Increased urge for movement, physical and mental restlessness, fundamental symptoms of restricting anorexia nervosa?

Regina C Casper,Ulrich Voderholzer,Sandra Schlegl,Silke Naab

doi:10.1002/brb3.1556

Abstract

ObjectiveContinued mobility in the presence of severe weight loss is a well known, yet insufficiently researched characteristic of anorexia nervosa (AN). This study was designed to assess the prevalence of the drive for activity, here operationalized as an increased urge for movement, physical restlessness, and mental restlessness.MethodParticipants were 83 female consecutively admitted adolescent patients qualifying for a diagnosis of AN (ICD‐10), restricting subtype. Information collected included responses to a questionnaire inquiring retrospectively about physical and psychological reactions after significant weight loss (on average 12.5 kg) and to measures of psychiatric and eating disorder pathology and exercise behaviors at hospital admission.ResultsOver 80% of AN patients reported experiencing, at least partly, either, an increased urge for movement, physical or mental restlessness after significant weight loss. Altogether 95.1% reported, at least partly, one or a combination of two or all three symptoms. The sensations coexisted with equally high levels of fatigue and loss of energy, typically observed in starvation. The increased urge for movement and physical restlessness were foremost associated with reported actual physical activity and with weight loss. By contrast, mental restlessness was strongly linked to the degree of eating disorder pathology and to the severity of psychiatric symptoms.DiscussionThis is the first investigation of the presence of an increased urge for movement, physical restlessness, and mental restlessness after significant weight loss in patients with acute AN. The symptoms, given their high frequency and specificity, are likely pathogenic for AN and, if replicated, deserve to be considered for inclusion as diagnostic criteria for AN.

Highlights

Anorexia nervosa (AN) is a serious disorder of voluntary food restriction primarily occurring in female adolescents leading to excessive weight loss
Mental restlessness was reported by over 80% of patients; 70% reported feeling alert, 64% were able to concentrate, and 55% reported feeling motivated with 39% endorsing mental energy
We explored the relationships between the three principal variables and responses to all other items on the Reactions to Weight Loss Questionnaire (RWLQ) (Table 1)

Summary

Introduction

Anorexia nervosa (AN) is a serious disorder of voluntary food restriction primarily occurring in female adolescents leading to excessive weight loss. Prolonged severe energy restriction in humans is generally accompanied by a host of physiological and metabolic adaptations. These adjustments, designed to conserve energy, eventually lead to a reduction in and avoidance of physical activity, inertia, and apathy (Keys, Brozek, Henschel, Mickelsen, & Taylor, 1950). A review of studies that measured daily activity using movement sensors and total energy expenditure found that day to day physical activity levels and daily energy expenditure in AN patients did not significantly differ from those in healthy controls (Casper, 2018)

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