approach.

  2. Neurobiology of anorexia and bulimia nervosa.

    PubMed

    Kaye, Walter

    2008-04-22

    Anorexia nervosa (AN) and bulimia nervosa (BN) are related disorders of unknown etiology that most commonly begin during adolescence in women. AN and BN have unique and puzzling symptoms, such as restricted eating or binge-purge behaviors, body image distortions, denial of emaciation, and resistance to treatment. These are often chronic and relapsing disorders, and AN has the highest death rate of any psychiatric disorder. The lack of understanding of the pathogenesis of this illness has hindered the development of effective interventions, particularly for AN. Individuals with AN and BN are consistently characterized by perfectionism, obsessive-compulsiveness, and dysphoric mood. Individuals with AN tend to have high constraint, constriction of affect and emotional expressiveness, ahendonia and asceticism, whereas individuals with BN tend to be more impulsive and sensation seeking. Such symptoms often begin in childhood, before the onset of an eating disorder, and persist after recovery, suggesting they are traits that create a vulnerability for developing an ED. There is growing acknowledgement that neurobiological vulnerabilities make a substantial contribution to the pathogenesis of AN and BN. Considerable evidence suggests that altered brain serotonin (5-HT) function contributes to dysregulation of appetite, mood, and impulse control in AN and BN. Brain imaging studies, using 5-HT specific ligands, show that disturbances of 5-HT function occur when people are ill, and persist after recovery from AN and BN. It is possible that a trait-related disturbance of 5-HT neuronal modulation predates the onset of AN and contributes to premorbid symptoms of anxiety, obsessionality, and inhibition. This dysphoric temperament may involve an inherent dysregulation of emotional and reward pathways which also mediate the hedonic aspects of feeding, thus making these individuals vulnerable to disturbed appetitive behaviors. Restricting food intake may become powerfully

  3. Fat Attenuation at CT in Anorexia Nervosa

    PubMed Central

    Gill, Corey M.; Torriani, Martin; Murphy, Rachel; Harris, Tamara B.; Miller, Karen K.; Klibanski, Anne

    2016-01-01

    Purpose To investigate the composition, cross-sectional area (CSA), and hormonal correlates of different fat depots in women with anorexia nervosa (AN) and control subjects with normal weights to find out whether patients with AN have lower fat CSA but higher attenuation than did control subjects and whether these changes may be mediated by gonadal steroids, cortisol, and thyroid hormones. Materials and Methods This study was institutional review board approved and HIPAA compliant. Written informed consent was obtained. Forty premenopausal women with AN and 40 normal-weight women of comparable age (mean age ± standard deviation, 26 years ± 5) were studied. All individuals underwent computed tomography of the abdomen and thigh with a calibration phantom. Abdominal subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), thigh SAT, and thigh intermuscular adipose tissue CSA and attenuation were quantified. Serum estradiol, thyroid hormones, and urinary free cortisol levels were assessed. Variables were compared by using analysis of variance. Associations were examined by using linear regression analysis. Results Women with AN had higher fat attenuation than did control subjects (−100.1 to −46.7 HU vs −117.6 to −61.8 HU, P < .0001), despite lower fat CSA (2.0–62.8 cm2 vs 5.5–185.9 cm2, P < .0001). VAT attenuation but not CSA was inversely associated with lowest prior lifetime body mass index in AN (r = −0.71, P = .006). Serum estradiol levels were inversely associated with fat attenuation (r = −0.34 to −0.61, P = .03 to <.0001) and were positively associated with fat CSA of all compartments (r = 0.42–0.64, P = .007 to <.0001). Thyroxine levels and urinary free cortisol levels were positively associated with thigh SAT attenuation (r = 0.64 [P = .006] and r = 0.68 [P = .0004], respectively) and were inversely associated with abdominal SAT and VAT CSA (r = −0.44 to −0.58, P = .04 to .02). Conclusion Women with AN have differences in fat

  4. Increased P-wave dispersion a risk for atrial fibrillation in adolescents with anorexia nervosa.

    PubMed

    Ertuğrul, İlker; Akgül, Sinem; Derman, Orhan; Karagöz, Tevfik; Kanbur, Nuray

    2016-01-01

    Studies have shown that a prolonged P-wave dispersion is a risk factor for the development of atrial fibrillation. The aim of this study was to evaluate P-wave dispersion in adolescents with anorexia nervosa at diagnosis. We evaluated electrocardiographic findings, particularly the P-wave dispersion, at initial assessment in 47 adolescents with anorexia nervosa. Comparison of P-wave dispersion between adolescents with anorexia nervosa and controls showed a statistically significant higher P-wave dispersion in patients with anorexia nervosa (72 ± 16.3 msec) when compared to the control group (43.8 ± 9.5 msec). Percent of body weight lost, lower body mass index, and higher weight loss rate in the patients with anorexia nervosa had no effect on P-wave dispersion. Due to the fact that anorexia nervosa has a high mortality rate we believe that cardiac pathologies such as atrial fibrillation must also be considered in the medical evaluation.

  5. Goethe's Ottilie: an early 19th century description of anorexia nervosa.

    PubMed Central

    Bhanji, S; Jolles, F E; Jolles, R A

    1990-01-01

    The view that the prevalence of anorexia nervosa is influenced by social attitudes and customs is a popular one. Unfortunately the scarcity of medical accounts prior to the later decades of the last century make it difficult if not impossible to estimate the prevalence of anorexia nervosa at various periods in history. The authors present the history of one of Goethe's literary heroines and suggest that similar studies could throw some light on the epidemiology of anorexia nervosa in the past. PMID:2213809

  6. Medical complications of anorexia nervosa and their treatments: an update on some critical aspects.

    PubMed

    Brown, Carrie; Mehler, Philip S

    2015-12-01

    Anorexia nervosa has the highest mortality rate of any psychiatric disorder. Many of the deaths are attributable to medical complications which arise as the malnutrition and weight loss worsens. Every body system may be adversely affected by anorexia nervosa. Yet, remarkably, most of the medical complications of anorexia nervosa are treatable and reversible with optimal medical care, as part of a multidisciplinary team who are often involved in the care of these patients. Herein, we will describe the medical complications of anorexia nervosa and their treatments.

  7. Cardiac abnormalities in young women with anorexia nervosa.

    PubMed Central

    de Simone, G.; Scalfi, L.; Galderisi, M.; Celentano, A.; Di Biase, G.; Tammaro, P.; Garofalo, M.; Mureddu, G. F.; de Divitiis, O.; Contaldo, F.

    1994-01-01

    OBJECTIVE--To identify the characteristics of cardiac involvement in the self-induced starvation phase of anorexia nervosa. METHODS--Doppler echocardiographic indices of left ventricular geometry, function, and filling were examined in 21 white women (mean (SD) 22 (5) years) with anorexia nervosa according to the DSMIII (Diagnostic and Statistical Manual of Mental Disorders) criteria, 19 women (23 (2) years) of normal weight, and 22 constitutionally thin women (21 (4) years) with body mass index < 20. RESULTS--13 patients (62%) had abnormalities of mitral valve motion compared with one normal weight woman and two thin women (p < 0.001) v both control groups). Left ventricular chamber dimension and mass were significantly less in women with anorexia nervosa than in either the women of normal weight or the thin women, even after standardisation for body size or after controlling for blood pressure. There were no substantial changes in left ventricular shape. Midwall shortening as a percentage of the values predicted from end systolic stress was significantly lower in the starving patients than in women of normal weight: when endocardial shortening was used as the index this difference was overestimated. The cardiac index was also significantly reduced in anorexia nervosa because of a low stroke index and heart rate. The total peripheral resistance was significantly higher in starving patients than in both control groups. The left atrial dimension was significantly smaller in anorexia than in the women of normal weight and the thin women, independently of body size. The transmitral flow velocity E/A ratio was significantly higher in anorexia than in both the control groups because of the reduction of peak velocity A. When data from all three groups were pooled the flow velocity E/A ratio was inversely related to left atrial dimension (r = -0.43, p < 0.0001) and cardiac output (r = -0.64, p < 0.0001) independently of body size. CONCLUSIONS--Anorexia nervosa caused

  8. Perception of autonomy and connectedness prior to the onset of anorexia nervosa and bulimia nervosa.

    PubMed

    Huemer, Julia; Haidvogl, Maria; Mattejat, Fritz; Wagner, Gudrun; Nobis, Gerald; Fernandez-Aranda, Fernando; Collier, David A; Treasure, Janet L; Karwautz, Andreas F K

    2012-01-01

    This study examines retrospective correlates of nonshared family environment prior to onset of disease, by means of multiple familial informants, among anorexia and bulimia nervosa patients. A total of 332 participants was included (anorexia nervosa, restrictive type (AN-R): n = 41 plus families); bulimic patients (anorexia nervosa, binge-purging type; bulimia nervosa: n = 59 plus families). The EATAET Lifetime Diagnostic Interview was used to establish the diagnosis; the Subjective Family Image Test was used to derive emotional connectedness (EC) and individual autonomy (IA). Bulimic and AN-R patients perceived significantly lower EC prior to onset of disease compared to their healthy sisters. Bulimic patients perceived significantly lower EC prior to onset of disease compared to AN-R patients and compared to their mothers and fathers. A low family sum - sister pairs sum comparison - of EC had a significant influence on the risk of developing bulimia nervosa. Contrary to expectations, AN-R patients did not perceive significantly lower levels of IA compared to their sisters, prior to onset of disease. Findings of low IA in currently ill AN-R patients may represent a disease consequence, not a risk factor. Developmental child psychiatrists should direct their attention to disturbances of EC, which may be present prior to the onset of the disease.

  9. Anorexia nervosa: a unified neurological perspective.

    PubMed

    Hasan, Tasneem Fatema; Hasan, Hunaid

    2011-01-01

    The roles of corticotrophin-releasing factor (CRF), opioid peptides, leptin and ghrelin in anorexia nervosa (AN) were discussed in this paper. CRF is the key mediator of the hypothalamo-pituitary-adrenal (HPA) axis and also acts at various other parts of the brain, such as the limbic system and the peripheral nervous system. CRF action is mediated through the CRF1 and CRF2 receptors, with both HPA axis-dependent and HPA axis-independent actions, where the latter shows nil involvement of the autonomic nervous system. CRF1 receptors mediate both the HPA axis-dependent and independent pathways through CRF, while the CRF2 receptors exclusively mediate the HPA axis-independent pathways through urocortin. Opioid peptides are involved in the adaptation and regulation of energy intake and utilization through reward-related behavior. Opioids play a role in the addictive component of AN, as described by the "auto-addiction opioids theory". Their interactions have demonstrated the psychological aspect of AN and have shown to prevent the functioning of the physiological homeostasis. Important opioids involved are β-lipotropin, β-endorphin and dynorphin, which interact with both µ and κ opioids receptors to regulate reward-mediated behavior and describe the higher incidence of AN seen in females. Moreover, ghrelin is known as the "hunger" hormone and helps stimulate growth hormone (GH) and hepatic insulin-like-growth-factor-1(IGF-1), maintaining anabolism and preserving a lean body mass. In AN, high levels of GH due to GH resistance along with low levels of IGF-1 are observed. Leptin plays a role in suppressing appetite through the inhibition of neuropeptide Y gene. Moreover, the CRF, opioid, leptin and ghrelin mechanisms operate collectively at the HPA axis and express the physiological and psychological components of AN. Fear conditioning is an intricate learning process occurring at the level of the hippocampus, amygdala, lateral septum and the dorsal raphe by involving

  10. Anorexia Nervosa: A Unified Neurological Perspective

    PubMed Central

    Hasan, Tasneem Fatema; Hasan, Hunaid

    2011-01-01

    The roles of corticotrophin-releasing factor (CRF), opioid peptides, leptin and ghrelin in anorexia nervosa (AN) were discussed in this paper. CRF is the key mediator of the hypothalamo-pituitary-adrenal (HPA) axis and also acts at various other parts of the brain, such as the limbic system and the peripheral nervous system. CRF action is mediated through the CRF1 and CRF2 receptors, with both HPA axis-dependent and HPA axis-independent actions, where the latter shows nil involvement of the autonomic nervous system. CRF1 receptors mediate both the HPA axis-dependent and independent pathways through CRF, while the CRF2 receptors exclusively mediate the HPA axis-independent pathways through urocortin. Opioid peptides are involved in the adaptation and regulation of energy intake and utilization through reward-related behavior. Opioids play a role in the addictive component of AN, as described by the “auto-addiction opioids theory”. Their interactions have demonstrated the psychological aspect of AN and have shown to prevent the functioning of the physiological homeostasis. Important opioids involved are β-lipotropin, β-endorphin and dynorphin, which interact with both µ and κ opioids receptors to regulate reward-mediated behavior and describe the higher incidence of AN seen in females. Moreover, ghrelin is known as the “hunger” hormone and helps stimulate growth hormone (GH) and hepatic insulin-like-growth-factor-1(IGF-1), maintaining anabolism and preserving a lean body mass. In AN, high levels of GH due to GH resistance along with low levels of IGF-1 are observed. Leptin plays a role in suppressing appetite through the inhibition of neuropeptide Y gene. Moreover, the CRF, opioid, leptin and ghrelin mechanisms operate collectively at the HPA axis and express the physiological and psychological components of AN. Fear conditioning is an intricate learning process occurring at the level of the hippocampus, amygdala, lateral septum and the dorsal raphe by

  11. Is anorexia nervosa a delusional disorder? An assessment of eating beliefs in anorexia nervosa.

    PubMed

    Steinglass, Joanna E; Eisen, Jane L; Attia, Evelyn; Mayer, Laurel; Walsh, B Timothy

    2007-03-01

    Anorexia nervosa (AN) is a serious mental illness, characterized in part by intense and irrational beliefs about shape and weight, including fear of gaining weight. Although these beliefs are considered to be a diagnostic criterion for the illness, they have not been systematically characterized. This study used the Brown Assessment of Beliefs Scale (BABS) to identify the dominant belief that interfered with eating in a sample of underweight patients with AN (N=25). The degree of insight was assessed quantitatively. The majority of participants (68%) spontaneously reported a dominant belief consistent with fear of gaining weight or becoming fat. Twenty percent of patients were categorized as delusional. The total score on the BABS was significantly correlated with the drive-for-thinness subscale of the Eating Disorders Inventory (EDI) (r=0.41, p=0.04), but did not correlate with overall measures of AN severity (body mass index [BMI], duration of illness, lowest BMI, other subscales of the EDI, or total EDI score). These findings highlight the centrality of fear of fat in AN and suggest the possibility that there is a subgroup of patients whose concerns about their weight reaches delusional proportions. This subpopulation of patients warrants further study, since patients with more delusional beliefs may have a form of AN that is more refractory to treatment.

  12. The Disjointed Historical Trajectory of Anorexia Nervosa Before 1970.

    PubMed

    Court, John P M; Kaplan, Allan S

    2016-01-01

    Responses in pre-modern eras to anorexia nervosa (as now understood) varied widely, from religious piety and sanctity through fear and superstition. While noting briefly the limited conceptualizations from pre-modern history this article is primarily focused from the late 19th century, commencing with helpful but tentative formulations of anorexia nervosa for early-modern medicine that were laid out, consistently between themselves, by Lesègue, Gull and Osler. Yet that promising biomedical advent was superseded for more than a half-century by deep, internal divisions and bitter rifts that festered between three medical disciplines: neurology; Freudian psychotherapy; and Kraepelinian biological psychiatry. Mid-20th century developments preceded the 1960-1980s' improved understanding of suffering and movement toward effective remediation introduced by Dr. Hilde Bruch.

  13. [Water intoxication in two girls with anorexia nervosa].

    PubMed

    Vandepitte, M; Vandereycken, W

    2008-01-01

    Two girls, 16 and 18 years old, with anorexia nervosa developed generalized convulsion as a result of drinking excessive amounts of water. The neurological symptoms disappeared, but the girls held on to their excessive drinking habits, despite psychoeducation. Although fluid restriction is known to be a major problem for anorexia nervosa patients within the context of extreme fasting, one should realize that these patients can also run the risk of water intoxication following excessive water intake. Therefore all patients should be questioned explicitly about their daily fluid intake. In the case of polydipsia, the patient's blood should be tested and serum electrolytes should be measured. Patients should be given psychoeducation in order to make them more aware of the possible dangers of excessive water intake.

  14. Prolonged QT interval in a man with anorexia nervosa

    PubMed Central

    Macías-Robles, María Dolores; Perez-Clemente, Ana María; Maciá-Bobes, Carmen; Alvarez-Rueda, María Asunción; Pozo-Nuevo, Sergio

    2009-01-01

    Anorexia nervosa is an eating disorder characterized by the avoidance of food intake, which usually leads to a weight loss. Cardiac co-morbility is common and we can find sometimes a mass loss from the left ventricle, which can be seen by echocardiography. But the commonest complications are rhythm variations, typically bradycardia with a prolonged QT interval in up to a 40% of the cases, which altogether elevates ventricular tachycardia and sudden death risk. We present the case of a male who was diagnosed with anorexia nervosa and developed asthenia, a long QT interval and also a severe both hypokalaemia and hypomagnesaemia. We intend to discuss the pathogenic paths as well as prophylactic and therapeutic measures to this potentially-lethal pathology. PMID:19646241

  15. Decreased platelet monoamine oxidase activity in female anorexia nervosa.

    PubMed

    Díaz-Marsá, M; Carrasco, J L; Hollander, E; César, J; Saiz-Ruiz, J

    2000-03-01

    To study if platelet MAO activity, previously described as a serotonergic index, is modified in a sample of pure restrictive anorectic patients. Twenty-five female patients with DSM-IV anorexia nervosa restricting type were studied and compared with 30 healthy female controls. Platelet MAO activity was measured by isotopic methods using C-14 benzylamine. Impulsive personality features were measured with specific rating scales and temperament studied with Cloninger's TCI. Platelet MAO activity was significantly lower (4.3+2.7 nmol/h/ 108 platelets) in the anorectic patients than in the control group (6.7+2.8) (P<0.01). Platelet MAO was inversely correlated with scores on impulsivity scales and positively correlated with the dimension 'persistence' of Cloninger's TCI. Platelet MAO activity is lowered in a group of patients with anorexia nervosa and might involve some dysfunction in the regulation of impulse control.

  16. Nutritional rehabilitation of anorexia nervosa. Goals and dangers.

    PubMed

    Golden, Neville H; Meyer, Wendy

    2004-01-01

    Nutritional rehabilitation of adolescents with anorexia nervosa is both a science and an art. The goals are to promote metabolic recovery; restore a healthy body weight; reverse the medical complications of the disorder and to improve eating behaviors and psychological functioning. Most, but not all of the medical complications are reversible with nutritional rehabilitation. Refeeding patients with anorexia nervosa results in deposition of lean body mass initially, followed by restoration of adipose tissue as treatment goal weight is approached. The major danger of nutritional rehabilitation is the refeeding syndrome, characterized by fluid and electrolyte, cardiac, hematological and neurological complications, the most serious of which is sudden unexpected death. The refeeding syndrome is most likely to occur in those who are severely malnourished. In such patients, this complication can be avoided by slow refeeding with careful monitoring of body weight, heart rate and rhythm and serum electrolytes, especially serum phosphorus. This paper reviews our clinical experience.

  17. Early-onset anorexia nervosa in girls with Asperger syndrome

    PubMed Central

    Dudova, Iva; Kocourkova, Jana; Koutek, Jiri

    2015-01-01

    Eating disorders frequently occur in conjunction with autism spectrum disorders, posing diagnostic and therapeutic difficulties. The comorbidity of anorexia nervosa and Asperger syndrome is a significant clinical complication and has been associated with a poorer prognosis. The authors are presenting the cases of an eleven-year-old girl and a five-and-a-half-year-old girl with comorbid eating disorders and Asperger syndrome. PMID:26170676

  18. Neural Mechanisms Supporting Maladaptive Food Choices in Anorexia Nervosa

    PubMed Central

    Foerde, Karin; Steinglass, Joanna; Shohamy, Daphna; Walsh, B. Timothy

    2015-01-01

    People routinely make poor choices, despite knowledge of negative consequences. We found that individuals with Anorexia Nervosa, who make maladaptive food choices to the point of starvation, engaged the dorsal striatum more than healthy controls when making choices about what to eat, and that activity in fronto-striatal circuits was correlated with their actual food consumption in a meal the next day. PMID:26457555

  19. Heat in the treatment of patients with anorexia nervosa.

    PubMed

    Gutierrez, E; Vazquez, R

    2001-03-01

    The paper presents the results of heat treatment in three cases of anorexia nervosa (AN), in which marked overactivity and/or strenuous exercising were prominent clinical features. Heat was supplied in three ways: continuous exposure to a warm environment, wearing a thermal waistcoat, and sauna baths in an infrared cabin. The outcomes went far beyond what had been expected, as the disappearance of hyperactivity was followed by progressive recovery.

  20. Early-onset anorexia nervosa in girls with Asperger syndrome.

    PubMed

    Dudova, Iva; Kocourkova, Jana; Koutek, Jiri

    2015-01-01

    Eating disorders frequently occur in conjunction with autism spectrum disorders, posing diagnostic and therapeutic difficulties. The comorbidity of anorexia nervosa and Asperger syndrome is a significant clinical complication and has been associated with a poorer prognosis. The authors are presenting the cases of an eleven-year-old girl and a five-and-a-half-year-old girl with comorbid eating disorders and Asperger syndrome.

  1. Anorexia nervosa: a multifactorial disease of nutritional origin?

    PubMed

    Tannhauser, Pia P

    2002-01-01

    Nutrition in general, with infant and child nutrition in particular, have changed in the past century through altered farming practices and eating habits. Food intake in childhood can influence the expression of the genetic potential. In this paper it is attempted to show how childhood zinc deficiency, aggravated in puberty by high energy/low zinc ratio of the diet and stresses of various kinds, can influence both mental and physical development and ultimately lead to the development of anorexia nervosa.

  2. On the uses of history in psychiatry: diagnostic implications for anorexia nervosa.

    PubMed

    Habermas, Tilmann

    2005-09-01

    The current study demonstrates that recent attempts to equate anorexia nervosa with any form of voluntary self-starvation are not justified. Three arguments are critically reconsidered: That weight phobia was not part of early case reports on anorexia nervosa, that weight phobia should be eliminated from the diagnosis of anorexia nervosa, and that there is a continuity of forms of extreme fasting since the late Middle Ages. A critical approach to the history of eating disorders by interpreting historical sources makes the emergence of anorexia with weight phobia in the middle of the 19th century probable. The criteria for establishing psychiatric diagnoses and the differences between historical types of extreme fasting also support the historical novelty of anorexia nervosa. The etiologic implications of the historical specificity of anorexia nervosa are limited. Research should be directed to better understand self-starvation without weight phobia. 2005 by Wiley Periodicals, Inc.

  3. Food cravings in women with a history of anorexia nervosa.

    PubMed

    Gendall, K A; Sullivan, P F; Joyce, P R; Bulik, C M

    1997-12-01

    The objective of the present study was to determine the prevalence and characteristics of food cravings in women with a history of anorexia nervosa. One hundred one control women selected at random and 64 women with a diagnosis of anorexia nervosa 10 to 14 years earlier (cases) completed the Diagnostic Interview for Genetic Studies, a food craving questionnaire, the Temperament and Character Inventory and the Three-Factor Eating Questionnaire. A similar proportion of cases and controls reported food cravings. A greater proportion of cases reported strong cravings with two or more features of intensity (p = .02). Cravings in the cases were more likely to be characterized by difficulty resisting the craved food (p = .0008), anxiety when the craved food was unavailable (p = .002), and a high frequency of occurrence (p = .001). The cases who craved were significantly more likely to have had lifetime BN (p = .02). A similar prevalence of food craving in cases as in controls suggests that successful control of food intake and/or denial of hunger overrides dietary restriction as a precondition for craving in anorexia nervosa. A dysfunction in the serotonergic system, the provision of intermittent reinforcement by binge episodes, and/or frustration due to unsuccessful attempts at dietary restraint may mediate the association of cravings with the presence of lifetime bulimia.

  4. Anorexia nervosa and body fat distribution: a systematic review.

    PubMed

    El Ghoch, Marwan; Calugi, Simona; Lamburghini, Silvia; Dalle Grave, Riccardo

    2014-09-23

    The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa. Literature searches, study selection, method development and quality appraisal were performed independently by two authors, and data was synthesized using a narrative approach. Twenty studies met the inclusion criteria and were consequently analyzed. The review had five main findings. First, during anorexia nervosa adolescent females lose more central body fat, while adult females more peripheral fat. Second, partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females. Third, after short-term weight restoration, whether partial or complete, adults show a central adiposity phenotype with respect to healthy age-matched controls. Fourth, central fat distribution is associated with increased insulin resistance, but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults. Fifth, the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration, indicating that preferential central distribution of body fat is a transitory phenomenon. However, a discrepancy in the findings has been noted, especially between adolescents and adults; besides age and gender, these appear to be related to differences in the methodology and time of body composition assessments. The PROSPERO Registry-Anorexia Nervosa and Body Fat Distribution: A Systematic Review (CRD42014008738).

  5. Anorexia Nervosa and Body Fat Distribution: A Systematic Review

    PubMed Central

    El Ghoch, Marwan; Calugi, Simona; Lamburghini, Silvia; Dalle Grave, Riccardo

    2014-01-01

    The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa. Literature searches, study selection, method development and quality appraisal were performed independently by two authors, and data was synthesized using a narrative approach. Twenty studies met the inclusion criteria and were consequently analyzed. The review had five main findings. First, during anorexia nervosa adolescent females lose more central body fat, while adult females more peripheral fat. Second, partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females. Third, after short-term weight restoration, whether partial or complete, adults show a central adiposity phenotype with respect to healthy age-matched controls. Fourth, central fat distribution is associated with increased insulin resistance, but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults. Fifth, the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration, indicating that preferential central distribution of body fat is a transitory phenomenon. However, a discrepancy in the findings has been noted, especially between adolescents and adults; besides age and gender, these appear to be related to differences in the methodology and time of body composition assessments. The PROSPERO Registry—Anorexia Nervosa and Body Fat Distribution: A Systematic Review (CRD42014008738). PMID:25251296

  6. Adjunctive Methylphenidate in the Treatment of Bulimia Nervosa Co-occurring with Bipolar Disorder and Substance Dependence

    PubMed Central

    McElroy, Susan L.

    2013-01-01

    Bulimia nervosa is associated with bipolar disorder, substance dependence, attention-deficit hyperactivity disorder, and anxiety disorders. Few reports, however, have addressed the treatment of patients with all of these conditions. We describe a young woman with bulimia nervosa, bipolar I disorder, cocaine and alcohol dependence, attention-deficit hyperactivity disorder, and panic disorder who achieved a sustained (>1 year) remission of her bulimia nervosa symptoms and significant improvement of her attention-deficit hyperactivity disorder symptoms with adjunctive methylphenidate after her bipolar, substance use, and panic disorders were successfully treated with hospitalization, intensive psychotherapy, quetiapine, and lamotrigine. Further research into the use of stimulants in bulimia nervosa, including in patients with complex comorbidity, is required. PMID:23556140

  7. A new service model for the treatment of severe anorexia nervosa in the community: the Anorexia Nervosa Intensive Treatment Team

    PubMed Central

    Munro, Calum; Thomson, Victoria; Corr, Jean; Randell, Louise; Davies, Jennie E.; Gittoes, Claire; Honeyman, Vicky; Freeman, Chris P.

    2014-01-01

    Aims and method A community intensive treatment service for severe anorexia nervosa is described. The service is multidisciplinary but driven by a focus on psychological formulation. Psychological and dietetic interventions are grounded in a process of active risk management. Evaluations of safety, cost and acceptability of the service are described. Results Patients are highly satisfied with their care. A relatively low mortality rate for such a high-risk population was observed. In-patient bed use and costs were substantially reduced. Clinical implications There is a case for greater use of intensive community care for patients with severe anorexia nervosa, as it can be acceptable to patients, relatively safe and cost less than admission. PMID:25285220

  8. Autism and anorexia nervosa: Two facets of the same disease?

    PubMed

    Odent, Michel

    2010-07-01

    We compiled data included in the Primal Health Research Database (www.primalhealthresearch.com) to test the hypothesis that when two pathological conditions or personality traits share the same critical period for gene-environment interaction, we should expect further similarities, particularly from clinical and pathophysiological perspectives. The keywords 'autism' and 'anorexia nervosa' (but not bulimia nervosa) lead to studies suggesting that for both conditions the perinatal period is critical. We take this example to look at other possible links between these pathological entities. From a clinical perspective, several teams have independently emphasized the importance of autistic traits in anorexia nervosa. Deficits in the processing of oxytocin have been demonstrated in both cases. Autistic groups have significantly lower blood oxytocin levels than normal groups, and oxytocin levels increase with age in the normal group only. In autistic groups there is a high ratio of intermediates of oxytocin synthesis (OX-T) to the nonapeptide oxytocin (OT). On the other hand, it has been reported that the level of oxytocin in the cerebrospinal fluid of anorexic women is significantly lower than the level of oxytocin in bulimic and control subjects. Scanning data reveal similar asymmetric functions with left hemisphere preponderance in autistic spectrum disorders and anorexia. A comparative study of the mirror neurons systems is another promising avenue for research. Such an accumulation of similarities from a great diversity of perspectives suggests that anorexia nervosa might be considered a female variant of the autistic spectrum. A plausible interpretation is that prenatal exposure to male hormones might protect against the expression of this disease: girls who have a twin brother are at low risk for anorexia nervosa, compared with girls who have a twin sister, and with controls; furthermore genetic linkage analyses do not detect change on the X chromosome. From an

  9. Anorexia Nervosa/Bulimia. LC Science Tracer Bullet, TB 85-8.

    ERIC Educational Resources Information Center

    Halasz, Hisako, Comp.

    This bibliography is intended to help readers locate material on anorexia nervosa and bulimia in the collections of the Library of Congress. A scope note briefly defines the terms "anorexia nervosa" and "bulimia" and discusses similarities and differences between the two eating disorders. Four references are included as introductions to the topic…

  10. Testing the Hypothesis of the Multidimensional Model of Anorexia Nervosa in Adolescents.

    ERIC Educational Resources Information Center

    Lyon, Maureen; Chatoor, Irene; Atkins, Darlene; Silber, Tomas; Mosimann, James; Gray, James

    1997-01-01

    Tested six hypothesized risk factors of a model for anorexia nervosa. Results confirmed three of the risk factors: family history of depression, feelings of ineffectiveness, and poor interceptive awareness. Alcohol and drug abuse also figured prominently in the family history of patients with anorexia nervosa. (RJM)

  11. Locus of Control, Psychopathology, and Weight Gain in Juvenile Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Strober, Michael

    1982-01-01

    Based on a hypothesized disturbance in personal control and efficacy in anorexia nervosa, locus of control score in female adolescents with anorexia nervosa was compared to scores obtained from depressed and conduct-disordered controls and to adolescent female standardization norms. (Author/CL)

  12. Bulimics with and without Prior Anorexia Nervosa: A Comparison of Personality Characteristics.

    ERIC Educational Resources Information Center

    Katzman, Melanie A.; Wolchik, Sharlene A.

    A controversial issue in the literature on eating disorders is whether or not bulimia is a disorder distinct from anorexia nervosa. To compare the personality and behavioral characteristics of bulimic women with and without prior anorexia nervosa, 14 female college students (mean age 19.6 years, 86 percent white) were divided into two groups…

  13. Testing the Hypothesis of the Multidimensional Model of Anorexia Nervosa in Adolescents.

    ERIC Educational Resources Information Center

    Lyon, Maureen; Chatoor, Irene; Atkins, Darlene; Silber, Tomas; Mosimann, James; Gray, James

    1997-01-01

    Tested six hypothesized risk factors of a model for anorexia nervosa. Results confirmed three of the risk factors: family history of depression, feelings of ineffectiveness, and poor interceptive awareness. Alcohol and drug abuse also figured prominently in the family history of patients with anorexia nervosa. (RJM)

  14. Locus of Control, Psychopathology, and Weight Gain in Juvenile Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Strober, Michael

    1982-01-01

    Based on a hypothesized disturbance in personal control and efficacy in anorexia nervosa, locus of control score in female adolescents with anorexia nervosa was compared to scores obtained from depressed and conduct-disordered controls and to adolescent female standardization norms. (Author/CL)

  15. A Comparison of Short- And Long-Term Family Therapy for Adolescent Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Lock, James; Agras, W. Stewart; Bryson, Susan; Kraemer, Helena C.

    2005-01-01

    Objective: Research suggests that family treatment for adolescents with anorexia nervosa may be effective. This study was designed to determine the optimal length of such family therapy. Method: Eighty-six adolescents (12-18 years of age) diagnosed with anorexia nervosa were allocated at random to either a short-term (10 sessions over 6 months) or…

  16. Manualized Family-Based Treatment for Anorexia Nervosa: A Case Series.

    ERIC Educational Resources Information Center

    Le Grange, Daniel; Binford, Roslyn; Loeb, Katharine L.

    2005-01-01

    Objective: The purpose of this study was to describe a case series of children and adolescents (mean age = 14.5 years, SD = 2.3; range 9-18) with anorexia nervosa who received manualized family-based treatment for their eating disorder. Method: Forty-five patients with anorexia nervosa were compared pre- and post-treatment on weight and menstrual…

  17. A Comparison of Short- And Long-Term Family Therapy for Adolescent Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Lock, James; Agras, W. Stewart; Bryson, Susan; Kraemer, Helena C.

    2005-01-01

    Objective: Research suggests that family treatment for adolescents with anorexia nervosa may be effective. This study was designed to determine the optimal length of such family therapy. Method: Eighty-six adolescents (12-18 years of age) diagnosed with anorexia nervosa were allocated at random to either a short-term (10 sessions over 6 months) or…

  18. Coming Together to Calm the Hunger: Group Therapy Program for Adults Diagnosed with Anorexia Nervosa

    ERIC Educational Resources Information Center

    Ponech, Heather; McBride, Dawn Lorraine

    2012-01-01

    This project provides a comprehensive overview of the research literature on anorexia nervosa in female adults and concludes by offering 14 group therapy lesson plans for anorexia nervosa that therapists may use in their practice. There is a remarkable lack of research on the efficacy of treatment designed for individuals diagnosed with anorexia…

  19. Manualized Family-Based Treatment for Anorexia Nervosa: A Case Series.

    ERIC Educational Resources Information Center

    Le Grange, Daniel; Binford, Roslyn; Loeb, Katharine L.

    2005-01-01

    Objective: The purpose of this study was to describe a case series of children and adolescents (mean age = 14.5 years, SD = 2.3; range 9-18) with anorexia nervosa who received manualized family-based treatment for their eating disorder. Method: Forty-five patients with anorexia nervosa were compared pre- and post-treatment on weight and menstrual…

  20. Gray matter decrease of the anterior cingulate cortex in anorexia nervosa.

    PubMed

    Mühlau, Mark; Gaser, Christian; Ilg, Rüdiger; Conrad, Bastian; Leibl, Carl; Cebulla, Marian H; Backmund, Herbert; Gerlinghoff, Monika; Lommer, Peter; Schnebel, Andreas; Wohlschläger, Afra M; Zimmer, Claus; Nunnemann, Sabine

    2007-12-01

    The brain regions that are critically involved in the pathophysiology of anorexia nervosa have not been clearly elucidated. Moreover, decrease in cerebral tissue during extreme malnutrition has been demonstrated repeatedly in anorexia nervosa, but data regarding the reversibility of this cerebral tissue decrease are conflicting. The authors examined region-specific gray matter changes and global cerebral volumes in recovered patients with anorexia nervosa. High-resolution, T1-weighted magnetic resonance imaging (MRI) and voxel-based morphometry were performed in 22 recovered women with anorexia nervosa and in 37 healthy comparison women. Recovery was defined as a body mass index above 17.0 kg/m(2) and regular menses for at least 6 months. The global volumes of gray matter (but not white matter) were decreased in patients with anorexia nervosa by approximately 1%. Analyses of region-specific gray matter changes revealed a gray matter decrease bilaterally in the anterior cingulate cortex of approximately 5%, which remained significant after correction for global effects. This gray matter decrease correlated significantly with the lowest body mass index of lifetime but not with other clinical variables. In anorexia nervosa, part of the global gray matter loss persists over the long run. Region-specific gray matter loss in the anterior cingulate cortex is directly related to the severity of anorexia nervosa, indicating an important role of this area in the pathophysiology of the disorder. Further research is warranted to determine the cause, specificity, and functional consequences of this structural brain change in anorexia nervosa.

  1. A Developmental View of Anorexia Nervosa.

    ERIC Educational Resources Information Center

    Akeroyd-Guillory, Denise

    1988-01-01

    Conducted research, based on Erikson's theory of identity development, to examine anorexic's progression through early stages of development. Results support the view that the negative aspects of development are clearly present in the anorexic. Findings have implications for school counselors. Introductory questionnaire on anorexia is appended.…

  2. Association of CNR1 and FAAH endocannabinoid gene polymorphisms with anorexia nervosa and bulimia nervosa: evidence for synergistic effects.

    PubMed

    Monteleone, P; Bifulco, M; Di Filippo, C; Gazzerro, P; Canestrelli, B; Monteleone, F; Proto, M C; Di Genio, M; Grimaldi, C; Maj, M

    2009-10-01

    Endocannabinoids modulate eating behavior; hence, endocannabinoid genes may contribute to the biological vulnerability to eating disorders. The rs1049353 (1359 G/A) single nucleotide polymorphism (SNP) of the gene coding the endocannabinoid CB1 receptor (CNR1) and the rs324420 (cDNA 385C to A) SNP of the gene coding fatty acid amide hydrolase (FAAH), the major degrading enzyme of endocannabinoids, have been suggested to have functional effects on mature proteins. Therefore, we explored the possibility that those SNPs were associated to anorexia nervosa and/or bulimia nervosa. The distributions of the CNR1 1359 G/A SNP and of the FAAH cDNA 385C to A SNP were investigated in 134 patients with anorexia nervosa, 180 patients with bulimia nervosa and 148 normal weight healthy controls. Additive effects of the two SNPs in the genetic susceptibility to anorexia nervosa and bulimia nervosa were also tested. As compared to healthy controls, anorexic and bulimic patients showed significantly higher frequencies of the AG genotype and the A allele of the CNR1 1359 G/A SNP. Similarly, the AC genotype and the A allele of the FAAH cDNA 385C to A SNP were significantly more frequent in anorexic and bulimic individuals. A synergistic effect of the two SNPs was evident in anorexia nervosa but not in bulimia nervosa. Present findings show for the first time that the CNR1 1359 G/A SNP and the FAAH cDNA 385C to A SNP are significantly associated to anorexia nervosa and bulimia nervosa, and demonstrate a synergistic effect of the two SNPs in anorexia nervosa.

  3. Simulating Category Learning and Set Shifting Deficits in Patients Weight-Restored from Anorexia Nervosa

    DTIC Science & Technology

    2014-01-01

    indicating that, compared to the CW group, the AN group had greater drive for thinness, bulimia symptoms, body dissatisfaction, feelings of...animal models of binge eating, bulimia nervosa, and anorexia nervosa. Neuropharmacology, 63, 87–96. doi:10.1016/j.neuropharm.2011.11.010 Bailer, U. F...receptor radioligand measures is associated with harm avoidant symptoms in anorexia and bulimia nervosa. Psychiatry Research, 211, 160-168

  4. Disruption of brain white matter microstructure in women with anorexia nervosa

    PubMed Central

    Via, Esther; Zalesky, Andrew; Sánchez, Isabel; Forcano, Laura; Harrison, Ben J.; Pujol, Jesús; Fernández-Aranda, Fernando; Menchón, José Manuel; Soriano-Mas, Carles; Cardoner, Narcís; Fornito, Alex

    2014-01-01

    Background The etiology of anorexia nervosa is still unknown. Multiple and distributed brain regions have been implicated in its pathophysiology, implying a dysfunction of connected neural circuits. Despite these findings, the role of white matter in anorexia nervosa has been rarely assessed. In this study, we used diffusion tensor imaging (DTI) to characterize alterations of white matter microstructure in a clinically homogeneous sample of patients with anorexia nervosa. Methods Women with anorexia nervosa (restricting subtype) and healthy controls underwent brain DTI. We used tract-based spatial statistics to compare fractional anisotropy (FA) and mean diffusivity (MD) maps between the groups. Furthermore, axial (AD) and radial diffusivity (RD) measures were extracted from regions showing group differences in either FA or MD. Results We enrolled 19 women with anorexia nervosa and 19 healthy controls in our study. Patients with anorexia nervosa showed significant FA decreases in the parietal part of the left superior longitudinal fasciculus (SLF; pFWE < 0.05), with increased MD and RD but no differences in AD. Patients with anorexia nervosa also showed significantly increased MD in the fornix (pFWE < 0.05), accompanied by decreased FA and increased RD and AD. Limitations Limitations include our modest sample size and cross-sectional design. Conclusion Our findings support the presence of white matter pathology in patients with anorexia nervosa. Alterations in the SLF and fornix might be relevant to key symptoms of anorexia nervosa, such as body image distortion or impairments in body–energy–balance and reward processes. The differences found in both areas replicate those found in previous DTI studies and support a role for white matter pathology of specific neural circuits in individuals with anorexia nervosa. PMID:24913136

  5. Disruption of brain white matter microstructure in women with anorexia nervosa.

    PubMed

    Via, Esther; Zalesky, Andrew; Sánchez, Isabel; Forcano, Laura; Harrison, Ben J; Pujol, Jesús; Fernández-Aranda, Fernando; Menchón, José Manuel; Soriano-Mas, Carles; Cardoner, Narcís; Fornito, Alex

    2014-11-01

    The etiology of anorexia nervosa is still unknown. Multiple and distributed brain regions have been implicated in its pathophysiology, implying a dysfunction of connected neural circuits. Despite these findings, the role of white matter in anorexia nervosa has been rarely assessed. In this study, we used diffusion tensor imaging (DTI) to characterize alterations of white matter microstructure in a clinically homogeneous sample of patients with anorexia nervosa. Women with anorexia nervosa (restricting subtype) and healthy controls underwent brain DTI. We used tract-based spatial statistics to compare fractional anisotropy (FA) and mean diffusivity (MD) maps between the groups. Furthermore, axial (AD) and radial diffusivity (RD) measures were extracted from regions showing group differences in either FA or MD. We enrolled 19 women with anorexia nervosa and 19 healthy controls in our study. Patients with anorexia nervosa showed significant FA decreases in the parietal part of the left superior longitudinal fasciculus (SLF; p(FWE) < 0.05), with increased MD and RD but no differences in AD. Patients with anorexia nervosa also showed significantly increased MD in the fornix (p(FWE) < 0.05), accompanied by decreased FA and increased RD and AD. Limitations include our modest sample size and cross-sectional design. Our findings support the presence of white matter pathology in patients with anorexia nervosa. Alterations in the SLF and fornix might be relevant to key symptoms of anorexia nervosa, such as body image distortion or impairments in body-energy-balance and reward processes. The differences found in both areas replicate those found in previous DTI studies and support a role for white matter pathology of specific neural circuits in individuals with anorexia nervosa.

  6. Psychiatrists' attitudes towards autonomy, best interests and compulsory treatment in anorexia nervosa: a questionnaire survey.

    PubMed

    Tan, Jacinta O A; Doll, Helen A; Fitzpatrick, Raymond; Stewart, Anne; Hope, Tony

    2008-12-17

    The compulsory treatment of anorexia nervosa is a contentious issue. Research suggests that psychiatrists have a range of attitudes towards patients suffering from anorexia nervosa, and towards the use of compulsory treatment for the disorder. A postal self-completed attitudinal questionnaire was sent to senior psychiatrists in the United Kingdom who were mostly general adult psychiatrists, child and adolescent psychiatrists, or psychiatrists with an interest in eating disorders. Respondents generally supported a role for compulsory measures under mental health legislation in the treatment of patients with anorexia nervosa. Compared to 'mild' anorexia nervosa, respondents generally were less likely to feel that patients with 'severe' anorexia nervosa were intentionally engaging in weight loss behaviours, were able to control their behaviours, wanted to get better, or were able to reason properly. However, eating disorder specialists were less likely than other psychiatrists to think that patients with 'mild' anorexia nervosa were choosing to engage in their behaviours or able to control their behaviours. Child and adolescent psychiatrists were more likely to have a positive view of the use of parental consent and compulsory treatment for an adolescent with anorexia nervosa. Three factors emerged from factor analysis of the responses named: 'Support for the powers of the Mental Health Act to protect from harm'; 'Primacy of best interests'; and 'Autonomy viewed as being preserved in anorexia nervosa'. Different scores on these factor scales were given in terms of type of specialist and gender. In general, senior psychiatrists tend to support the use of compulsory treatment to protect the health of patients at risk and also to protect the welfare of patients in their best interests. In particular, eating disorder specialists tend to support the compulsory treatment of patients with anorexia nervosa independently of views about their decision-making capacity, while

  7. Altered Social Reward and Attention in Anorexia Nervosa

    PubMed Central

    Watson, Karli K.; Werling, Donna M.; Zucker, Nancy L.; Platt, Michael L.

    2010-01-01

    Dysfunctional social reward and social attention are present in a variety of neuropsychiatric disorders including autism, schizophrenia, and social anxiety. Here we show that similar social reward and attention dysfunction are present in anorexia nervosa (AN), a disorder defined by avoidance of food and extreme weight loss. We measured the implicit reward value of social stimuli for female participants with (n = 11) and without (n = 11) AN using an econometric choice task and also tracked gaze patterns during free viewing of images of female faces and bodies. As predicted, the reward value of viewing bodies varied inversely with observed body weight for women with anorexia but not control women, in contrast with their explicit ratings of attractiveness. Surprisingly, women with AN, unlike control women, did not find female faces rewarding and avoided looking at both the face and eyes – independent of observed body weight. These findings suggest comorbid dysfunction in the neural circuits mediating gustatory and social reward in anorexia nervosa. PMID:21887145

  8. Brain connectome modularity in weight-restored anorexia nervosa and body dysmorphic disorder.

    PubMed

    Zhang, A; Leow, A; Zhan, L; GadElkarim, J; Moody, T; Khalsa, S; Strober, M; Feusner, J D

    2016-10-01

    Anorexia nervosa (AN) and body dysmorphic disorder (BDD) frequently co-occur, and have several overlapping phenomenological features. Little is known about their shared neurobiology. The aim of the study was to compare modular organization of brain structural connectivity. We acquired diffusion-weighted magnetic resonance imaging data on unmedicated individuals with BDD (n = 29), weight-restored AN (n = 24) and healthy controls (HC) (n = 31). We constructed connectivity matrices using whole-brain white matter tractography, and compared modular structures across groups. AN showed abnormal modularity involving frontal, basal ganglia and posterior cingulate nodes. There was a trend in BDD for similar abnormalities, but no significant differences compared with AN. In AN, poor insight correlated with longer path length in right caudal anterior cingulate and right posterior cingulate. Abnormal network organization patterns in AN, partially shared with BDD, may have implications for understanding integration between reward and habit/ritual formation, as well as conflict monitoring/error detection.

  9. Brain connectome modularity in weight-restored anorexia nervosa and body dysmorphic disorder

    PubMed Central

    Zhang, A; Leow, A; Zhan, L; GadElkarim, J; Moody, T; Khalsa, S; Strober, M; Feusner, JD

    2017-01-01

    Background Anorexia nervosa (AN) and body dysmorphic disorder (BDD) frequently co-occur, and have several overlapping phenomenological features. Little is known about their shared neurobiology. Aims To compare modular organization of brain structural connectivity. Methods We acquired diffusion-weighted magnetic resonance imaging data on unmedicated individuals with BDD (n=29), weight-restored AN (n=24), and healthy controls (HC) (n=31). We constructed connectivity matrices using whole-brain white matter tractography, and compared modular structures across groups. Results AN showed abnormal modularity involving frontal, basal ganglia, and posterior cingulate nodes. There was a trend in BDD for similar abnormalities, but no significant differences compared with AN. In AN, poor insight correlated with longer path length in right caudal anterior cingulate and right posterior cingulate. Conclusions Abnormal network organization patterns in AN, partially shared with BDD, may have implications for understanding integration between reward and habit/ritual formation, as well as conflict monitoring/error detection. PMID:27429183

  10. Altered insula response to sweet taste processing after recovery from anorexia and bulimia nervosa.

    PubMed

    Oberndorfer, Tyson A; Frank, Guido K W; Simmons, Alan N; Wagner, Angela; McCurdy, Danyale; Fudge, Julie L; Yang, Tony T; Paulus, Martin P; Kaye, Walter H

    2013-10-01

    Recent studies suggest that altered function of higher-order appetitive neural circuitry may contribute to restricted eating in anorexia nervosa and overeating in bulimia nervosa. This study used sweet tastes to interrogate gustatory neurocircuitry involving the anterior insula and related regions that modulate sensory-interoceptive-reward signals in response to palatable foods. Participants who had recovered from anorexia nervosa and bulimia nervosa were studied to avoid confounding effects of altered nutritional state. Functional MRI measured brain response to repeated tastes of sucrose and sucralose to disentangle neural processing of caloric and noncaloric sweet tastes. Whole-brain functional analysis was constrained to anatomical regions of interest. Relative to matched comparison women (N=14), women recovered from anorexia nervosa (N=14) had significantly diminished and women recovered from bulimia nervosa (N=14) had significantly elevated hemodynamic response to tastes of sucrose in the right anterior insula. Anterior insula response to sucrose compared with sucralose was exaggerated in the recovered group (lower in women recovered from anorexia nervosa and higher in women recovered from bulimia nervosa). The anterior insula integrates sensory reward aspects of taste in the service of nutritional homeostasis. One possibility is that restricted eating and weight loss occur in anorexia nervosa because of a failure to accurately recognize hunger signals, whereas overeating in bulimia nervosa could represent an exaggerated perception of hunger signals. This response may reflect the altered calibration of signals related to sweet taste and the caloric content of food and may offer a pathway to novel and more effective treatments.

  11. Hypovitaminosis D3, Leukopenia, and Human Serotonin Transporter Polymorphism in Anorexia Nervosa and Bulimia Nervosa.

    PubMed

    Tasegian, Anna; Curcio, Francesco; Dalla Ragione, Laura; Rossetti, Francesca; Cataldi, Samuela; Codini, Michela; Ambesi-Impiombato, Francesco Saverio; Beccari, Tommaso; Albi, Elisabetta

    2016-01-01

    Vitamin D3 has been described to have different extraskeletal roles by acting as parahormone in obesity, diabetes, cancer, cognitive impairment, and dementia and to have important regulatory functions in innate immunity. There are no studies showing extraskeletal changes associated with hypovitaminosis D3 in eating disorders. Methods. We have analyzed the blood of 18 patients affected by anorexia nervosa and bulimia nervosa collected over a 15-month period. We performed a panel of chemical and clinical analyses: the assay of vitamin D3, the immunoblotting of vitamin D receptor and peroxisome proliferator-activated receptor gamma, and the genotyping of 5-hydroxytryptamine transporter linked polymorphic region. Results. We choose 18 patients with a normal blood test profile such as thyroid hormones, hepatic and renal parameters, triglycerides, proteins, vitamin B12, and folic acid. Among these emerged the case of a woman with long-term anorexia nervosa and the case of a woman with long-term bulimia nervosa both complicated by anxiety and depression, severe hypovitaminosis D3, decrease of vitamin D receptor, leukopenia, and 5-hydroxytryptamine transporter linked polymorphic region short allele. Conclusion. The results induce hypothesising that the severe hypovitaminosis D3 might be responsible for the lack of the inflammatory response and the depressive symptoms in patients with long-term eating disorders.

  12. Electrocortical processing of food and emotional pictures in anorexia nervosa and bulimia nervosa.

    PubMed

    Blechert, Jens; Feige, Bernd; Joos, Andreas; Zeeck, Almut; Tuschen-Caffier, Brunna

    2011-06-01

    Objective To compare the electrocortical processing of food pictures in participants with anorexia nervosa (n = 21), bulimia nervosa (n = 22), and healthy controls (HCs) (n = 32) by measuring the early posterior negativity, an event-related potential that reflects stimulus salience and selective attention. Methods We exposed these three groups to a rapid stream of high- and low-calorie food pictures, as well as standard emotional and neutral pictures. Results Event-related potentials in the time range of 220 milliseconds to 310 milliseconds on posterior electrodes differed between groups: patients with eating disorders showed facilitated processing of both high- and low-calorie food pictures relative to neutral pictures, whereas HC participants did so only for the high-calorie pictures. Subjective palatability of the pictures was rated highest by patients with anorexia nervosa, followed by the HC and bulimia nervosa groups. Conclusions Patients with eating disorders show a generalized attentional bias for food images, regardless of caloric value. This might explain the persistent preoccupation with food in these individuals.

  13. Osteomalacia in a patient with severe anorexia nervosa.

    PubMed

    Oliveri, B; Gomez Acotto, C; Mautalen, C

    1999-10-01

    A 27-year-old woman with anorexia nervosa since adolescence was referred to our unit for generalized bone pain most severe at the pelvis and an inability to stand. She reported a pelvic fracture diagnosed one year earlier, which had failed to heal. Laboratory tests showed low serum phosphate, normal total serum calcium corrected for serum albumin, and very low urinary calcium excretion. Serum bone alkaline phosphatase and parathyroid hormone levels were elevated, whereas 25-hydroxy-vitamin D was severely decreased. Multiple vertebral and rib fractures were seen on plain radiographs. Radiographic images consistent with osteomalacia were pseudofractures of the left inferior pubic ramus, a bilateral complete fracture of the superior pubic ramus, and a characteristic pseudofracture (Looser zone) in the lateral margin of the right scapula. Vitamin D-deficient osteomalacia with secondary hyperparathyroidism was strongly suspected at this point, but it was decided not to confirm this diagnosis by bone biopsy with histomorphometry and osteoid labeling because of the emotional instability of the patient. Dual-energy X-ray absorptiometry disclosed severe demineralization. After two months on calcium and vitamin D supplements, the bone pain had abated and the patient was able to stand. Serum calcium had increased; serum phosphate, 25-hydroxy-vitamin D, and parathyroid hormone had returned to normal, and the pseudofractures showed evidence of healing. Osteoporosis is a well-known complication of anorexia nervosa. This case shows that osteomalacia can also occur. Vitamin D status should be assessed in patients with long-standing severe anorexia nervosa.

  14. Anorexia nervosa and bulimia: an activity-oriented approach.

    PubMed

    Giles, G M

    1985-08-01

    In recent years, there has been a growing trend away from a dogmatic adherence to any one approach in the treatment of eating disorders. This paper adds the new element of practice in relation to cognitive change. The activity-oriented approach outlined here stresses that patients with anorexia nervosa or bulimia must maintain responsibility for their own food intake throughout treatment. The key role of the occupational therapist in the treatment team is outlined, and suggestions for assessment and management of this type of patient are given.

  15. Diagnosis and outcome of anorexia nervosa: the St George's view.

    PubMed Central

    Crisp, A H

    1977-01-01

    Anorexia nervosa has been viewed here as a defensive biologically regressed posture pivoting around the events of puberty and reflecting primary gain. There is rarely any secondary gain - on the contrary life is miserable though still usually possible. The disorder is rooted in psychobiological mechanisms within the individual and in individual and family psychopathology concerning the meaning of body weight and fatness, evoked by the proband's adolescence and its maturational challenges. There are many identifiable 'risk factors' that can influence the evolution of the condition. Treatment requires a combined behavioural and psychotherapeutic approach involving special medical and nursing and psychotherapeutic skills. PMID:896784

  16. Can Family-Based Treatment of Anorexia Nervosa Be Manualized?

    PubMed Central

    Lock, James; Le Grange, Daniel

    2001-01-01

    The authors report on the development of a manual for treating adolescents with anorexia nervosa modeled on a family-based intervention originating at the Maudsley Hospital in London. The manual provides the first detailed account of a clinical approach shown to be consistently efficacious in randomized clinical trials for this disorder. Manualized family therapy appears to be acceptable to therapists, patients, and families. Preliminary outcomes are comparable to what would be expected in clinically supervised sessions. These results suggest that through the use of this manual a valuable treatment approach can now be tested more broadly in controlled and uncontrolled settings. PMID:11696652

  17. Alterations in brain structures related to taste reward circuitry in ill and recovered anorexia nervosa and in bulimia nervosa.

    PubMed

    Frank, Guido K; Shott, Megan E; Hagman, Jennifer O; Mittal, Vijay A

    2013-10-01

    The pathophysiology of anorexia nervosa remains obscure, but structural brain alterations could be functionally important biomarkers. The authors assessed taste pleasantness and reward sensitivity in relation to brain structure, which may be related to food avoidance commonly seen in eating disorders. The authors used structural MR imaging to study gray and white matter volumes in women with current restricting-type anorexia nervosa (N=19), women recovered from restricting-type anorexia nervosa (N=24), women with bulimia nervosa (N=19), and healthy comparison women (N=24). All eating disorder groups exhibited increased gray matter volume of the medial orbitofrontal cortex (gyrus rectus). Manual tracing confirmed larger gyrus rectus volume, and volume predicted taste pleasantness ratings across all groups. Analyses also indicated other morphological differences between diagnostic categories. Antero-ventral insula gray matter volumes were increased on the right side in the anorexia nervosa and recovered anorexia nervosa groups and on the left side in the bulimia nervosa group relative to the healthy comparison group. Dorsal striatum volumes were reduced in the recovered anorexia nervosa and bulimia nervosa groups and predicted sensitivity to reward in all three eating disorder groups. The eating disorder groups also showed reduced white matter in right temporal and parietal areas relative to the healthy comparison group. The results held when a range of covariates, such as age, depression, anxiety, and medications, were controlled for. Brain structure in the medial orbitofrontal cortex, insula, and striatum is altered in eating disorders and suggests altered brain circuitry that has been associated with taste pleasantness and reward value.

  18. Altered thresholds for thermoregulatory sweating and vasodilatation in anorexia nervosa.

    PubMed Central

    Luck, P; Wakeling, A

    1980-01-01

    The changes in peripheral (hand) blood flow that occurred when deep body temperature was raised were measured in 13 patients with anorexia nervosa and 13 control subjects. The relation between blood flow and core temperature was shifted to the left in the patients with anorexia, with the onset of vasodilatation occurring at lower core and mean skin temperatures: no significant differences in the slopes of the responses were evident. The onset of thermal sweating occurred at lower core and mean skin temperatures in the patients with anorexia than in the controls. After ingestion of a high-energy liquid meal core temperature increased in the patients, and this was accompanied by a significant rise in peripheral blood flow in most cases. A similar meal in the normal subjects was followed by either no change in core temperature or a slight fall, and no consistent change in peripheral blood flow. These findings suggest that the lowering of thresholds for thermoregulatory sweating and vasodilatation may be a contributory factor to the abnormally low core temperature of patients with anorexia and may also explain some of their common complaints relating to feelings of warmth in the hands and feet after meals. PMID:7427504

  19. Increased neural processing of rewarding and aversive food stimuli in recovered anorexia nervosa.

    PubMed

    Cowdrey, Felicity A; Park, Rebecca J; Harmer, Catherine J; McCabe, Ciara

    2011-10-15

    Recent evidence has shown that individuals with acute anorexia nervosa and those recovered have aberrant physiological responses to rewarding stimuli. We hypothesized that women recovered from anorexia nervosa would show aberrant neural responses to both rewarding and aversive disorder-relevant stimuli. Using functional magnetic resonance imaging (fMRI), the neural response to the sight and flavor of chocolate, and their combination, in 15 women recovered from restricting-type anorexia nervosa and 16 healthy control subjects matched for age and body mass index was investigated. The neural response to a control aversive condition, consisting of the sight of moldy strawberries and a corresponding unpleasant taste, was also measured. Participants simultaneously recorded subjective ratings of "pleasantness," "intensity," and "wanting." Despite no differences between the groups in subjective ratings, individuals recovered from anorexia nervosa showed increased neural response to the pleasant chocolate taste in the ventral striatum and pleasant chocolate sight in the occipital cortex. The recovered participants also showed increased neural response to the aversive strawberry taste in the insula and putamen and to the aversive strawberry sight in the anterior cingulate cortex and caudate. Individuals recovered from anorexia nervosa have increased neural responses to both rewarding and aversive food stimuli. These findings suggest that even after recovery, women with anorexia nervosa have increased salience attribution to food stimuli. These results aid our neurobiological understanding and support the view that the neural response to reward may constitute a neural biomarker for anorexia nervosa. Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.

  20. How much should I eat? Estimation of meal portions in anorexia nervosa.

    PubMed

    Milos, Gabriella; Kuenzli, Cornelia; Soelch, Chantal Martin; Schumacher, Sonja; Moergeli, Hanspeter; Mueller-Pfeiffer, Christoph

    2013-04-01

    Pathological concern regarding one's weight and weight gain is a crucial feature of anorexia nervosa. Consequently, anorexia nervosa patients often claim that they are uncertain regarding the amount of food they should eat. The present study investigated whether individuals with anorexia nervosa show an altered estimation of meal portion sizes and whether this estimation is modulated by an intent-to-eat instruction (where patients are asked to imagine having to eat the presented meal), meal type and meal portion size. Twenty-four women with anorexia nervosa and 27 healthy women estimated, using a visual analogue scale, the size of six different portions of three different meals, with and without intent-to-eat instructions. Subjects with anorexia nervosa estimated the size of small and medium meal portions (but not large meal servings) as being significantly larger, compared to estimates of healthy controls. The overestimation of small meal portions by anorexia nervosa subjects was significantly greater in the intent-to-eat, compared to general, condition. These findings suggest that disturbed perceptions associated with anorexia nervosa not only include interoceptive awareness (i.e., body weight and shape), but also extend to external disorder-related objects such as meal portion size. Specific therapeutic interventions, such as training regarding meal portion evaluation, could address these difficulties. Copyright © 2013. Published by Elsevier Ltd.

  1. Birth outcomes and pregnancy complications in women with a history of anorexia nervosa.

    PubMed

    Ekéus, C; Lindberg, L; Lindblad, F; Hjern, A

    2006-08-01

    To examine birth outcomes and pregnancy complications in women with a history of anorexia nervosa. Prospective cohort study. Nationwide study in Sweden. All primiparous women--discharged from hospital with a diagnosis of anorexia nervosa during 1973 to 1996--who gave birth during 1983 to 2002 (n = 1000) were compared with all non-anorexia nervosa primiparous women who gave birth during the same years (n = 827,582). Register study with data from Medical Birth Registry and National Patient Discharge Register. Pre-eclampsia, instrumental delivery, prematurity, small for gestational age, birthweight, Apgar score and perinatal mortality. Main birth outcome measures in women with a history of anorexia nervosa were very similar to the main population. The only observed differences were a slightly lower mean birthweight and lower adjusted odds ratios for instrumental delivery in the anorexia nervosa group compared with the main population. Neither severity of the disease nor a shorter recovery phase after first hospitalisation was related to pregnancy complications or birth outcomes. A history of anorexia nervosa was not associated with negative birth outcomes. Thus, special obstetric monitoring of pregnant women with history of anorexia nervosa does not seem to be warranted in a country with a satisfactory maternity surveillance.

  2. Prediction error and somatosensory insula activation in women recovered from anorexia nervosa

    PubMed Central

    Frank, Guido K.W.; Collier, Shaleise; Shott, Megan E.; O’Reilly, Randall C.

    2016-01-01

    Background Previous research in patients with anorexia nervosa showed heightened brain response during a taste reward conditioning task and heightened sensitivity to rewarding and punishing stimuli. Here we tested the hypothesis that individuals recovered from anorexia nervosa would also experience greater brain activation during this task as well as higher sensitivity to salient stimuli than controls. Methods Women recovered from restricting-type anorexia nervosa and healthy control women underwent fMRI during application of a prediction error taste reward learning paradigm. Results Twenty-four women recovered from anorexia nervosa (mean age 30.3 ± 8.1 yr) and 24 control women (mean age 27.4 ± 6.3 yr) took part in this study. The recovered anorexia nervosa group showed greater left posterior insula activation for the prediction error model analysis than the control group (family-wise error– and small volume–corrected p < 0.05). A group × condition analysis found greater posterior insula response in women recovered from anorexia nervosa than controls for unexpected stimulus omission, but not for unexpected receipt. Sensitivity to punishment was elevated in women recovered from anorexia nervosa. Limitations This was a cross-sectional study, and the sample size was modest. Conclusion Anorexia nervosa after recovery is associated with heightened prediction error–related brain response in the posterior insula as well as greater response to unexpected reward stimulus omission. This finding, together with behaviourally increased sensitivity to punishment, could indicate that individuals recovered from anorexia nervosa are particularly responsive to punishment. The posterior insula processes somatosensory stimuli, including unexpected bodily states, and greater response could indicate altered perception or integration of unexpected or maybe unwanted bodily feelings. Whether those findings develop during the ill state or whether they are biological traits requires

  3. Prediction error and somatosensory insula activation in women recovered from anorexia nervosa.

    PubMed

    Frank, Guido K W; Collier, Shaleise; Shott, Megan E; O'Reilly, Randall C

    2016-08-01

    Previous research in patients with anorexia nervosa showed heightened brain response during a taste reward conditioning task and heightened sensitivity to rewarding and punishing stimuli. Here we tested the hypothesis that individuals recovered from anorexia nervosa would also experience greater brain activation during this task as well as higher sensitivity to salient stimuli than controls. Women recovered from restricting-type anorexia nervosa and healthy control women underwent fMRI during application of a prediction error taste reward learning paradigm. Twenty-four women recovered from anorexia nervosa (mean age 30.3 ± 8.1 yr) and 24 control women (mean age 27.4 ± 6.3 yr) took part in this study. The recovered anorexia nervosa group showed greater left posterior insula activation for the prediction error model analysis than the control group (family-wise error- and small volume-corrected p < 0.05). A group × condition analysis found greater posterior insula response in women recovered from anorexia nervosa than controls for unexpected stimulus omission, but not for unexpected receipt. Sensitivity to punishment was elevated in women recovered from anorexia nervosa. This was a cross-sectional study, and the sample size was modest. Anorexia nervosa after recovery is associated with heightened prediction error-related brain response in the posterior insula as well as greater response to unexpected reward stimulus omission. This finding, together with behaviourally increased sensitivity to punishment, could indicate that individuals recovered from anorexia nervosa are particularly responsive to punishment. The posterior insula processes somatosensory stimuli, including unexpected bodily states, and greater response could indicate altered perception or integration of unexpected or maybe unwanted bodily feelings. Whether those findings develop during the ill state or whether they are biological traits requires further study.

  4. Leptin in anorexia nervosa and bulimia nervosa: importance of assay technique and method of interpretation.

    PubMed

    Frederich, Robert; Hu, Shousheng; Raymond, Nancy; Pomeroy, Claire

    2002-02-01

    Studies of the role of leptin in patients with anorexia nervosa and bulimia nervosa have conflicted in their data and interpretation. Such differences may be a result of the assay methods used or the way results are compared with those from normal controls. To investigate these possibilities, we analyzed serum leptin levels in anorexic, bulimic, obese, and control individuals, thereby spanning the full range of human body weights, using three frequently employed commercial kits. Kits from Linco (St Louis, MO) and DSL (Webster, TX) employ a radioimmunoassay method, and the R&D Systems kit (Minneapolis, MN) uses an enzyme-linked immunosorbent assay. We found that the three kits provide results that are highly linearly correlated with each other and remarkably linearly related to percent ideal body weight (%IBW) over more than three orders of magnitude (Linco, r = 0.90; R&D, r = 0.87; DSL, r = 0.86). For very low leptin levels, the more sensitive kits from R&D and Linco appeared to give more reliable results. Measurement method does not appear to explain the literature conflicts. We found that patients with anorexia nervosa have serum leptin values that lie above the line extrapolated from the %IBW/leptin curve generated from analysis of all non-anorexic patients. Therefore, in anorexia nervosa, inappropriately high leptin levels for %IBW may contribute to a blunted physiologic response to underweight and consequent resistance to dietary treatment. By contrast, most bulimic patients have leptin levels significantly below those predicted from the same %IBW/leptin curve. The relative leptin deficiency in bulimic subjects may contribute to food-craving behavior. We propose that using the %IBW/ leptin curve can facilitate identification of true pathophysiologic abnormalities in eating-disordered individuals and provide a basis for the design of therapeutic interventions or monitoring of response to treatment.

  5. Dissociative episode secondary to hypoglycemic state in anorexia nervosa: a case report.

    PubMed

    Ramli, Musa; Hassan, Almashoor Syed; Rosnani, Sarkarsi

    2009-04-01

    Hypoglycemic attack had been reported as one of the medical complications in anorexia nervosa. We present a 25-year-old man who was diagnosed earlier with anorexia nervosa, presented with an episode of dissociative state during which he was caught for shoplifting. In the history, he had a few episodes of fainting spells, which are most possibly due to hypoglycemia. There was no evidence to suggest any misdeeds to support that the stealing was intentional. Hypoglycemic attack may be common in anorexia nervosa, but this is a rare case with medico-legal implication. (c) 2008 by Wiley Periodicals, Inc.

  6. Phosphorus-31 magnetic resonance spectroscopic observations in 4 cases with anorexia nervosa.

    PubMed

    Kato, T; Shioiri, T; Murashita, J; Inubushi, T

    1997-05-01

    1. Brain phosphorus metabolism was examined using phosphorus-31 magnetic resonance spectroscopy in 4 patients with anorexia nervosa. 2. In 4 patients examined before treatment, phosphodiester (PDE) peak area was significantly higher than that in 13 normal females. 3. In 6 data points in 4 patients, lower levels of PME were associated with malnutrition reflected by endocrinological abnormalities. 4. These data suggest that severe malnutrition in patients with anorexia nervosa may result in abnormality in membrane phospholipid metabolism, which might be responsible for brain atrophy in anorexia nervosa.

  7. Anorexia nervosa and gender identity disorder in biologic males: a report of two cases.

    PubMed

    Winston, Anthony P; Acharya, Sudha; Chaudhuri, Shreemantee; Fellowes, Lynette

    2004-07-01

    Gender identity disorder is a rare disorder of uncertain etiology. The emphasis on body shape in this disorder suggests that there may be an association with anorexia nervosa. We report two cases of anorexia nervosa and gender identity disorder in biologic males who presented to an eating disorders service. One was treated successfully as an outpatient and subsequently underwent gender reassignment surgery. The other patient required admission and prolonged psychotherapy. Differences between the two cases are discussed. Issues of gender identity should be considered in the assessment of male patients presenting with anorexia nervosa. Copyright 2004 by Wiley Periodicals, Inc.

  8. A clinical and phenomenological study of 185 Spanish adolescents with anorexia nervosa.

    PubMed

    Toro, J; Nicolau, R; Cervera, M; Castro, J; Blecua, M J; Zaragoza, M; Toro, A

    1995-07-01

    The objectives of the present study were the following to determine the socio-familial, academic and interpersonal characteristics specific to anorexia nervosa (AN); to study comorbidity in patients with anorexia and morbidity in their parents; and to ascertain whether patients with anorexia nervosa in Spain are similar to those in other countries. The research team revised the clinical records of 185 Spanish adolescents with AN (aged 11-18 years). The results were compared with those obtained from a group of 185 psychiatric patients without AN matched by sex, age, time of consultation and centre. No significant differences were found with regard to broken home, birth order or parent-patient conflict. The parents of patients with anorexia have a higher standard of education and develop more affective disorders. When compared with other patients, the individuals with anorexia nervosa perform much better academically but are more socially withdrawn. Males with anorexia nervosa perform worse academically than females and have more anxiety diagnoses. Patients with anorexia have a high comorbidity for affective and obsessive-compulsive disorders. Sufferers from anorexia nervosa in Spain are clinically analogous to patients with anorexia in other countries. The two characteristics specific to these patients are a high standard of academic performance and an intense degree of social withdrawal, although there are certain factors common to other pathologies relating to adolescence.

  9. An Integrative Bio-Psycho-Social Theory of Anorexia Nervosa.

    PubMed

    Munro, Calum; Randell, Louise; Lawrie, Stephen M

    2017-01-01

    The need for novel approaches to understanding and treating anorexia nervosa (AN) is well recognized. The aim of this paper is to describe an integrative bio-psycho-social theory of maintaining factors in AN. We took a triangulation approach to develop a clinically relevant theory with face validity and internal consistency. We developed theoretical ideas from our clinical practice and reviewed theoretical ideas within the eating disorders and wider bio-psycho-social literature. The synthesis of these ideas and concepts into a clinically meaningful framework is described here. We suggest eight key factors central to understanding the maintenance and treatment resistance of anorexia nervosa: genetic or experiential predisposing factors; dysfunctional feelings processing and regulation systems; excessive vulnerable feelings; 'feared self' beliefs; starvation as a maladaptive physiological feelings regulation mechanism; maladaptive psychological coping modes; maladaptive social behaviour; and unmet physical and psychological core needs. Each of these factors serves to maintain the disorder. The concept of universal physical and psychological core needs can provide an underpinning integrative framework for working with this distinctly physical and psychological disorder. This framework could be used within any treatment model. We suggest that treatments which help address the profound lack of trust, emotional security and self-acceptance in this patient group will in turn address unmet needs and improve well-being. Copyright © 2016 John Wiley & Sons, Ltd.

  10. Explicit vs. implicit body image evaluation in restrictive anorexia nervosa.

    PubMed

    Cserjési, Renáta; Vermeulen, Nicolas; Luminet, Olivier; Marechal, Clarisse; Nef, François; Simon, Yves; Lénárd, László

    2010-01-30

    In the present study we investigated the evaluation of body shapes in patients with restrictive anorexia nervosa (AN) on both automatic and controlled levels. The first aim of the study was to examine whether an ultra-thin ideal or negative attitudes toward overweight might be the motivation behind pathological restriction. The second aim was to investigate the relationship between body figure evaluations, eating disorder symptoms and mood. A Modified Affective Priming Test was used to measure implicit evaluations of body silhouettes, while a Likert scale was used to assess explicit evaluations. The study involved 35 women with restrictive anorexia nervosa and 35 age- and education-level-matched controls with normal body weight. In contrast to the control group, the patients did not show a positive attitude toward the ultra-thin body shape on the automatic level. The AN group both on the automatic and the self-reported levels evaluated the overweight body as negative. Depression and anxiety did not influence body evaluation. Strong negative evaluation of overweight appears to be a key issue in AN rather than positive evaluation of ultra-thin role models.

  11. Plasma BDNF levels following weight recovery in anorexia nervosa.

    PubMed

    Phillips, Kathryn E; Jimerson, David C; Pillai, Anilkumar; Wolfe, Barbara E

    2016-10-15

    Preclinical studies have implicated brain-derived neurotrophic factor (BDNF) in the regulation of eating behavior and body weight. As reviewed in this report, prior studies of BDNF levels in anorexia nervosa have yielded variable results, perhaps reflecting effects of malnutrition and psychiatric comorbidity. The goal of the current report was to assess plasma BDNF as a biomarker in weight-recovered individuals with a history of anorexia nervosa (ANWR). Study groups included women meeting criteria for ANWR and healthy female controls. Participants were in a normal weight range, free of current major psychiatric disorder, and free of medication. Self-ratings included eating disorder symptoms, depression and anxiety. Plasma BDNF levels were measured by enzyme linked immunoassay. Plasma BDNF levels were not significantly different for ANWR and control groups. Plasma BDNF levels were inversely correlated with anxiety ratings in controls (p<0.02) but not in the ANWR group. This report provides new evidence that circulating BDNF concentrations do not differ in healthy controls and ANWR free of psychiatric comorbidity. Additionally, the data provide new information on the relationship between plasma BDNF and anxiety in these two study groups. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Functional brain alterations in anorexia nervosa: a scoping review.

    PubMed

    Fuglset, Tone Seim; Landrø, Nils Inge; Reas, Deborah Lynn; Rø, Øyvind

    2016-01-01

    Neuroimaging allows for the identification of brain abnormalities and alterations that are associated with anorexia nervosa (AN). We performed a scoping review to map out the extent and nature of recent research activity on functional magnetic resonance imaging (fMRI) in individuals diagnosed with, or recovered from, AN (AN-REC). A literature search of PubMed, Psychinfo and Embase was conducted using the search terms "anorexia nervosa" AND "functional magnetic resonance imaging." We included fMRI studies that involved a comparison between individuals with AN or AN-REC and healthy controls published in English language between 2010 and 2015. A total of 49 papers were included, regardless of the experimental stimuli or paradigm. Findings varied considerably across studies, reflecting methodological differences in study design, such as sample differences and experimental paradigms. Collectively, studies published during the past five years suggest altered activation in regions related to the fronto-striato and the limbic circuits, which are theorized to have an important role in the pathophysiology of AN.

  13. Literature Review of Cognitive Neuroscience and Anorexia Nervosa.

    PubMed

    Reville, Marie-Claire; O'Connor, Lorna; Frampton, Ian

    2016-02-01

    Studies published between the beginning of 2013 and May 2015 on the neuropsychological functioning of patients with anorexia nervosa compared with healthy participants framed in the context of the Research Domain Criteria matrix identifies evidence for functional differences in three domains: Negative Valance Systems-negative attentional biases and lack of neural responsivity to hunger; Cognitive Systems-limited congruence between clinical and cognitive performance, poorer non-verbal than verbal performance, altered attentional styles to disorder related stimuli, perceptual processing impairment in discriminating body images, weaknesses in central coherence, set shifting weaknesses at low weight status, decision-making weaknesses, and greater neural resources required for working memory; Systems for Social Processes-patients appear to have a different attentional response to faces, and perception and understanding of self and others. Hence, there is evidence to suggest that patients with anorexia nervosa have a specific neuropsychological performance style across tasks in three domains of functioning. Some current controversies and areas for future development are identified.

  14. Anorexia nervosa: hypogonadotrophic hypogonadism and bone mineral density.

    PubMed

    Muñoz, M T; Argente, J

    2002-01-01

    Anorexia nervosa is a chronic illness that involves a reduction in caloric intake, loss of weight and amenorrhoea, either primary or secondary. In addition to prolonged amenorrhoea, osteopenia and osteoporosis are the most frequent complications. Patients exhibit an alteration in the hypothalamic-pituitary-gonadal axis, which is responsible for the menstrual disorders. The increase in gonadotrophin secretion that can be observed after ponderal recuperation suggests that malnutrition could be the most important mechanism involved in the decrease in gonadotrophin secretion. The loss of fat tissue, as a consequence of the restriction of nutrients, has been associated with hypoleptinaemia, abnormal secretion of peptides implicated in food control (neuropeptide Y, melanocortins and corticotrophin-releasing hormone, among others) and diminution of the amount of total body fat. Despite oestrogen therapy, the severe loss of bone mass may progress. Other factors such as weight loss, duration of amenorrhoea and low insulin-like growth factor-I (IGF-I) levels could contribute to the loss of bone mass in women with anorexia nervosa. The recuperation of weight and, in particular, the amount of total body fat could lead to the spontaneous recuperation of menstruation. Copyright 2002 S. Karger AG, Basel

  15. Applying evidence-based management to anorexia nervosa.

    PubMed

    Treasure, Janet

    2016-09-01

    This paper considers how the three principles of evidence based practice (clinical expertise, scientific evidence, and patient preference) can be applied to the complexity of treatment for anorexia nervosa AN. A narrative review of the evidence of these three domains is presented. Clinical cases are used to illustrate how the formulation and management can be put into practice at different stages of illness. The management of anorexia nervosa is complex. First, individuals with the illness do not regard the manifestations of the illness as a source of concern rather they are embraced and integrated into their identity. This contrasts to the reaction of other people who are terrified by the overt signs of ill health. Thus engagement into treatment is problematic. Second, the core symptom restricted eating, produces malnutrition which impacts on brain, body, and the social network. Thus a mixture of psychological and physical problems gradually accumulates over the course of the illness. This means that the treatment targets increase over time. Thus treatment has to work with motivation and readiness to change and tackle the various domains of ill health. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  16. Investigation of Oxytocin Secretion in Anorexia Nervosa and Bulimia Nervosa: Relationships to Temperament Personality Dimensions.

    PubMed

    Monteleone, Alessio Maria; Scognamiglio, Pasquale; Volpe, Umberto; Di Maso, Virginia; Monteleone, Palmiero

    2016-01-01

    Published studies suggested an implication of oxytocin in some temperament characteristics of personality. Therefore, we measured oxytocin secretion in 23 women with anorexia nervosa (AN), 27 with bulimia nervosa (BN) and 19 healthy controls and explored the relationships between circulating oxytocin and patients' personality traits. Plasma oxytocin levels were significantly reduced in AN women but not in BN ones. In healthy women, the attachment subscale scores of the reward dependence temperament and the harm avoidance (HA) scores explained 82% of the variability in circulating oxytocin. In BN patients, plasma oxytocin resulted to be negatively correlated with HA, whereas no significant correlations emerged in AN patients. These findings confirm a dysregulation of oxytocin production in AN but not in BN and show, for the first time, a disruption of the associations between hormone levels and patients' temperament traits, which may have a role in certain deranged behaviours of eating disorder patients. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

  17. Anorexia nervosa complicated by diabetes mellitus: the case for permissive hyperglycemia.

    PubMed

    Brown, Carrie; Mehler, Philip S

    2014-09-01

    The coexistence of Type 1 Diabetes Mellitus and anorexia nervosa results in an increased incidence of known diabetic complications such as retinopathy and nephropathy, presumably because blood glucose is difficult to control within the throes of comorbid anorexia nervosa. In addition, even when a diabetic patient with anorexia nervosa has committed to resolving his or her eating disorder, glucose control is again difficult and fraught with complexity and peril as will be highlighted in the following case report. Prudence dictates that strict glucose control is not indicated for the relatively short period of time that constitutes the early stage of refeeding in a patient with severe anorexia nervosa. Rather, "permissive hyperglycemia" may be the more optimal course to pursue, as a clinical strategy which is considerate of both the criticality of the refeeding treatment plan and of the long-term nature of the diabetic illness.

  18. Delayed gastric emptying and improvement with domperidone in a patient with anorexia nervosa.

    PubMed

    Russell, D M; Freedman, M L; Feiglin, D H; Jeejeebhoy, K N; Swinson, R P; Garfinkel, P E

    1983-09-01

    A woman with anorexia nervosa who displayed severe bloating after eating was treated with domperidone, a novel compound with prokinetic properties. Both subjective ratings of satiety and assessment of gastric emptying documented improvement.

  19. Basal activity of the HPA axis and cognitive function in anorexia nervosa.

    PubMed

    Seed, Julie A; McCue, Patricia M; Wesnes, Keith A; Dahabra, Sylvia; Young, Allan H

    2002-03-01

    Elevated cortisol and cognitive impairments have been described in anorexia nervosa, but the relationship between these two variables has not been adequately explored. We profiled the pattern and extent of the cognitive impairment in anorexia nervosa and determined how this related to cortisol secretion. Twenty patients with anorexia nervosa and a matched control group completed a computerized cognitive assessment battery. Diurnal cortisol secretion was measured by serial saliva sampling. Patients were significantly impaired on tasks of attention, long-term memory and working memory. Both groups showed the expected diurnal variation in cortisol production, but no evidence was found for patient cortisol hypersecretion. No correlation was found between cortisol secretion and any of the cognitive task measures. These data suggest that at least some of the cognitive impairments seen in anorexia nervosa are attributable to something other than a basal increase in cortisol secretion. The limitations of cortisol as an indicator of HPA axis activity are discussed.

  20. Neural responses to emotional faces in women recovered from anorexia nervosa.

    PubMed

    Cowdrey, Felicity A; Harmer, Catherine J; Park, Rebecca J; McCabe, Ciara

    2012-03-31

    Impairments in emotional processing have been associated with anorexia nervosa. However, it is unknown whether neural and behavioural differences in the processing of emotional stimuli persist following recovery. The aim of this study was to investigate the neural processing of emotional faces in individuals recovered from anorexia nervosa compared with healthy controls. Thirty-two participants (16 recovered anorexia nervosa, 16 healthy controls) underwent a functional magnetic resonance imaging (fMRI) scan. Participants viewed fearful and happy emotional faces and indicated the gender of the face presented. Whole brain analysis revealed no significant differences between the groups to the contrasts of fear versus happy and vice versa. Region of interest analysis demonstrated no significant differences in the neural response to happy or fearful stimuli between the groups in the amygdala or fusiform gyrus. These results suggest that processing of emotional faces may not be aberrant after recovery from anorexia nervosa. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  1. Appetite regulatory hormones in women with anorexia nervosa: binge-eating/purging versus restricting type.

    PubMed

    Eddy, Kamryn T; Lawson, Elizabeth A; Meade, Christina; Meenaghan, Erinne; Horton, Sarah E; Misra, Madhusmita; Klibanski, Anne; Miller, Karen K

    2015-01-01

    Anorexia nervosa is a psychiatric illness characterized by low weight, disordered eating, and hallmark neuroendocrine dysfunction. Behavioral phenotypes are defined by predominant restriction or bingeing/purging; binge-eating/purging type anorexia nervosa is associated with poorer outcome. The pathophysiology underlying anorexia nervosa types is unknown, but altered hormones, known to be involved in eating behaviors, may play a role. To examine the role of anorexigenic hormones in anorexia nervosa subtypes, we examined serum levels of peptide YY (PYY; total and active [3-36] forms), brain-derived neurotrophic factor (BDNF), and leptin as primary outcomes in women with DSM-5 restricting type anorexia nervosa (n = 50), binge-eating/purging type anorexia nervosa (n = 25), and healthy controls (n = 22). In addition, women completed validated secondary outcome measures of eating disorder psychopathology (Eating Disorder Examination-Questionnaire) and depression and anxiety symptoms (Hamilton Rating Scales for Depression [HDRS] and Anxiety [HARS]). The study samples were collected from May 22, 2004, to February 7, 2012. Mean PYY 3-36 and leptin levels were lower and BDNF levels higher in binge-eating/purging type anorexia nervosa than in restricting type anorexia nervosa (all P values < .05). After controlling for body mass index, differences in PYY and PYY 3-36 between anorexia nervosa types were significant (P < .05) and differences in BDNF were at the trend level (P < .10). PYY 3-36 was positively (r = 0.27, P = .02) and leptin was negatively (r = -0.51, P < .0001) associated with dietary restraint; BDNF was positively associated with frequency of purging (r = 0.21, P = .04); and leptin was negatively associated with frequency of bingeing (r = -0.29, P = .007) and purging (r = -0.31, P = .004). Among women with anorexia nervosa, the anorexigenic hormones PYY, BDNF, and leptin are differentially regulated between the restricting and binge/purge types. Whether these

  2. Appetite Regulatory Hormones in Women With Anorexia Nervosa: Binge-Eating/Purging Versus Restricting Type

    PubMed Central

    Eddy, Kamryn T.; Lawson, Elizabeth A.; Meade, Christina; Meenaghan, Erinne; Horton, Sarah E.; Misra, Madhusmita; Klibanski, Anne; Miller, Karen K.

    2015-01-01

    Objective Anorexia nervosa is a psychiatric illness characterized by low weight, disordered eating, and hallmark neuroendocrine dysfunction. Behavioral phenotypes are defined by predominant restriction or bingeing/purging; binge-eating/purging type anorexia nervosa is associated with poorer outcome. The pathophysiology underlying anorexia nervosa types is unknown, but altered hormones, known to be involved in eating behaviors, may play a role. Method To examine the role of anorexigenic hormones in anorexia nervosa subtypes, we examined serum levels of peptide YY (PYY; total and active [3-36] forms), brain-derived neurotrophic factor (BDNF), and leptin as primary outcomes in women with OSM-5 restricting type anorexia nervosa (n=50), binge-eating/purging type anorexia nervosa (n = 22), and healthy controls (n = 22).1n addition, women completed validated secondary outcome measures of eating disorder psychopathology (Eating Disorder Examination-Questionnaire) and depression and anxiety symptoms (Hamilton Rating Scales for Depression [HDRS] and Anxiety [HARS]). The study samples were collected from May 22, 2004, to February 7, 2012. Results Mean PYY 3-36 and leptin levels were lower and BDNF levels higher in binge-eating/purging type anorexia nervosa than in restricting type anorexia nervosa (all Pvalues <.05). After controlling for body mass index, differences in PYY and PYY 3-36 between anorexia nervosa types were significant (P<.05) and differences in BDNF were at the trend level (P < .10). PYY 3-36 was positively (r=0.27, P=.02) and leptin was negatively (r=−0.51, P< .0001) associated with dietary restraint; BDNF was positively associated with frequency of purging (r=0.21, P=.04); and leptin was negatively associated with frequency of bingeing (r=−0.29, P=.007) and purging (r=−0.31, P=.004). Conclusions Among women with anorexia nervosa, the anorexigenic hormones PYY, BDNF, and leptin are differentially regulated between the restricting and binge/purge types

  3. Review of Liebman et al.'s 'An integrated treatment program for anorexia nervosa'.

    PubMed

    Wright, Shelagh

    2006-07-01

    This article reviews the paper by Liebman, Minuchin, and Baker (1974) describing the use of a family meal as part of an integrated treatment approach for anorexia nervosa. The ideas laid out in the paper are described and discussed in terms of the understanding of anorexia nervosa at the time as well as placed in a current clinical and theoretical context. A comment is made on whether or not, in this author's opinion, the paper stands 'the test of time'.

  4. Dysfunctional metacognition and drive for thinness in typical and atypical anorexia nervosa.

    PubMed

    Davenport, Emily; Rushford, Nola; Soon, Siew; McDermott, Cressida

    2015-01-01

    Anorexia nervosa is complex and difficult to treat. In cognitive therapies the focus has been on cognitive content rather than process. Process-oriented therapies may modify the higher level cognitive processes of metacognition, reported as dysfunctional in adult anorexia nervosa. Their association with clinical features of anorexia nervosa, however, is unclear. With reclassification of anorexia nervosa by DSM-5 into typical and atypical groups, comparability of metacognition and drive for thinness across groups and relationships within groups is also unclear. Main objectives were to determine whether metacognitive factors differ across typical and atypical anorexia nervosa and a non-clinical community sample, and to explore a process model by determining whether drive for thinness is concurrently predicted by metacognitive factors. Women receiving treatment for anorexia nervosa (n = 119) and non-clinical community participants (n = 100), aged between 18 and 46 years, completed the Eating Disorders Inventory (3(rd) Edition) and Metacognitions Questionnaire (Brief Version). Body Mass Index (BMI) of 18.5 kg/m(2) differentiated between typical (n = 75) and atypical (n = 44) anorexia nervosa. Multivariate analyses of variance and regression analyses were conducted. Metacognitive profiles were similar in both typical and atypical anorexia nervosa and confirmed as more dysfunctional than in the non-clinical group. Drive for thinness was concurrently predicted in the typical patients by the metacognitive factors, positive beliefs about worry, and need to control thoughts; in the atypical patients by negative beliefs about worry and, inversely, by cognitive self-consciousness, and in the non-clinical group by cognitive self-consciousness. Despite having a healthier weight, the atypical group was as severely affected by dysfunctional metacognitions and drive for thinness as the typical group. Because metacognition concurrently predicted drive for thinness

  5. Significant Locus and Metabolic Genetic Correlations Revealed in Genome-Wide Association Study of Anorexia Nervosa.

    PubMed

    Duncan, Laramie; Yilmaz, Zeynep; Gaspar, Helena; Walters, Raymond; Goldstein, Jackie; Anttila, Verneri; Bulik-Sullivan, Brendan; Ripke, Stephan; Thornton, Laura; Hinney, Anke; Daly, Mark; Sullivan, Patrick F; Zeggini, Eleftheria; Breen, Gerome; Bulik, Cynthia M

    2017-09-01

    The authors conducted a genome-wide association study of anorexia nervosa and calculated genetic correlations with a series of psychiatric, educational, and metabolic phenotypes. Following uniform quality control and imputation procedures using the 1000 Genomes Project (phase 3) in 12 case-control cohorts comprising 3,495 anorexia nervosa cases and 10,982 controls, the authors performed standard association analysis followed by a meta-analysis across cohorts. Linkage disequilibrium score regression was used to calculate genome-wide common variant heritability (single-nucleotide polymorphism [SNP]-based heritability [h(2)SNP]), partitioned heritability, and genetic correlations (rg) between anorexia nervosa and 159 other phenotypes. Results were obtained for 10,641,224 SNPs and insertion-deletion variants with minor allele frequencies >1% and imputation quality scores >0.6. The h(2)SNP of anorexia nervosa was 0.20 (SE=0.02), suggesting that a substantial fraction of the twin-based heritability arises from common genetic variation. The authors identified one genome-wide significant locus on chromosome 12 (rs4622308) in a region harboring a previously reported type 1 diabetes and autoimmune disorder locus. Significant positive genetic correlations were observed between anorexia nervosa and schizophrenia, neuroticism, educational attainment, and high-density lipoprotein cholesterol, and significant negative genetic correlations were observed between anorexia nervosa and body mass index, insulin, glucose, and lipid phenotypes. Anorexia nervosa is a complex heritable phenotype for which this study has uncovered the first genome-wide significant locus. Anorexia nervosa also has large and significant genetic correlations with both psychiatric phenotypes and metabolic traits. The study results encourage a reconceptualization of this frequently lethal disorder as one with both psychiatric and metabolic etiology.

  6. Process evaluation of the maudsley model for treatment of adults with anorexia nervosa trial. Part II: Patient experiences of two psychological therapies for treatment of anorexia nervosa.

    PubMed

    Lose, Anna; Davies, Charlotte; Renwick, Beth; Kenyon, Martha; Treasure, Janet; Schmidt, Ulrike

    2014-03-01

    This study is the second part of a process evaluation, embedded in the MOSAIC study, a large randomised controlled trial comparing two different psychological therapies, the Maudsley Model for Treatment of Adults with Anorexia Nervosa (MANTRA) and Specialist Supportive Clinical Management (SSCM). The study adopted a qualitative approach to examine patient experiences of the two treatments. Seventeen semi-structured interviews were conducted with Anorexia Nervosa and Eating Disorder Not Otherwise Specified-Anorexia Nervosa type patients, and transcripts were analysed thematically. Patient responses yielded five main themes: positive and helpful aspects, beneficial outcomes, less helpful aspects, possible improvements to the treatments, and the therapeutic and external environment. The findings show clear differences and some overlaps between patients' views on MANTRA and SSCM. Both therapies were experienced by patients as credible and largely helpful, albeit in different ways. These results are in agreement with those of therapists' views on these treatments. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.

  7. Mental capacity to consent to treatment in anorexia nervosa: explorative study

    PubMed Central

    Danner, Unna N.; Hoek, Hans W.; van Elburg, Annemarie A.

    2016-01-01

    Background Mental capacity to consent to treatment in anorexia nervosa is a neglected area in clinical decision-making. Aims To examine clinical and neuropsychological parameters associated with diminished mental capacity in anorexia nervosa. Method An explorative study was conducted in 70 adult female patients with severe anorexia nervosa. Mental capacity to consent to treatment was assessed by experienced psychiatrists. Further measurements included the MacCAT-T (to assess mental capacity status), a range of clinical measures (body mass index (BMI) and comorbidity) and neuropsychological tests assessing decision-making, central coherence and set-shifting capacity. Results Diminished mental capacity occurs in a third of patients with severe anorexia nervosa and is associated with a low BMI, less appreciation of illness and treatment, previous treatment for anorexia nervosa, low social functioning and poor set shifting. Conclusions Assessment of diminished mental capacity in anorexia nervosa requires careful evaluation of not only BMI, but also the degree of appreciation of illness and treatment, history and the tendency to have a rigid thinking style. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence. PMID:27703767

  8. Brain dysfunction in anorexia nervosa: cause or consequence of under-nutrition?

    PubMed

    Hay, Phillipa J; Sachdev, Perminder

    2011-05-01

    Imaging studies that demonstrate loss of brain substance help explain why people with anorexia nervosa have cognitive deficits and may help to elucidate the cognitive style found in many patients. It is not known whether a neurobiological vulnerability predisposes to anorexia nervosa or if this is associated with maintenance of symptoms once the illness develops. Evidence emerging from functional neuro-imaging studies raise the possibility of a biological abnormality that may predispose to anorexia nervosa. Studies have found abnormal functioning in the frontal, limbic, occipital, striatal and cerebellar regions that may persist after recovery. However, most recent cross-sectional and prospective studies indicate improved cerebral activity and mixed findings in regards to neurocognitve function with recovery from anorexia nervosa. The elucidation of the neurobiology of anorexia nervosa has benefited from recent advances in neuro-imaging and cognitive neuroscience. Further research is needed to examine the degree to which abnormalities are a consequence of starvation or are caused by a putative anorexia nervosa endophenotype.

  9. Oesophageal and gastric motility disorders in patients categorised as having primary anorexia nervosa.

    PubMed Central

    Stacher, G; Kiss, A; Wiesnagrotzki, S; Bergmann, H; Höbart, J; Schneider, C

    1986-01-01

    Gastrointestinal motor function in patients with primary anorexia nervosa has rarely been investigated. We studied oesophageal motor activity in 30 consecutive patients meeting standard diagnostic criteria for primary anorexia nervosa (Feighner et al; DSM III). Seven were found to suffer from achalasia instead of primary anorexia nervosa, one from diffuse oesophageal spasm and one from severe gastro-oesophageal reflux and upper oesophageal sphincter hypertonicity, while partly non-propulsive and repetitive high amplitude, long duration contractions prevailed in the lower oesophagus of another six. In four patients with oesophageal dysmotility not responding to therapy and in 12 of 15 patients with normal oesophageal manometry, gastric emptying of a semisolid meal was studied. Emptying was normal in only three but markedly delayed in 13 cases (half emptying times 97-330 min, median: 147 min, as compared with 21-119 min, median: 47 min, in 24 healthy controls). In eight patients, the effects of domperidone 10 mg iv and placebo were compared under random double blind conditions. Half emptying times were shortened significantly (p less than 0.01) by domperidone. Conclusions: symptoms of disordered upper gastrointestinal motor activity may be mistaken as indicating primary anorexia nervosa; clinical evaluation of patients with presumed primary anorexia nervosa should rule out the possibility that disordered oesophageal motor activity underlies the symptoms; delayed gastric emptying is a frequent feature in primary anorexia nervosa and might be returned to normal with domperidone. PMID:3781322

  10. Practice guidelines for acupuncturists using acupuncture as an adjunctive treatment for anorexia nervosa.

    PubMed

    Fogarty, Sarah; Ramjan, Lucie Michelle

    2015-02-01

    Anorexia nervosa is a potentially life-threatening eating disorder where people intentionally refuse to eat sufficient amounts to maintain a healthy body-weight for fear of becoming fat. The intense preoccupation with restriction of food and control of body weight makes this one of the most complex and confusing conditions for practitioners to treat. While no single treatment has been found to be superior to another in the treatment of anorexia nervosa, general practice guidelines are available to guide mainstream treatment, however there are no guidelines for practitioners of complementary therapies. Complementary therapies such as acupuncture show promise as an adjunctive therapy in improving co-morbidities such as depression and anxiety levels among people with anorexia nervosa, by strengthening mind, body and overall well-being. The aim of this guideline is to assist and support acupuncture practitioners to deliver effective and safe adjunctive acupuncture treatments to people with anorexia nervosa, by providing a practice guideline that is underpinned by an ethical and evidence-based framework. The use of complementary therapies and specifically acupuncture in the treatment of anorexia nervosa may provide important adjunctive care to allow a comprehensive treatment approach that potentially improves quality of life, reduces anxiety and instils hope for recovery. It is hoped that acupuncture practitioners treating patients with anorexia nervosa will refer to these guidelines and apply the guidance (as deemed appropriate).

  11. Young peoples' stigmatizing attitudes and beliefs about anorexia nervosa and muscle dysmorphia.

    PubMed

    Griffiths, Scott; Mond, Jonathan M; Murray, Stuart B; Touyz, Stephen

    2014-03-01

    The nature and extent of stigma toward individuals with anorexia nervosa and muscle dysmorphia remains underexplored. This study investigated attitudes and beliefs likely to be conducive to stigmatization of individuals with these conditions. Male and female undergraduate students (n = 361) read one of four vignettes describing a fictional male or female character with anorexia nervosa or muscle dysmorphia, after which they responded to a series of questions addressing potentially stigmatizing attitudes and beliefs toward each character. Characters with anorexia nervosa were more stigmatized than characters with muscle dysmorphia, female characters were more stigmatized than male characters, and male participants were more stigmatizing than female participants. A large effect of character diagnosis on masculinity was observed, such that characters with anorexia nervosa were perceived as less masculine than characters with muscle dysmorphia, and this effect was more pronounced among male participants. However, no significant corresponding effects were observed for femininity. Females with anorexia nervosa may be particularly susceptible to stigmatization, especially by males. Anorexia nervosa and muscle dysmorphia are perceived as "female" and "male" disorders respectively, in line with societal gender role expectations, and this stigmatization is tied more strongly to perceptions of sufferers' masculinity than femininity. Copyright © 2013 Wiley Periodicals, Inc.

  12. Unusual Presentation of Uncommon Disease: Anorexia Nervosa Presenting as Wernicke-Korsakoff Syndrome—A Case Report from Southeast Asia

    PubMed Central

    Mushtaq, Raheel; Shah, Tabindah; Bhat, Mudasir; Mushtaq, Sahil

    2014-01-01

    Anorexia nervosa presenting as Wernicke-Korsakoff syndrome is rare. The causes of Wernicke-Korsakoff syndrome are multiple like alcohol abuse, thyrotoxicosis, haemodialysis, severe malnutrition because of gastric carcinoma and pyloric obstruction, hyperemesis gravidarum, and prolonged parenteral feeding. We report a case of anorexia nervosa, who presented with Wernicke's encephalopathy and progressed to Korsakoff's syndrome. Knowledge, awareness, and early intervention of anorexia nervosa by mental health professionals can prevent development of Wernicke-Korsakoff syndrome. PMID:24963430

  13. Unusual presentation of uncommon disease: anorexia nervosa presenting as wernicke-korsakoff syndrome-a case report from southeast Asia.

    PubMed

    Mushtaq, Raheel; Shoib, Sheikh; Shah, Tabindah; Bhat, Mudasir; Singh, Randhir; Mushtaq, Sahil

    2014-01-01

    Anorexia nervosa presenting as Wernicke-Korsakoff syndrome is rare. The causes of Wernicke-Korsakoff syndrome are multiple like alcohol abuse, thyrotoxicosis, haemodialysis, severe malnutrition because of gastric carcinoma and pyloric obstruction, hyperemesis gravidarum, and prolonged parenteral feeding. We report a case of anorexia nervosa, who presented with Wernicke's encephalopathy and progressed to Korsakoff's syndrome. Knowledge, awareness, and early intervention of anorexia nervosa by mental health professionals can prevent development of Wernicke-Korsakoff syndrome.

  14. Dialectical Behavior Therapy of Anorexia and Bulimia Nervosa among Adolescents: A Case Series

    ERIC Educational Resources Information Center

    Salbach-Andrae, Harriet; Bohnekamp, Inga; Pfeiffer, Ernst; Lehmkuhl, Ulrike; Miller, Alec L.

    2008-01-01

    The aim of this study was to describe a case series of adolescents (mean age = 16.5 years, SD = 1.0) with anorexia nervosa (AN) and bulimia nervosa (BN) who received dialectical behavior therapy (DBT). Twelve outpatients with AN and BN took part in 25 weeks of twice weekly therapy consisting of individual therapy and a skills training group.…

  15. Dialectical Behavior Therapy of Anorexia and Bulimia Nervosa among Adolescents: A Case Series

    ERIC Educational Resources Information Center

    Salbach-Andrae, Harriet; Bohnekamp, Inga; Pfeiffer, Ernst; Lehmkuhl, Ulrike; Miller, Alec L.

    2008-01-01

    The aim of this study was to describe a case series of adolescents (mean age = 16.5 years, SD = 1.0) with anorexia nervosa (AN) and bulimia nervosa (BN) who received dialectical behavior therapy (DBT). Twelve outpatients with AN and BN took part in 25 weeks of twice weekly therapy consisting of individual therapy and a skills training group.…

  16. Emotion-focused therapy in a case of anorexia nervosa.

    PubMed

    Dolhanty, Joanne; Greenberg, Leslie S

    2009-01-01

    An emotion-focused approach to the treatment of eating disorders and to case formulation is described in an individual with anorexia nervosa (AN). The basic theory of emotion-focused therapy (EFT), the steps of case formulation and an outline of the tasks and course of treatment of an individual recently hospitalized on an inpatient unit for eating disorders highlight key aspects of the approach. The transformation in this individual, in terms of gaining access to her internal experience, understanding and tolerating her emotions, and working through her core themes of insecure attachment and worthlessness, is described. Weight and scores on self-report measures at the outset of treatment and at 18 months are provided.

  17. Habit learning and anorexia nervosa: a cognitive neuroscience hypothesis.

    PubMed

    Steinglass, Joanna; Walsh, B Timothy

    2006-05-01

    Anorexia nervosa (AN) is characterized by abnormal behaviors involving eating and weight that are impressively resistant to change. The persistence of these behaviors likely plays an important role in the high relapse rate after initial treatment. Persistent, stereotyped behaviors are also characteristic of obsessive-compulsive disorder (OCD). This article presents a neurocognitive model of AN, based on comparisons with OCD. This article reviews clinical, neuropsychological, and neuroimaging findings in both OCD and AN relevant to a neurobiological understanding of a potential mechanism of the perpetuation of AN. The identification of specific neurocognitive disturbances in individuals with OCD has led to a compelling hypothesis of the neural mechanisms mediating this disorder. Evidence suggests that similar disturbances, involving neural circuits between the cortex and the basal ganglia, may be present in individuals with AN. Research on such neurocognitive disturbances has the potential both to inform understanding of neural mechanisms underlying AN and to lead to advances in treatment. 2006 by Wiley Periodicals, Inc.

  18. What Can Cognitive Neuroscience Teach Us About Anorexia Nervosa?

    PubMed Central

    Kidd, Amelia; Steinglass, Joanna

    2012-01-01

    Anorexia nervosa (AN) is a complex illness and highly challenging to treat. One promising approach to significantly advance our understanding of the underlying pathophysiology of AN involves developing a cognitive neuroscience model of illness. Cognitive neuroscience uses probes such as neuropsychological tasks and neuroimaging techniques to identify the neural underpinnings of behavior. With this approach, advances have been made in identifying higher order cognitive processes that likely mediate symptom expression in AN. Identification of related neuropathology is beginning. Such findings have led to the development of complex neurobehavioral models that aim to explain the etiology and persistence of AN. Future research will use these advanced tools to test and refine hypotheses about the underlying mechanisms of AN. PMID:22660896

  19. What can cognitive neuroscience teach us about anorexia nervosa?

    PubMed

    Kidd, Amelia; Steinglass, Joanna

    2012-08-01

    Anorexia nervosa (AN) is a complex illness and highly challenging to treat. One promising approach to significantly advance our understanding of the underlying pathophysiology of AN involves developing a cognitive neuroscience model of illness. Cognitive neuroscience uses probes such as neuropsychological tasks and neuroimaging techniques to identify the neural underpinnings of behavior. With this approach, advances have been made in identifying higher-order cognitive processes that likely mediate symptom expression in AN. Identification of related neuropathology is beginning. Such findings led to the development of complex neurobehavioral models that aim to explain the etiology and persistence of AN. Future research will use these advanced tools to test and refine hypotheses about the underlying mechanisms of AN.

  20. An Adolescent Boy with Comorbid Anorexia Nervosa and Hashimoto Thyroiditis.

    PubMed

    Pehlivantürk Kızılkan, Melis; Kanbur, Nuray; Akgül, Sinem; Alikaşifoğlu, Ayfer

    2016-03-05

    Low triiodothyronine syndrome is a physiological adaptation encountered in anorexia nervosa (AN) and generally improves with sufficient weight gain. However, when a primary thyroid pathology accompanies AN, both the evaluation of thyroid hormone levels and the management of the co-morbid disease become more challenging. Hashimoto thyroiditis could complicate the management of AN by causing hyper- or hypothyroidism. AN could also negatively affect the treatment of Hashimoto thyroiditis by altering body weight and metabolic rate, as well as by causing drug non-compliance. We present the case of a 15-year-old boy with comorbid AN restrictive sub-type and Hashimoto thyroiditis. In this case report, we aimed to draw attention to the challenges that could be encountered in the diagnosis, treatment, and follow-up of patients with AN when accompanied by Hashimoto thyroiditis.

  1. Effects of Anorexia Nervosa on the Endocrine System.

    PubMed

    Baskaran, Charumathi; Misra, Madhusmita; Klibanski, Anne

    2017-03-01

    Anorexia nervosa (AN) is characterized by severe undernutrition associated with alterations in multiple endocrine axes, which are primarily adaptive to the state of caloric deprivation. Hormonal changes include growth hormone (GH) resistance with low insulin like growth factor-1 (IGF-1) levels, hypothalamic hypogonadism, relative hypercortisolemia and changes in appetite regulating hormones, including leptin, ghrelin, and peptide YY. These alterations contribute to abnormalities in bone metabolism leading to low bone mass, impaired bone microarchitecture, and increased risk for fracture, and may also negatively impact cognition, emotions and mood. The best strategy to improve all biologic outcomes is weight and menstrual recovery. Physiological estrogen replacement improves bone accrual rates and measures of trait anxiety in adolescents with AN. Other therapies including testosterone and IGF-1 replacement, and use of DHEA with oral estrogen-progesterone combination pills, bisphosphonates and teriparatide have also been studied to improve bone outcomes. Copyright© of YS Medical Media ltd.

  2. Hypothyroidism due to Hashimoto's thyroiditis masked by anorexia nervosa.

    PubMed

    Smalls-Mantey, Adjoa; Steinglass, Joanna; Primack, Marshall; Clark-Hamilton, Jill; Bongiovi, Mary

    2015-11-01

    Anorexia nervosa (AN) is typically associated with altered thyroid function tests, notably a low total and free T3 , and lower, but within normal range, free T4 and TSH. A 16-year-old girl with a four-year history of AN presented with elevated TSH that fluctuated with changes in weight. TSH was within normal limits (1.7-3.64 mIU/L) following periods of weight loss and elevated with weight gain (5.9-21.66 mIU/L). Antithyroperoxidase antibodies were markedly elevated, suggesting chronic Hashimoto's thyroiditis. Of note, the elevated TSH that would be expected in Hashimoto's thyroiditis was blunted by weight loss associated with AN. Physicians should be aware that AN may contribute to masking thyroid abnormalities in Hashimoto's thyroiditis.

  3. [Sialadenosis as secondary organ manifestation of anorexia nervosa (author's transl)].

    PubMed

    Anders, D; Harms, D; Kriens, O; Schmidt, H

    1975-03-01

    In a 13-year-old boy the occurence of a sialadenosis of the submaxillary glands was observed in association with anorexia nervosa (a.n.). The non-inflammatory salivary gland enlargement became apparent after the boy had suffered a progressive weight loss of 5 kilograms during a period of three years prior to admission. The psychogenic origin of the disorder could be confirmed by 1. the history of the patient being almost identical compared to the few observations of a.n. in males, 2. the absence of any other organ involvement, and 3. follow up over a period of two years during which time the boy regained normal weight, and the salivary gland enlargement disappeared spontaneously. The diagnosis of sialadenosis was based on histological examination.

  4. [Anorexia nervosa in a worker: a case report].

    PubMed

    Reinoso-Barbero, Luis; Díaz-Garrido, Ramón; Reyes-García, Rocío; Fernández-Fernández, Miguel; Garrido-Astray, María-Concepción; Muñoz-Ruipérez, Carmen

    2015-01-01

    We describe the management of a case of anorexia nervosa (body mass index, -BMI-, 13,6 Kg/m2) in a bank teller. The case was detected through routine occupational health surveillance. After being evaluated by different specialists (general practitioner, psychiatrist and endocrinologist) and being closely monitored (by psychology, nursing, and occupational medicine), the worker regained weight to a near normal BMI (17 Kg/m2) in less than a year and a half. Eating disorders are a common pathology (non-occupationally related), but their high prevalence (5% of the population over a lifetime) and social and job-related impact (affecting more than 20% of cases), make them a necessary focus of attention for health promotion in the workplace. Health prevention, promotion and surveillance may be also reinforced at the workplace. Copyright belongs to the Societat Catalana de Salut Laboral.

  5. Understanding women's journey of recovering from anorexia nervosa.

    PubMed

    Weaver, Kathryn; Wuest, Judith; Ciliska, Donna

    2005-02-01

    Previous studies of recovery from anorexia nervosa (AN) have concentrated on discrete behavioral responses of individual women. Little is understood about the subjective process of women's recovery in the context of family, community, or society. In this feminist grounded theory study, the authors explored the perceptions of 12 women who considered themselves recovered or recovering from AN. They discovered a substantive theory of self-development that explains, within the current social context, women's journey from the perilous self-soothing of devastating weight loss to the informed self-care of healthy eating and problem-solving practices. The findings provide an urgently needed explanatory framework to inform women, clinicians, and health policy makers in their prevention and recovery efforts.

  6. [Pathogenesis of anorexia nervosa. Neurobiological risk factors and possible endophenotypes].

    PubMed

    Pászthy, Bea; Törzsök-Sonnevend, Mária

    2014-01-26

    Anorexia nervosa is a serious, chronical state of illness which often starts in childhood or adolescence and has serious consequences on the quality of life. This review focuses on the heterogenity of the disease with emphasis on special diagnostic implications in case of childhood onset. Research findings of the last decade showed that genetic and neurobiological vulnerabilities are at least as potent risk factors as psychological, family constellations and sociocultural preferences. The heritability of eating disorders levels those of diseases predominantly influenced by biological factors. The authors give a summary of the most investigated neurobiologic and neurocognitive factors which could be the fundaments of a biological vulnerablilty. To date, no common risk factor could be identified, but some existing adversities can clearly be related to distinct subgroups with the disorder. The concept of endo- and subphenotypes leads to more specific and more efficient methods of therapy in other somatic and psychiatric diseases.

  7. Gut microeukaryotes during anorexia nervosa: a case report

    PubMed Central

    2014-01-01

    Background Few studies have focused on eukaryote community in the human gut. Here, the diversity of microeukaryotes in the gut microbiota of an anorexic patient was investigated using molecular and culture approaches. Case presentation A 21-year-old Caucasian woman was admitted in an intensive care unit for severe malnutrition in anorexia nervosa. One stool specimen was collected from the anorexic patient, culture and polymerase chain reaction-based explorations yielded a restricted diversity of fungi but four microeukaryotes Tetratrichomonas sp., Aspergillus ruber, Penicillium solitum and Cladosporium bruhnei previously undescribed in the human gut. Conclusions Establishing microeukaryote repertoire in gut microbiota contributes to the understanding of its role in human health. PMID:24418238

  8. Micronutrient Status in 153 Patients with Anorexia Nervosa

    PubMed Central

    Achamrah, Najate; Coëffier, Moïse; Rimbert, Agnès; Charles, Jocelyne; Folope, Vanessa; Petit, André; Déchelotte, Pierre; Grigioni, Sébastien

    2017-01-01

    Micronutrient status in Anorexia Nervosa (AN) has been poorly documented and previous data are often contradictory. We aimed to assess micronutrient status in a large population of AN patients. The relationships between micronutrient status and body composition were also determined. Anthropometric, biochemical parameters and body composition data were collected at referral in 153 patients with AN (28.5 ± 11 years). At least one trace element deficit was observed in almost half of patients; the most frequent was selenium deficit (40% of patients). At least one vitamin deficit was observed in 45.7% of patients, mostly vitamin A and B9. Albumin, transthyretin and CRP were within normal range in most patients. No correlations were found between body composition and micronutrient status. Our study suggests that micronutrient status is often altered in AN patients, which may contribute to neuropsychiatric dysfunction. Monitoring of micronutrients and correction of deficits should be included in the routine care of AN patients. PMID:28257095

  9. Micronutrient Status in 153 Patients with Anorexia Nervosa.

    PubMed

    Najate, Achamrah; Moïse, Coëffier; Agnès, Rimbert; Jocelyne, Charles; Vanessa, Folope; André, Petit; Pierre, Déchelotte; Sébastien, Grigioni

    2017-03-02

    Micronutrient status in Anorexia Nervosa (AN) has been poorly documented and previous data are often contradictory. We aimed to assess micronutrient status in a large population of AN patients. The relationships between micronutrient status and body composition were also determined. Anthropometric, biochemical parameters and body composition data were collected at referral in 153 patients with AN (28.5 ± 11 years). At least one trace element deficit was observed in almost half of patients; the most frequent was selenium deficit (40% of patients). At least one vitamin deficit was observed in 45.7% of patients, mostly vitamin A and B9. Albumin, transthyretin and CRP were within normal range in most patients. No correlations were found between body composition and micronutrient status. Our study suggests that micronutrient status is often altered in AN patients, which may contribute to neuropsychiatric dysfunction. Monitoring of micronutrients and correction of deficits should be included in the routine care of AN patients.

  10. Purtscher-Like Retinopathy Associated with Anorexia Nervosa

    PubMed Central

    Karasu, Bugra; Gunay, Betul Onal; Erdogan, Gurkan; Kardes, Esra; Gunay, Murat

    2016-01-01

    A 21-year-old girl presented with acute painless vision loss in her right eye. There was no remarkable ocular history and she had a history of anorexia nervosa. At presentation best-corrected visual acuities were counting fingers from 2 meters and 20/20, in the right and left eyes, respectively. Slit lamp examination result was normal. Fundus examination revealed multiple cotton wool spots and intraretinal hemorrhages surrounding the optic disc and macula in the right eye. Fluorescein angiography showed capillary filling defect and leakage from optic disc in the late phase of the angiogram. One week later best-corrected visual acuities remained the same in both eyes with similar fundus appearance. One month after initial presentation visual acuity was 20/20 in both eyes with no abnormality in fundus appearance. PMID:27069703

  11. An Adolescent Boy with Comorbid Anorexia Nervosa and Hashimoto Thyroiditis

    PubMed Central

    Pehlivantürk Kızılkan, Melis; Kanbur, Nuray; Akgül, Sinem; Alikaşifoğlu, Ayfer

    2016-01-01

    Low triiodothyronine syndrome is a physiological adaptation encountered in anorexia nervosa (AN) and generally improves with sufficient weight gain. However, when a primary thyroid pathology accompanies AN, both the evaluation of thyroid hormone levels and the management of the co-morbid disease become more challenging. Hashimoto thyroiditis could complicate the management of AN by causing hyper- or hypothyroidism. AN could also negatively affect the treatment of Hashimoto thyroiditis by altering body weight and metabolic rate, as well as by causing drug non-compliance. We present the case of a 15-year-old boy with comorbid AN restrictive sub-type and Hashimoto thyroiditis. In this case report, we aimed to draw attention to the challenges that could be encountered in the diagnosis, treatment, and follow-up of patients with AN when accompanied by Hashimoto thyroiditis. PMID:26757948

  12. Glial and neuronal damage markers in patients with anorexia nervosa.

    PubMed

    Ehrlich, Stefan; Burghardt, Roland; Weiss, Deike; Salbach-Andrae, Harriet; Craciun, Eugenia Maria; Goldhahn, Klaus; Klapp, Burghard F; Lehmkuhl, Ulrike

    2008-06-01

    Anorexia nervosa (AN) commonly arises during adolescence leading to interruptions of somatic and psychological development as well as to atrophic brain changes. It remains unclear whether these brain changes are related to the loss of neurons, glia, neuropil or merely due to fluid shifts. We determined leptin levels and two brain-derived damage markers: glial fibrillary acidic protein (GFAP) and neuron-specific enolase (NSE) of 43 acute AN patients and 50 healthy control woman (HCW). Peripheral GFAP and NSE concentrations of AN patients were not elevated and not different from HCW. Subjects with particularly low leptin concentration, indicating severe malnutrition, did not show abnormal values either. During weight recovery the marker proteins remained unchanged. Our preliminary results are in line with neuroimaging studies supporting the reversibility of brain changes in AN and do not substantiate hypotheses relying on the extensive damage of brain cells as an explanation for cerebral atrophy in AN.

  13. The Functional Significance of Shyness in Anorexia Nervosa

    PubMed Central

    Winecoff, Amy A.; Ngo, Lawrence; Moskovich, Ashley; Merwin, Rhonda; Zucker, Nancy

    2017-01-01

    The defining features of anorexia nervosa (AN) include disordered eating and disturbance in the experience of their bodies. however, many women with AN also demonstrate higher harm avoidance (HA), lower novelty seeking, and challenges with interpersonal functioning. The current study explored whether HA and novelty seeking could explain variation in disordered eating and social functioning in healthy control women (n = 18), weight-restored women with a history of AN (n = 17), and women currently-ill with AN (AN; n = 17). Our results indicated that clinical participants (AN + weight-restored women) reported poorer social skills than healthy control participants. Moreover, the relationship between eating disorder symptoms and social skill deficits was mediated by HA. Follow-up analyses indicated that only the ‘shyness with strangers’ factor of HA independently mediated this relationship. Collectively, our results suggest a better understanding of shyness in many individuals with eating disorders could inform models of interpersonal functioning in AN. PMID:25959923

  14. Anorexia nervosa: a psychiatric case register study from Aberdeen.

    PubMed

    Szmukler, G; McCance, C; McCrone, L; Hunter, D

    1986-02-01

    The results of an examination of the 238 cases of anorexia nervosa on the Aberdeen Psychiatric Case Register for the period 1965-82 are reported. A highly significant increase in the number of cases over time was found. The average annual incidence rate for the period 1978-82 was 4.06 per 100 000 population. The case notes of every second patient on the register were inspected to assess diagnostic reliability, to define patient characteristics further and to look for changes in these over time. The diagnosis was highly suspect in 5% of cases. A social class bias was found, with an over-representation of classes I and II but an under-representation of social class III. Few significant changes were noted in the patients over time. The utilization of services was also examined, and it was found that 24% of the patients remained in contact for 4 years or more.

  15. Gender identity disorder and anorexia nervosa in male monozygotic twins.

    PubMed

    Hepp, Urs; Milos, Gabriella; Braun-Scharm, Hellmuth

    2004-03-01

    Male identical twins with gender identity disorder (GID) in childhood and anorexia nervosa (AN) are presented. Etiologic aspects and the relationship among gender identity, sexual orientation, body dissatisfaction, and AN are discussed. Case reports and a review of the literature are reported. In childhood, both twins showed an atypical gender behavior. Whereas one of the twins later developed a transsexual gender identity and asked for sex reassignment, the other developed a male identity but his appearance and clothing are effeminate. According to their biologic sex, they are concordant in regard to their homosexual orientation. In adolescence, both developed AN. Monozygotism was proved by DNA analysis. GID in childhood could be at least partly hereditary, whereas the development of the later phenotype of the gender identification is more determined by environmental factors. GID might be a risk factor for the development of AN. Copyright 2004 by Wiley Periodicals, Inc. Int J Eat Disord 35: 239-243, 2004.

  16. Anorexia nervosa and gender dysphoria in two adolescents.

    PubMed

    Couturier, Jennifer; Pindiprolu, Bharadwaj; Findlay, Sheri; Johnson, Natasha

    2015-01-01

    Little has been published about the co-occurrence of gender dysphoria (GD) and eating disorders (ED) in adults, with no cases described in the adolescent population. The emphasis on body shape in both conditions suggests that there may be some overlap in symptomatology. We report two adolescent cases initially diagnosed with anorexia nervosa who later met criteria for GD. The drive for thinness for the 16-year-old male was associated with a wish to achieve a feminine physique whereas there was an emphasis for stunted breast growth and a desire for muscularity in the 13-year-old female. Complexities in presentation, evolution of symptoms over time, and the treatment of the two cases are discussed. Clinicians should inquire about sexual issues in the presentation of ED and should monitor for symptoms of GD, not only at initial presentation, but throughout treatment, especially as weight gain progresses. © 2014 Wiley Periodicals, Inc.

  17. [Association of anorexia nervosa and mitral valve prolapse].

    PubMed

    Amano, K; Sakamoto, T; Hada, Y; Hasegawa, I; Takahashi, T; Suzuki, J; Takahashi, H

    1986-01-01

    Four cases of anorexia nervosa recently encountered were reported in respect to their cardiovascular manifestations including prolapse of the cardiac valves and other poorly recognized cardiac findings. All four patients, aged 13 to 32 years, were women and had marked emaciation (35 to 44% weight loss of the ideal body weight) with typical hormone abnormalities. Chest radiographs showed a small cardiac shadow, and sinus bradycardia with low voltage was present in their electrocardiograms. One case, 13-year-old, had a mid-systolic click and occasionally a late systolic murmur, and also an abdominal continuous hum. Echocardiography including two-dimensional color flow-mapping disclosed mitral valve prolapse in all, and tricuspid valve prolapse in two. Mild to moderate pericardial effusion was noted in all between the right ventricle and diaphragm, and pericardiocentesis in one case had no effect on the valve movements. No inflammatory changes were observed in the specimen of the pericardium and also of the fluid. An association of mitral valve prolapse and anerexia nervosa was discussed based on the previous studies, but the final conclusion remains unknown.

  18. Laboratory parameters and appetite regulators in patients with anorexia nervosa.

    PubMed

    Himmerich, Hubertus; Schönknecht, Peter; Heitmann, Sabine; Sheldrick, Abigail J

    2010-03-01

    Anorexia nervosa (AN) has serious negative effects on multiple organs and systems of the human body. As patients often do not make their eating disorder the subject of discussion, the physician is forced to rely on the physical examination and laboratory parameters as diagnostic hints. Obvious signs of AN are a body mass index (BMI) below 17.5 kg/m, dry and scaly skin, lanugo, edema, acrocyanosis, petechias, dental problems, and low blood pressure. However, because the often complex laboratory alterations can be difficult for the general psychiatrist to interpret, this article presents some useful guidelines. The plasma of patients with AN often shows alterations in laboratory parameters and appetite regulators, including electrolytes, liver enzymes, leukocyte count, hemoglobin (Hb), leptin, neuropeptide Y (NPY), triiodothyronine (T3), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, ghrelin, pancreatic polypeptide (PP), tumor necrosis factor-alpha (TNF-alpha), and cortisol. Medical problems secondary to AN or due to the treatment itself may lead to further laboratory abnormalities. To date, despite these associated laboratory alterations, the diagnosis of anorexia is a clinical one, based on weight and specific psychopathology.

  19. The role of the right parietal lobe in anorexia nervosa.

    PubMed

    Nico, D; Daprati, E; Nighoghossian, N; Carrier, E; Duhamel, J-R; Sirigu, A

    2010-09-01

    Patients with anorexia nervosa (AN) overestimate their size despite being severely underweight. Whether this misperception echoes an underlying emotional disturbance or also reflects a genuine body-representation deficit is debatable. Current measures inquire directly about subjective perception of body image, thus distinguishing poorly between top-down effects of emotions/attitudes towards the body and disturbances due to proprioceptive disorders/distorted body schema. Disorders of body representation also emerge following damage to the right parietal lobe. The possibility that parietal dysfunction might contribute to AN is suspected, based on the demonstrated association of spatial impairments, comparable to those found after parietal lesion, with this syndrome. We used a behavioral task to compare body knowledge in severe anorexics (n=8), healthy volunteers (n=11) and stroke patients with focal damage to the left/right parietal lobe (n=4). We applied a psychophysical procedure based on the perception, in the dark, of an approaching visual stimulus that was turned off before reaching the observer. Participants had to predict whether the stimulus would have hit/missed their body, had it continued its linear motion. Healthy volunteers and left parietal patients estimated body boundaries very close to the real ones. Conversely, anorexics and right parietal patients underestimated eccentricity of their left body boundary. These findings are in line with the role the parietal cortex plays in developing and maintaining body representation, and support the possibility for a neuropsychological component in the pathogenesis of anorexia, offering alternative approaches to treatment of the disorder.

  20. Anorexia nervosa: the diagnosis. A postmodern ethics contribution to the bioethics debate on involuntary treatment for anorexia nervosa.

    PubMed

    Kendall, Sacha

    2014-03-01

    This paper argues that there is a relationship between understandings of anorexia nervosa (AN) and how the ethical issues associated with involuntary treatment for AN are identified, framed, and addressed. By positioning AN as a construct/discourse (hereinafter "AN: the diagnosis") several ethical issues are revealed. Firstly, "AN: the diagnosis" influences how the autonomy and competence of persons diagnosed with AN are understood by decision-makers in the treatment environment. Secondly, "AN: the diagnosis" impacts on how treatment and treatment efficacy are defined and the ethical justifiability of paternalism. Thirdly, "AN: the diagnosis" can limit the opportunity for persons with AN to construct an identity that casts them as a competent person. "AN: the diagnosis" can thus inherently affirm professional knowledge and values. Postmodern professional ethics can support professionals in managing these issues by highlighting the importance of taking responsibility for professional knowledge, values, and power and embracing moral uncertainty.

  1. Sensory modulation disorder symptoms in anorexia nervosa and bulimia nervosa: A pilot study.

    PubMed

    Brand-Gothelf, Ayelet; Parush, Shula; Eitan, Yehudith; Admoni, Shai; Gur, Eitan; Stein, Daniel

    2016-01-01

    Individuals with anorexia nervosa (AN) and bulimia nervosa (BN) may exhibit reduced ability to modulate sensory, physiological, and affective responses. The aim of the present study is to assess sensory modulation disorder (SMD) symptoms in patients with AN and BN. We assessed female adolescent and young adult inpatients with restrictive type anorexia nervosa (AN-R; n = 20) and BN (n = 20) evaluated in the acute stage of their illness, and 27 female controls. Another group of 20 inpatients with AN-R was assessed on admission and discharge, upon achieving their required weight. Participants completed standardized questionnaires assessing the severity of their eating disorder (ED) and the sensory responsiveness questionnaire (SRQ). Inpatients with AN-R demonstrated elevated overall sensory over-responsiveness as well as elevated scores on the taste/gustatory, vestibular/kinesthetic and somatosensory/tactile SRQ modalities compared with patients with BN and controls. Significant correlations between the severity of sensory over-responsiveness and ED-related symptomatology were found in acutely-ill patients with AN-R and to a lesser extent, following weight restoration. Elevated sensory over-responsiveness was retained in weight-restored inpatients with AN-R. Inpatients with BN demonstrated greater sensory under-responsiveness in the intensity subscale of the SRQ, but not in the frequency and combined SRQ dimensions. Female inpatients with AN-R exhibited sensory over-responsiveness both in the acute stage of their illness and following weight restoration, suggesting that sensory over-responsiveness may represent a trait related to the illness itself above and beyond the influence of malnutrition. The finding for sensory under-responsiveness in BN is less consistent. © 2015 Wiley Periodicals, Inc.

  2. Severity of eating disorder symptoms related to oxytocin receptor polymorphisms in anorexia nervosa.

    PubMed

    Acevedo, Summer F; Valencia, Celeste; Lutter, Michael; McAdams, Carrie J

    2015-08-30

    Oxytocin is a peptide hormone important for social behavior and differences in psychological traits have been associated with variants of the oxytocin receptor gene in healthy people. We examined whether single nucleotide polymorphisms (SNPs) of the oxytocin receptor gene (OXTR) correlated with clinical symptoms in women with anorexia nervosa, bulimia nervosa, and healthy comparison (HC) women. Subjects completed clinical assessments and provided DNA for analysis. Subjects were divided into four groups: HC, subjects currently with anorexia nervosa (AN-C), subjects with a history of anorexia nervosa but in long-term weight recovery (AN-WR), and subjects with bulimia nervosa (BN). Five SNPs of the oxytocin receptor were examined. Minor allele carriers showed greater severity in most of the psychiatric symptoms. Importantly, the combination of having had anorexia and carrying either of the A alleles for two SNPS in the OXTR gene (rs53576, rs2254298) was associated with increased severity specifically for ED symptoms including cognitions and behaviors associated both with eating and appearance. A review of psychosocial data related to the OXTR polymorphisms examined is included in the discussion. OXTR polymorphisms may be a useful intermediate endophenotype to consider in the treatment of patients with anorexia nervosa.

  3. Severity of eating disorder symptoms related to oxytocin receptor polymorphisms in anorexia nervosa

    PubMed Central

    Acevedo, Summer F.; Valencia, Celeste; Lutter, Michael; McAdams, Carrie J.

    2015-01-01

    Oxytocin is a peptide hormone important for social behavior, and differences in psychological traits have been associated with variants of the oxytocin receptor gene in healthy people. We examined whether small nucleotide polymorphisms (SNPs) of the oxytocin receptor gene (OXTR) correlated with clinical symptoms in women with anorexia nervosa, bulimia nervosa, and healthy comparison (HC) women. Subjects completed clinical assessments and provided DNA for analysis. Subjects were divided into four groups: HC, subjects currently with anorexia nervosa (AN-C), subjects with a history of anorexia nervosa but in long-term weight recovery (AN-WR), and subjects with bulimia nervosa (BN). Five SNPs of the oxytocin receptor were examined. Minor allele carriers showed greater severity in most of the psychiatric symptoms. Importantly, the combination of having had anorexia and carrying either of the A alleles for two SNPS in the OXTR gene (rs53576, rs2254298) was associated with increased severity specifically for ED symptoms including cognitions and behaviors associated both with eating and appearance. A review of psychosocial data related to the OXTR polymorphisms examined is included in the discussion. OXTR polymorphisms may be a useful intermediate endophenotype to consider in the treatment of patients with anorexia nervosa. PMID:26106053

  4. Living as a couple with anorexia nervosa: A dyadic interpretative phenomenological analysis.

    PubMed

    Antoine, Pascal; Flinois, Bérengère; Doba, Karyn; Nandrino, Jean-Louis; Dodin, Vincent; Hendrickx, Marion

    2016-10-01

    This study examined the difficulties couples face in relation to anorexia nervosa. Using interpretative phenomenological analysis, five couples in which one of the partners lives with anorexia nervosa were interviewed separately. The findings are conceptualized into three areas: first, the encounter 'at the crossroads between remission and relapse'; second, the way that 'anorexia reveals itself'; and finally, the way the 'ménage à trois' works, including the illness fully as part of the couple. Psychotherapists should take into account the context of the couple and the complex interaction between the couple and the illness to support both partners' development of appropriate responses.

  5. What can we learn from the history of male anorexia nervosa?

    PubMed

    Zhang, Chengyuan

    2014-01-01

    The eating disorders literature has focussed on females and little is known of the male experience. The overall image this has generated suggests a young woman in conflict with socio-cultural pressures which associate thinness with beauty. Historical studies have examined anorexia nervosa from an entirely female focus while ignoring how diagnostic categories have shaped approaches to the male body. This paper will track the case of the male with anorexia nervosa through changing theories of causation and treatment approaches, from when the condition first emerged in 1873 to the present. In doing so, we gain a valuable new insight into how anorexia nervosa has been historically gendered and the far-reaching implications this has had for diagnosis and treatment of the male sufferer. Similarities between the sexes helped to establish male anorexia as a distinct category. However, this shifted focus away from important differences, which have yet unexplored implications in the assessment, diagnosis and management of disordered eating. Throughout history, there has been constant pressure to give a precise definition to anorexia nervosa, despite being fraught with medical uncertainties. This has resulted in inevitably harmful generalisations rooted in the dominant epidemiology. This paper reveals that anorexia nervosa is a truly global phenomenon which cannot be adequately constructed through exclusive studies of the female. There is consequently a pressing need to address the dearth of research examining eating disorders in males.

  6. A rat in the labyrinth of anorexia nervosa: contributions of the activity-based anorexia rodent model to the understanding of anorexia nervosa.

    PubMed

    Gutierrez, Emilio

    2013-05-01

    Activity-based anorexia (ABA) is an analogous animal model of anorexia nervosa where food-restricted rats develop excessive running activity when given free access to a running wheel; their body weight sharply decreases, and finally self-starvation and death ensue unless animals are removed from the experimental conditions. The parallel of this animal model with major signs in the human disorder has been the focus of much attention from researchers and clinicians as a platform for translational research. The paper reviews the historical antecedents of ABA, research characterizing its occurrence, and its main limitations and strengths as a model of AN. As a symptomatic model of AN, the ABA model can provide clinicians with innovative and alternative routes for improving the treatment of AN.

  7. Using the Activity-based Anorexia Rodent Model to Study the Neurobiological Basis of Anorexia Nervosa.

    PubMed

    Chowdhury, Tara Gunkali; Chen, Yi-Wen; Aoki, Chiye

    2015-10-22

    Anorexia nervosa (AN) is a psychiatric illness characterized by excessively restricted caloric intake and abnormally high levels of physical activity. A challenging illness to treat, due to the lack of understanding of the underlying neurobiology, AN has the highest mortality rate among psychiatric illnesses. To address this need, neuroscientists are using an animal model to study how neural circuits may contribute toward vulnerability to AN and may be affected by AN. Activity-based anorexia (ABA) is a bio-behavioral phenomenon described in rodents that models the key symptoms of anorexia nervosa. When rodents with free access to voluntary exercise on a running wheel experience food restriction, they become hyperactive - running more than animals with free access to food. Here, we describe the procedures by which ABA is induced in adolescent female C57BL/6 mice. On postnatal day 36 (P36), the animal is housed with access to voluntary exercise on a running wheel. After 4 days of acclimation to the running wheel, on P40, all food is removed from the cage. For the next 3 days, food is returned to the cage (allowing animals free food access) for 2 hr daily. After the fourth day of food restriction, free access to food is returned and the running wheel is removed from the cage to allow the animals to recover. Continuous multi-day analysis of running wheel activity shows that mice become hyperactive within 24 hr following the onset of food restriction. The mice run even during the limited time during which they have access to food. Additionally, the circadian pattern of wheel running becomes disrupted by the experience of food restriction. We have been able to correlate neurobiological changes with various aspects of the animals' wheel running behavior to implicate particular brain regions and neurochemical changes with resilience and vulnerability to food-restriction induced hyperactivity.

  8. Phobic memory and somatic vulnerabilities in anorexia nervosa: a necessary unity?

    PubMed Central

    Myslobodsky, Michael

    2005-01-01

    Anorexia nervosa is a clinically significant illness that may be associated with permanent medical complications involving almost every organ system. The paper raises a question whether some of them are associated with premorbid vulnerability such as subcellular ion channel abnormalities ('channelopathy') that determines the clinical expression of the bodily response to self-imposed malnutrition. Aberrant channels emerge as a tempting, if rather speculative alternative to the notion of cognitively-driven neurotransmitter modulation deficit in anorexia nervosa. The concept of channelopathies is in keeping with some characteristics of anorexia nervosa, such as a genetically-based predisposition to hypophagia, early onset, cardiac abnormalities, an appetite-enhancing efficacy of some antiepileptic drugs, and others. The purpose of this article is to stimulate further basic research of ion channel biophysics in relation to restrictive anorexia. PMID:16144551

  9. Phobic memory and somatic vulnerabilities in anorexia nervosa: a necessary unity?

    PubMed

    Myslobodsky, Michael

    2005-09-06

    Anorexia nervosa is a clinically significant illness that may be associated with permanent medical complications involving almost every organ system. The paper raises a question whether some of them are associated with premorbid vulnerability such as subcellular ion channel abnormalities ('channelopathy') that determines the clinical expression of the bodily response to self-imposed malnutrition. Aberrant channels emerge as a tempting, if rather speculative alternative to the notion of cognitively-driven neurotransmitter modulation deficit in anorexia nervosa. The concept of channelopathies is in keeping with some characteristics of anorexia nervosa, such as a genetically-based predisposition to hypophagia, early onset, cardiac abnormalities, an appetite-enhancing efficacy of some antiepileptic drugs, and others. The purpose of this article is to stimulate further basic research of ion channel biophysics in relation to restrictive anorexia.

  10. Partially restored resting-state functional connectivity in women recovered from anorexia nervosa

    PubMed Central

    Boehm, Ilka; Geisler, Daniel; Tam, Friederike; King, Joseph A.; Ritschel, Franziska; Seidel, Maria; Bernardoni, Fabio; Murr, Julia; Goschke, Thomas; Calhoun, Vince D.; Roessner, Veit; Ehrlich, Stefan

    2016-01-01

    Background We have previously shown increased resting-state functional connectivity (rsFC) in the frontoparietal network (FPN) and the default mode network (DMN) in patients with acute anorexia nervosa. Based on these findings we investigated within-network rsFC in patients recovered from anorexia nervosa to examine whether these abnormalities are a state or trait marker of the disease. To extend the understanding of functional connectivity in patients with anorexia nervosa, we also estimated rsFC between large-scale networks. Methods Girls and women recovered from anorexia nervosa and pair-wise, age- and sex-matched healthy controls underwent a resting-state fMRI scan. Using independent component analyses (ICA), we isolated the FPN, DMN and salience network. We used standard comparisons as well as a hypothesis-based approach to test the findings of our previous rsFC study in this recovered cohort. Temporal correlations between network time-course pairs were computed to investigate functional network connectivity (FNC). Results Thirty-one patients recovered from anorexia nervosa and 31 controls participated in our study. Standard group comparisons revealed reduced rsFC between the dorsolateral prefrontal cortex (dlPFC) and the FPN in the recovered group. Using a hypothesis-based approach we extended the previous finding of increased rsFC between the angular gyrus and the FPN in patients recovered from anorexia nervosa. No group differences in FNC were revealed. Limitations The study design did not allow us to conclude that the difference found in rsFC constitutes a scar effect of the disease. Conclusion This study suggests that some abnormal rsFC patterns found in patients recovered from anorexia nervosa normalize after long-term weight restoration, while distorted rsFC in the FPN, a network that has been associated with cognitive control, may constitute a trait marker of the disorder. PMID:27045551

  11. Partially restored resting-state functional connectivity in women recovered from anorexia nervosa.

    PubMed

    Boehm, Ilka; Geisler, Daniel; Tam, Friederike; King, Joseph A; Ritschel, Franziska; Seidel, Maria; Bernardoni, Fabio; Murr, Julia; Goschke, Thomas; Calhoun, Vince D; Roessner, Veit; Ehrlich, Stefan

    2016-10-01

    We have previously shown increased resting-state functional connectivity (rsFC) in the frontoparietal network (FPN) and the default mode network (DMN) in patients with acute anorexia nervosa. Based on these findings we investigated within-network rsFC in patients recovered from anorexia nervosa to examine whether these abnormalities are a state or trait marker of the disease. To extend the understanding of functional connectivity in patients with anorexia nervosa, we also estimated rsFC between large-scale networks. Girls and women recovered from anorexia nervosa and pair-wise, age- and sex-matched healthy controls underwent a resting-state fMRI scan. Using independent component analyses (ICA), we isolated the FPN, DMN and salience network. We used standard comparisons as well as a hypothesis-based approach to test the findings of our previous rsFC study in this recovered cohort. Temporal correlations between network time-course pairs were computed to investigate functional network connectivity (FNC). Thirty-one patients recovered from anorexia nervosa and 31 controls participated in our study. Standard group comparisons revealed reduced rsFC between the dorsolateral prefrontal cortex (dlPFC) and the FPN in the recovered group. Using a hypothesis-based approach we extended the previous finding of increased rsFC between the angular gyrus and the FPN in patients recovered from anorexia nervosa. No group differences in FNC were revealed. The study design did not allow us to conclude that the difference found in rsFC constitutes a scar effect of the disease. This study suggests that some abnormal rsFC patterns found in patients recovered from anorexia nervosa normalize after long-term weight restoration, while distorted rsFC in the FPN, a network that has been associated with cognitive control, may constitute a trait marker of the disorder.

  12. Positive beliefs about anorexia nervosa and muscle dysmorphia are associated with eating disorder symptomatology.

    PubMed

    Griffiths, Scott; Mond, Jonathan M; Murray, Stuart B; Touyz, Stephen

    2015-09-01

    The ego-syntonic nature of anorexia nervosa means that sufferers often deny their symptoms or experience them as positive or comforting. Positive beliefs about eating disorder symptoms may contribute to the development and/or maintenance of eating-disordered behaviour. To date, however, research in this field has been confined to women and anorexia nervosa. Given increasing scientific interest in muscle dysmorphia, a potential eating disorder with ego-syntonic qualities, there is a need to extend current research to include men and muscle dysmorphia. The present study examined whether positive beliefs about anorexia nervosa and muscle dysmorphia were associated with more marked eating disorder symptoms and explored sex differences in these associations. Male and female university students (n = 492) read descriptions of a male or female character with clinically significant symptoms of anorexia nervosa or muscle dysmorphia. Participants subsequently answered questions about the characters and completed a measure of disordered eating. Knowledge, personal history and interpersonal familiarity with the conditions were assessed. Results from two simultaneous multiple regressions showed that more positive beliefs about anorexia nervosa and muscle dysmorphia were uniquely associated with more eating disorder symptoms for both male and female participants. Effect sizes for these relationships were medium to large (partial eta-squared = 0.09-0.10). The relationships were not moderated by the sex of the participant, nor the sex of the character. Although preliminary, these findings suggest that, among young men and women, positive beliefs about anorexia nervosa and muscle dysmorphia may contribute to the development and maintenance of these conditions. Some symptoms of muscle dysmorphia may be perceived as ego-syntonic, providing another parallel with anorexia nervosa. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  13. An Adolescent Case of Citrin Deficiency With Severe Anorexia Mimicking Anorexia Nervosa.

    PubMed

    Takeuchi, Satsuki; Yazaki, Masahide; Yamada, Shinji; Fukuyama, Tetsuhiro; Inui, Akio; Iwasaki, Yasushi; Ikeda, Shu-ichi

    2015-08-01

    We report a 12-year-old female citrin-deficient patient presenting with severe anorexia and body weight loss, mimicking the restricting type of anorexia nervosa (AN). She showed normal development until age 10 years when she started to play volleyball at school. She then became gradually anorexic, and her growth was stunted. At age 12, she was admitted to hospital because of severe anorexia and thinness. She was first thought to have AN, and drip infusion of glucose solution and high-calorie drinks were given, but her condition deteriorated further. She had a history of neonatal hepatitis and was therefore suspected to have citrin deficiency (CD). Genetic analysis of SLC25A13 revealed that she was compound heterozygous for 851del4 and IVS16ins3kb, and a diagnosis of CD was made. A low-carbohydrate diet with oral intake of arginine and ursodeoxycholic acid was started, and her condition gradually improved. The clinical features in our patient were similar to those of AN, and therefore AN may also be an important clinical sign in adolescent patients with CD. Copyright © 2015 by the American Academy of Pediatrics.

  14. Reduced salience and default mode network activity in women with anorexia nervosa.

    PubMed

    McFadden, Kristina L; Tregellas, Jason R; Shott, Megan E; Frank, Guido K W

    2014-05-01

    The neurobiology of anorexia nervosa is poorly understood. Neuronal networks contributing to action selection, self-regulation and interoception could contribute to pathologic eating and body perception in people with anorexia nervosa. We tested the hypothesis that the salience network (SN) and default mode network (DMN) would show decreased intrinsic activity in women with anorexia nervosa and those who had recovered from the disease compared to controls. The basal ganglia (BGN) and sensorimotor networks (SMN) were also investigated. Between January 2008 and January 2012, women with restricting-type anorexia nervosa, women who recovered from the disease and healthy control women completed functional magnetic resonance imaging during a conditioned stimulus task. Network activity was studied using independent component analysis. We studied 20 women with anorexia nervosa, 24 recovered women and 24 controls. Salience network activity in the anterior cingulate cortex was reduced in women with anorexia nervosa (p = 0.030; all results false-discovery rate- corrected) and recovered women (p = 0.039) compared to controls. Default mode network activity in the precuneus was reduced in women with anorexia compared to controls (p = 0.023). Sensorimotor network activity in the supplementary motor area (SMA; p = 0.008), and the left (p = 0.028) and right (p = 0.002) postcentral gyrus was reduced in women with anorexia compared to controls; SMN activity in the SMA (p = 0.019) and the right postcentral gyrus (p = 0.008) was reduced in women with anorexia compared to recovered women. There were no group differences in the BGN. Differences between patient and control populations (e.g., depression, anxiety, medication) are potential confounds, but were included as covariates. Reduced SN activity in women with anorexia nervosa and recovered women could be a trait-related biomarker or illness remnant, altering the drive to approach food. The alterations in the DMN and SMN observed only

  15. Reduced salience and default mode network activity in women with anorexia nervosa

    PubMed Central

    McFadden, Kristina L.; Tregellas, Jason R.; Shott, Megan E.; Frank, Guido K.W.

    2014-01-01

    Background The neurobiology of anorexia nervosa is poorly understood. Neuronal networks contributing to action selection, self-regulation and interoception could contribute to pathologic eating and body perception in people with anorexia nervosa. We tested the hypothesis that the salience network (SN) and default mode network (DMN) would show decreased intrinsic activity in women with anorexia nervosa and those who had recovered from the disease compared to controls. The basal ganglia (BGN) and sensorimotor networks (SMN) were also investigated. Methods Between January 2008 and January 2012, women with restricting-type anorexia nervosa, women who recovered from the disease and healthy control women completed functional magnetic resonance imaging during a conditioned stimulus task. Network activity was studied using independent component analysis. Results We studied 20 women with anorexia nervosa, 24 recovered women and 24 controls. Salience network activity in the anterior cingulate cortex was reduced in women with anorexia nervosa (p = 0.030; all results false-discovery rate–corrected) and recovered women (p = 0.039) compared to controls. Default mode network activity in the precuneus was reduced in women with anorexia compared to controls (p = 0.023). Sensorimotor network activity in the supplementary motor area (SMA; p = 0.008), and the left (p = 0.028) and right (p = 0.002) postcentral gyrus was reduced in women with anorexia compared to controls; SMN activity in the SMA (p = 0.019) and the right postcentral gyrus (p = 0.008) was reduced in women with anorexia compared to recovered women. There were no group differences in the BGN. Limitations Differences between patient and control populations (e.g., depression, anxiety, medication) are potential confounds, but were included as covariates. Conclusion Reduced SN activity in women with anorexia nervosa and recovered women could be a trait-related biomarker or illness remnant, altering the drive to approach

  16. Food motivation circuitry hypoactivation related to hedonic and nonhedonic aspects of hunger and satiety in women with active anorexia nervosa and weight-restored women with anorexia nervosa

    PubMed Central

    Holsen, Laura M.; Lawson, Elizabeth A.; Blum, Justine; Ko, Eunice; Makris, Nikos; Fazeli, Pouneh K.; Klibanski, Anne; Goldstein, Jill M.

    2012-01-01

    Background Previous studies have provided evidence of food motivation circuitry dysfunction in individuals with anorexia nervosa. However, methodological limitations present challenges to the development of a cohesive neurobiological model of anorexia nervosa. Our goal was to investigate the neural circuitry of appetite dysregulation across states of hunger and satiety in active and weight-restored phases of anorexia nervosa using robust methodology to advance our understanding of potential neural circuitry abnormalities related to hedonic and nonhedonic state and trait. Methods We scanned women with active anorexia nervosa, weight-restored women with anorexia nervosa and healthy-weight controls on a 3-T Siemens magnetic resonance scanner while they viewed images of high- and low-calorie foods and objects before (premeal) and after (postmeal) eating a 400 kcal meal. Results We enrolled 12 women with active disease, 10 weight-restored women with anorexia nervosa and 11 controls in our study. Compared with controls, both weight-restored women and those with active disease demonstrated hypoactivity premeal in the hypothalamus, amygdala and anterior insula in response to high-calorie foods (v. objects). Postmeal, hypoactivation in the anterior insula persisted in women with active disease. Percent signal change in the anterior insula was positively correlated with food stimuli ratings and hedonic and nonhedonic appetite ratings in controls, but not women with active disease. Limitations Our findings are limited by a relatively small sample size, which prevented the use of an analysis of variance model and exploration of interaction effects, although our substantial effect sizes of between-group differences suggest adequate power for our statistical analysis approach. Participants taking psychotropic medications were included. Conclusion Our data provide evidence of potential state and trait hypoactivations in food motivation regions involved in the assessment of food

  17. Food motivation circuitry hypoactivation related to hedonic and nonhedonic aspects of hunger and satiety in women with active anorexia nervosa and weight-restored women with anorexia nervosa.

    PubMed

    Holsen, Laura M; Lawson, Elizabeth A; Blum, Justine; Ko, Eunice; Makris, Nikos; Fazeli, Pouneh K; Klibanski, Anne; Goldstein, Jill M

    2012-09-01

    Previous studies have provided evidence of food motivation circuitry dysfunction in individuals with anorexia nervosa. However, methodological limitations present challenges to the development of a cohesive neurobiological model of anorexia nervosa. Our goal was to investigate the neural circuitry of appetite dysregulation across states of hunger and satiety in active and weight-restored phases of anorexia nervosa using robust methodology to advance our understanding of potential neural circuitry abnormalities related to hedonic and nonhedonic state and trait. We scanned women with active anorexia nervosa, weight-restored women with anorexia nervosa and healthy-weight controls on a 3-T Siemens magnetic resonance scanner while they viewed images of high- and low-calorie foods and objects before (premeal) and after (postmeal) eating a 400 kcal meal. We enrolled 12 women with active disease, 10 weight-restored women with anorexia nervosa and 11 controls in our study. Compared with controls, both weight-restored women and those with active disease demonstrated hypoactivity premeal in the hypothalamus, amygdala and anterior insula in response to high-calorie foods (v. objects). Postmeal, hypoactivation in the anterior insula persisted in women with active disease. Percent signal change in the anterior insula was positively correlated with food stimuli ratings and hedonic and nonhedonic appetite ratings in controls, but not women with active disease. Our findings are limited by a relatively small sample size, which prevented the use of an analysis of variance model and exploration of interaction effects, although our substantial effect sizes of between-group differences suggest adequate power for our statistical analysis approach. Participants taking psychotropic medications were included. Our data provide evidence of potential state and trait hypoactivations in food motivation regions involved in the assessment of food's reward value and integration of these with

  18. Interleukin-7 Plasma Levels in Human Differentiate Anorexia Nervosa, Constitutional Thinness and Healthy Obesity

    PubMed Central

    Germain, Natacha; Viltart, Odile; Loyens, Anne; Bruchet, Céline; Nadin, Katia; Wolowczuk, Isabelle; Estour, Bruno; Galusca, Bogdan

    2016-01-01

    Introduction Interleukin-7 (IL-7) is a cytokine involved in energy homeostasis as demonstrated in rodents. Anorexia nervosa is characterized by restrained eating behavior despite adaptive orexigenic regulation profile including high ghrelin plasma levels. Constitutional thinness is a physiological condition of resistance to weight gain with physiological anorexigenic profile including high Peptide YY plasma level. Healthy obesity can be considered as a physiological state of resistance to weight loss with opposite appetite regulating profile to constitutional thinness including low Peptide YY plasma level. No studies in IL-7 are yet available in those populations. Therefore we evaluated circadian plasma levels of IL-7 in anorexia nervosa compared to constitutional thinness, healthy obese and control females. Materials and Methods 10 restrictive-type anorexia nervosa women, 5 bingeing/purging anorexia nervosa woman, 5 recovered restrictive anorexia nervosa women, 4 bulimic females, 10 constitutional thinness women, 7 healthy obese females, and 10 normal weight women controls were enrolled in this cross-sectional study, performed in endocrinology unit and academic laboratory. Twelve-point circadian profiles of plasma IL-7 levels were measured in each subject. Results 24h mean IL-7 plasma levels (pg/ml, mean±SEM) were decreased in restrictive-type anorexia nervosa (123.4±14.4, p<0.0037), bingeing/purging anorexia nervosa (24.2±5.6, p<0.001), recovered restrictive anorexia nervosa (64.2±16.1, p = 0.01) and healthy obese patients (51±3.2, p<0.001) compared to controls (187.7±28.6). Bulimic patients (197.4±42.7) and constitutional thinness patients (264.3±35.8) were similar to controls. Conclusions Low IL-7 is part of the adaptive profile in restrictive-type anorexia nervosa, confirming its difference with constitutional thinness. Healthy obesity, with low IL-7, is once again in mirror image of constitutional thinness with normal high IL-7. PMID:27611669

  19. Dying on the Inside: What Every Teacher Needs to Know About Anorexia Nervosa, Bulimia, and the Individual Child.

    ERIC Educational Resources Information Center

    Zimmer, Marc

    This document provides teachers with information on the identifying features of anorexia nervosa and bulimia and suggests steps which teachers can take to encourage individual children in more positive behavior. The paper makes clear distinctions between anorexia nervosa, bulimia, and bulimarexia, describing the symptoms of each disorder. It is…

  20. Interhemispheric functional connectivity in anorexia and bulimia nervosa.

    PubMed

    Canna, Antonietta; Prinster, Anna; Monteleone, Alessio Maria; Cantone, Elena; Monteleone, Palmiero; Volpe, Umberto; Maj, Mario; Di Salle, Francesco; Esposito, Fabrizio

    2017-05-01

    The functional interplay between hemispheres is fundamental for behavioral, cognitive, and emotional control. Anorexia nervosa (AN) and bulimia nervosa (BN) have been largely studied with brain magnetic resonance imaging (MRI) in relation to the functional mechanisms of high-level processing, but not in terms of possible inter-hemispheric functional connectivity anomalies. Using resting-state functional MRI (fMRI), voxel-mirrored homotopic connectivity (VMHC) and regional inter-hemispheric spectral coherence (IHSC) were studied in 15 AN and 13 BN patients and 16 healthy controls (HC). Using T1-weighted and diffusion tensor imaging MRI scans, regional VMHC values were correlated with the left-right asymmetry of corresponding homotopic gray matter volumes and with the white matter callosal fractional anisotropy (FA). Compared to HC, AN patients exhibited reduced VMHC in cerebellum, insula, and precuneus, while BN patients showed reduced VMHC in dorso-lateral prefrontal and orbito-frontal cortices. The regional IHSC analysis highlighted that the inter-hemispheric functional connectivity was higher in the 'Slow-5' band in all regions except the insula. No group differences in left-right structural asymmetries and in VMHC vs. callosal FA correlations were significant in the comparisons between cohorts. These anomalies, not explained by structural changes, indicate that AN and BN, at least in their acute phase, are associated with a loss of inter-hemispheric connectivity in regions implicated in self-referential, cognitive control and reward processing. These findings may thus gather novel functional markers to explore aberrant features of these eating disorders. © 2016 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

  1. Dysphagia in severe anorexia nervosa and potential therapeutic intervention: a case series.

    PubMed

    Holmes, Samantha R M; Gudridge, Tricia A; Gaudiani, Jennifer L; Mehler, Philip S

    2012-07-01

    In severe anorexia nervosa, there are a litany of medical complications that affect virtually every body system, and severe weakness is a typical characteristic. To our knowledge, aspiration risk, dysphagia recognition, and dysphagia management and intervention have not been well described in the literature in regard to severe anorexia nervosa. The purpose of this case series is to increase awareness among clinicians of possible oropharyngeal dysphagia symptoms that may present in patients with severe anorexia nervosa. We describe the cases of 3 patients with severe anorexia nervosa who presented with symptoms of dysphagia. The speech-language pathology team administered dysphagia therapy to the 3 patients utilizing neuromuscular electrical stimulation (NMES) in conjunction with swallowing therapy tasks that included strengthening exercises and compensatory strategies. After the course of dysphagia treatment intervention, the 3 patients were able to tolerate an oral diet with improved swallowing function and no ongoing aspiration. The use of NMES in conjunction with traditional swallowing exercises in the treatment of dysphagia in patients with anorexia nervosa may reduce the need for enteral feeding and prolonged hospitalization. In regard to dysphagia intervention and management within this population and across other populations, rigorous randomized controlled studies are necessary for determining the efficacy of NMES and traditional swallowing therapy implementation.

  2. Alterations in brain structure in adults with anorexia nervosa and the impact of illness duration.

    PubMed

    Fonville, L; Giampietro, V; Williams, S C R; Simmons, A; Tchanturia, K

    2014-07-01

    Brain structure alterations have been reported in anorexia nervosa, but findings have been inconsistent. This may be due to inadequate sample size, sample heterogeneity or differences in methodology. High resolution magnetic resonance images were acquired of 33 adult participants with anorexia nervosa and 33 healthy participants, the largest study sample to date, in order to assess whole-brain volume, ventricular cerebrospinal fluid, white matter and grey matter volume. Voxel-based morphometry was conducted to assess regional grey matter volume. Levels of depression, anxiety, obsessionality and eating disorder-related symptoms were measured and used to explore correlations with brain structure. Participants with anorexia nervosa had smaller brain volumes as well as a global decrease in grey matter volume with ventricular enlargement. Voxel-based morphometry revealed a decrease in grey matter volume spanning across the cerebellum, temporal, frontal and occipital lobes. A correlation was found between grey matter volume loss and duration of illness in the cerebellum and mesencephalon. No correlations were found with clinical measures. Findings are in accordance with several previous studies on brain structure and match functional studies that have assessed the symptomatology of anorexia nervosa, such as body image distortion and cognitive bias to food. The correlation with duration of illness supports the implication of cerebellar atrophy in the maintenance of low weight and disrupted eating behaviour and illustrates its role in the chronic phase of anorexia nervosa. The lack of other correlations suggests that these findings are not related to the presence of co-morbid disorders.

  3. Increased resting state functional connectivity in the default mode network in recovered anorexia nervosa.

    PubMed

    Cowdrey, Felicity A; Filippini, Nicola; Park, Rebecca J; Smith, Stephen M; McCabe, Ciara

    2014-02-01

    Functional brain imaging studies have shown abnormal neural activity in individuals recovered from anorexia nervosa (AN) during both cognitive and emotional task paradigms. It has been suggested that this abnormal activity which persists into recovery might underpin the neurobiology of the disorder and constitute a neural biomarker for AN. However, no study to date has assessed functional changes in neural networks in the absence of task-induced activity in those recovered from AN. Therefore, the aim of this study was to investigate whole brain resting state functional connectivity in nonmedicated women recovered from anorexia nervosa. Functional magnetic resonance imaging scans were obtained from 16 nonmedicated participants recovered from anorexia nervosa and 15 healthy control participants. Independent component analysis revealed functionally relevant resting state networks. Dual regression analysis revealed increased temporal correlation (coherence) in the default mode network (DMN) which is thought to be involved in self-referential processing. Specifically, compared to healthy control participants the recovered anorexia nervosa participants showed increased temporal coherence between the DMN and the precuneus and the dorsolateral prefrontal cortex/inferior frontal gyrus. The findings support the view that dysfunction in resting state functional connectivity in regions involved in self-referential processing and cognitive control might be a vulnerability marker for the development of anorexia nervosa. Copyright © 2012 Wiley Periodicals, Inc.

  4. Anorexia nervosa versus bulimia nervosa: differences based on retrospective correlates in a case-control study.

    PubMed

    Machado, Bárbara C; Gonçalves, Sónia F; Martins, Carla; Brandão, Isabel; Roma-Torres, António; Hoek, Hans W; Machado, Paulo P

    2016-06-01

    This study is the result of two Portuguese case-control studies that examined the replication of retrospective correlates and preceding life events in anorexia nervosa (AN) and bulimia nervosa (BN) development. This study aims to identify retrospective correlates that distinguish AN and BN METHOD: A case-control design was used to compare a group of women who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for AN (N = 98) and BN (N = 79) with healthy controls (N = 86) and with other psychiatric disorders (N = 68). Each control group was matched with AN patients regarding age and parental social categories. Risk factors were assessed by interviewing each person with the Oxford Risk Factor Interview. Compared to AN, women with BN reported significantly higher rates of paternal high expectations, excessive family importance placed on fitness/keeping in shape, and negative consequences due to adolescent overweight and adolescent objective overweight. Overweight during adolescence emerged as the most relevant retrospective correlate in the distinction between BN and AN participants. Family expectations and the importance placed on keeping in shape were also significant retrospective correlates in the BN group.

  5. Trail making task performance in inpatients with anorexia nervosa and bulimia nervosa.

    PubMed

    Vall, Eva; Wade, Tracey D

    2015-07-01

    Set-shifting inefficiencies have been consistently identified in adults with anorexia nervosa (AN). It is less clear to what degree similar inefficiencies are present in those with bulimia nervosa (BN). It is also unknown whether perfectionism is related to set-shifting performance. We employed a commonly used set-shifting measure, the Trail Making Test (TMT), to compare the performance of inpatients with AN and BN with a healthy control sample. We also investigated whether perfectionism predicted TMT scores. Only the BN sample showed significantly suboptimal performance, while the AN sample was indistinguishable from controls on all measures. There were no differences between the AN subtypes (restrictive or binge/purge), but group sizes were small. Higher personal standards perfectionism was associated with better TMT scores across groups. Higher concern over mistakes perfectionism predicted better accuracy in the BN sample. Further research into the set-shifting profile of individuals with BN or binge/purge behaviours is needed. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

  6. Childhood trauma and cortisol awakening response in symptomatic patients with anorexia nervosa and bulimia nervosa.

    PubMed

    Monteleone, Alessio Maria; Monteleone, Palmiero; Serino, Ismene; Scognamiglio, Pasquale; Di Genio, Monica; Maj, Mario

    2015-09-01

    Exposure to trauma during childhood is a risk factor for eating disorders (EDs) in adulthood. The biological mechanisms underlying such increased risk seem to involve the endogenous stress response system (i.e., the hypothalamic-pituitary-adrenal [HPA] axis), which undergoes trauma-induced functional changes that may persist later in life. In the present study, we examined the effects of childhood trauma experiences on HPA-axis activity, comparing saliva cortisol awakening response (CAR) in adult patients with anorexia nervosa (AN) or bulimia nervosa (BN) with CAR in adult healthy controls. Twenty-three patients with symptomatic AN, 21 patients with symptomatic BN, and 29 healthy women collected saliva samples at awakening and again after 15, 30, and 60 min. Participants also completed the Childhood Trauma Questionnaire and eating-related psychopathological rating scales. According to the Childhood Trauma Questionnaire, 13 individuals with AN and 12 individuals with BN, but none of the healthy women, reported childhood maltreatment. Compared with the control group, the non-maltreated AN patient group exhibited an enhanced CAR, whereas the group of non-maltreated BN patients showed a normal CAR. Moreover, both AN and BN patient groups with childhood maltreatment exhibited statistically significant blunting of CAR compared with non-maltreated groups. The present findings add to the evidence supporting the concept that there is a dysregulation of HPA-axis activity in symptomatic patients with EDs and suggest that childhood trauma exposure may contribute to such dysregulation. © 2014 Wiley Periodicals, Inc.

  7. Understanding the Relation between Anorexia Nervosa and Bulimia Nervosa in a Swedish National Twin Sample

    PubMed Central

    Bulik, Cynthia M; Thornton, Laura; Root, Tammy L.; Pisetsky, Emily M.; Lichtenstein, Paul; Pedersen, Nancy L.

    2010-01-01

    Background We present a bivariate twin analysis of anorexia nervosa (AN) and bulimia nervosa (BN) to determine the extent to which shared genetic and environmental factors contribute to liability to these disorders. Method Focusing on females from the Swedish Twin study of Adults: Genes and Environment (STAGE) (N=7000), we calculated heritability estimates for narrow and broad AN and BN and estimated their genetic correlation. Results In the full model, the heritability estimate for narrow AN was (a2 = .57; 95% CI: .00, .81) and for narrow BN (a2 = .62; 95% CI: .08, .70) with the remaining variance accounted for by unique environmental factors. Shared environmental factors estimates were (c2 = .00; 95% CI: .00, .67) for AN and (c2 = .00; 95% CI: .00, .40) for BN. Moderate additive genetic (.46) and unique environmental (.42) correlations between AN and BN were observed. Heritability estimates for broad AN were lower (a2 = .29; 95% CI: .04, .43) than for narrow AN, but estimates for broad BN were similar to narrow BN. The genetic correlation for broad AN and BN was .79 and the unique environmental correlation was .44. Conclusions We highlight the contribution of additive genetic factors to both narrow and broad AN and BN and demonstrate a moderate overlap of both genetic and unique environmental factors that influence the two conditions. Common concurrent and sequential comorbidity of AN and BN can in part be accounted for by shared genetic and environmental influences on liability although independent factors also operative. PMID:19828139

  8. Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder in Midlife and Beyond.

    PubMed

    Elran-Barak, Roni; Fitzsimmons-Craft, Ellen E; Benyamini, Yael; Crow, Scott J; Peterson, Carol B; Hill, Laura L; Crosby, Ross D; Mitchell, James E; Le Grange, Daniel

    2015-08-01

    We examined eating disorders in midlife and beyond by comparing frequency of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding or eating disorder (OSFED) among midlife eating disorder treatment-seeking individuals and younger controls. We also compared demographic and eating disorder-related characteristics across diagnoses and age groups. Participants included 2,118 treatment-seeking adults who self-reported their eating-related symptoms on the Eating Disorder Questionnaire. Results showed that percent of patients with BN was significantly lower whereas percent of patients with BED and OSFED was significantly higher among midlife relative to younger patients. Percent of patients with AN did not differ between midlife and younger patients. Additionally, midlife and younger patients with BED and OSFED differed on several demographic (e.g., marital status) and eating disorder-related characteristics (e.g., BMI, compulsive exercising). This study suggests that BN is less common whereas BED and OSFED are more common among midlife eating disorder treatment-seeking individuals relative to younger controls. In addition, AN and BN present fairly similarly whereas BED and OSFED present fairly differently among midlife patients relative to younger controls. Attention to these differences and similarities is necessary to understand eating disorders in midlife.

  9. Differential impairments underlying decision making in anorexia nervosa and bulimia nervosa: a cognitive modeling analysis.

    PubMed

    Chan, Trista Wai Sze; Ahn, Woo-Young; Bates, John E; Busemeyer, Jerome R; Guillaume, Sebastien; Redgrave, Graham W; Danner, Unna N; Courtet, Philippe

    2014-03-01

    This study examined the underlying processes of decision-making impairments in individuals with anorexia nervosa (AN) and bulimia nervosa (BN). We deconstructed their performance on the widely used decision task, the Iowa Gambling Task (IGT) into cognitive, motivational, and response processes using cognitive modeling analysis. We hypothesized that IGT performance would be characterized by impaired memory functions and heightened punishment sensitivity in AN, and by elevated sensitivity to reward as opposed to punishment in BN. We analyzed trial-by-trial data of IGT obtained from 224 individuals: 94 individuals with AN, 63 with BN, and 67 healthy comparison individuals (HC). The prospect valence learning model was used to assess cognitive, motivational, and response processes underlying IGT performance. Individuals with AN showed marginally impaired IGT performance compared to HC. Their performance was characterized by impairments in memory functions. Individuals with BN showed significantly impaired IGT performance compared to HC. They showed greater relative sensitivity to gains as opposed to losses than HC. Memory functions in AN were positively correlated with body mass index. This study identified differential impairments underlying IGT performance in AN and BN. Findings suggest that impaired decision making in AN might involve impaired memory functions. Impaired decision making in BN might involve altered reward and punishment sensitivity. Copyright © 2013 Wiley Periodicals, Inc.

  10. Quantitative evidence for distinct cognitive impairment in anorexia nervosa and bulimia nervosa.

    PubMed

    Zakzanis, Konstantine K; Campbell, Zachariah; Polsinelli, Angelina

    2010-03-01

    It is generally agreed that at least some aspects of abnormal eating behaviour is indeed due in part to disordered cognition. The accumulated literature illustrates cognitive impairment in patients with anorexia nervosa (AN) and bulimia nervosa (BN). Yet beyond being inconsistent, these independent studies also do not reveal the magnitude of impairment within and across studies and fail to give due consideration to the magnitude of impairment so as to understand the severity and breadth of impairment and/or differences in cognitive profiles between patients with AN and BN. Hence, the present review on the subject sought to articulate the magnitude of cognitive impairment in patients with AN and BN by quantitatively synthesizing the existing literature using meta-analytic methodology. The results demonstrate modest evidence of cognitive impairment specific to AN and BN that is related to body mass index in AN in terms of its severity, and is differentially impaired between disorders. Together, these results suggest that disturbed cognition is figural in the presentation of eating disorders and may serve to play an integral role in its cause and maintenance. Implications of these findings with respects to future research are discussed.

  11. Examining implicit attitudes toward emaciation and thinness in anorexia nervosa.

    PubMed

    Smith, April R; Joiner, Thomas E; Dodd, Dorian R

    2014-03-01

    To determine if females with anorexia nervosa (AN) associate emaciation with beauty by examining implicit attitudes toward emaciated bodies relative to thin bodies. Thirty women with AN and 29 healthy control women were primed by viewing images of either emaciated or thin women. Participants then completed a lexical decision task (LDT), wherein they distinguished words from nonwords as quickly and accurately as possible. Response times were measured. Real words consisted of beautiful, ugly, neutral, and positive words. Body mass index (BMI) was measured and several clinical interviews were completed, including the Eating Disorders Examination Questionnaire 4 (EDEQ-4). There was a significant effect of group in the emaciated condition; participants with AN responded faster to both beautiful and ugly words than control women did. Eating disorder symptom severity (as measured by the EDEQ-4 subscales) predicted the strength of the association between emaciation and beauty. At an implicit, automatic level, women with AN in this study had stronger associations between emaciation and both beauty and ugliness than control women did, suggesting that women with AN may have atypical beliefs about beauty. Thin ideal internalization is an important factor in the development and maintenance of eating disorders; the type of thin ideal being internalized may be important to consider, particularly given the extent to which pro-eating disorder websites promote idealization of emaciation. The associations found by using the LDT highlight the utility of implicit measures, particularly when conducting assessments involving sensitive or atypical beliefs. Copyright © 2013 Wiley Periodicals, Inc.

  12. Pre-meal anxiety and food intake in anorexia nervosa.

    PubMed

    Steinglass, Joanna E; Sysko, Robyn; Mayer, Laurel; Berner, Laura A; Schebendach, Janet; Wang, Yuanjia; Chen, Huaihou; Albano, Anne Marie; Simpson, H Blair; Walsh, B Timothy

    2010-10-01

    Anorexia nervosa (AN) is a serious mental illness characterized by reduced caloric intake that often persists after acute weight restoration. This preliminary study assesses the relationship between pre-meal anxiety and food intake in recently weight-restored individuals with AN. We hypothesized that pre-meal anxiety is inversely related to caloric intake in AN. Caloric intake and pre-meal anxiety were measured in three laboratory-based assessments (yogurt snack, multi-item lunch, macaroni and cheese lunch). Anxiety was measured by Spielberger State-Trait Anxiety Inventory (STAI-S) administered prior to the meal. Acutely weight-restored patients with AN were compared with healthy controls (HCs). Associations between anxiety and intake were analyzed first within each meal type separately and then using a model to combine the sample. In the multi-item lunch and the macaroni and cheese lunch, AN ate significantly less than HC (p=0.01, p<0.001). Pre-meal anxiety was significantly correlated with intake among AN, but not HC. In the yogurt snack, there was no significant association between anxiety and intake among patients or controls, and the groups did not differ in caloric intake. The association between pre-meal anxiety and intake among weight-restored individuals with AN suggests a potential target for relapse prevention treatment.

  13. An investigation of habit learning in Anorexia Nervosa.

    PubMed

    Godier, Lauren R; de Wit, Sanne; Pinto, Anthony; Steinglass, Joanna E; Greene, Ashley L; Scaife, Jessica; Gillan, Claire M; Walsh, B Timothy; Simpson, Helen-Blair; Park, Rebecca J

    2016-10-30

    Anorexia Nervosa (AN) is a disorder characterised by compulsive behaviour, such as self-starvation and excessive exercise, which develop in the pursuit of weight-loss. Recent theory suggests that once established, compulsive weight-loss behaviours in AN may become habitual. In two parallel studies, we measured whether individuals with AN showed a bias toward habits using two outcome-devaluation tasks. In Study 1, 23 women with AN (restrictive and binge/purge subtypes), and 18 healthy controls (HC) completed the slips-of-action paradigm, designed to assess reward-based habits. In Study 2, 13 women with restrictive AN, 14 women recovered from restrictive AN, and 17 female HC participants completed the slips-of-action paradigm, and an avoidance paradigm, designed to assess aversive habits. AN participants showed no deficit relative to HCs in the ability to use feedback to respond correctly to stimuli. Following devaluation of outcomes, all groups in both studies were equally able to withhold inappropriate responses, suggesting no deficit in the balance between goal-directed and habitual control of behaviour in these tasks in AN. These results suggest that individuals with AN do not show a generalised tendency to rely on habits in two outcome-devaluation tasks. Future research is needed to investigate the potential role of disorder-specific habits in the maintenance of behaviour in AN. Copyright © 2016. Published by Elsevier Ireland Ltd.

  14. Pre-meal anxiety and food intake in Anorexia Nervosa

    PubMed Central

    Steinglass, Joanna E.; Sysko, Robyn; Mayer, Laurel; Berner, Laura A.; Schebendach, Janet; Wang, Yuanjia; Chen, Huaihou; Albano, Anne Marie; Simpson, H. Blair; Walsh, B. Timothy

    2010-01-01

    Anorexia Nervosa (AN) is a serious mental illness characterized by reduced caloric intake that often persists after acute weight restoration. This preliminary study assesses the relationship between pre-meal anxiety and food intake in recently weight-restored individuals with AN. We hypothesized that pre-meal anxiety is inversely related to caloric intake in AN. Caloric intake and pre-meal anxiety were measured in 3 laboratory- based assessments (yogurt snack, multi-item lunch, macaroni and cheese lunch). Anxiety was measured by Spielberger State-Trait Anxiety Inventory (STAI-S) administered prior to the meal. Acutely weight-restored patients with AN were compared with healthy controls (HC). Associations between anxiety and intake were analyzed first within each meal type separately and then using a model to combine the sample. In the multi-item lunch and the macaroni & cheese lunch, AN ate significantly less than HC (p = 0.01, p<0.001). Pre-meal anxiety was significantly correlated with intake among AN, but not HC. In the yogurt snack, there was no significant association between anxiety and intake among patients or controls, and the groups did not differ in caloric intake. The association between pre-meal anxiety and intake among weight restored individuals with AN suggests a potential target for relapse prevention treatment. PMID:20570701

  15. Increased capacity to delay reward in anorexia nervosa.

    PubMed

    Steinglass, Joanna E; Figner, Bernd; Berkowitz, Staci; Simpson, H Blair; Weber, Elke U; Walsh, B Timothy

    2012-07-01

    Individuals with anorexia nervosa (AN) are often characterized as possessing excessive self-control and are unusual in their ability to reduce or avoid the consumption of palatable foods. This behavior promotes potentially life-threatening weight loss and suggests disturbances in reward processing. We studied whether individuals with AN showed evidence of increased self-control by examining the tendency to delay receipt of a monetary, non-food related, reward. Underweight AN (n = 36) and healthy controls (HC, n = 28) completed a monetary intertemporal choice task measuring delay discounting factor. Individuals with AN reduced the value of a monetary reward over time significantly less than HC (F[1,61] = 5.03; p = 0.029). Secondary analyses indicated that the restricting subtype of AN, in particular, showed significantly less discounting than HC (F[1,46] = 8.3; p = 0.006). These findings indicate that some individuals with AN show less temporal discounting than HC, suggestive of enhanced self-control that is not limited to food consumption. This is in contrast to other psychiatric disorders, for example, substance abuse, which are characterized by greater discounting. Though preliminary, these findings suggest that excessive self-control may contribute to pathological processes and individuals with AN may have neuropsychological characteristics that enhance their ability to delay reward and thereby may help to maintain persistent food restriction.

  16. Neurobiological model of the persistence of anorexia nervosa.

    PubMed

    Steinglass, Joanna E; Walsh, B Timothy

    2016-01-01

    Anorexia Nervosa (AN) is characterized by the maintenance of an undernourished, or starved, state. Persistent restrictive eating, or the recurrent intake of a diet that is inadequate to sustain a healthy weight, is the central behavior maintaining AN. To understand this disturbance, we need to understand the neural mechanisms that allow or promote the persistent choice of inadequate caloric intake. While a range of neural disturbances have been reported in AN, abnormalities in systems relevant to reward processing and the development of habit systems have been consistently described in both structural and functional neuroimaging studies. Most recently, brain and behavior have been directly examined by investigating the neural underpinnings of restrictive food choice. These recent data suggest that, among individuals with AN, dorsal frontostriatal circuits play a greater role in guiding decisions regarding what to eat than among healthy individuals. This line of research attempts to leverage advances in the field of cognitive neuroscience to further our understanding of persistent maladaptive choices of individuals with AN, in the hope that such advances will help in the development of novel treatments for this potentially fatal disorder.

  17. Increased Capacity to Delay Reward in Anorexia Nervosa

    PubMed Central

    Steinglass, Joanna; Figner, Bernd; Berkowitz, Staci; Simpson, H. Blair; Weber, Elke U.; Walsh, B. Timothy

    2013-01-01

    Individuals with anorexia nervosa (AN) are often characterized as possessing excessive self-control and are unusual in their ability to reduce or avoid the consumption of palatable foods. This behavior promotes potentially life-threatening weight loss and suggests disturbances in reward processing. We studied whether individuals with AN showed evidence of increased self-control by examining the tendency to delay receipt of a monetary, non-food related, reward. Underweight AN (n=36) and healthy controls (HC, n=28) completed a monetary intertemporal choice task measuring delay discounting factor. Individuals with AN reduced the value of a monetary reward over time significantly less than HC (F[1,61]=5.03, p=0.029). Secondary analyses indicated that the restricting subtype of AN, in particular, showed significantly less discounting than HC (F[1,46]=8.3, p=0.006). These findings indicate that some individuals with AN show less temporal discounting than HC, suggestive of enhanced self-control that is not limited to food consumption. This is in contrast to other psychiatric disorders, e.g. substance abuse, which are characterized by greater discounting. Though preliminary, these findings suggest that excessive self-control may contribute to pathological processes and individuals with AN may have neuropsychological characteristics that enhance their ability to delay reward and thereby may help to maintain persistent food restriction. PMID:22591835

  18. Alexithymia, emotional empathy, and self-regulation in Anorexia Nervosa

    PubMed Central

    Beadle, Janelle N.; Paradiso, Sergio; Salerno, Alexandria; McCormick, Laurie M.

    2013-01-01

    BACKGROUND During starvation, individuals with Anorexia Nervosa (AN) experience poor awareness of personal emotions (alexithymia), difficulty understanding others’ mental states (cognitive empathy), and poor regulation of personal emotions (self-regulation). Despite its important role in social interaction and interpersonal relationships, emotional empathy has not been measured in AN. Furthermore, how weight affects relationships among alexithymia, empathy, and self-regulation has not been investigated. METHODS Women with AN were tested longitudinally during starvation (N=26) and after weight restoration (N=20) and compared to 16 age-matched healthy women at comparable time-points. The Toronto Alexithymia Scale 20 (TAS-20) assessed alexithymia and the Interpersonal Reactivity Index (IRI) measured empathy. Self-regulation was assessed by a subset of 37 items from the MMPI 2. RESULTS Relative to comparison participants, AN participants at starvation and weight restoration reported greater alexithymia and personal distress (a domain of emotional empathy measuring vicarious negative arousal to others’ suffering). Among AN participants, personal distress was positively correlated with alexithymia and negatively correlated with self-regulation, when accounting for depression. CONCLUSIONS This study provides evidence that alexithymia and personal distress may represent vulnerability features of AN. Higher levels of personal distress in AN may be related to poor self-regulation and emotional awareness. PMID:23638441

  19. Emotion Acceptance Behavior Therapy for Anorexia Nervosa: A Pilot Study

    PubMed Central

    Wildes, Jennifer E.; Marcus, Marsha D.; Cheng, Yu; McCabe, Elizabeth B.; Gaskill, Jill A.

    2015-01-01

    Objective This study aimed to evaluate the preliminary efficacy of Emotion Acceptance Behavior Therapy (EABT), an outpatient psychotherapeutic intervention for anorexia nervosa (AN) based on a disorder-specific model of symptom maintenance that emphasizes emotion avoidance. EABT combines standard behavioral interventions that are central to the clinical management of AN with evidence-supported strategies to increase emotion awareness, decrease emotion avoidance, and encourage resumption of valued activities and relationships outside the eating disorder. Method Twenty-four individuals aged ≥17 years with AN were treated using the EABT manual. EABT was delivered in 33–58 individual sessions provided over 38–53 weeks. Assessments were conducted before and after treatment, and at 3- and 6-month follow-ups. Results Thirteen patients (54.2%) completed EABT; 11 (45.8%) dropped out or were withdrawn. EABT was associated with significant improvements in weight, disordered eating symptoms, and emotion avoidance that were maintained over 6-month follow-up. The majority of EABT completers achieved a body mass index >18.5 (n=9/13) or had a normal Eating Disorder Examination Global score (n=10/13) at post-treatment. Discussion Preliminary data suggest that EABT may have utility for a subset of adults with AN. Future research will focus on improving outcomes in EABT non-responders and identifying of mechanisms that drive treatment response. PMID:24407934

  20. [Blunted erythropoietic response in the anemia of anorexia nervosa].

    PubMed

    Juncà, Jordi; Sorigué, Marc; Rodríguez-Hernández, Inés; Aldea, Marta; Granada, María Luisa; Sánchez-Planell, Lluis

    2015-11-20

    The cause of the anemia in anorexia nervosa (AN) has not been fully ascertained. Ferritin, folate and cobalamin values are usually within normal ranges. Anemia does not have a relationship with bone marrow changes and erythropoietin (EPO) levels have not been investigated. The objective of this study was to evaluate the EPO response in a small group of AN patients. EPO levels were measured in serum samples of 41 female AN patients (11 with anemia, and 30 with normal blood cell count). The adequacy of EPO response was assessed by comparing the increase observed in a group of normal weight patients with anemia. EPO concentrations in anemic AN patients were higher than in non-anemic: 20.63mU/mL (4.04-28.46) vs 8.7mU/mL (3.9-20.93), P=.0088, but the increase in EPO was lower than expected (27.85mU/mL [17.7-118.9]), P=.014. BMI and the difference between actual and expected EPO were inversely correlated. Inadequate EPO response may partly explain anemia in AN, but further studies are necessary. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  1. Cognitive Profile of Children and Adolescents with Anorexia Nervosa

    PubMed Central

    Kjaersdam Telléus, Gry; Jepsen, Jens Richardt; Bentz, Mette; Christiansen, Eva; Jensen, Signe O W; Fagerlund, Birgitte; Thomsen, Per Hove

    2015-01-01

    Objective Few studies of cognitive functioning in children and adolescents with anorexia nervosa (AN) have been conducted. The aim of this study was to examine the neurocognitive and intelligence profile of this clinical group. Method The study was a matched case–control (N = 188), multi-centre study including children and adolescents with AN (N = 94) and healthy control participants (N = 94). Results The results suggest that Full Scale Intelligence Quotient (Wechsler Intelligence Scale for Children-III/Wechsler Adult Intelligence Scale-III) in this patient group is close to the normal population mean of 100. Individuals with AN exhibited significantly worse performance in nonverbal intelligence functions (i.e. Wechsler Intelligence Scale for Children-III/Wechsler Adult Intelligence Scale-III, Perceptual Organization Index) and in verbal memory (Test of Memory and Learning—Second Edition, Memory for Stories) and motor speed (Cambridge Neuropsychological Test Automated Battery, Simple and Choice Reaction Time) compared with healthy control participants. No significant difference in set-shifting ability (Cambridge Neuropsychological Test Automated Battery, Intra-Extra Dimensional Set Shift and Trail Making Test B) was found. Conclusions Inefficiency in nonverbal intelligence functions and in specific cognitive functions was found in this study of children and adolescents with AN. © 2014 The Authors. European Eating Disorders Review published by John Wiley & Sons, Ltd. PMID:25504443

  2. Functional connectivity correlates of response inhibition impairment in anorexia nervosa.

    PubMed

    Collantoni, Enrico; Michelon, Silvia; Tenconi, Elena; Degortes, Daniela; Titton, Francesca; Manara, Renzo; Clementi, Maurizio; Pinato, Claudia; Forzan, Monica; Cassina, Matteo; Santonastaso, Paolo; Favaro, Angela

    2016-01-30

    Anorexia nervosa (AN) is a disorder characterized by high levels of cognitive control and behavioral perseveration. The present study aims at exploring inhibitory control abilities and their functional connectivity correlates in patients with AN. Inhibitory control - an executive function that allows the realization of adaptive behavior according to environmental contingencies - has been assessed by means of the Stop-Signal paradigm. The study involved 155 patients with lifetime AN and 102 healthy women. A subsample underwent resting-state functional magnetic resonance imaging and was genotyped for COMT and 5-HTTLPR polymorphisms. AN patients showed an impaired response inhibition and a disruption of the functional connectivity of the ventral attention circuit, a neural network implicated in behavioral response when a stimulus occurs unexpected. The 5-HTTLPR genotype appears to significantly interact with the functional connectivity of ventral attention network in explaining task performance in both patients and controls, suggesting a role of the serotoninergic system in mechanisms of response selection. The disruption of the ventral attention network in patients with AN suggests lower efficiency of bottom-up signal filtering, which might be involved in difficulties to adapt behavioral responses to environmental needs. Our findings deserve further research to confirm their scientific and therapeutic implications. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. Anorexia nervosa, perfectionism, and dopamine D4 receptor (DRD4).

    PubMed

    Bachner-Melman, Rachel; Lerer, Elad; Zohar, Ada H; Kremer, Ilana; Elizur, Yoel; Nemanov, Lubov; Golan, Moria; Blank, Shulamit; Gritsenko, Inga; Ebstein, Richard P

    2007-09-05

    The dopamine D4 receptor (DRD4), a well-characterized, polymorphic gene, is an attractive candidate for contributing risk to disordered eating and anorexia nervosa (AN). We tested association using UNPHASED for 5 DRD4 polymorphic loci, 3 promoter region SNPs (C-521T, C-616G, A-809G), the 120 bp promoter region tandem duplication and the exon III repeat, in 202 AN trios and 418 control families. Since perfectionism characterizes AN, we tested these five loci for association with the Child and Adolescent Perfectionism Scale (CAPS) in the AN and control groups. Single locus analysis showed significant association between the 'C' C-521T allele and AN. Haplotype analysis also showed significant association, particularly a 4-locus haplotype (exon III&120 bp repeat&C-521T&A-809G). Association was also observed between DRD4 and CAPS scores both for AN and control subjects. The insulin-like growth factor 2 (IGF2) and the arginine vasopressin 1a receptor (AVPR1a), previously shown to be associated with disordered eating, were also associated with CAPS scores. Three genes associated with AN were also associated with perfectionism. Personality traits are potential endophenotypes for understanding the etiology of eating disorders and one of the several pathways to eating pathology may be mediated by the impact of DNA sequences on perfectionism. Copyright 2007 Wiley-Liss, Inc.

  4. Accommodation of Symptoms in Anorexia Nervosa: A Qualitative Study.

    PubMed

    Fox, John R E; Whittlesea, Anna

    2016-06-17

    Anorexia nervosa (AN) continues to remain poorly understood within eating disorders. Recent research and theory have moved away from understanding its aetiological causes, addressing instead potential maintaining factors. This study is focused on interpersonal maintenance factors: the response of close others. Relatives of those with AN typically carry the main burden of care, and research has found high levels of carer distress and unmet needs. Recent theories have proposed this emotional impact to contribute to expressed emotion and other unhelpful caregiver interactions which inadvertently maintain AN. One such understudied response is accommodation, described as a 'process' whereby caregivers 'assist or participate' in symptomatic behaviours of the cared for individual. There is a dearth of research relating to accommodation within eating disorders, particularly qualitative accounts. This study utilized a grounded theory methodology to explore caregivers' responses to managing AN, focusing particularly on carers' experience of accommodation. Eight participants with experience of caring for an individual diagnosed with AN were interviewed. Participants were recruited from a national eating disorder charity and regional eating disorder service. A number of themes emerged, including the importance of caregivers' emotional resources in mediating accommodation responses. Low-perceived efficacy over AN contributed to caregiver burnout. Decreased emotional resources influenced a shift in caregiving aims conducive with accommodation. Nevertheless, carers perceived accommodation as counterproductive to recovery and consequently experienced internal conflict (cognitive dissonance). Dissonance was reduced using a number of cognitive and behavioural strategies. The implications of these findings are discussed with reference to existing literature. Copyright © 2016 John Wiley & Sons, Ltd.

  5. Neural correlates of body dissatisfaction in anorexia nervosa.

    PubMed

    Friederich, Hans-Christoph; Brooks, Samantha; Uher, Rudolf; Campbell, Iain C; Giampietro, Vincent; Brammer, Mick; Williams, Steve C R; Herzog, Wolfgang; Treasure, Janet

    2010-08-01

    Body dissatisfaction is an important precipitating and maintenance factor in anorexia nervosa (AN) and behavioral studies suggest that a cognitive-affective component and a perceptual component (perceptual disturbance of one's own body) are both important in this pathophysiology. However, the functional neuroanatomy of body dissatisfaction in AN is largely unknown. This study has investigated self-other body-shape comparison to establish neural correlates of body dissatisfaction in patients with AN. 17 women with AN and 18 age and sex-matched healthy control (HC) subjects were scanned using functional magnetic resonance imaging while comparing themselves with images of slim idealized female bodies (active condition) or viewing images of interior home designs (control condition). Participants were asked to compare their body shape or room design with those presented. Patients with AN (in comparison to the HC group) showed greater anxiety to the self-other body-shape comparison, and they were less satisfied with their current body shape. In the patient group (in comparison to the HC group) the self-other body-shape comparison induced more activation of the right sensorimotor brain regions (insula, premotor cortex) and less activation of the rostral anterior cingulate cortex (ACC). Insula hyperactivation along with ACC hypoactivation may be critical for altered interoceptive awareness to body self-comparison and/or for altered implicit motivation to thin-idealized body images in AN patients. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

  6. Clinical investigation of set-shifting subtypes in anorexia nervosa.

    PubMed

    Abbate-Daga, Giovanni; Buzzichelli, Sara; Marzola, Enrica; Amianto, Federico; Fassino, Secondo

    2014-11-30

    While evidence continues to accumulate on the relevance of cognitive inflexibility in anorexia nervosa (AN), its clinical correlates remain unclear. We aimed at examining the relationship between set-shifting and clinical variables (i.e., eating psychopathology, depression, and personality) in AN. Ninety-four individuals affected by AN and 59 healthy controls (HC) were recruited. All participants were assessed using: Eating Disorders Inventory-2 (EDI-2), Temperament and Character Inventory (TCI), Beck Depression Inventory (BDI), and Wisconsin Card Sorting Test (WCST). The AN group scored worse than HCs on set-shifting. According to their neuropsychological performances, AN patients were split into two groups corresponding to poor (N=30) and intact (N=64) set-shifting subtypes. Interoceptive awareness, impulse regulation, and maturity fears on the EDI-2 and depression on the BDI differed across all groups (HC, intact, and poor set-shifting subtype). Self-directedness on the TCI differed significantly among all groups. Cooperativeness and reward dependence differed instead only between HC and AN poor set-shifting subtype. After controlling for depression, only interoceptive awareness remained significant with reward dependence showing a trend towards statistical significance. These findings suggest that multiple clinical variables may be correlated with set-shifting performances in AN. The factors contributing to impaired cognitive inflexibility could be more complex than heretofore generally considered.

  7. Perfectionism in anorexia nervosa: novel performance based evidence.

    PubMed

    Lloyd, Samantha; Yiend, Jenny; Schmidt, Ulrike; Tchanturia, Kate

    2014-01-01

    Existing research into perfectionism in Anorexia Nervosa (AN) is limited by a reliance upon self-report measures. This study used novel performance based measures to investigate whether there is behavioural evidence for elevated perfectionism in AN. 153 participants took part in the study--81 with a diagnosis of AN and 72 healthy controls (HCs). Participants completed two performance based tasks assessing perfectionism--a text replication task and a bead sorting task--along with self-report measures of perfectionism. Significant group differences were observed on both tasks. In the text replication task the AN group took significantly longer compared with healthy controls (p = 0.03, d = 0.36) and produced significantly higher quality copies (p = <0.01, d = 0.45). In the bead sorting task, there was a trend towards more participants in the AN group choosing to check their work compared with the HC group (p = 0.07, d = 0.30) and the AN group took significantly longer checking than those in the HC group (p = <0.01, d = 0.45). Only copy quality uniquely predicted scores on self report measures of perfectionism. This study provides empirically tested evidence of elevated performance based perfectionism in AN compared with a healthy control group.

  8. The perception of affective touch in anorexia nervosa.

    PubMed

    Crucianelli, Laura; Cardi, Valentina; Treasure, Janet; Jenkinson, Paul M; Fotopoulou, Aikaterini

    2016-05-30

    Anorexia nervosa (AN) is a disorder characterized by restricted eating, fears of gaining weight, and body image distortions. The etiology remains unknown; however impairments in social cognition and reward circuits contribute to the onset and maintenance of the disorder. One possibility is that AN is associated with reduced perceived pleasantness during social interactions. We therefore examined the perception of interpersonal, 'affective touch' and its social modulation in AN. We measured the perceived pleasantness of light, dynamic stroking touches applied to the forearm of 25 AN patients and 30 healthy controls using C Tactile (CT) afferents-optimal (3cm/s) and non-optimal (18cm/s) velocities, while simultaneously displaying images of faces showing rejecting, neutral and accepting expressions. CT-optimal touch, but not CT non-optimal touch, elicited significantly lower pleasantness ratings in AN patients compared with healthy controls. Pleasantness ratings were modulated by facial expressions in both groups in a similar fashion; namely, presenting socially accepting faces increased the perception of touch pleasantness more than neutral and rejecting faces. Our findings suggest that individuals with AN have a disordered, CT-based affective touch system. This impairment may be linked to their weakened interoceptive perception and distorted body representation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Family-based early intervention for anorexia nervosa.

    PubMed

    Jones, Megan; Völker, Ulrike; Lock, James; Taylor, C Barr; Jacobi, Corinna

    2012-05-01

    This study explores whether potential risk factors for anorexia nervosa (AN) can be modified by a family-based Internet-facilitated intervention and examines the feasibility, acceptability, and short-term efficacy of the Parents Act Now programme in the USA and Germany. Forty-six girls aged 11-17 were studied during a 12-month period and evaluated at screening, baseline, and post-intervention. Parents participated in the six-week intervention. Twenty-four per cent of girls (n = 791) screened met the risk criteria for AN. Parents accessed the majority of the online sessions and rated the programme favourably. At post-assessment, 16 of 19 participants evidenced reduced risk status. Participants remained stable or increased in ideal body weight and reported decreased eating disorder attitudes and behaviours. Results suggest that an easily disseminated, brief, online programme with minimal therapist support is feasible, accepted favourably by parents, and may be beneficial for prevention of exacerbation of AN pathology. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.

  10. Altered social attention in anorexia nervosa during real social interaction.

    PubMed

    Dalmaso, Mario; Castelli, Luigi; Scatturin, Pietro; Carli, Lorenza; Todisco, Patrizia; Palomba, Daniela; Galfano, Giovanni

    2016-03-17

    The capacity to devote attentional resources in response to body-related signals provided by others is still largely unexplored in individuals with Anorexia Nervosa (AN). Here, we tested this capacity through a novel paradigm that mimics a social interaction with a real partner. Healthy individuals (Experiment 1) and individuals with AN (Experiment 2) completed a task with another person which consisted in performing, alternatively, rapid aiming movements to lateralised targets. Generally, this task leads to a form of Inhibition of Return (IOR), which consists of longer reaction times when an individual has to respond to a location previously searched by either himself (individual IOR) or by the partner (social IOR) as compared to previously unexplored locations. IOR is considered as an important attentional mechanism that promotes an effective exploration of the environment during social interaction. Here, healthy individuals displayed both individual and social IOR that were both reliable and of the same magnitude. Individuals with AN displayed a non-significant individual IOR but a reliable social IOR that was also significantly stronger than individual IOR. These results suggest the presence of a reduced sensitivity in processing body-related stimuli conveyed by oneself in individuals with AN which is reflected in action-based attentional processes.

  11. Self-esteem in patients treated for anorexia nervosa.

    PubMed

    Karpowicz, Ewa; Skärsäter, Ingela; Nevonen, Lauri

    2009-10-01

    Anorexia nervosa (AN) mainly affects girls or women between 13 and 45 years of age. According to previous studies, one of the reasons for the desire to be thin is low self-esteem. The purpose of the study was to examine the self-esteem of 38 female patients with AN between 16 and 25 years of age, before and after 3 months of treatment at a specialist ward for eating disorders in Göteborg, Sweden. A quantitative pre- and post-assessment based on two self-rating questionnaires, the Rosenberg Self-Esteem Scale (RSE-S) and three subscales (weight phobia, body dissatisfaction, and ineffectiveness) of Eating Disorder Inventory-2 (EDI-2), together with body mass index (BMI), were used in the study, which was conducted between June 2005 and March 2008. The results reveal that self-esteem, BMI, weight phobia, and body dissatisfaction improved significantly between pre- and post-treatment. The RSE-S and EDI-2 ineffectiveness correlate highly with one another, which lends support to convergent validity, and the internal consistency was high for both the RSE-S and EDI-2 ineffectiveness. The results indicate that the treatment was effective, as both patients' self-esteem and BMI increased after completed treatment, which was the primary goal of the treatment at this ward. Future studies should focus on follow up and the way self-esteem manifests itself at different points in time within an individual.

  12. Executive functioning in anorexia nervosa patients and their unaffected relatives.

    PubMed

    Galimberti, Elisa; Fadda, Emma; Cavallini, Maria Cristina; Martoni, Riccardo Maria; Erzegovesi, Stefano; Bellodi, Laura

    2013-08-15

    Formal genetic studies suggested a substantial genetic influence for anorexia nervosa (AN), but currently results are inconsistent. The use of the neurocognitive endophenotype approach may facilitate our understanding of the AN pathophysiology. We investigated decision-making, set-shifting and planning in AN patients (n=29) and their unaffected relatives (n=29) compared to healthy probands (n=29) and their relatives (n=29). The Iowa Gambling Task (IGT), the Tower of Hanoi (ToH) and the Wisconsin Card Sorting Test (WCST) were administered. Concordance rates and heritability indices were also calculated in probands/relatives. Impaired performance on the IGT and the WCST were found in both AN probands and their relatives, although planning appeared to be preserved. The IGT heritability index suggested the presence of genetic effects that influence this measure. No evidence for genetic effects was found for the WCST. The results suggest the presence of a shared dysfunctional executive profile in women with AN and their unaffected relatives, characterized by deficient decision-making and set-shifting. Concordance analysis strongly suggests that these impairments aggregate in AN families, supporting the hypothesis that they may constitute biological markers for AN. Decision-making impairment presents a moderate heritability, suggesting that decision-making may be a candidate endophenotype for AN.

  13. Altered social attention in anorexia nervosa during real social interaction

    PubMed Central

    Dalmaso, Mario; Castelli, Luigi; Scatturin, Pietro; Carli, Lorenza; Todisco, Patrizia; Palomba, Daniela; Galfano, Giovanni

    2016-01-01

    The capacity to devote attentional resources in response to body-related signals provided by others is still largely unexplored in individuals with Anorexia Nervosa (AN). Here, we tested this capacity through a novel paradigm that mimics a social interaction with a real partner. Healthy individuals (Experiment 1) and individuals with AN (Experiment 2) completed a task with another person which consisted in performing, alternatively, rapid aiming movements to lateralised targets. Generally, this task leads to a form of Inhibition of Return (IOR), which consists of longer reaction times when an individual has to respond to a location previously searched by either himself (individual IOR) or by the partner (social IOR) as compared to previously unexplored locations. IOR is considered as an important attentional mechanism that promotes an effective exploration of the environment during social interaction. Here, healthy individuals displayed both individual and social IOR that were both reliable and of the same magnitude. Individuals with AN displayed a non-significant individual IOR but a reliable social IOR that was also significantly stronger than individual IOR. These results suggest the presence of a reduced sensitivity in processing body-related stimuli conveyed by oneself in individuals with AN which is reflected in action-based attentional processes. PMID:26984784

  14. Atypical antipsychotics as augmentation therapy in anorexia nervosa.

    PubMed

    Marzola, Enrica; Desedime, Nadia; Giovannone, Cristina; Amianto, Federico; Fassino, Secondo; Abbate-Daga, Giovanni

    2015-01-01

    Anorexia nervosa (AN) is a life-threatening and difficult to treat mental illness with the highest mortality rates of any psychiatric disorder. We aimed to garner preliminary data on the real-world use of olanzapine and aripiprazole as augmentation agents of Selective Serotonin Reuptake Inhibitors (SSRIs) in adult inpatients affected by AN. We retrospectively evaluated the clinical charts of patients who were hospitalized between 2012 and 2014. Patients were evaluated upon admission and discharge. We investigated eating symptomatology, and both general and eating psychopathology using: Hamilton Rating Scale for Anxiety, Hamilton Rating Scale for Depression, and Yale-Brown-Cornell Eating Disorders Scale. The charts of 75 patients were included in this study. The sample resulted equally distributed among those receiving SSRIs and either aripiprazole or olanzapine in addition to SSRIs. Notwithstanding a few baseline clinical differences, upon discharge all groups were significantly improved on all measures. Interestingly, aripiprazole showed the greatest effectiveness in reducing eating-related preoccupations and rituals with a large effect size. The body of evidence on medication management in AN is in dismal condition. Augmentation therapy is a well-established approach to a variety of mental disorders and it is often used in every-day clinical practice with patients affected by AN as well. Nevertheless, to date very little data is available on this topic. Results from our sample yielded promising results on the effectiveness of aripiprazole augmentation in reducing eating-related obsessions and compulsions. Randomized controlled trials are warranted to confirm these encouraging findings.

  15. Alexithymia, emotional empathy, and self-regulation in anorexia nervosa.

    PubMed

    Beadle, Janelle N; Paradiso, Sergio; Salerno, Alexandria; McCormick, Laurie M

    2013-05-01

    Individuals with anorexia nervosa (AN) who are starved have poor awareness (alexithymia), reduced understanding of others' mental states (cognitive empathy), and difficulty regulating personal emotions (self-regulation). Despite its important role in social interaction, sympathy for others (emotional empathy) has not been measured in AN. Furthermore, it is unknown how restoring weight affects the relationship among alexithymia, empathy, and self-regulation in AN. Women with AN were tested longitudinally during their starvation period (N = 26) and after weight was restored (N = 20) and compared with 16 age-matched healthy women. Alexithymia, empathy, and self-regulation were assessed with the Toronto Alexithymia Scale, the Interpersonal Reactivity Index, and items measuring self-regulation from the Minnesota Multiphasic Personality Inventory-2, respectively. Relative to comparison participants, individuals with AN during both starvation and weight restoration reported greater alexithymia and emotional empathy in one domain, personal distress (vicarious negative arousal to others' suffering). Among AN participants, personal distress was positively correlated with alexithymia and negatively correlated with self-regulation, when accounting for depression. High levels of alexithymia and personal distress may be persistent features of AN because they do not resolve upon weight restoration. Greater personal distress in AN may be a function of poor emotional awareness and regulation.

  16. Evidence for alterations of cortical folding in anorexia nervosa.

    PubMed

    Schultz, C Christoph; Wagner, Gerd; de la Cruz, Feliberto; Berger, Sandy; Reichenbach, Jürgen R; Sauer, Heinrich; Bär, Karl J

    2017-02-01

    Anorexia nervosa (AN) is highly heritable, and the perspective on the etiology of AN has changed from a behavioral to a neurobiological and neurodevelopmental view. However, cortical folding as an important marker for deviations in brain development has yet rarely been explored in AN. Hence, in order to determine potential cortical folding alterations, we investigated fine-grained cortical folding in a cohort of 26 patients with AN, of whom 6 patients were recovered regarding their weight at the time point of MRI measurement. MRI-derived cortical folding was computed and compared between patients and healthy controls at about 150,000 points per hemisphere using a surface-based technique (FreeSurfer). Patients with AN exhibited highly significant increased cortical folding in a right dorsolateral prefrontal cortex region (DLPFC). Furthermore, a statistical trend in the same direction was found in the right visual cortex. We did not find a correlation of local cortical folding and current symptoms of the disease. In conclusion, our analyses provide first evidence that altered DLPFC cortical folding plays a role in the etiology of AN. The absence of correlations with clinical parameters implicates a relatively independence of cortical folding alterations from the current symptomatology and might thus be regarded as a trait characteristic of the disease potentially related to other neurobiological features of AN.

  17. Radionuclide gastric emptying studies in patients with anorexia nervosa

    SciTech Connect

    Domstad, P.A.; Shih, W.J.; Humphries, L.; DeLand, F.H.; Digenis, G.A.

    1987-05-01

    To evaluate gastric emptying in anorexia nervosa patients, 26 patients (17 females, two males, ranging in age from 13 to 40 yr) with upper GI symptoms ingested 150-200 microCi (/sup 99m/Tc)triethelenetetraamine polysterene resin in cereal and were imaged in the supine position. Data were accumulated at 5 min intervals to obtain the gastric emptying time (GET). The results of the studies were divided into three categories: prolonged, 13 patients; rapid, 11; and normal 3. Twelve of 13 patients with prolonged GET were given 10 mg metoclopramide i.v. injections; nine of the 12 patients had a good response and three had no response. Five of the nine patients underwent metoclopramide therapy and four of the patients showed benefit from the therapy. One patient discontinued metoclopramide therapy because of somnolence. Although all patients had subjective symptoms of gastric dysfunction, our results indicated only 50% had objectively prolonged GET, and another 50% showed normal or even rapid GET. Therefore, this radionuclide study enables quantitatively objective documentation of gastric emptying, separation of those patients with rapid or normal GET from those with prolonged GET, thereby avoiding the possible side effects from metoclopramide medication, and prediction of effectiveness of metoclopramide therapy in patients with prolonged GET.

  18. Risk factors for cardiovascular disease in patients with anorexia nervosa.

    PubMed

    Matzkin, Valeria; Slobodianik, Nora; Pallaro, Anabel; Bello, Mabel; Geissler, Catherine

    2007-09-01

    hypercholesterolemia, hypercortisolemia and low levels of essential fatty acids, oestrogens and antioxidant vitamins are more prevalent in patients with anorexia nervosa (AN) than in the general population. This study aims (1) to compare cardiovascular risk parameters in-patients with AN and controls, and (2) to compare the parameters in-patients on admission and at four month follow up. Blood samples and anthropometry were taken from patients with AN on admission (N=30) and matched controls (N=30). Twenty one patients were re-tested after four months of treatment. Total cholesterol, LDL, Apo B and fibrinogen concentrations were elevated in patients on admission compared with controls, while retinol and tocopherol were decreased. Low levels of T3, T4 and estradiol were correlated with increased cholesterol values. After treatment there was a tendency for most of the abnormal markers to normalise. However, HDL levels decreased leaving patients with an undesirable lipid profile. Cardiovascular disease is not commonly a problem in these patients, however, with age, and without treatment, the cardiovascular risk may increase.

  19. Therapeutic potential of ghrelin in restricting-type anorexia nervosa.

    PubMed

    Hotta, Mari; Ohwada, Rina; Akamizu, Takashi; Shibasaki, Tamotsu; Kangawa, Kenji

    2012-01-01

    Anorexia nervosa (AN) is an eating disorder characterized by a decrease in caloric intake and malnutrition. It is associated with a variety of medical morbidities as well as significant mortality. Nutritional support is of paramount importance to prevent impaired quality of life later in life in affected patients. Some patients with restricting-type AN who are fully motivated to gain body weight cannot increase their food intake because of malnutrition-induced gastrointestinal dysfunction. Chronicity of AN prevents participation in social activities and leads to increased medical expenses. Therefore, there is a pressing need for effective appetite-stimulating therapies for patients with AN. Ghrelin is the only orexigenic hormone that can be given intravenously. Intravenous infusion of ghrelin is reported to increase food intake and body weight in healthy subjects as well as in patients with poor nutritional status. Here, we introduce the results of a pilot study that investigated the effects of ghrelin on appetite, energy intake, and nutritional parameters in five patients with restricting-type AN, who are fully motivated to gain body weight but could not increase their food intake because of malnutrition-induced gastrointestinal dysfunction. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. Imaging techniques in the management of anorexia and bulimia nervosa.

    PubMed

    Mazzetti di Pietralata, G

    2002-06-01

    This paper discusses the contribution offered by radiological techniques to the diagnosis of the medical and surgical complications of anorexia nervosa (AN) and bulimia (BN) with the aim of providing general indications as to their use and suggesting the best-suited techniques. In the broad field of the complications of malnourishment, the use of magnetic resonance (MR) instead of computed tomography (CT) in the assessment of brain atrophy provides much more information at a better cost-benefit ratio. Like brain atrophy, other complications may be chance radiographic findings, such as cathartic colon and colon ptosis. Pulmonary tuberculosis and the presence of bronchopneumonia in conditions of malnutrition demand that conventional X-rays be supplemented by high-resolution CT scans, MR and echotomography. When checking for parotidomegaly and polycystic ovary, the best imaging technique is echotomography. Radiologists are also called upon to express their view in the case of emergencies such as the rupture of the esophagus and osteoporosis-induced fractures.

  1. Work and social adjustment in patients with anorexia nervosa.

    PubMed

    Tchanturia, Kate; Hambrook, David; Curtis, Hannah; Jones, Tamsin; Lounes, Naima; Fenn, Kristina; Keyes, Alex; Stevenson, Lauren; Davies, Helen

    2013-01-01

    The Work and Social Adjustment Scale (WSAS) assesses patients' perceptions of impairment in everyday functioning and has been reported as a simple and reliable self-report measure in different psychiatric disorders. This study compared WSAS data from an anorexia nervosa (AN) patient group with that from healthy controls (HCs) and published data from other patient groups. A total of 160 female participants (AN, 77; HC, 83) completed the WSAS as well as measures of eating disorder symptom severity and brief assessments of anxiety and depression. Work and Social Adjustment Scale scores for the AN group were found to be in the severely impaired range, whereas the scores for those within the HC group indicated very little, or no impairment. Total WSAS scores in the AN group were significantly correlated with severity of clinical symptoms, and eating disorder-specific symptoms were the best predictor of social and occupational functional impairment. The greatest impairment in the AN group was reported in the realm of social leisure. Consistent with reports in other clinical populations, it is suggested that the WSAS could be an extremely useful and meaningful measure to assess social and occupational functioning in people with eating disorders, in addition to eating disorder-specific assessments. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

  2. Impaired processing of self-face recognition in anorexia nervosa.

    PubMed

    Hirot, France; Lesage, Marine; Pedron, Lya; Meyer, Isabelle; Thomas, Pierre; Cottencin, Olivier; Guardia, Dewi

    2016-03-01

    Body image disturbances and massive weight loss are major clinical symptoms of anorexia nervosa (AN). The aim of the present study was to examine the influence of body changes and eating attitudes on self-face recognition ability in AN. Twenty-seven subjects suffering from AN and 27 control participants performed a self-face recognition task (SFRT). During the task, digital morphs between their own face and a gender-matched unfamiliar face were presented in a random sequence. Participants' self-face recognition failures, cognitive flexibility, body concern and eating habits were assessed with the Self-Face Recognition Questionnaire (SFRQ), Trail Making Test (TMT), Body Shape Questionnaire (BSQ) and Eating Disorder Inventory-2 (EDI-2), respectively. Subjects suffering from AN exhibited significantly greater difficulties than control participants in identifying their own face (p = 0.028). No significant difference was observed between the two groups for TMT (all p > 0.1, non-significant). Regarding predictors of self-face recognition skills, there was a negative correlation between SFRT and body mass index (p = 0.01) and a positive correlation between SFRQ and EDI-2 (p < 0.001) or BSQ (p < 0.001). Among factors involved, nutritional status and intensity of eating disorders could play a part in impaired self-face recognition.

  3. Anorexia Nervosa and its Associated Endocrinopathy in Young People

    PubMed Central

    Misra, Madhusmita; Klibanski, Anne

    2016-01-01

    Anorexia nervosa (AN) is a condition of severe undernutrition associated with adaptive changes in many endocrine axes. These changes include hypogonadotropic hypogonadism, acquired growth hormone resistance with low insulin like growth factor-1 (IGF-1) levels, hypercortisolemia, altered secretion of adipokines and appetite regulating hormones, and low bone mineral density (BMD). Bone health is impaired subsequent to low BMI, decreased lean mass, and the endocrine changes described above. In addition to low areal BMD, AN is characterized by a decrease in volumetric BMD, changes in bone geometry, and reductions in strength estimates, leading to an increased risk for fracture. Weight restoration is essential for restoration of normal endocrine function; however, hypercortisolemia, high PYY levels, and ghrelin dynamics may not completely normalize. In some patients, hypogonadotropic hypogonadism persists despite weight restoration. Weight gain and menstrual recovery are critical for improving bone health in AN, however, residual deficits may persist. Physiologic estrogen replacement using transdermal, but not oral, estrogen increases bone accrual in adolescents with AN, while bisphosphonates improve BMD in adults. Recombinant human IGF-1 and teriparatide have been used in a few studies as bone anabolic therapies. More data are necessary to determine the optimal therapeutic strategies for low BMD in AN. PMID:26863308

  4. Inpatient Cognitive Behavior Therapy for Adolescents with Anorexia Nervosa: Immediate and Longer-Term Effects

    PubMed Central

    Dalle Grave, Riccardo; Calugi, Simona; El Ghoch, Marwan; Conti, Maddalena; Fairburn, Christopher G.

    2014-01-01

    Introduction: Inpatient treatment for anorexia nervosa is often successful in restoring body weight, but a high percentage of patients relapse following discharge. The aim of the present study was to establish the immediate and longer-term effects of a novel inpatient program for adolescents that was designed to produce enduring change. Method: Twenty-seven consecutive patients with severe anorexia nervosa were admitted to a 20-week inpatient treatment program based on the enhanced cognitive behavior therapy (CBT-E). The patients were assessed before and after hospitalization, and 6 and 12 months later. Results: Twenty-six patients (96%) completed the program. In these patients, there was a substantial improvement in weight, eating disorder features, and general psychopathology that was well maintained at 12-month follow-up. Conclusion: These findings suggest that inpatient CBT-E is a promising approach to the treatment of adolescents with severe anorexia nervosa. PMID:24575055

  5. Evaluating the potential of deep brain stimulation for treatment-resistant anorexia nervosa.

    PubMed

    Lipsman, Nir; Woodside, Blake; Lozano, Andres M

    2013-01-01

    Anorexia nervosa is a chronic and debilitating psychiatric disorder associated with one of the highest mortality rates of any psychiatric condition. Despite advances in neuroimaging, genetics, pharmacology, and psychosocial interventions in the last half-century, little progress has been made in altering the natural history of the condition or its outcomes. Evidence is now emerging that the condition is, at least in part, maintained by dysfunctional activity in key neuroanatomic circuits subserving illness-maintaining symptoms. Abnormal reward processing, compulsive hyperactivity, chronic anxiety, and depression, all suggest that anorexia nervosa shares much in common with other conditions, such as major depression and obsessive-compulsive disorder, for which surgical therapy with deep brain stimulation (DBS) has been tried, with promising results. As a result, the use of DBS in treatment-resistant anorexia nervosa should be evaluated in carefully designed, early-phase feasibility trials. © 2013 Elsevier B.V. All rights reserved.

  6. Disseminated tuberculosis with multiple intracerebral tuberculomas in a patient with anorexia nervosa.

    PubMed

    Ahn, Jung Yong; Chang, Jong Hee; Kim, Keun Su; Kim, Won Joo

    2007-04-01

    Multiple tuberculous mycobacterial infections infrequently occur in immunocompromised patients. The malnutrition resulted from anorexia nervosa may contribute to the significant impairment of immunity. The authors present a 23-year-old female patient initially diagnosed with anorexia nervosa. Immunological study revealed that helper T-cell (CD4) and cytotoxic T-cell (CD8) comprised 25 and 32%, respectively, with a CD4 to CD8 ratio of 0.78. Brain magnetic resonance imaging revealed various multiple rings enhancing lesions with edematous change in both cerebral and cerebellar hemispheres. Open biopsy disclosed palisading epithelioid granuloma surrounded by inflamed granulation tissue. After anti-tuberculous therapy for 12 months, her weight was completely restored, but multiple intracranial tuberculomas were not completely disappeared. Disseminated tuberculous mycobacterial infections including multiple intracranial tuberculomas may be attributed to immunocompromised status in anorexia nervosa.

  7. Cushing's disease in a young woman with anorexia nervosa: pathophysiological implications.

    PubMed

    Katz, J L; Weiner, H; Kream, J; Zumoff, B

    1986-12-01

    This report describes a 17-year old student who was found to have Cushing's syndrome two years after she had developed anorexia nervosa (AN). The Cushing's syndrome was treated with bilateral resection of enlarged, hyperplastic, non-tumorous adrenal glands. The diagnosis was further confirmed four years later when, two to three years after new symptoms had appeared, an ACTH secreting pituitary adenoma (that is, Cushing's disease) was found on surgery. The possible mechanism for the development of Cushing's disease in a patient with prior anorexia nervosa, a sequence of events reported once previously, is discussed. It is suggested that increased hypothalamic-pituitary corticotroph stimulation in association with the anorexia nervosa, a now well-established endocrine phenomenon, activated an occult, inactive pituitary basophil adenoma in this patient, eventually resulting in autonomous pituitary overproduction of ACTH by the tumor.

  8. Dietary zinc intake of vegetarian and nonvegetarian patients with anorexia nervosa.

    PubMed

    Bakan, R; Birmingham, C L; Aeberhardt, L; Goldner, E M

    1993-03-01

    Anorexia nervosa (AN) and zinc deficiency, found most frequently in young females, have a number of symptoms in common. These include weight loss, alterations in taste and appetite, depression, and amenorrhea. Approximately half of anorexia nervosa patients (ANs) are vegetarian (VANs), a practice that may increase their risk for zinc deficiency. This study compared the dietary intake of zinc and related nutrients in 9 outpatient VANs with that of 11 outpatient nonvegetarian patients with anorexia nervosa (NVANs). VANs reported significantly lower (p < .05) dietary intakes of zinc, fat, and protein, and a significantly higher (p < .05) intake of calories from carbohydrates than NVANs. There were no significant differences between the groups in dietary intake of calories, calcium, copper, iron, or magnesium. These findings indicate that zinc intake should be routinely assessed in VANs and that zinc supplementation of their diets may be indicated.

  9. Role of Psychotropic Medications in the Management of Anorexia Nervosa: Rationale, Evidence and Future Prospects

    PubMed Central

    Frank, Guido K.W.; Shott, Megan E.

    2016-01-01

    Anorexia nervosa is a severe psychiatric disorder without approved medication intervention. Every class of psychoactive medication has been tried to improve treatment outcome; however, randomized controlled trials have been ambiguous at best and across studies have not shown robust improvements in weight gain and recovery. Here we review the available literature on pharmacological interventions since anorexia nervosa came to greater public recognition in the 1960s. This will include a critical review of why those trials may not have been successful. We further provide a neurobiological background for the disorder and discuss how cognition, learning and emotion-regulating circuits could become treatment targets in the future. Making every effort to develop effective pharmacological treatment options for anorexia nervosa is imperative, as it continues to be a complex psychiatric disorder with high disease burden and mortality. PMID:27106297

  10. Management of anorexia and bulimia nervosa: An evidence-based review

    PubMed Central

    Chakraborty, Kaustav; Basu, Debasish

    2010-01-01

    Anorexia nervosa and bulimia nervosa are primarily psychiatric disorders characterized by severe disturbances of eating behavior. Eating disorders are most prevalent in the Western culture where food is in abundance and female attractiveness is equated with thinness. Eating disorders are rare in countries like India. Despite a plethora of management options available to the mental health professionals, no major breakthrough has been achieved in recent years. Nutritional rehabilitation along with some form of re educative psychotherapy remains the mainstay of management of anorexia nervosa. In bulimia nervosa, both fluoxetine and cognitive behavior therapy have been found to be effective. Although the above-mentioned management options have been in use for decades, the active ingredient is still to be ascertained. PMID:20838508

  11. Postprandial oxytocin secretion is associated with severity of anxiety and depressive symptoms in anorexia nervosa

    PubMed Central

    Lawson, Elizabeth A.; Holsen, Laura M.; Santin, McKale; DeSanti, Rebecca; Meenaghan, Erinne; Eddy, Kamryn T.; Herzog, David B.; Goldstein, Jill M.; Klibanski, Anne

    2013-01-01

    Objective Anorexia nervosa, a psychiatric disorder characterized by self-induced starvation, is associated with endocrine dysfunction and comorbid anxiety and depression. Animal data suggest that oxytocin may have anxiolytic and antidepressant effects. We have reported increased postprandial oxytocin levels in women with active anorexia nervosa (AN), and decreased levels in weight-recovered women with anorexia nervosa (ANWR) compared to healthy controls (HC). A meal may represent a significant source of stress in patients with disordered eating. We therefore investigated the association between post-prandial oxytocin secretion and symptoms of anxiety and depression in anorexia nervosa. Method We performed a cross-sectional study of 35 women (13 AN, 9 ANWR and 13 HC). Serum oxytocin and cortisol and plasma leptin levels were measured fasting and 30, 60, and 120min after a standardized mixed meal. The area under the curve (AUC), and for oxytocin, postprandial nadir and peak levels were determined. Anxiety and depressive symptoms were assessed using the Spielberger State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory II (BDI-II). Results In women with anorexia nervosa, oxytocin AUC and post-prandial nadir and peak levels were positively associated with STAI scores. Oxytocin AUC and nadir levels were positively associated with BDI-II scores. After controlling for cortisol AUC, most relationships remained significant. After controlling for leptin AUC, all of the relationships remained significant. Oxytocin secretion explained up to 51% of the variance in STAI trait and 24% of BDI-II scores. Conclusions Abnormal post-prandial oxytocin secretion in women with anorexia nervosa is associated with increased symptoms of anxiety and depression. This may represent an adaptive response of oxytocin secretion to food-related symptoms of anxiety and depression. PMID:23759466

  12. An examination of autism spectrum traits in adolescents with anorexia nervosa and their parents.

    PubMed

    Rhind, Charlotte; Bonfioli, Elena; Hibbs, Rebecca; Goddard, Elizabeth; Macdonald, Pamela; Gowers, Simon; Schmidt, Ulrike; Tchanturia, Kate; Micali, Nadia; Treasure, Janet

    2014-01-01

    There may be a link between anorexia nervosa and autism spectrum disorders. The aims of this study were to examine whether adolescents with anorexia nervosa have autism spectrum and/or obsessive-compulsive traits, how many would meet diagnostic criteria for autism spectrum disorder, and whether these traits are shared by parents. A total of 150 adolescents receiving outpatient treatment for anorexia nervosa or subthreshold anorexia nervosa and their parents completed the autism spectrum disorder and eating disorder sections of the Development and Well-being Assessment. Patients also completed the Children Yale-Brown Obsessive-Compulsive Scale and other measures of psychiatric morbidity, and parents completed the short Autism Quotient and Obsessive-Compulsive Inventory Revised. Adolescents with anorexia nervosa had a below average social aptitude (19% below cut-off) and high levels of peer relationship problems (39% above cut-off) and obsessive-compulsive symptoms (56% above cut-off). Six cases (4%, all females) were assigned a possible (n = 5) or definite (n = 1) diagnosis of autism spectrum disorder. Parental levels of autism spectrum and obsessive-compulsive traits were within the normal range. This study suggests that adolescents with anorexia nervosa have elevated levels of autism spectrum traits, obsessive-compulsive symptoms, and a small proportion fulfil diagnostic criteria for a probable autism spectrum disorder. These traits did not appear to be familial. This comorbidity has been associated with a poorer prognosis. Therefore, adaptation of treatment for this subgroup may be warranted. Controlled-trials.com: ISRCTN83003225. Registered on 29 September 2011.

  13. Cancer Incidence among Patients with Anorexia Nervosa from Sweden, Denmark and Finland

    PubMed Central

    Mellemkjaer, Lene; Papadopoulos, Fotios C.; Pukkala, Eero; Ekbom, Anders; Gissler, Mika; Christensen, Jane; Olsen, Jørgen H.

    2015-01-01

    A diet with restricted energy content reduces the occurrence of cancer in animal experiments. It is not known if the underlying mechanism also exists in human beings. To determine whether cancer incidence is reduced among patients with anorexia nervosa who tend to have a low intake of energy, we carried out a retrospective cohort study of 22 654 women and 1678 men diagnosed with anorexia nervosa at ages 10-50 years during 1968-2010 according to National Hospital Registers in Sweden, Denmark and Finland. The comparison group consisted of randomly selected persons from population registers who were similar to the anorexia nervosa patients in respect to sex, year of birth and place of residence. Patients and population comparisons were followed for cancer by linkage to Cancer Registries. Incidence rate ratios (IRR) were estimated using Poisson models. In total, 366 cases of cancer (excluding non-melanoma skin cancer) were seen among women with anorexia nervosa, and the IRR for all cancer sites was 0.97 (95% CI = 0.87-1.08) adjusted for age, parity and age at first child. There were 76 breast cancers corresponding to an adjusted IRR of 0.61 (95% CI = 0.49-0.77). Significantly increased IRRs were observed for esophageal, lung, and liver cancer. Among men with anorexia nervosa, there were 23 cases of cancer (age-adjusted IRR = 1.08; 95% CI = 0.71-1.66). There seems to be no general reduction in cancer occurrence among patients with anorexia nervosa, giving little support to the energy restriction hypothesis. PMID:26000630

  14. Cancer Incidence among Patients with Anorexia Nervosa from Sweden, Denmark and Finland.

    PubMed

    Mellemkjaer, Lene; Papadopoulos, Fotios C; Pukkala, Eero; Ekbom, Anders; Gissler, Mika; Christensen, Jane; Olsen, Jørgen H

    2015-01-01

    A diet with restricted energy content reduces the occurrence of cancer in animal experiments. It is not known if the underlying mechanism also exists in human beings. To determine whether cancer incidence is reduced among patients with anorexia nervosa who tend to have a low intake of energy, we carried out a retrospective cohort study of 22 654 women and 1678 men diagnosed with anorexia nervosa at ages 10-50 years during 1968-2010 according to National Hospital Registers in Sweden, Denmark and Finland. The comparison group consisted of randomly selected persons from population registers who were similar to the anorexia nervosa patients in respect to sex, year of birth and place of residence. Patients and population comparisons were followed for cancer by linkage to Cancer Registries. Incidence rate ratios (IRR) were estimated using Poisson models. In total, 366 cases of cancer (excluding non-melanoma skin cancer) were seen among women with anorexia nervosa, and the IRR for all cancer sites was 0.97 (95% CI = 0.87-1.08) adjusted for age, parity and age at first child. There were 76 breast cancers corresponding to an adjusted IRR of 0.61 (95% CI = 0.49-0.77). Significantly increased IRRs were observed for esophageal, lung, and liver cancer. Among men with anorexia nervosa, there were 23 cases of cancer (age-adjusted IRR = 1.08; 95% CI = 0.71-1.66). There seems to be no general reduction in cancer occurrence among patients with anorexia nervosa, giving little support to the energy restriction hypothesis.

  15. Association of Elevated Reward Prediction Error Response With Weight Gain in Adolescent Anorexia Nervosa.

    PubMed

    DeGuzman, Marisa; Shott, Megan E; Yang, Tony T; Riederer, Justin; Frank, Guido K W

    2017-06-01

    Anorexia nervosa is a psychiatric disorder of unknown etiology. Understanding associations between behavior and neurobiology is important in treatment development. Using a novel monetary reward task during functional magnetic resonance brain imaging, the authors tested how brain reward learning in adolescent anorexia nervosa changes with weight restoration. Female adolescents with anorexia nervosa (N=21; mean age, 16.4 years [SD=1.9]) underwent functional MRI (fMRI) before and after treatment; similarly, healthy female control adolescents (N=21; mean age, 15.2 years [SD=2.4]) underwent fMRI on two occasions. Brain function was tested using the reward prediction error construct, a computational model for reward receipt and omission related to motivation and neural dopamine responsiveness. Compared with the control group, the anorexia nervosa group exhibited greater brain response 1) for prediction error regression within the caudate, ventral caudate/nucleus accumbens, and anterior and posterior insula, 2) to unexpected reward receipt in the anterior and posterior insula, and 3) to unexpected reward omission in the caudate body. Prediction error and unexpected reward omission response tended to normalize with treatment, while unexpected reward receipt response remained significantly elevated. Greater caudate prediction error response when underweight was associated with lower weight gain during treatment. Punishment sensitivity correlated positively with ventral caudate prediction error response. Reward system responsiveness is elevated in adolescent anorexia nervosa when underweight and after weight restoration. Heightened prediction error activity in brain reward regions may represent a phenotype of adolescent anorexia nervosa that does not respond well to treatment. Prediction error response could be a neurobiological marker of illness severity that can indicate individual treatment needs.

  16. Cerebral perfusion differences in women currently with and recovered from anorexia nervosa

    PubMed Central

    Sheng, Min; Lu, Hanzhang; Liu, Peiying; Thomas, Binu P.; McAdams, Carrie J.

    2015-01-01

    Anorexia nervosa is a serious psychiatric disorder characterized by restricted eating, a pursuit of thinness, and altered perceptions of body shape and size. Neuroimaging in anorexia nervosa has revealed morphological and functional alterations in the brain. A better understanding of physiological changes in anorexia nervosa could provide a brain-specific health marker relevant to treatment and outcomes. In this study, we applied several advanced magnetic resonance imaging (MRI) techniques to quantify regional and global cerebral blood flow (CBF) in 25 healthy women (HC), 23 patients currently with anorexia (AN-C) and 19 patients in long-term weight recovery following anorexia (AN-WR). Specifically, CBF was measured with pseudo-continuous arterial spin labeling (pCASL) MRI and then verified by a different technique, phase contrast (PC) MRI. Venous T2 values were determined by T2 relaxation under spin tagging (TRUST) MRI, and were used to corroborate the CBF results. These novel techniques were implemented on a standard 3T MRI scanner without any exogenous tracers, and the total scan duration was less than 10 min. Voxel-wise comparison revealed that the AN-WR group showed lower CBF in bilateral temporal and frontal lobes than the AN-C group. Compared with the HC group, the AN-C group also showed higher CBF in the right temporal lobe. Whole-brain-averaged CBF was significantly decreased in the AN-WR group compared with the AN-C group, consistent with the PC-MRI results. Venous T2 values were lower in the AN-WR group than in the AN-C group, consistent with the CBF results. A review of prior work examining CBF in anorexia nervosa is included in the discussion. This study identifies several differences in the cerebral physiological alterations in anorexia nervosa, and finds specific differences relevant to the current state of the disorder. PMID:25795596

  17. Cerebral perfusion differences in women currently with and recovered from anorexia nervosa.

    PubMed

    Sheng, Min; Lu, Hanzhang; Liu, Peiying; Thomas, Binu P; McAdams, Carrie J

    2015-05-30

    Anorexia nervosa is a serious psychiatric disorder characterized by restricted eating, a pursuit of thinness, and altered perceptions of body shape and size. Neuroimaging in anorexia nervosa has revealed morphological and functional alterations in the brain. A better understanding of physiological changes in anorexia nervosa could provide a brain-specific health marker relevant to treatment and outcomes. In this study, we applied several advanced magnetic resonance imaging (MRI) techniques to quantify regional and global cerebral blood flow (CBF) in 25 healthy women (HC), 23 patients currently with anorexia (AN-C) and 19 patients in long-term weight recovery following anorexia (AN-WR). Specifically, CBF was measured with pseudo-continuous arterial spin labeling (pCASL) MRI and then verified by a different technique, phase contrast (PC) MRI. Venous T2 values were determined by T2 relaxation under spin tagging (TRUST) MRI, and were used to corroborate the CBF results. These novel techniques were implemented on a standard 3T MRI scanner without any exogenous tracers, and the total scan duration was less than 10min. Voxel-wise comparison revealed that the AN-WR group showed lower CBF in bilateral temporal and frontal lobes than the AN-C group. Compared with the HC group, the AN-C group also showed higher CBF in the right temporal lobe. Whole-brain-averaged CBF was significantly decreased in the AN-WR group compared with the AN-C group, consistent with the PC-MRI results. Venous T2 values were lower in the AN-WR group than in the AN-C group, consistent with the CBF results. A review of prior work examining CBF in anorexia nervosa is included in the discussion. This study identifies several differences in the cerebral physiological alterations in anorexia nervosa, and finds specific differences relevant to the current state of the disorder. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  18. [Prevention and Treatment of Eating Disorders: The Health Care Network Anorexia and Bulimia nervosa].

    PubMed

    Weigel, Angelika; Gumz, Antje; Kästner, Denise; Romer, Georg; Wegscheider, Karl; Löwe, Bernd

    2015-07-01

    The "Health care network anorexia and bulimia nervosa", a subproject of psychenet - the Hamburg network for mental health - aims to decrease the incidence of eating disorders as well as the risk for chronic illness courses. One focal project, therefore, evaluates a school-based prevention manual in a randomized controlled trial. The other one examines the impact of a systemic public health intervention on early treatment initiation in anorexia nervosa. The present article provides an overview about study design and interventions in both focal projects as well as preliminary results.

  19. Elevated levels of exhaled nitric oxide in patients with anorexia nervosa.

    PubMed

    Oświęcimska, Joanna; Ziora, Katarzyna; Ziora, Dariusz; Machura, Edyta; Smerdziński, Sebastian; Pyś-Spychała, Magdalena; Kasperski, Jacek; Zamłyński, Jacek; Kasperska-Zajac, Alicja

    2014-09-01

    Nitric oxide (NO) is involved in eating behavior and inflammatory response. Moreover, there is evidence that NO production is altered in patients with anorexia nervosa (AN). To assess whether the overproduction of NO in AN can affect NO level in exhaled air. Exhaled NO level was studied in 23 girls with AN and compared with that of healthy age- and gender-matched nonatopic controls. Exhaled NO levels were significantly higher in girls with AN compared with healthy age-matched controls. It appears that anorexia nervosa was accompanied by a higher level of exhaled NO, likely resulting from a systemic increase in NO production because of the severe catabolic state.

  20. Underweight subjects with anorexia nervosa have an enhanced salivary cortisol response not seen in weight restored subjects with anorexia nervosa.

    PubMed

    Monteleone, Alessio Maria; Monteleone, Palmiero; Serino, Ismene; Amodio, Roberta; Monaco, Francesco; Maj, Mario

    2016-08-01

    The cortisol response to awakening (CAR) has been reported to be enhanced in symptomatic patients with anorexia nervosa (AN). However, it has been not established whether the dysregulation of CAR was a primary phenomenon or a change secondary to malnutrition. Therefore, we aimed to explore the salivary CAR in both underweight and weigh-restored women with AN. Fifty-nine women volunteered for the study. They were 18 underweight AN women, 15 weight-restored AN women and 26 normal-weight healthy women. Saliva samples were collected in the morning, immediately on awakening and after 15, 30 and 60min to measure saliva levels of cortisol. Participants' anxiety levels in the morning of sampling were measured by the State-Trait Anxiety Inventory. As compared to control women, underweight AN patients showed an enhanced CAR whereas weight-restored patients had a normal CAR. These results could be not explained by group differences in body mass index or levels of anxiety. These findings show, for the first time, that the enhanced CAR occurring in the acute phase of AN is not seen in weight-recovered patients, suggesting that the dysregulated activity of the hypothalamus-pituitary-adrenal axis of symptomatic AN patients is a state-dependent phenomenon. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Severe and enduring anorexia nervosa (SEED-AN): a qualitative study of patients with 20+ years of anorexia nervosa.

    PubMed

    Robinson, Paul H; Kukucska, Roza; Guidetti, Giulia; Leavey, Gerard

    2015-07-01

    Little is known about how patients with long-term eating disorders manage their clinical problems. We carried out a preliminary qualitative study (using Thematic Analysis) of patients with severe and enduring anorexia nervosa (SEED-AN) in which we undertook recorded interviews in eight participants whose conditions had lasted 20-40 years. We found 15 principle features in physical, psychological, social, family, occupational and treatment realms. Psychological and social realms were most affected. Severe physical problems were reported. They described feelings of unworthiness, frugality regarding money and obsessive time-keeping. Persisting with negligible social networks, participants described depression and hopelessness, while somehow achieving a sense of pride at their endurance and survival in spite of the eating disorder. They emphasized the importance of professional help in managing their care. The severe and enduring description, often reserved for people with psychotic illness, is appropriately applied to SEED-AN, which has major impacts in all realms. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

  2. Obsessive-Compulsive Disorder and Anorexia Nervosa in a High School Athlete: A Case Report

    PubMed Central

    Gee, Rebecca L.; Telew, Nicholas

    1999-01-01

    Objective: To describe the case of a basketball and track athlete who presented with both anorexia nervosa and obsessive- compulsive disorder (OCD). Background: OCD is a psychiatric condition known to appear with significant frequency among those with anorexia. Although treatable with drug and behavioral therapy, it must be specifically sought because some of its symptoms are similar to those of anorexia nervosa. Differential Diagnosis: Obsessive-compulsive disorder, anxiety disorder. Treatment: Behavioral therapy involves exposure to the obsessive fears without allowing the patient to ritualize. This is best used in combination with drugs that selectively block the reuptake of serotonin in the brain. Uniqueness: Anorexia nervosa is notoriously difficult to treat. In our patient, anorexic symptoms all but disappeared along with the OCD in a matter of weeks, once treatment of the OCD began. Lengthy treatment for anorexia alone had been unsuccessful. Conclusions: OCD occurs frequently in patients with anorexia, and successful treatment requires that both conditions be specifically identified and managed. Athletic trainers may be the first to recognize key signs and symptoms of this illness; by referring the individual for psychiatric evaluation, they can be instrumental in helping the patient to obtain appropriate treatment. PMID:16558592

  3. Evaluation of enhanced attention to local detail in anorexia nervosa using the embedded figures test; an FMRI study.

    PubMed

    Fonville, Leon; Lao-Kaim, Nick P; Giampietro, Vincent; Van den Eynde, Frederique; Davies, Helen; Lounes, Naima; Andrew, Christopher; Dalton, Jeffrey; Simmons, Andrew; Williams, Steven C R; Baron-Cohen, Simon; Tchanturia, Kate

    2013-01-01

    The behavioural literature in anorexia nervosa and autism spectrum disorders has indicated an overlap in cognitive profiles. One such domain is the enhancement of local processing over global processing. While functional imaging studies of autism spectrum disorder have revealed differential neural patterns compared to controls in response to tests of local versus global processing, no studies have explored such effects in anorexia nervosa. This study uses functional magnetic resonance imaging in conjunction with the embedded figures test, to explore the neural correlates of this enhanced attention to detail in the largest anorexia nervosa cohort to date. On the embedded figures tests participants are required to indicate which of two complex figures contains a simple geometrical shape. The findings indicate that whilst healthy controls showed greater accuracy on the task than people with anorexia nervosa, different brain regions were recruited. Healthy controls showed greater activation in the precuneus whilst people with anorexia nervosa showed greater activation in the fusiform gyrus. This suggests that different cognitive strategies were used to perform the task, i.e. healthy controls demonstrated greater emphasis on visuospatial searching and people with anorexia nervosa employed a more object recognition-based approach. This is in accordance with previous findings in autism spectrum disorder using a similar methodology and has implications for therapies addressing the appropriate adjustment of cognitive strategies in anorexia nervosa.

  4. Abnormal white matter properties in adolescent girls with anorexia nervosa

    PubMed Central

    Travis, Katherine E.; Golden, Neville H.; Feldman, Heidi M.; Solomon, Murray; Nguyen, Jenny; Mezer, Aviv; Yeatman, Jason D.; Dougherty, Robert F.

    2015-01-01

    Anorexia nervosa (AN) is a serious eating disorder that typically emerges during adolescence and occurs most frequently in females. To date, very few studies have investigated the possible impact of AN on white matter tissue properties during adolescence, when white matter is still developing. The present study evaluated white matter tissue properties in adolescent girls with AN using diffusion MRI with tractography and T1 relaxometry to measure R1 (1/T1), an index of myelin content. Fifteen adolescent girls with AN (mean age = 16.6 years ± 1.4) were compared to fifteen age-matched girls with normal weight and eating behaviors (mean age = 17.1 years ± 1.3). We identified and segmented 9 bilateral cerebral tracts (18) and 8 callosal fiber tracts in each participant's brain (26 total). Tract profiles were generated by computing measures for fractional anisotropy (FA) and R1 along the trajectory of each tract. Compared to controls, FA in the AN group was significantly decreased in 4 of 26 white matter tracts and significantly increased in 2 of 26 white matter tracts. R1 was significantly decreased in the AN group compared to controls in 11 of 26 white matter tracts. Reduced FA in combination with reduced R1 suggests that the observed white matter differences in AN are likely due to reductions in myelin content. For the majority of tracts, group differences in FA and R1 did not occur within the same tract. The present findings have important implications for understanding the neurobiological factors underlying white matter changes associated with AN and invite further investigations examining associations between white matter properties and specific physiological, cognitive, social, or emotional functions affected in AN. PMID:26740918

  5. Decreased feedback learning in anorexia nervosa persists after weight restoration.

    PubMed

    Foerde, Karin; Steinglass, Joanna E

    2017-04-01

    Anorexia Nervosa (AN) is a serious disorder, with a mortality rate the highest of any psychiatric illness. It is notoriously challenging to treat and mechanisms of illness are not well understood. Reward system abnormalities have been proposed across theoretical models of the persistence of AN. Feedback learning is an important component of how reward systems shape behavior and we hypothesized that individuals with AN would show poorer learning from feedback. We administered the acquired equivalence task to measure both learning from incremental feedback and generalization of that learning to novel stimuli. Participants were individuals with AN (n = 36) before and after intensive weight restoration treatment and healthy comparison participants (HC, n = 26) tested twice. Performance was assessed as accuracy during the Learning and Test phases, for both trained and novel stimuli. The relationship between task performance and eating disorder severity at baseline was also assessed. Both before and after treatment, individuals with AN showed reduced learning from feedback in the Learning phase (F3,180  = 2.75, p = .048) and lower accuracy during the Test phase (F1,60  = 4.29, p = .043), as compared with HC. Individuals with AN did not differ from HC in accuracy for novel stimuli (F1,60  = 1.04, p = .312), indicating no deficit in generalization. Decreased acquisition of feedback learning was associated with longer illness duration and with greater eating disorder symptom severity at baseline. Individuals with AN show reduced learning from feedback or reinforcement, which may contribute to difficulties in changing maladaptive behaviors. © 2017 Wiley Periodicals, Inc.

  6. Family functioning in two treatments for adolescent anorexia nervosa

    PubMed Central

    Ciao, Anna C.; Accurso, Erin C.; Fitzsimmons-Craft, Ellen E.; Lock, James; Le Grange, Daniel

    2015-01-01

    Objective Family functioning impairment is widely reported in the eating disorders literature, yet few studies have examined the role of family functioning in treatment for adolescent anorexia nervosa (AN). This study examined family functioning in two treatments for adolescent AN from multiple family members’ perspectives. Method Participants were 121 adolescents with AN ages 12–18 from a randomized-controlled trial comparing family-based treatment (FBT) to individual adolescent-focused therapy (AFT). Multiple clinical characteristics were assessed at baseline. Family functioning from the perspective of the adolescent and both parents was assessed at baseline and after one year of treatment. Full remission from AN was defined as achieving both weight restoration and normalized eating disorder psychopathology. Results In general, families dealing with AN reported some baseline impairment in family functioning, but average ratings were only slightly elevated compared to published impaired functioning cutoffs. Adolescents’ perspectives on family functioning were the most impaired and were generally associated with poorer psychosocial functioning and greater clinical severity. Regardless of initial level of family functioning, improvements in several family functioning domains were uniquely related to full remission at the end of treatment in both FBT and AFT. However, FBT had a more positive impact on several specific aspects of family functioning compared to AFT. Discussion Families seeking treatment for adolescent AN report some difficulties in family functioning, with adolescents reporting the greatest impairment. While FBT may be effective in improving some specific aspects of family dynamics, remission from AN was associated with improved family dynamics, regardless of treatment type. PMID:24902822

  7. Abnormal white matter properties in adolescent girls with anorexia nervosa.

    PubMed

    Travis, Katherine E; Golden, Neville H; Feldman, Heidi M; Solomon, Murray; Nguyen, Jenny; Mezer, Aviv; Yeatman, Jason D; Dougherty, Robert F

    2015-01-01

    Anorexia nervosa (AN) is a serious eating disorder that typically emerges during adolescence and occurs most frequently in females. To date, very few studies have investigated the possible impact of AN on white matter tissue properties during adolescence, when white matter is still developing. The present study evaluated white matter tissue properties in adolescent girls with AN using diffusion MRI with tractography and T1 relaxometry to measure R1 (1/T1), an index of myelin content. Fifteen adolescent girls with AN (mean age = 16.6 years ± 1.4) were compared to fifteen age-matched girls with normal weight and eating behaviors (mean age = 17.1 years ± 1.3). We identified and segmented 9 bilateral cerebral tracts (18) and 8 callosal fiber tracts in each participant's brain (26 total). Tract profiles were generated by computing measures for fractional anisotropy (FA) and R1 along the trajectory of each tract. Compared to controls, FA in the AN group was significantly decreased in 4 of 26 white matter tracts and significantly increased in 2 of 26 white matter tracts. R1 was significantly decreased in the AN group compared to controls in 11 of 26 white matter tracts. Reduced FA in combination with reduced R1 suggests that the observed white matter differences in AN are likely due to reductions in myelin content. For the majority of tracts, group differences in FA and R1 did not occur within the same tract. The present findings have important implications for understanding the neurobiological factors underlying white matter changes associated with AN and invite further investigations examining associations between white matter properties and specific physiological, cognitive, social, or emotional functions affected in AN.

  8. Anorexia nervosa and Wernicke-Korsakoff syndrome: a case report

    PubMed Central

    2010-01-01

    women, and the subgroup of patients with anorexia nervosa who also misuse alcohol is probably at a particular risk of developing Wernicke-Korsakoff syndrome. The present case report highlights this relevant issue. PMID:20646296

  9. Anorexia nervosa and Wernicke-Korsakoff syndrome: a case report.

    PubMed

    Saad, Laura; Silva, Luiz Fal; Banzato, Claudio Em; Dantas, Clarissa R; Garcia, Celso

    2010-07-20

    anorexia nervosa who also misuse alcohol is probably at a particular risk of developing Wernicke-Korsakoff syndrome. The present case report highlights this relevant issue.

  10. A genome-wide association study of anorexia nervosa

    PubMed Central

    Boraska, Vesna; Franklin, Christopher S; Floyd, James AB; Thornton, Laura M; Huckins, Laura M; Southam, Lorraine; Rayner, N William; Tachmazidou, Ioanna; Klump, Kelly L; Treasure, Janet; Lewis, Cathryn M; Schmidt, Ulrike; Tozzi, Federica; Kiezebrink, Kirsty; Hebebrand, Johannes; Gorwood, Philip; Adan, Roger AH; Kas, Martien JH; Favaro, Angela; Santonastaso, Paolo; Fernández-Aranda, Fernando; Gratacos, Monica; Rybakowski, Filip; Dmitrzak-Weglarz, Monika; Kaprio, Jaakko; Keski-Rahkonen, Anna; Raevuori, Anu; Van Furth, Eric F; Landt, Margarita CT Slof-Op t; Hudson, James I; Reichborn-Kjennerud, Ted; Knudsen, Gun Peggy S; Monteleone, Palmiero; Kaplan, Allan S; Karwautz, Andreas; Hakonarson, Hakon; Berrettini, Wade H; Guo, Yiran; Li, Dong; Schork, Nicholas J.; Komaki, Gen; Ando, Tetsuya; Inoko, Hidetoshi; Esko, Tõnu; Fischer, Krista; Männik, Katrin; Metspalu, Andres; Baker, Jessica H; Cone, Roger D; Dackor, Jennifer; DeSocio, Janiece E; Hilliard, Christopher E; O'Toole, Julie K; Pantel, Jacques; Szatkiewicz, Jin P; Taico, Chrysecolla; Zerwas, Stephanie; Trace, Sara E; Davis, Oliver SP; Helder, Sietske; Bühren, Katharina; Burghardt, Roland; de Zwaan, Martina; Egberts, Karin; Ehrlich, Stefan; Herpertz-Dahlmann, Beate; Herzog, Wolfgang; Imgart, Hartmut; Scherag, André; Scherag, Susann; Zipfel, Stephan; Boni, Claudette; Ramoz, Nicolas; Versini, Audrey; Brandys, Marek K; Danner, Unna N; de Kovel, Carolien; Hendriks, Judith; Koeleman, Bobby PC; Ophoff, Roel A; Strengman, Eric; van Elburg, Annemarie A; Bruson, Alice; Clementi, Maurizio; Degortes, Daniela; Forzan, Monica; Tenconi, Elena; Docampo, Elisa; Escaramís, Geòrgia; Jiménez-Murcia, Susana; Lissowska, Jolanta; Rajewski, Andrzej; Szeszenia-Dabrowska, Neonila; Slopien, Agnieszka; Hauser, Joanna; Karhunen, Leila; Meulenbelt, Ingrid; Slagboom, P Eline; Tortorella, Alfonso; Maj, Mario; Dedoussis, George; Dikeos, Dimitris; Gonidakis, Fragiskos; Tziouvas, Konstantinos; Tsitsika, Artemis; Papezova, Hana; Slachtova, Lenka; Martaskova, Debora; Kennedy, James L.; Levitan, Robert D.; Yilmaz, Zeynep; Huemer, Julia; Koubek, Doris; Merl, Elisabeth; Wagner, Gudrun; Lichtenstein, Paul; Breen, Gerome; Cohen-Woods, Sarah; Farmer, Anne; McGuffin, Peter; Cichon, Sven; Giegling, Ina; Herms, Stefan; Rujescu, Dan; Schreiber, Stefan; Wichmann, H-Erich; Dina, Christian; Sladek, Rob; Gambaro, Giovanni; Soranzo, Nicole; Julia, Antonio; Marsal, Sara; Rabionet, Raquel; Gaborieau, Valerie; Dick, Danielle M; Palotie, Aarno; Ripatti, Samuli; Widén, Elisabeth; Andreassen, Ole A; Espeseth, Thomas; Lundervold, Astri; Reinvang, Ivar; Steen, Vidar M; Le Hellard, Stephanie; Mattingsdal, Morten; Ntalla, Ioanna; Bencko, Vladimir; Foretova, Lenka; Janout, Vladimir; Navratilova, Marie; Gallinger, Steven; Pinto, Dalila; Scherer, Stephen; Aschauer, Harald; Carlberg, Laura; Schosser, Alexandra; Alfredsson, Lars; Ding, Bo; Klareskog, Lars; Padyukov, Leonid; Finan, Chris; Kalsi, Gursharan; Roberts, Marion; Logan, Darren W; Peltonen, Leena; Ritchie, Graham RS; Barrett, Jeffrey C; Estivill, Xavier; Hinney, Anke; Sullivan, Patrick F; Collier, David A; Zeggini, Eleftheria; Bulik, Cynthia M

    2015-01-01

    Anorexia nervosa (AN) is a complex and heritable eating disorder characterized by dangerously low body weight. Neither candidate gene studies nor an initial genome wide association study (GWAS) have yielded significant and replicated results. We performed a GWAS in 2,907 cases with AN from 14 countries (15 sites) and 14,860 ancestrally matched controls as part of the Genetic Consortium for AN (GCAN) and the Wellcome Trust Case Control Consortium 3 (WTCCC3). Individual association analyses were conducted in each stratum and meta-analyzed across all 15 discovery datasets. Seventy-six (72 independent) SNPs were taken forward for in silico (two datasets) or de novo (13 datasets) replication genotyping in 2,677 independent AN cases and 8,629 European ancestry controls along with 458 AN cases and 421 controls from Japan. The final global meta-analysis across discovery and replication datasets comprised 5,551 AN cases and 21,080 controls. AN subtype analyses (1,606 AN restricting; 1,445 AN binge-purge) were performed. No findings reached genome-wide significance. Two intronic variants were suggestively associated: rs9839776 (P=3.01×10-7) in SOX2OT and rs17030795 (P=5.84×10-6) in PPP3CA. Two additional signals were specific to Europeans: rs1523921 (P=5.76×10-6) between CUL3 and FAM124B and rs1886797 (P=8.05×10-6) near SPATA13. Comparing discovery to replication results, 76% of the effects were in the same direction, an observation highly unlikely to be due to chance (P=4×10-6), strongly suggesting that true findings exist but that our sample, the largest yet reported, was underpowered for their detection. The accrual of large genotyped AN case-control samples should be an immediate priority for the field. PMID:24514567

  11. Gyrification brain abnormalities as predictors of outcome in anorexia nervosa.

    PubMed

    Favaro, Angela; Tenconi, Elena; Degortes, Daniela; Manara, Renzo; Santonastaso, Paolo

    2015-12-01

    Gyrification brain abnormalities are considered a marker of early deviations from normal developmental trajectories and a putative predictor of poor outcome in psychiatric disorders. The aim of this study was to explore cortical folding morphology in patients with anorexia nervosa (AN). A MRI brain study was conducted on 38 patients with AN, 20 fully recovered patients, and 38 healthy women. Local gyrification was measured with procedures implemented in FreeSurfer. Vertex-wise comparisons were carried out to compare: (1) AN patients and healthy women; (2) patients with a full remission at a 3-year longitudinal follow-up assessment and patients who did not recover. AN patients exhibited significantly lower gyrification when compared with healthy controls. Patients with a poor 3-year outcome had significantly lower baseline gyrification when compared to both healthy women and patients with full recovery at follow-up, even after controlling for the effects of duration of illness and gray matter volume. No significant correlation has been found between gyrification, body mass index, amount of weight loss, onset age, and duration of illness. Brain gyrification significantly predicted outcome at follow-up even after controlling for the effects of duration of illness and other clinical prognostic factors. Although the role of starvation in determining our findings cannot be excluded, our study showed that brain gyrification might be a predictor of outcome in AN. Further studies are needed to understand if brain gyrification abnormalities are indices of early neurodevelopmental alterations, the consequence of starvation, or the interaction between both factors. © 2015 Wiley Periodicals, Inc.

  12. Sense of self and anorexia nervosa: A grounded theory.

    PubMed

    Williams, Karen; King, Jane; Fox, John R E

    2016-06-01

    The aim of this study was to explore the nature of the relationship between the self and the eating disorder in individuals with a lifetime history of anorexia nervosa (AN). A qualitative design was used, given the exploratory nature of the study and the need to gain rich and in-depth data regarding the topic under investigation. Semi-structured interviews were conducted with 11 women with a lifetime history of AN. Interview transcripts were analysed using constructivist grounded theory methodology. A theoretical framework of the nature of the relationship between the self and AN was developed, which included five related categories: AN taking over the self, AN protecting the self, sharing the self with AN, being no one without AN, and discovering the real me (accepting the fear). Participants described a process of the self being taken over by AN to the point where it was shared with the eating disorder. This led participants to fear being no one without AN and to be unable to let go of the disorder, appreciating AN's ability to protect the self. To recover from AN, participants had to discover the real self, by accepting the fear of the unknown and separating the self from AN. The findings have important implications for the target of therapeutic interventions to improve recovery rates. The self is shared with the eating disorder in AN, and separating the self from AN is crucial to recover from the disorder. Therapeutic interventions for AN need to target the enmeshed relationship between the self and the eating disorder, as opposed to focusing exclusively on weight and shape concerns. © 2015 The British Psychological Society.

  13. Is deep brain stimulation a treatment option for anorexia nervosa?

    PubMed Central

    2013-01-01

    Anorexia nervosa (AN) is a severe psychiatric disorder with high rates of morbidity, comorbidity and mortality, which in a subset of patients (21%) takes on a chronic course. Since an evidence based treatment for AN is scarce, it is crucial to investigate new treatment options, preferably focused on influencing the underlying neurobiological mechanisms of AN. The objective of the present paper was to review the evidence for possible neurobiological correlates of AN, and to hypothesize about potential targets for Deep brain stimulation (DBS) as a treatment for chronic, therapy-refractory AN. One avenue for exploring new treatment options based on the neurobiological correlates of AN, is the search for symptomatologic and neurobiologic parallels between AN and other compulsivity- or reward-related disorders. As in other compulsive disorders, the fronto-striatal circuitry, in particular the insula, the ventral striatum (VS) and the prefrontal, orbitofrontal, temporal, parietal and anterior cingulate cortices, are likely to be implicated in the neuropathogenesis of AN. In this paper we will review the few available cases in which DBS has been performed in patients with AN (either as primary diagnosis or as comorbid condition). Given the overlap in symptomatology and neurocircuitry between reward-related disorders such as obsessive compulsive disorder (OCD) and AN, and the established efficacy of accumbal DBS in OCD, we hypothesize that DBS of the nucleus accumbens (NAc) and other areas associated with reward, e.g. the anterior cingulated cortex (ACC), might be an effective treatment for patients with chronic, treatment refractory AN, providing not only weight restoration, but also significant and sustained improvement in AN core symptoms and associated comorbidities and complications. Possible targets for DBS in AN are the ACC, the ventral anterior limb of the capsula interna (vALIC) and the VS. We suggest conducting larger efficacy studies that also explore the

  14. A genome-wide association study of anorexia nervosa

    PubMed Central

    Boraska, Vesna; Franklin, Christopher S; Floyd, James AB; Thornton, Laura M; Huckins, Laura M; Southam, Lorraine; Rayner, N William; Tachmazidou, Ioanna; Klump, Kelly L; Treasure, Janet; Lewis, Cathryn M; Schmidt, Ulrike; Tozzi, Federica; Kiezebrink, Kirsty; Hebebrand, Johannes; Gorwood, Philip; Adan, Roger AH; Kas, Martien JH; Favaro, Angela; Santonastaso, Paolo; Fernández-Aranda, Fernando; Gratacos, Monica; Rybakowski, Filip; Dmitrzak-Weglarz, Monika; Kaprio, Jaakko; Keski-Rahkonen, Anna; Raevuori, Anu; Van Furth, Eric F; Slof-Op t Landt, Margarita CT; Hudson, James I; Reichborn-Kjennerud, Ted; Knudsen, Gun Peggy S; Monteleone, Palmiero; Kaplan, Allan S; Karwautz, Andreas; Hakonarson, Hakon; Berrettini, Wade H; Guo, Yiran; Li, Dong; Schork, Nicholas J.; Komaki, Gen; Ando, Tetsuya; Inoko, Hidetoshi; Esko, Tõnu; Fischer, Krista; Männik, Katrin; Metspalu, Andres; Baker, Jessica H; Cone, Roger D; Dackor, Jennifer; DeSocio, Janiece E; Hilliard, Christopher E; O’Toole, Julie K; Pantel, Jacques; Szatkiewicz, Jin P; Taico, Chrysecolla; Zerwas, Stephanie; Trace, Sara E; Davis, Oliver SP; Helder, Sietske; Bühren, Katharina; Burghardt, Roland; de Zwaan, Martina; Egberts, Karin; Ehrlich, Stefan; Herpertz-Dahlmann, Beate; Herzog, Wolfgang; Imgart, Hartmut; Scherag, André; Scherag, Susann; Zipfel, Stephan; Boni, Claudette; Ramoz, Nicolas; Versini, Audrey; Brandys, Marek K; Danner, Unna N; de Kovel, Carolien; Hendriks, Judith; Koeleman, Bobby PC; Ophoff, Roel A; Strengman, Eric; van Elburg, Annemarie A; Bruson, Alice; Clementi, Maurizio; Degortes, Daniela; Forzan, Monica; Tenconi, Elena; Docampo, Elisa; Escaramís, Geòrgia; Jiménez-Murcia, Susana; Lissowska, Jolanta; Rajewski, Andrzej; Szeszenia-Dabrowska, Neonila; Slopien, Agnieszka; Hauser, Joanna; Karhunen, Leila; Meulenbelt, Ingrid; Slagboom, P Eline; Tortorella, Alfonso; Maj, Mario; Dedoussis, George; Dikeos, Dimitris; Gonidakis, Fragiskos; Tziouvas, Konstantinos; Tsitsika, Artemis; Papezova, Hana; Slachtova, Lenka; Martaskova, Debora; Kennedy, James L.; Levitan, Robert D.; Yilmaz, Zeynep; Huemer, Julia; Koubek, Doris; Merl, Elisabeth; Wagner, Gudrun; Lichtenstein, Paul; Breen, Gerome; Cohen-Woods, Sarah; Farmer, Anne; McGuffin, Peter; Cichon, Sven; Giegling, Ina; Herms, Stefan; Rujescu, Dan; Schreiber, Stefan; Wichmann, H-Erich; Dina, Christian; Sladek, Rob; Gambaro, Giovanni; Soranzo, Nicole; Julia, Antonio; Marsal, Sara; Rabionet, Raquel; Gaborieau, Valerie; Dick, Danielle M; Palotie, Aarno; Ripatti, Samuli; Widén, Elisabeth; Andreassen, Ole A; Espeseth, Thomas; Lundervold, Astri; Reinvang, Ivar; Steen, Vidar M; Le Hellard, Stephanie; Mattingsdal, Morten; Ntalla, Ioanna; Bencko, Vladimir; Foretova, Lenka; Janout, Vladimir; Navratilova, Marie; Gallinger, Steven; Pinto, Dalila; Scherer, Stephen; Aschauer, Harald; Carlberg, Laura; Schosser, Alexandra; Alfredsson, Lars; Ding, Bo; Klareskog, Lars; Padyukov, Leonid; Finan, Chris; Kalsi, Gursharan; Roberts, Marion; Logan, Darren W; Peltonen, Leena; Ritchie, Graham RS; Barrett, Jeffrey C; Estivill, Xavier; Hinney, Anke; Sullivan, Patrick F; Collier, David A; Zeggini, Eleftheria; Bulik, Cynthia M

    2013-01-01

    Anorexia nervosa (AN) is a complex and heritable eating disorder characterized by dangerously low body weight. Neither candidate gene studies nor an initial genome wide association study (GWAS) have yielded significant and replicated results. We performed a GWAS in 2,907 cases with AN from 14 countries (15 sites) and 14,860 ancestrally matched controls as part of the Genetic Consortium for AN (GCAN) and the Wellcome Trust Case Control Consortium 3 (WTCCC3). Individual association analyses were conducted in each stratum and meta-analyzed across all 15 discovery datasets. Seventy-six (72 independent) SNPs were taken forward for in silico (two datasets) or de novo (13 datasets) replication genotyping in 2,677 independent AN cases and 8,629 European ancestry controls along with 458 AN cases and 421 controls from Japan. The final global meta-analysis across discovery and replication datasets comprised 5,551 AN cases and 21,080 controls. AN subtype analyses (1,606 AN restricting; 1,445 AN binge-purge) were performed. No findings reached genome-wide significance. Two intronic variants were suggestively associated: rs9839776 (P=3.01×10−7) in SOX2OT and rs17030795 (P=5.84×10−6) in PPP3CA. Two additional signals were specific to Europeans: rs1523921 (P=5.76×10−6) between CUL3 and FAM124B and rs1886797 (P=8.05×10−6) near SPATA13. Comparing discovery to replication results, 76% of the effects were in the same direction, an observation highly unlikely to be due to chance (P= 4×10−6), strongly suggesting that true findings exist but that our sample, the largest yet reported, was underpowered for their detection. The accrual of large genotyped AN case-control samples should be an immediate priority for the field. PMID:21079607

  15. Atypical Antipsychotics as Augmentation Therapy in Anorexia Nervosa

    PubMed Central

    Marzola, Enrica; Desedime, Nadia; Giovannone, Cristina; Amianto, Federico; Fassino, Secondo; Abbate-Daga, Giovanni

    2015-01-01

    Anorexia nervosa (AN) is a life-threatening and difficult to treat mental illness with the highest mortality rates of any psychiatric disorder. We aimed to garner preliminary data on the real-world use of olanzapine and aripiprazole as augmentation agents of Selective Serotonin Reuptake Inhibitors (SSRIs) in adult inpatients affected by AN. We retrospectively evaluated the clinical charts of patients who were hospitalized between 2012 and 2014. Patients were evaluated upon admission and discharge. We investigated eating symptomatology, and both general and eating psychopathology using: Hamilton Rating Scale for Anxiety, Hamilton Rating Scale for Depression, and Yale-Brown-Cornell Eating Disorders Scale. The charts of 75 patients were included in this study. The sample resulted equally distributed among those receiving SSRIs and either aripiprazole or olanzapine in addition to SSRIs. Notwithstanding a few baseline clinical differences, upon discharge all groups were significantly improved on all measures. Interestingly, aripiprazole showed the greatest effectiveness in reducing eating-related preoccupations and rituals with a large effect size. The body of evidence on medication management in AN is in dismal condition. Augmentation therapy is a well-established approach to a variety of mental disorders and it is often used in every-day clinical practice with patients affected by AN as well. Nevertheless, to date very little data is available on this topic. Results from our sample yielded promising results on the effectiveness of aripiprazole augmentation in reducing eating-related obsessions and compulsions. Randomized controlled trials are warranted to confirm these encouraging findings. PMID:25922939

  16. A genome-wide association study of anorexia nervosa.

    PubMed

    Boraska, V; Franklin, C S; Floyd, J A B; Thornton, L M; Huckins, L M; Southam, L; Rayner, N W; Tachmazidou, I; Klump, K L; Treasure, J; Lewis, C M; Schmidt, U; Tozzi, F; Kiezebrink, K; Hebebrand, J; Gorwood, P; Adan, R A H; Kas, M J H; Favaro, A; Santonastaso, P; Fernández-Aranda, F; Gratacos, M; Rybakowski, F; Dmitrzak-Weglarz, M; Kaprio, J; Keski-Rahkonen, A; Raevuori, A; Van Furth, E F; Slof-Op 't Landt, M C T; Hudson, J I; Reichborn-Kjennerud, T; Knudsen, G P S; Monteleone, P; Kaplan, A S; Karwautz, A; Hakonarson, H; Berrettini, W H; Guo, Y; Li, D; Schork, N J; Komaki, G; Ando, T; Inoko, H; Esko, T; Fischer, K; Männik, K; Metspalu, A; Baker, J H; Cone, R D; Dackor, J; DeSocio, J E; Hilliard, C E; O'Toole, J K; Pantel, J; Szatkiewicz, J P; Taico, C; Zerwas, S; Trace, S E; Davis, O S P; Helder, S; Bühren, K; Burghardt, R; de Zwaan, M; Egberts, K; Ehrlich, S; Herpertz-Dahlmann, B; Herzog, W; Imgart, H; Scherag, A; Scherag, S; Zipfel, S; Boni, C; Ramoz, N; Versini, A; Brandys, M K; Danner, U N; de Kovel, C; Hendriks, J; Koeleman, B P C; Ophoff, R A; Strengman, E; van Elburg, A A; Bruson, A; Clementi, M; Degortes, D; Forzan, M; Tenconi, E; Docampo, E; Escaramís, G; Jiménez-Murcia, S; Lissowska, J; Rajewski, A; Szeszenia-Dabrowska, N; Slopien, A; Hauser, J; Karhunen, L; Meulenbelt, I; Slagboom, P E; Tortorella, A; Maj, M; Dedoussis, G; Dikeos, D; Gonidakis, F; Tziouvas, K; Tsitsika, A; Papezova, H; Slachtova, L; Martaskova, D; Kennedy, J L; Levitan, R D; Yilmaz, Z; Huemer, J; Koubek, D; Merl, E; Wagner, G; Lichtenstein, P; Breen, G; Cohen-Woods, S; Farmer, A; McGuffin, P; Cichon, S; Giegling, I; Herms, S; Rujescu, D; Schreiber, S; Wichmann, H-E; Dina, C; Sladek, R; Gambaro, G; Soranzo, N; Julia, A; Marsal, S; Rabionet, R; Gaborieau, V; Dick, D M; Palotie, A; Ripatti, S; Widén, E; Andreassen, O A; Espeseth, T; Lundervold, A; Reinvang, I; Steen, V M; Le Hellard, S; Mattingsdal, M; Ntalla, I; Bencko, V; Foretova, L; Janout, V; Navratilova, M; Gallinger, S; Pinto, D; Scherer, S W; Aschauer, H; Carlberg, L; Schosser, A; Alfredsson, L; Ding, B; Klareskog, L; Padyukov, L; Courtet, P; Guillaume, S; Jaussent, I; Finan, C; Kalsi, G; Roberts, M; Logan, D W; Peltonen, L; Ritchie, G R S; Barrett, J C; Estivill, X; Hinney, A; Sullivan, P F; Collier, D A; Zeggini, E; Bulik, C M

    2014-10-01

    Anorexia nervosa (AN) is a complex and heritable eating disorder characterized by dangerously low body weight. Neither candidate gene studies nor an initial genome-wide association study (GWAS) have yielded significant and replicated results. We performed a GWAS in 2907 cases with AN from 14 countries (15 sites) and 14 860 ancestrally matched controls as part of the Genetic Consortium for AN (GCAN) and the Wellcome Trust Case Control Consortium 3 (WTCCC3). Individual association analyses were conducted in each stratum and meta-analyzed across all 15 discovery data sets. Seventy-six (72 independent) single nucleotide polymorphisms were taken forward for in silico (two data sets) or de novo (13 data sets) replication genotyping in 2677 independent AN cases and 8629 European ancestry controls along with 458 AN cases and 421 controls from Japan. The final global meta-analysis across discovery and replication data sets comprised 5551 AN cases and 21 080 controls. AN subtype analyses (1606 AN restricting; 1445 AN binge-purge) were performed. No findings reached genome-wide significance. Two intronic variants were suggestively associated: rs9839776 (P=3.01 × 10(-7)) in SOX2OT and rs17030795 (P=5.84 × 10(-6)) in PPP3CA. Two additional signals were specific to Europeans: rs1523921 (P=5.76 × 10(-)(6)) between CUL3 and FAM124B and rs1886797 (P=8.05 × 10(-)(6)) near SPATA13. Comparing discovery with replication results, 76% of the effects were in the same direction, an observation highly unlikely to be due to chance (P=4 × 10(-6)), strongly suggesting that true findings exist but our sample, the largest yet reported, was underpowered for their detection. The accrual of large genotyped AN case-control samples should be an immediate priority for the field.

  17. The role of adiponectin multimers in anorexia nervosa.

    PubMed

    Amitani, Haruka; Asakawa, Akihiro; Ogiso, Kazuma; Nakahara, Toshihiro; Ushikai, Miharu; Haruta, Izumi; Koyama, Ken-ichiro; Amitani, Marie; Cheng, Kai-chun; Inui, Akio

    2013-01-01

    Anorexia nervosa (AN) continues to be a refractory disease because of its unknown pathogenesis. The role of adiponectin in AN has not been clarified. Moreover, few reports have described the relations between adiponectin isoforms and AN in the physical and psychological states. Therefore, we measured plasma adiponectin and its isoforms levels in patients with AN to examine their roles in AN. Eighteen women participated in this study: nine patients with AN and nine age-matched healthy controls. We examined plasma adiponectin and its isoforms levels in all subjects and administered three types of psychological test to patients with AN: the Eating Disorders Inventory-2, the Maudsley Obsessional-Compulsive Inventory, and the Beck Depression Inventory-2. We found that the percentage of high-molecular-weight (HMW) to total adiponectin (%HMW) was significantly low and the percentage of low-molecular-weight (LMW) to total adiponectin (%LMW) was significantly high in the AN group compared with the control group. The %HMW positively and the %LMW negatively correlated with body mass index in the entire study population. The %HMW was also positively correlated with psychological symptoms such as social insecurity or cleaning evaluated with the Eating Disorders Inventory-2 or the Maudsley Obsessional-Compulsive Inventory. Our study indicates that all adiponectin isoforms should be evaluated in patients with AN in addition to total adiponectin. The decreased %HMW and the increased %LMW that were correlated with the body mass index and some components of psychopathology in our patients may indicate a complex role of adiponectin isoforms in maintaining energy homeostasis and emotion during extreme malnourishment. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. The impact of childhood sexual abuse in anorexia nervosa.

    PubMed

    Carter, Jacqueline C; Bewell, Carmen; Blackmore, Elizabeth; Woodside, D Blake

    2006-03-01

    The aim of this study was to examine the impact of childhood sexual abuse (CSA) on clinical characteristics and premature termination of treatment in anorexia nervosa (AN). The participants were 77 consecutive patients with AN admitted to an inpatient eating disorders unit. The patients were assessed in terms of eating disorder symptoms, general psychopathology, and CSA history at admission to hospital. Thirty-seven patients (48%) reported a history of CSA before the onset of the eating disorder. Individuals with a history of CSA reported significantly greater psychiatric comorbidity, including higher levels of depression and anxiety, lower self-esteem, more interpersonal problems, and more severe obsessive-compulsive symptoms. Patients with the binge-purge subtype of AN (AN-BP) were significantly more likely to report a history of CSA prior to the onset of the eating disorder as compared with patients with the restricting subtype (AN-R) of the illness (65% of the AN-BP patients vs. 37% of the AN-R patients; p<.02). Contrary to our predictions, abused patients were not significantly more likely to dropout of treatment overall. However, patients of the binge-purge subtype (AN-BP) with a history of CSA were significantly more likely to terminate treatment prematurely as compared with the other patients. Consistent with previous findings, the present results indicate that the prevalence of CSA is high among individuals seeking inpatient treatment for AN. A history of CSA was associated with greater psychiatric disturbance overall and a higher rate of dropout for patients of the binge-purge subtype.

  19. Self-reported and behavioural impulsivity in anorexia nervosa.

    PubMed

    Phillipou, Andrea; Abel, Larry Allen; Castle, David Jonathan; Gurvich, Caroline; Hughes, Matthew Edward; Rossell, Susan Lee

    2016-09-22

    To examine how self-reported and behavioural impulsivity are related in anorexia nervosa (AN). Twenty-four females with AN and 25 healthy controls (HC) participant in the study. Self-reported impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11). The scale yields three second-order factors: Attentional, motor and non-planning. Behavioural impulsivity was investigated with the continuous performance test (CPT), a computer-based task of sustained attention in which numbers are flashed briefly on screen and participants are required to click the mouse when the same number appears consecutively. The rate of commission and omission errors can be used a measure of behavioural imulsivity. AN participants self-reported increased attentional [AN: 20.67 (3.64), HC: 13.88 (2.91), P = 0.001] and reduced motor impulsivity [AN: 11.55 (2.28), HC: 14.08 (2.78), P = 0.002]. The rate of omission or commission errors on the CPT did not differ between groups (P > 0.05). BIS-11 and CPT measures did not significantly correlate, but attentional impulsivity was related to negative mood states in AN (depression: r = 0.52, P = 0.010, anxiety: r = 0.55, P = 0.006, stress: r = 0.57, P = 0.004). The discrepancy between self-reported and behavioural impulsivity are discussed in terms of perfectionism in AN. Furthermore, it is suggested that improving negative mood states may resolve this inconsistency in AN.

  20. Comprehensive neurocognitive assessment of patients with anorexia nervosa

    PubMed Central

    Phillipou, Andrea; Gurvich, Caroline; Castle, David Jonathan; Abel, Larry Allen; Rossell, Susan Lee

    2015-01-01

    AIM: To utilise a comprehensive cognitive battery to gain a better understanding of cognitive performance in anorexia nervosa (AN). METHODS: Twenty-six individuals with AN and 27 healthy control participants matched for age, gender and premorbid intelligence, participated in the study. A standard cognitive battery, the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery, was used to investigate performance on seven cognitive domains with the use of 10 different tasks: speed of processing [Brief Assessment Of Cognition In Schizophrenia: Symbol Coding, Category Fluency: Animal Naming (Fluency) and Trail Making Test: Part A], attention/vigilance [Continuous Performance Test - Identical Pairs (CPT-IP)], working memory [Wechsler Memory Scale (WMS®-III): Spatial Span, and Letter-Number Span (LNS)], verbal learning [Hopkins Verbal Learning Test - Revised], visual learning [Brief Visuospatial Memory Test - Revised], reasoning and problem solving [Neuropsychological Assessment Battery: Mazes], and social cognition [Mayer-Salovey-Caruso Emotional Intelligence Test: Managing Emotions]. Statistical analyses involved the use of multivariate and univariate analyses of variance. RESULTS: Analyses conducted on the cognitive domain scores revealed no overall significant difference between groups nor any interaction between group and domain score [F(1,45) = 0.73, P = 0.649]. Analyses conducted on each of the specific tasks within the cognitive domains revealed significantly slower reaction times for false alarm responses on the CPT-IP task in AN [F(1,51) = 12.80, P < 0.01, Cohen’s d = 0.982] and a trend towards poorer performance in AN on the backward component of the WMS®-III Spatial Span task [F(1,51) = 5.88, P = 0.02, Cohen’s d = -0.665]. The finding of slower reaction times of false alarm responses is, however, limited due to the small number of false alarm responses for either group. CONCLUSION: The findings are discussed

  1. GH/IGF-I axis in anorexia nervosa.

    PubMed

    Gianotti, L; Lanfranco, F; Ramunni, J; Destefanis, S; Ghigo, E; Arvat, E

    2002-06-01

    Patients with anorexia nervosa (AN) may develop multiple endocrine abnormalities, including amenorrhea, hyperactivity of the hypothalamus-pituitary-adrenal axis, hypothyroidism and particular changes in the activity of the growth hormone (GH)/insulin-like growth factor I (IGF-I) axis. Exaggerated GH secretion and reduced IGF-I levels are usually found in AN, as well as in conditions of malnutrition and malabsorption, insulin-dependent diabetes mellitus, liver cirrhosis and catabolic states. In AN, GH hypersecretion at least partially reflects malnutrition-induced peripheral GH resistance, which leads to reduced IGF-I synthesis and release; this implies an impairment of the negative IGF-I feedback action on GH secretion. On the other hand, primary alterations in the neural control of GH secretion cannot be ruled out. The neuroendocrine alterations include enhanced somatotroph responsiveness to growth hormone releasing hormone (GHRH) and impaired GH response to most central nervous system-mediated stimuli. Particular resistance to cholinergic manipulation has also been demonstrated, thus suggesting a somewhat specific alteration in the somatostatin (SS)-mediated cholinergic influence on GH secretion. Moreover, paradoxical GH responses to glucose load, thyrotropin releasing hormone (TRH) and luteinizing hormone releasing hormone (LHRH) have also been reported. The effect of reduced leptin levels on GH hypersecretion in AN is still unclear, but ghrelin (the gastric hormone that is a natural ligand of the GH secretagogue receptor and strongly stimulates somatotroph secretion) is thought to play a major role. Regardless of the supposed central and peripheral alterations, it has to be emphasised that the activity of the GH/IGF-I axis in AN is generally restored by nutritional and stable weight gain. It therefore reflects an impaired nutritional state and cannot be considered a primary hallmark of the disease.

  2. Self-reported and behavioural impulsivity in anorexia nervosa

    PubMed Central

    Phillipou, Andrea; Abel, Larry Allen; Castle, David Jonathan; Gurvich, Caroline; Hughes, Matthew Edward; Rossell, Susan Lee

    2016-01-01

    AIM To examine how self-reported and behavioural impulsivity are related in anorexia nervosa (AN). METHODS Twenty-four females with AN and 25 healthy controls (HC) participant in the study. Self-reported impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11). The scale yields three second-order factors: Attentional, motor and non-planning. Behavioural impulsivity was investigated with the continuous performance test (CPT), a computer-based task of sustained attention in which numbers are flashed briefly on screen and participants are required to click the mouse when the same number appears consecutively. The rate of commission and omission errors can be used a measure of behavioural imulsivity. RESULTS AN participants self-reported increased attentional [AN: 20.67 (3.64), HC: 13.88 (2.91), P = 0.001] and reduced motor impulsivity [AN: 11.55 (2.28), HC: 14.08 (2.78), P = 0.002]. The rate of omission or commission errors on the CPT did not differ between groups (P > 0.05). BIS-11 and CPT measures did not significantly correlate, but attentional impulsivity was related to negative mood states in AN (depression: r = 0.52, P = 0.010, anxiety: r = 0.55, P = 0.006, stress: r = 0.57, P = 0.004). CONCLUSION The discrepancy between self-reported and behavioural impulsivity are discussed in terms of perfectionism in AN. Furthermore, it is suggested that improving negative mood states may resolve this inconsistency in AN. PMID:27679774

  3. Ghrelin: Central and Peripheral Implications in Anorexia Nervosa

    PubMed Central

    Méquinion, Mathieu; Langlet, Fanny; Zgheib, Sara; Dickson, Suzanne; Dehouck, Bénédicte; Chauveau, Christophe; Viltart, Odile

    2012-01-01

    Increasing clinical and therapeutic interest in the neurobiology of eating disorders reflects their dramatic impact on health. Chronic food restriction resulting in severe weight loss is a major symptom described in restrictive anorexia nervosa (AN) patients, and they also suffer from metabolic disturbances, infertility, osteopenia, and osteoporosis. Restrictive AN, mostly observed in young women, is the third largest cause of chronic illness in teenagers of industrialized countries. From a neurobiological perspective, AN-linked behaviors can be considered an adaptation that permits the endurance of reduced energy supply, involving central and/or peripheral reprograming. The severe weight loss observed in AN patients is accompanied by significant changes in hormones involved in energy balance, feeding behavior, and bone formation, all of which can be replicated in animals models. Increasing evidence suggests that AN could be an addictive behavior disorder, potentially linking defects in the reward mechanism with suppressed food intake, heightened physical activity, and mood disorder. Surprisingly, the plasma levels of ghrelin, an orexigenic hormone that drives food-motivated behavior, are increased. This increase in plasma ghrelin levels seems paradoxical in light of the restrained eating adopted by AN patients, and may rather result from an adaptation to the disease. The aim of this review is to describe the role played by ghrelin in AN focusing on its central vs. peripheral actions. In AN patients and in rodent AN models, chronic food restriction induces profound alterations in the « ghrelin » signaling that leads to the development of inappropriate behaviors like hyperactivity or addiction to food starvation and therefore a greater depletion in energy reserves. The question of a transient insensitivity to ghrelin and/or a potential metabolic reprograming is discussed in regard of new clinical treatments currently investigated. PMID:23549309

  4. Celiac Disease and Anorexia Nervosa: A Nationwide Study.

    PubMed

    Mårild, Karl; Størdal, Ketil; Bulik, Cynthia M; Rewers, Marian; Ekbom, Anders; Liu, Edwin; Ludvigsson, Jonas F

    2017-05-01

    Previous research suggests an association of celiac disease (CD) with anorexia nervosa (AN), but data are mostly limited to case reports. We aimed to determine whether CD is associated with the diagnosis of AN. Register-based cohort and case-control study including women with CD (n = 17 959) and sex- and age-matched population-based controls (n = 89 379). CD (villous atrophy) was identified through the histopathology records of Sweden's 28 pathology departments. Inpatient and hospital-based outpatient records were used to identify AN. Hazard ratios for incident AN diagnosis were estimated by using stratified Cox regression with CD diagnosis as a time-dependent exposure variable. In the secondary analyses, we used conditional logistic regression to estimate odds ratios for being diagnosed with AN before CD. Median age of CD diagnosis was 28 years. During 1 174 401 person-years of follow-up, 54 patients with CD were diagnosed with AN (27/100 000 person-years) compared with 180 matched controls (18/100 000 person-years). The hazard ratio for later AN was 1.46 (95% confidence interval [CI], 1.08-1.98) and 1.31 beyond the first year after CD diagnosis (95% CI, 0.95-1.81). A previous AN diagnosis was also associated with CD (odds ratio, 2.18; 95% CI, 1.45-3.29). Estimates remained largely unchanged when adjusted for socioeconomic characteristics and type 1 diabetes. The bidirectional association between AN diagnosis and CD warrants attention in the initial assessment and follow-up of these conditions because underdiagnosis and misdiagnosis of these disorders likely cause protracted and unnecessary morbidity. Copyright © 2017 by the American Academy of Pediatrics.

  5. Evaluation of the DSM-5 Severity Indicator for Anorexia Nervosa.

    PubMed

    Machado, Paulo P P; Grilo, Carlos M; Crosby, Ross D

    2017-05-01

    This study tested the new DSM-5 severity criterion for anorexia nervosa (AN) based on proposed body mass index (BMI) cut-points. Participants were a clinical sample of 201 treatment-seeking patients diagnosed with DSM-5 AN in Portugal. Participants were categorised based on DSM-5 severity levels and were compared on demographic and clinical variables assessed with the Eating Disorder Examination-Questionnaire. Based on DSM-5 severity definitions for AN, 73 (36.3%) participants were categorised as mild (≥17.0 BMI), 40 (19.9%) as moderate (16-16.99 BMI), 30 (14.9%) as severe (15-15.99 BMI) and 58 (28.9%) as extreme (<15 BMI). The severity groups did not differ significantly in age or gender. Analyses comparing the severity groups on measures of eating-disorder psychopathology revealed no significant differences on the Eating Disorder Examination-Questionnaire global or subscale scores. The groups also did not differ significantly on the frequency of binge eating or purging episodes within the past 28 days. Our findings, in this clinical sample of patients with AN in Portugal, provide no evidence for the new DSM-5 severity ratings based on BMI level. Further research on the validity of the DSM-5 specifiers is needed and should test additional clinical or functional variables and especially prognostic utility for course and outcome across eating disorders. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

  6. Latent profile analysis of eating episodes in anorexia nervosa

    PubMed Central

    Goldschmidt, Andrea B.; Wonderlich, Stephen A.; Crosby, Ross D.; Cao, Li; Engel, Scott G.; Lavender, Jason M.; Mitchell, James E.; Crow, Scott J.; Peterson, Carol B.; Le Grange, Daniel

    2014-01-01

    Background Despite being characterized primarily by disturbances in eating behavior, relatively little is known about specific eating behaviors in anorexia nervosa (AN) and how they relate to different emotional, behavioral, and environmental features. Methods Women with AN (n=118) completed a 2-week ecological momentary assessment (EMA) protocol during which they reported on daily eating- and mood-related patterns. Latent profile analysis was used to identify classes of eating episodes based on the presence or absence of the following indicators: loss of control; overeating; eating by oneself; food avoidance; and dietary restraint. Results The best-fitting model supported a 5-class solution: avoidant eating; solitary eating; binge eating; restrictive eating; and loss of control eating. The loss of control and binge eating classes were characterized by high levels of concurrent negative affect and a greater likelihood of engaging in compensatory behaviors. The restrictive eating class was associated with the greatest number of concurrently-reported stressful events, while the avoidant and solitary eating episode classes were characterized by relatively few accompanying stressful events. Body checking was least likely to occur in conjunction with restrictive eating behaviors. Conclusions Results support the presence of discrete types of eating episodes in AN that are associated with varying degrees of negative affect, stress, and behavioral features of eating disorders. Loss of control and dietary restriction may serve distinct functional purposes in AN, as highlighted by their differing associations with negative affect and stress. Clinical interventions for AN may benefit from targeting functional aspects of eating behavior among those with the disorder. PMID:24630466

  7. A systematic review of physical therapy interventions for patients with anorexia and bulemia nervosa.

    PubMed

    Vancampfort, Davy; Vanderlinden, Johan; De Hert, Marc; Soundy, Andrew; Adámkova, Milena; Skjaerven, Liv Helvik; Catalán-Matamoros, Daniel; Lundvik Gyllensten, Amanda; Gómez-Conesa, Antonia; Probst, Michel

    2014-01-01

    The purpose of this systematic review was to summarise the evidence from randomised controlled trials examining the effectiveness of physical therapy compared with care as usual or a wait-list condition on eating pathology and on physiological and psychological parameters in patients with anorexia and bulimia nervosa. EMBASE, PsycINFO, PubMed, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database and The Cochrane Library were searched from their inception until February, 2013. Articles were eligible if they utilised a randomised controlled trial design, compared physical therapy with a placebo condition, control intervention, or standard care and included patients with anorexia and bulimia nervosa. The methodological quality was assessed with the Jadad scale. Eight randomised controlled trials involving 213 patients (age range: 16-36 years) met all selection criteria. Three of the 8 included studies were of strong methodological quality (Jadad score≥3). Major methodological weaknesses were attrition and selection bias. The main results demonstrate that aerobic and resistance training result in significantly increased muscle strength, body mass index and body fat percentage in anorexia patients. In addition, aerobic exercise, yoga, massage and basic body awareness therapy significantly lowered scores of eating pathology and depressive symptoms in both anorexia and bulimia nervosa patients. No adverse effects were reported. The paucity and heterogeneity of available studies limits overall conclusions and highlights the need for further research. Implications for Rehabilitation Supervised physical therapy might increase weight in anorexia nervosa patients. Aerobic exercise, massage, basic body awareness therapy and yoga might reduce eating pathology in patients with anorexia and bulimia nervosa. Aerobic exercise, yoga and basic body awareness therapy might improve mental and physical quality of life in patients with an eating

  8. Therapist adherence in the strong without anorexia nervosa (SWAN) study: A randomized controlled trial of three treatments for adults with anorexia nervosa

    PubMed Central

    Andony, Louise J; Tay, Elaine; Allen, Karina L; Wade, Tracey D; Hay, Phillipa; Touyz, Stephen; McIntosh, Virginia VW; Treasure, Janet; Schmidt, Ulrike H; Fairburn, Christopher G; Erceg-Hurn, David M; Fursland, Anthea; Crosby, Ross D; Byrne, Susan M

    2015-01-01

    Objective To develop a psychotherapy rating scale to measure therapist adherence in the Strong Without Anorexia Nervosa (SWAN) study, a multi-center randomized controlled trial comparing three different psychological treatments for adults with anorexia nervosa. The three treatments under investigation were Enhanced Cognitive Behavioural Therapy (CBT-E), the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), and Specialist Supportive Clinical Management (SSCM). Method The SWAN Psychotherapy Rating Scale (SWAN-PRS) was developed, after consultation with the developers of the treatments, and refined. Using the SWAN-PRS, two independent raters initially rated 48 audiotapes of treatment sessions to yield inter-rater reliability data. One rater proceeded to rate a total of 98 audiotapes from 64 trial participants. Results The SWAN-PRS demonstrated sound psychometric properties, and was considered a reliable measure of therapist adherence. The three treatments were highly distinguishable by independent raters, with therapists demonstrating significantly more behaviors consistent with the actual allocated treatment compared to the other two treatment modalities. There were no significant site differences in therapist adherence observed. Discussion The findings provide support for the internal validity of the SWAN study. The SWAN-PRS was deemed suitable for use in other trials involving CBT-E, MANTRA, or SSCM. © 2015 The Authors. International Journal of Eating Disorders Published by Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:1170–1175) PMID:26769445

  9. Therapist adherence in the strong without anorexia nervosa (SWAN) study: A randomized controlled trial of three treatments for adults with anorexia nervosa.

    PubMed

    Andony, Louise J; Tay, Elaine; Allen, Karina L; Wade, Tracey D; Hay, Phillipa; Touyz, Stephen; McIntosh, Virginia V W; Treasure, Janet; Schmidt, Ulrike H; Fairburn, Christopher G; Erceg-Hurn, David M; Fursland, Anthea; Crosby, Ross D; Byrne, Susan M

    2015-12-01

    To develop a psychotherapy rating scale to measure therapist adherence in the Strong Without Anorexia Nervosa (SWAN) study, a multi-center randomized controlled trial comparing three different psychological treatments for adults with anorexia nervosa. The three treatments under investigation were Enhanced Cognitive Behavioural Therapy (CBT-E), the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), and Specialist Supportive Clinical Management (SSCM). The SWAN Psychotherapy Rating Scale (SWAN-PRS) was developed, after consultation with the developers of the treatments, and refined. Using the SWAN-PRS, two independent raters initially rated 48 audiotapes of treatment sessions to yield inter-rater reliability data. One rater proceeded to rate a total of 98 audiotapes from 64 trial participants. The SWAN-PRS demonstrated sound psychometric properties, and was considered a reliable measure of therapist adherence. The three treatments were highly distinguishable by independent raters, with therapists demonstrating significantly more behaviors consistent with the actual allocated treatment compared to the other two treatment modalities. There were no significant site differences in therapist adherence observed. The findings provide support for the internal validity of the SWAN study. The SWAN-PRS was deemed suitable for use in other trials involving CBT-E, MANTRA, or SSCM. The Authors. International Journal of Eating Disorders Published by Wiley Periodicals, Inc.

  10. Assessment and Treatment of Anorexia Nervosa and Bulimia in School Age Children.

    ERIC Educational Resources Information Center

    Peters, Carole; And Others

    1984-01-01

    Anorexia nervosa and bulimia are major concerns for high school students, especially females. These syndromes interfere with normal functioning and social development and can be life-threatening. Definitions, characteristics, symptoms, and treatment approaches for these two eating disorders are discussed, and suggestions for involvement of the…

  11. Familial Contributions to the Etiology and Course of Anorexia Nervosa and Bulimia.

    ERIC Educational Resources Information Center

    Strober, Michael; Humphrey, Laura Lynn

    1987-01-01

    Discusses familial influences in anorexia nervosa and bulimia. Reviews descriptions of family interaction, familial correlates of course and phenomenology of symptoms, and studies of familial transmission. Concludes that certain personality factors, possibly genetically determined, predispose the individual to greater sensitivity and vulnerability…

  12. Family lunch session: an introduction to family therapy in anorexia nervosa.

    PubMed

    Rosman, B L; Minuchin, S; Liebman, R

    1975-10-01

    Family lunch sessions have proved a useful diagnostic and therapeutic technique in the treatment of anorexia nervosa. This paper describes the goals of these sessions and the strategies employed in the restructuring of family relationships. Data are presented illustrating changes in eating behavior of eight identified patients.

  13. How Schools Can Help Combat Student Eating Disorders. Anorexia Nervosa and Bulimia.

    ERIC Educational Resources Information Center

    Levine, Michael P.

    This book presents a comprehensive review of anorexia nervosa and bulimia and the roles that schools can have in preventing, identifying, and treating these disorders. Chapter 1 provides an overview of student eating disorders and presents a case study of a high school student with an eating disorder. Chapter 2 discusses the nature of anorexia…

  14. Theory of Mind and the Brain in Anorexia Nervosa: Relation to Treatment Outcome

    ERIC Educational Resources Information Center

    Schulte-Ruther, Martin; Mainz, Verena; Fink, Gereon R.; Herpertz-Dahlmann, Beate; Konrad, Kerstin

    2012-01-01

    Objective: Converging evidence suggests deficits in theory-of-mind (ToM) processing in patients with anorexia nervosa (AN). The present study aimed at elucidating the neural mechanisms underlying ToM-deficits in AN. Method: A total of 19 adolescent patients with AN and 21 age-matched controls were investigated using functional magnetic resonance…

  15. Predictors of treatment acceptance and completion in anorexia nervosa: implications for future study designs.

    PubMed

    Halmi, Katherine A; Agras, W Stewart; Crow, Scott; Mitchell, James; Wilson, G Terence; Bryson, Susan W; Kraemer, Helena C

    2005-07-01

    There have been very few randomized controlled treatment studies of anorexia nervosa. To evaluate factors leading to nonacceptance and noncompletion of treatment for 2 specific therapies and their combination in the treatment of anorexia nervosa. Randomized prospective study. Weill-Cornell Medical Center, White Plains, NY; University of Minnesota, Minneapolis; and Stanford University, Stanford, Calif. Patients One hundred twenty-two patients meeting DSM-IV criteria for anorexia nervosa. Treatment with cognitive-behavioral therapy, fluoxetine hydrochloride, or their combination for 1 year. Dropout rate and acceptance of treatment (defined as staying in treatment at least 5 weeks). Of the 122 randomized cases, 21 (17%) were withdrawn; the overall dropout rate was 46% (56/122) in the remaining patients. Treatment acceptance occurred in 89 (73%) of the 122 randomized cases. Of the 41 assigned to medication alone, acceptance occurred in 23 (56%). In the other 2 groups, acceptance rate was differentiated by high and low obsessive preoccupation scores (rates of 91% and 60%, respectively). The only predictor of treatment completion was high self-esteem, which was associated with a 51% rate of treatment acceptance. Acceptance of treatment and relatively high dropout rates pose a major problem for research in the treatment of anorexia nervosa. Differing characteristics predict dropout rates and acceptance, which need to be carefully studied before comparative treatment trials are conducted.

  16. Comparison of Long-Term Outcomes in Adolescents with Anorexia Nervosa Treated with Family Therapy

    ERIC Educational Resources Information Center

    Lock, James; Couturier, Jennifer; Agras, W. Stewart

    2006-01-01

    Objective: To describe the relative effectiveness of a short versus long course of family-based therapy (FBT) for adolescent anorexia nervosa at long-term follow-up. Method: This study used clinical and structured interviews to assess psychological and psychosocial outcomes of adolescents (ages 12-18 years at baseline) who were previously treated…

  17. Theory of Mind and the Brain in Anorexia Nervosa: Relation to Treatment Outcome

    ERIC Educational Resources Information Center

    Schulte-Ruther, Martin; Mainz, Verena; Fink, Gereon R.; Herpertz-Dahlmann, Beate; Konrad, Kerstin

    2012-01-01

    Objective: Converging evidence suggests deficits in theory-of-mind (ToM) processing in patients with anorexia nervosa (AN). The present study aimed at elucidating the neural mechanisms underlying ToM-deficits in AN. Method: A total of 19 adolescent patients with AN and 21 age-matched controls were investigated using functional magnetic resonance…

  18. Anticipation of Body-Scaled Action Is Modified in Anorexia Nervosa

    ERIC Educational Resources Information Center

    Guardia, Dewi; Lafargue, Gilles; Thomas, Pierre; Dodin, Vincent; Cottencin, Olivier; Luyat, Marion

    2010-01-01

    Patients with anorexia nervosa frequently believe they are larger than they really are. The precise nature of this bias is not known: is it a false belief related to the patient's aesthetic and emotional attitudes towards her body? Or could it also reflect abnormal processing of the representation of the body in action? We tested this latter…

  19. Skill Acquisition in Ski Instruction and the Skill Model's Application to Treating Anorexia Nervosa

    ERIC Educational Resources Information Center

    Duesund, Liv; Jespersen, Ejgil

    2004-01-01

    The Dreyfus skill model has a wide range of applications to various domains, including sport, nursing, engineering, flying, and so forth. In this article, the authors discuss the skill model in connection with two different research projects concerning ski instruction and treating anorexia nervosa. The latter project has been published but not in…

  20. [Pregnancy in anorexia nervosa--an oxymoron that has become reality].

    PubMed

    Wohl, Michal Lotan; Gur, Eitan

    2015-07-01

    In the last decade there has been a significant increase in the incidence of pregnancy in patients suffering from anorexia nervosa. This change is partly explained by the social processes that constitute a significant factor in the etiology of the disease. Yearning for thinness as representing the values of control and success has become a major cultural desire and this swept into a vortex of the disease many sexually active women at childbearing age, which was rare in anorexic patients in the past. Additionally, because amenorrhea is a common condition in anorexia nervosa, pregnancy during active disease seems to be an impossible oxymoron. While some patients succeed in conceiving spontaneously, fertility clinics provide an alternative solution for those who have difficulties conceiving. It seems that fertility professionals have little knowledge about anorexia nervosa and even when they diagnose it, the dilemma as to whether to refuse to treat these patients is not easy to solve. Pregnancy in anorectic patients during active disease puts the fetus at increased risk for complications during pregnancy and labor. Common complications are spontaneous abortion and growth retardation. One must take into consideration that underweight pregnant women require a professional eating disorders assessment and, if indeed it turns out that anorexia nervosa is active, it is necessary to refer her to an eating disorders clinic for treatment and to define the pregnancy as a pregnancy at-risk.

  1. Anorexia nervosa in a girl of Chinese origin: psychological, somatic and transcultural factors.

    PubMed

    Demarque, Mélissa; Guzman, Gabriela; Morrison, Elodie; Ahovi, Jonathan; Moro, Marie Rose; Blanchet-Collet, Corinne

    2015-04-01

    The increased prevalence of anorexia nervosa reported in non-Western societies inevitably raises the issue of the influence of cultural factors in the genesis and the patterns of this disorder. Anorexia nervosa is not a straightforward Western culture-bound syndrome, although an influence of Western ideals of thinness does exist. The illness seems more related to rapid cultural shifts, either societal or individual, such as those occurring in the migratory process. Migrants and their children have to face the acculturation process and may experience a culture-clash. The pathology can also fulfil a positive acculturative function. This is a case study concerning a second-generation Chinese girl born in France presenting with anorexia nervosa. This case leads us to raise the issue of the choice of diagnostic criteria in relation to cultural background. We will also discuss the impact of the family's migratory history on the construction of identity in adolescence. Finally we will explore the specific features of care provision for anorexia nervosa in a transcultural setting. © The Author(s) 2013.

  2. Childhood Risk Factors for Lifetime Anorexia Nervosa by Age 30 Years in a National Birth Cohort

    ERIC Educational Resources Information Center

    Nicholls, Dasha E.; Viner, Russell M.

    2009-01-01

    Whether previously identified childhood risk factors for anorexia nervosa (AN) predict self-reported lifetime AN by age 30 is examined. The cohort confirmed four risk and two protective factors out of the 22 suggested risk factors. The study used data from the 1970 British Cohort Study.

  3. The Clinical Utility of Personality Subtypes in Patients with Anorexia Nervosa

    ERIC Educational Resources Information Center

    Wildes, Jennifer E.; Marcus, Marsha D.; Crosby, Ross D.; Ringham, Rebecca M.; Dapelo, Marcela Marin; Gaskill, Jill A.; Forbush, Kelsie T.

    2011-01-01

    Objective: Elucidation of clinically relevant subtypes has been proposed as a means of advancing treatment research, but classifying anorexia nervosa (AN) patients into restricting and binge-eating/purging types has demonstrated limited predictive validity. This study aimed to evaluate whether an approach to classifying eating disorder patients on…

  4. Skill Acquisition in Ski Instruction and the Skill Model's Application to Treating Anorexia Nervosa

    ERIC Educational Resources Information Center

    Duesund, Liv; Jespersen, Ejgil

    2004-01-01

    The Dreyfus skill model has a wide range of applications to various domains, including sport, nursing, engineering, flying, and so forth. In this article, the authors discuss the skill model in connection with two different research projects concerning ski instruction and treating anorexia nervosa. The latter project has been published but not in…

  5. Comorbid Depression and Anxiety in Childhood and Adolescent Anorexia Nervosa: Prevalence and Implications for Outcome

    ERIC Educational Resources Information Center

    Hughes, Elizabeth K.

    2012-01-01

    Background: Comorbid conditions are common in individuals with anorexia nervosa (AN) and can raise issues for diagnosis, prognosis, and treatment planning. Methods: First, reported prevalence rates for depression and anxiety in children and adolescents with AN were reviewed. Diagnostic issues and current understanding of the temporal onset and…

  6. When Does the "Duty to Protect" Apply with a Client Who has Anorexia Nervosa?

    ERIC Educational Resources Information Center

    Werth, James L., Jr.; Wright, Kimberly S.; Archambault, Rita J.; Bardash, Rebekah, J.

    2003-01-01

    Individuals with eating disorders, especially those with anorexia nervosa, have the potential to experience significant harm and even death as a result of behaviors related to their condition. Because of this risk, the authors argue that there is a duty to protect (i.e., an obligation to take some action when a person is engaging or considering…

  7. Family-Based Treatment for Adolescent Anorexia Nervosa: A Promising Approach?

    ERIC Educational Resources Information Center

    Le Grange, Daniel

    2004-01-01

    Despite the fact that anorexia nervosa is a debilitating disorder with serious psychological and medical sequelae, few psychological treatments have been studied. Of these, interventions that involve the parents of the adolescent have proved to be most promising. This is especially true for those cases with a short duration of illness (less than 3…

  8. Anorexia Nervosa and Autism Spectrum Disorders: Guided Investigation of Social Cognitive Endophenotypes

    ERIC Educational Resources Information Center

    Zucker, Nancy L.; Losh, Molly; Bulik, Cynthia M.; LaBar, Kevin S.; Piven, Joseph; Pelphrey, Kevin A.

    2007-01-01

    Death by suicide occurs in a disproportionate percentage of individuals with anorexia nervosa (AN), with a standardized mortality ratio indicating a 57-fold greater risk of death from suicide relative to an age-matched cohort. Longitudinal studies indicate impaired social functioning increases risk for fatal outcomes, while social impairment…

  9. The Clinical Utility of Personality Subtypes in Patients with Anorexia Nervosa

    ERIC Educational Resources Information Center

    Wildes, Jennifer E.; Marcus, Marsha D.; Crosby, Ross D.; Ringham, Rebecca M.; Dapelo, Marcela Marin; Gaskill, Jill A.; Forbush, Kelsie T.

    2011-01-01

    Objective: Elucidation of clinically relevant subtypes has been proposed as a means of advancing treatment research, but classifying anorexia nervosa (AN) patients into restricting and binge-eating/purging types has demonstrated limited predictive validity. This study aimed to evaluate whether an approach to classifying eating disorder patients on…

  10. Childhood Risk Factors for Lifetime Anorexia Nervosa by Age 30 Years in a National Birth Cohort

    ERIC Educational Resources Information Center

    Nicholls, Dasha E.; Viner, Russell M.

    2009-01-01

    Whether previously identified childhood risk factors for anorexia nervosa (AN) predict self-reported lifetime AN by age 30 is examined. The cohort confirmed four risk and two protective factors out of the 22 suggested risk factors. The study used data from the 1970 British Cohort Study.

  11. Is Family Therapy Useful for Treating Children with Anorexia Nervosa? Results of a Case Series

    ERIC Educational Resources Information Center

    Lock, James; le Grange, Daniel; Forsberg, Sarah; Hewell, Kristen

    2006-01-01

    Objective: Research suggests that family-based treatment (FBT) is an effective treatment for adolescents with anorexia nervosa (AN). This retrospective case series was designed to examine its usefulness with younger children. Method: Data were abstracted from medical records of 32 children with a mean age of 11.9 years (range 9.0-12.9) meeting…

  12. Perceived Treatment Effectiveness of Family Therapy for Chinese Patients Suffering from Anorexia Nervosa: A Qualitative Inquiry

    ERIC Educational Resources Information Center

    Ma, Joyce L. C.; Lai, Kelly

    2006-01-01

    Although family therapy has become highly acceptable in the West, its applicability and acceptability for Chinese adolescents and young women with anorexia nervosa (AN) remains unknown. In this article, we report the results of a qualitative study using post-treatment in-depth interviews to understand the subjective perceptions of sufferers of AN…

  13. The Importance of Emotional Insight in Cognitive Behaviour Therapy for Anorexia Nervosa: An Adolescent Case Study

    ERIC Educational Resources Information Center

    Rupa, Megha; Girimaji, Satish; Muthuswamy, Selvi; Jacob, Preeti; Ravi, Malavika

    2013-01-01

    Anorexia nervosa is a rare but sever psychiatric disorder in adolescence, with chronicity and death being the most feared consequence. Emotional Insight into one's problem is considered a key determinant of success in therapy. The following case study of a 14-year-old client, describes the process of therapy as it unfolded across 45 sessions. An…

  14. When Does the "Duty to Protect" Apply with a Client Who has Anorexia Nervosa?

    ERIC Educational Resources Information Center

    Werth, James L., Jr.; Wright, Kimberly S.; Archambault, Rita J.; Bardash, Rebekah, J.

    2003-01-01

    Individuals with eating disorders, especially those with anorexia nervosa, have the potential to experience significant harm and even death as a result of behaviors related to their condition. Because of this risk, the authors argue that there is a duty to protect (i.e., an obligation to take some action when a person is engaging or considering…

  15. Comorbid Depression and Anxiety in Childhood and Adolescent Anorexia Nervosa: Prevalence and Implications for Outcome

    ERIC Educational Resources Information Center

    Hughes, Elizabeth K.

    2012-01-01

    Background: Comorbid conditions are common in individuals with anorexia nervosa (AN) and can raise issues for diagnosis, prognosis, and treatment planning. Methods: First, reported prevalence rates for depression and anxiety in children and adolescents with AN were reviewed. Diagnostic issues and current understanding of the temporal onset and…

  16. Anorexia Nervosa and Autism Spectrum Disorders: Guided Investigation of Social Cognitive Endophenotypes

    ERIC Educational Resources Information Center

    Zucker, Nancy L.; Losh, Molly; Bulik, Cynthia M.; LaBar, Kevin S.; Piven, Joseph; Pelphrey, Kevin A.

    2007-01-01

    Death by suicide occurs in a disproportionate percentage of individuals with anorexia nervosa (AN), with a standardized mortality ratio indicating a 57-fold greater risk of death from suicide relative to an age-matched cohort. Longitudinal studies indicate impaired social functioning increases risk for fatal outcomes, while social impairment…

  17. Perceived Treatment Effectiveness of Family Therapy for Chinese Patients Suffering from Anorexia Nervosa: A Qualitative Inquiry

    ERIC Educational Resources Information Center

    Ma, Joyce L. C.; Lai, Kelly

    2006-01-01

    Although family therapy has become highly acceptable in the West, its applicability and acceptability for Chinese adolescents and young women with anorexia nervosa (AN) remains unknown. In this article, we report the results of a qualitative study using post-treatment in-depth interviews to understand the subjective perceptions of sufferers of AN…

  18. Anticipation of Body-Scaled Action Is Modified in Anorexia Nervosa

    ERIC Educational Resources Information Center

    Guardia, Dewi; Lafargue, Gilles; Thomas, Pierre; Dodin, Vincent; Cottencin, Olivier; Luyat, Marion

    2010-01-01

    Patients with anorexia nervosa frequently believe they are larger than they really are. The precise nature of this bias is not known: is it a false belief related to the patient's aesthetic and emotional attitudes towards her body? Or could it also reflect abnormal processing of the representation of the body in action? We tested this latter…

  19. Family-Based Treatment for Adolescent Anorexia Nervosa: A Promising Approach?

    ERIC Educational Resources Information Center

    Le Grange, Daniel

    2004-01-01

    Despite the fact that anorexia nervosa is a debilitating disorder with serious psychological and medical sequelae, few psychological treatments have been studied. Of these, interventions that involve the parents of the adolescent have proved to be most promising. This is especially true for those cases with a short duration of illness (less than 3…

  20. Is Family Therapy Useful for Treating Children with Anorexia Nervosa? Results of a Case Series

    ERIC Educational Resources Information Center

    Lock, James; le Grange, Daniel; Forsberg, Sarah; Hewell, Kristen

    2006-01-01

    Objective: Research suggests that family-based treatment (FBT) is an effective treatment for adolescents with anorexia nervosa (AN). This retrospective case series was designed to examine its usefulness with younger children. Method: Data were abstracted from medical records of 32 children with a mean age of 11.9 years (range 9.0-12.9) meeting…