Symptoms Of Anorexia Nervosa Research Articles

Bone Fracture History in Women With First Episode or With Persistent Anorexia Nervosa.

To investigate fractures history in women with first episode anorexia nervosa (AN) (FE-AN: ≤ 3years duration) and those with persistent AN (P-AN: ≥ 7years), compared to healthy controls (HC). One hundred nineteen women (FE-AN=49, P-AN=46 and HC=24) completed online questionnaires on eating disorders symptoms, their menstrual and their fracture history. Average illness duration was 1.9years (SD=0.8) in FE-AN and 15.3years (SD=8.5) in P-AN. Lifetime history of all fractures, including stress fractures, was higher in AN groups (FE-AN=33.3%; P-AN=37.8%) than in HC (4.2%, p<0.001). P-AN participants were 13.4 times more likely to report a fracture compared to HC, irrespective of age, whereas F-AN participants were 10.3 times more likely. In P-AN, higher BMI, shorter duration of amenorrhoea and history of pregnancy were inversely associated with fracture number. There is an increased risk of bone fracture even in the early stages of AN. This could be related to a time lapse between the initial symptoms of AN and formal diagnosis. This suggests guidelines recommending bone screening after 2-years of persistent low weight for adults should be revisited, and the risk of bone problems should be part of the dialogue between clinicians, patients and carers at the earliest opportunity.

Effect of cognitive remediation therapy in anorexia nervosa: a systematic review and meta-analysis.

Anorexia nervosa (AN) can significantly affect cognitive well-being. Cognitive remediation therapy (CRT) is regarded as one of the effective treatments for cognitive impairment in some mental illnesses such as schizophrenia, bipolar disorder, and attention deficit. For this reason, this systematic review and meta-analysis aim to assess the effectiveness of CRT in patients with AN. We conducted a search of Medline, ClinicalTrials.gov, and the Cochrane Database of Systematic Reviews from the inception of each database through April 8, 2023. Randomized clinical trials evaluating the effectiveness of CRT in comparison to placebo or other psychological treatments in patients with AN were included. The quality of the studies was assessed using the revised Cochrane risk-of-bias tool. For meta-analysis, effect sizes were measured using mean difference (MD) utilizing the random-effects model and inverse variance (IV) technique. To evaluate the certainty of the evidence, we applied the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. The study was registered in PROSPERO, ID: CRD42023411784. In the systematic review, six studies were included, of which four underwent meta-analysis. Among these, three trials encompassing 413 participants showed that CRT was associated with improved cognitive flexibility compared to control at the end of treatment (MD = -0.21, 95% CI [-0.44, 0.02], P=0.81, I2 = 0%). In two trials with 143 patients, those who received CRT showed similar effects on the severity of AN symptoms compared to the control group in the self-reporting questionnaires: EDE-Q (MD = -0.25, 95% CI [-0.76, 0.27], P=0.77, I2 = 0%) and EDEQOL (MD = -0.19, 95% CI [-0.41, 0.03], P=0.84, I2 = 0%). CRT did not show a statistically significant difference compared to the control group in improving abstract thinking skills and quality of life in individuals with AN. That indicates that CRT's efficacy remains inconclusive. Further research with larger, more diverse samples is needed to determine its long-term effects and potential benefits. PROSPERO, identifier CRD42023411784.

The role of body weight in college students’ perceptions of anorexia nervosa and atypical anorexia nervosa

Objective: The present experimental study assessed college students’ ability to recognize an eating disorder across various body weights. Participants: Undergraduate students (N = 428) from a midsized public university. Methods: Participants completed an online questionnaire and were randomized to read one of four vignettes describing a woman with anorexia nervosa symptoms who was underweight, average weight, overweight, or obese. Participants completed a survey to assess body image, eating concerns, and ability to recognize an eating disorder. Results: Results showed participants in the underweight condition were significantly more likely to correctly identify an eating disorder (adjusted residual = 2.5) and showed fewer incorrect identifications than would be expected (adjusted residual = −2.5). In the underweight condition, 83.78% correctly recognized an eating disorder, followed by average weight (76.84%), obesity (69.16%), and overweight (68.89%). Conclusions: College students may have a harder time recognizing an eating disorder in someone with a higher body weight.

Visual body size estimation in adolescent anorexia nervosa: Behavioural and neurophysiological data suggest intact visual perception and biased emotional attention

Body image disturbance is a key symptom of anorexia nervosa (AN). AN patients report body dissatisfaction and overestimate their own body size in several tasks. This study aimed to clarify whether this overestimation arises from deficits in visual perception. To this end, 36 adolescent restrictive-type AN patients and 42 matched healthy controls performed metric and depictive body size estimation (BSE) tasks. Magneto- and electroencephalography were measured during the size estimation of 66 computer-generated body pictures varying in size from underweight to overweight. AN patients versus controls showed overestimation across self-referential metric and depictive BSE tasks, but similar performance in a depictive BSE task without self-reference and similar early neurophysiological responses. Starting mid-latency (200 ms), AN patients showed relatively more neural activity in response to underweight body pictures and less neural activity in response to higher-weight body pictures in distributed brain regions. A secondary comparison of AN patients with slight vs. distinct overestimation during self-referential BSE uncovered relatively stronger neural responses to body pictures corresponding to the estimated body mass index. These results suggest that body image disturbances in adolescent restrictive-type AN patients depend on self-reference and do not represent a deficit of visual perception, but rather biased emotional attention.

Group cognitive remediation therapy for adolescents with anorexia nervosa: Outcomes before, after, and during follow-up in a real-world setting in Japan.

Objective: Cognitive remediation therapy (CRT) can be used as an adjunct treatment for adolescents with severe and complex anorexia nervosa (AN) requiring inpatient treatment. However, there has been only one study on CRT for adolescents with AN in Japan. This study explored group CRT as an adjunct to inpatient treatment for Japanese adolescents with severe and complex AN requiring inpatient care. Methods: Thirty-one adolescents with AN underwent group CRT. Neuropsychological (set-shifting and central coherence) and psychological assessments (motivation, self-esteem, and depressive symptoms) were measured before and after the intervention. Weight and AN symptoms were measured before and after the intervention and at follow-up, and the adolescents completed post-intervention and follow-up questionnaires. Results: Set-shifting led to medium to large effect size improvements. Medium effect size improvements in central coherence and depressive symptoms were also observed. The feedback from the adolescents was mainly positive, and the treatment completion rate was high. The patients also reported that the skills learned through group CRT could be applied in daily life. Conclusion: Group CRT may be beneficial for adolescents with severe and complex AN who require inpatient care.

Ovarian hormones and eating disorders.

The eating disorders anorexia nervosa and bulimia nervosa are much more common in women than in men. Also, there is evidence for a role of gene mutations in these disorders. This review examines recent data about the possibility that ovarian estrogens may contribute to the symptoms of anorexia nervosa and partly account for the sex difference in incidence of this disorder. Possible mechanisms linking genes that are abnormal in anorexia to pathways that could produce abnormal responses to estrogen are also examined. In addition, recent data pointing to a role of ovarian androgens in the symptoms of bulimia nervosa are reviewed. These data may point to more effective adjustments for the therapy of these difficult to treat disorders.

Neuropsychiatric considerations in treating anorexia nervosa patients with osteopathic manipulative medicine: a narrative review.

Osteopathic manipulative medicine (OMM) has a growing recognition in serving as an effective treatment topromote adaptation and homeostasis of the body by addressing musculoskeletal, neural, vascular, and lymphatic structures to promote self-healing and regulation. OMM can treat the musculoskeletal tension and sympathetic hyperactivity resulting from the increased cortisol response and hypersensitivity found in varying psychiatric illnesses, including anorexia nervosa (AN). This paper addresses the considerations necessary for treating AN patients with OMM, emphasizing the need to evaluate their abnormal high-level neuronal processing of sensory information, including differences in touch perception compared to the general population. Current literature was gathered utilizing a combination of the following keywords: anorexia nervosa, perception of touch, and osteopathic manipulative medicine/treatment. No literature was found addressing the effects of OMM on treating AN patients. Eight studies addressed the change in perception of touch found in AN patients. Results of the literature review reveal that the perceptions of touch in AN patients are distorted and can lead to reduced perceived pleasantness encountered in social interactions and touch. Specific changes have been found in C-tactile (CT) afferents responsible for the positive effects of touch, thus influencing emotional regulation. The significance of addressing this topic is to provide insight into the pathophysiological processes of AN and to inform physicians of unconventional stimuli that may exacerbate AN symptoms and behaviors. Further study is required to elucidate the role and mechanism of OMM in patients with AN and whether manual therapy could worsen pathological behavior and thinking patterns seen in AN patients. Such studies could include, but are not limited to, examining biological factors such as cortisol levels in AN patients receiving OMM and collecting data about AN patients' thinking patterns and behavior during OMM treatment.

Rethinking Therapeutic Strategies for Anorexia Nervosa: Insights From Psychedelic Medicine and Animal Models.

Anorexia nervosa (AN) has the highest mortality rate of any psychiatric disease, yet available pharmacological treatments are largely ineffective due, in part, to an inadequate understanding of the neurobiological drivers that underpin the condition. The recent resurgence of research into the clinical applications of psychedelic medicine for a range of mental disorders has highlighted the potential for classical psychedelics, including psilocybin, to alleviate symptoms of AN that relate to serotonergic signaling and cognitive inflexibility. Clinical trials using psychedelics in treatment-resistant depression have shown promising outcomes, although these studies are unable to circumvent some methodological biases. The first clinical trial to use psilocybin in patients with AN commenced in 2019, necessitating a better understanding of the neurobiological mechanisms through which psychedelics act. Animal models are beneficial in this respect, allowing for detailed scrutiny of brain function and behavior and the potential to study pharmacology without the confounds of expectancy and bias that are impossible to control for in patient populations. We argue that studies investigating the neurobiological effects of psychedelics in animal models, including the activity-based anorexia (ABA) rodent model, are particularly important to inform clinical applications, including the subpopulations of patients that may benefit most from psychedelic medicine. Appeared originally in Front Neurosci 2020; 14:43.

Social cognition and bulimic symptoms in male undergraduate students: The conditional effect of emotion dysregulation.

Research demonstrates associations between poor social cognition and eating disorder (ED) pathology. Moreover, research shows that individuals with EDs struggle with emotion regulation. The present study replicates and extends the literature on social cognition and ED pathology, which previously focused largely on symptoms of anorexia nervosa among women while the present study focuses on symptoms of bulimia nervosa among undergraduate men. Further, this study tests the hypothesis that better emotion regulation mitigates the association between social cognition and ED pathology. At a single timepoint, undergraduate males (n=520) completed a series of questionnaires, and a task assessing mentalising, a key element of social cognition. Consistent with hypotheses, bulimic symptoms were associated with worse mentalising and worse self-reported emotion regulation. Moreover, the association between mentalising and bulimic symptomatology was conditional on emotion regulation, such that it was strongest among those with more difficulties regulating their emotions. Results are consistent with existing theories that highlight an interplay between interpersonal (e.g., mentalisation) and intrapersonal (e.g., affective functioning) factors in relation to ED symptomatology. Among undergraduate males, bulimic symptoms were associated with worse mentalisation. However, a good ability to regulate emotions interrupted this association.

Psilocybin restrains activity-based anorexia in female rats by enhancing cognitive flexibility: contributions from 5-HT1A and 5-HT2A receptor mechanisms

Psilocybin has shown promise for alleviating symptoms of depression and is currently in clinical trials for the treatment of anorexia nervosa (AN), a condition that is characterised by persistent cognitive inflexibility. Considering that enhanced cognitive flexibility after psilocybin treatment is reported to occur in individuals with depression, it is plausible that psilocybin could improve symptoms of AN by breaking down cognitive inflexibility. A mechanistic understanding of the actions of psilocybin is required to tailor the clinical application of psilocybin to individuals most likely to respond with positive outcomes. This can only be achieved using incisive neurobiological approaches in animal models. Here, we use the activity-based anorexia (ABA) rat model and comprehensively assess aspects of reinforcement learning to show that psilocybin (post-acutely) improves body weight maintenance in female rats and facilitates cognitive flexibility, specifically via improved adaptation to the initial reversal of reward contingencies. Further, we reveal the involvement of signalling through the serotonin (5-HT) 1 A and 5-HT2A receptor subtypes in specific aspects of learning, demonstrating that 5-HT1A antagonism negates the cognitive enhancing effects of psilocybin. Moreover, we show that psilocybin elicits a transient increase and decrease in cortical transcription of these receptors (Htr2a and Htr1a, respectively), and a further reduction in the abundance of Htr2a transcripts in rats exposed to the ABA model. Together, these findings support the hypothesis that psilocybin could ameliorate cognitive inflexibility in the context of AN and highlight a need to better understand the therapeutic mechanisms independent of 5-HT2A receptor binding.

Perfectionism, self-esteem, and affective symptoms in anorexia nervosa subtypes: A network analysis of French inpatients.

Previous studies have highlighted the relevance of perfectionism, self-esteem, and anxio-depressive symptoms in anorexia nervosa (AN). However, the relationships between these factors and cardinal eating disorders (ED) symptoms remain unclear, particularly in AN subtypes. This study aimed to examine their interconnections using network analysis. The sample included n = 338 inpatients with AN who completed the Eating Disorder Examination Questionnaire, Frost Multidimensional Perfectionism Scale, Rosenberg Self-Esteem Scale, and Hospital Anxiety and Depression Scale. Using network analysis, we estimated three networks: full sample, AN-restrictive (AN-R) and AN-binge/purging (AN-BP) subtypes. We estimated central and bridge symptoms using expected influence and conducted an exploratory network comparison test to compare AN subtypes. Overvaluation of Weight and Shape, Concern over Mistakes, and Personal Standards were consistently central in all networks. The most central bridge symptoms across all networks were Concern over Mistakes and Self-Esteem. Concern over Mistakes bridged perfectionism and ED symptoms, while Self-Esteem was highly connected to all symptom clusters. Anxiety was significantly more central in the AN-R network compared to the AN-BP network. The present study contributes to a growing body of network studies suggesting that nodes related to perfectionism are just as central as cardinal ED symptoms, indicating the relevance of perfectionism in ED pathology. The high bridge centrality of self-esteem suggests that it may be an important link between perfectionism, mood, and ED symptoms. Future research should investigate the efficacy of targeting multiple psychological factors in the treatment of AN, as well as their potential transdiagnostic relevance.

Eating disorder symptom non-endorsers in hospitalised patients with anorexia nervosa: Who are they?

Impaired insight and illness denial are common in anorexia nervosa (AN). Missing an AN diagnosis may delay treatment and negatively impact outcomes. The current retrospective study examined the prevalence and characteristics of AN symptom non-endorsement (i.e., scoring within the normal range on the Eating Disorder Examination Questionnaire [EDE-Q] or the Eating Disorder Examination [EDE] interview) in three independent samples of hospitalised patients with AN (N1=154; N2=300; N3=194). A qualitative chart review of a subsample of non-endorsers (N4=32) extracted reports of disordered eating behaviours observed by the treatment team. The prevalence of non-endorsement ranged from 11% to 34% across sites. Non-endorsers were more likely to be diagnosed with AN restricting type (AN-R) and reported fewer symptoms of co-occurring psychopathology than endorsers. Groups benefitted equally from treatment. The qualitative chart review indicated that objective symptoms of AN were recorded by staff in over 90% of non-endorsers. Eating disorder symptom assessments using the EDE-Q or EDE may miss symptomatology in up to a third of individuals hospitalised with AN. This study highlights the potential utility of multi-modal assessment including patient interviews, collateral informants, and behavioural observation to circumvent non-endorsement.

Testing the role of associative learning in evidence-based treatments for anorexia nervosa.

Treatments for anorexia nervosa (AN) remain ineffective for many patients. Processes that can account for differential treatment outcomes remain mostly unknown. We propose that the field test the role of associative learning in current psychological treatments. We hold that this line of research could yield actionable information for understanding non-response and improving long-term outcomes. To make this argument, we define associative learning and outline its proposed role in understanding psychiatric disorders and their treatment. We then briefly review data exploring associative learning in AN. We argue that associative learning processes are implicitly implicated in existing treatments; by this rationale, baseline differences in learning may interfere with treatment response. Finally, we outline future research to test our hypotheses. Altogether, future research aimed at better understanding how associative learning may contribute to AN symptom persistence has the potential to inform novel directions in intervention research. PUBLIC SIGNIFICANCE: There is a pressing need to improve outcomes in treatments for anorexia nervosa (AN). We propose that individual differences in associative learning-the ability to form and update associations between cues, contexts, behaviors, and outcomes-may account for differential response to existing treatments. Undertaking this research could provide an understanding of how current treatments work and inform new approaches for those who may be at risk of poor outcomes.

Change in motivational bias during treatment predicts outcome in anorexia nervosa.

Reward and punishment sensitivity are known to be altered in anorexia nervosa (AN). Most research has examined these constructs separately although motivated behavior is influenced by considering both the potential for reward and risk of punishment. The present study sought to compare the relative balance of reward and punishment sensitivity in AN versus healthy controls (HCs) and examine whether motivational bias is associated with AN symptoms and treatment outcomes. Adolescents and adults with AN (n = 262) in a partial hospitalization program completed the Eating Disorders Examination Questionnaire (EDE-Q), Behavioral Inhibition System/Behavioral Activation System (BIS/BAS) scales, and Sensitivity to Punishment/Sensitivity to Reward Questionnaire (SPSRQ) at admission and discharge. HCs (HC; n = 90) completed the BIS/BAS and SPSRQ. Motivational Bias Scores were calculated to reflect the dominance of reward versus punishment sensitivity. Individuals with AN demonstrated significantly greater bias toward punishment sensitivity than HC. In AN, a bias toward punishment was associated with higher EDE-Q Global score at admission. Change in motivational bias during treatment predicted EDE-Q Global scores, but not BMI, at discharge, with greater increases in reward sensitivity or greater decreases in punishment sensitivity during treatment predicting lower eating pathology. Similar findings were observed using the BIS/BAS and SPSRQ. Change in motivational bias during treatment is associated with improved outcomes in AN. However, it appears that much of the change in motivational bias can be attributed to changes in punishment sensitivity, rather than reward sensitivity. Future research should examine the mechanisms underlying punishment sensitivity decreases during treatment. Sensitivity to reward and punishment may be important treatment targets for individuals with anorexia nervosa (AN). To date, most research has considered reward and punishment sensitivity separately, rather than examining their relationship to each other. We found that the balance of reward and punishment sensitivity (i.e., motivational bias) differs between healthy controlsand those with AN and that this bias is associated with eating disorder symptoms and treatment outcome.

Recovery Trajectories in Adolescent Girls with Anorexia Nervosa

Background: This study aimed to document recovery trajectories among adolescents with anorexia nervosa (AN) based on three markers of remission, namely changes in body weight, food restriction, and excessive exercise, and to identify predictors of these trajectories. Methods: One hundred twenty-six adolescent girls (14.7 ± 1.3 years) were recruited during initial assessment visits at specialized eating disorder (ED) programs in five University Health Centers across the province of Quebec, Canada. z-BMI and AN symptom severity (food restriction and excessive exercise) were assessed at initial assessment visits and subsequently reassessed at each quarterly follow-up over a 12-month period to identify recovery trajectories. Results: Considering the three markers of remission, three distinct trajectories emerged: Group 1, rapid responders; Group 2, gradual responders; and Group 3, unstable responders. At initial visits, a difference between groups was found regarding the type of treatment (p = 0.01) and weight suppression (p = 0.02). Group 1 had a higher number of youths hospitalized than Group 2 and Group 3, and a greater weight suppression than Group 3. Furthermore, individuals with atypical AN were more likely to belong to Group 2 than to Group 1 and Group 3 (p &lt; 0.0001). Conclusions: This study contributes to a better understanding of the heterogeneity of recovery trajectories in adolescent girls with AN.

Preliminary study: cognitive behavioural therapy for insomnia in adolescents with anorexia nervosa

PurposeInsomnia and anorexia nervosa (AN) are frequently comorbid, negatively affecting the evolution and the prognosis of AN. Within this framework, the management of sleep disorders appears as critical. The aim of this retrospective study is to assess, for the first time, the efficacy of cognitive and behavioural therapy for insomnia (CBT-I) on sleep disturbances in adolescents with AN. To do so, we investigated the impact of CBT-I on sleep disturbances and sleep-related outcomes, in BMI, AN symptoms, anxiety and depressive symptoms, emotionality and quality of life. These features were compared between two groups of patients with AN, one following CBT-I, and the other receiving the regular treatment at the psychiatric unit.MethodsData collection occurred between January and May 2022. The study included 42 adolescents in-treatment at the Eating Disorders care specialised unit at Salvator Hospital in Marseille. They were randomly assigned to the CBT-I group (N = 31) or the control group (N = 11). Several clinical elements were assessed using sleep diaries and self-report questionnaires.ResultsParticipants undergoing CBT-I showed a significant improvement in sleep latency, total wake time and sleep efficacy, as well as in physical well-being. No significant effects were found regarding AN symptoms.ConclusionThese preliminary findings provide support for CBT-I effectiveness in adolescents with AN, as shown by significant improvements in several sleep parameters, as well as in physical well-being. These promising results, underline the relevance of this topic and its potential benefits for a more appropriate treatment for adolescents with AN.Level of evidence: Level V, retrospective study.

Prospective associations between cognitive flexibility and eating disorder symptoms in anorexia nervosa and bulimia nervosa

This study investigated concurrent and prospective associations between measures of reversal learning and attentional set-shifting and eating disorder symptoms at baseline, 3 months, and 6 months among individuals with anorexia nervosa restricting subtype (AN-R, n = 26), AN binge eating/purging subtype (AN-BP, n = 22), bulimia nervosa (BN, n = 35), and healthy controls (n = 27), and explored whether these associations differed by diagnosis. At baseline, participants completed diagnostic interviews, height/weight measurements, and measures of set-shifting (the Intradimensional/Extradimensional shift task) and reversal learning (a probabilistic reversal learning task). At 3- and 6-month follow-up, participants with eating disorders completed assessments of weight and eating disorder symptoms. A one-way analysis of variance found no evidence that baseline reversal learning and attentional set-shifting differed across diagnostic groups. Multilevel modeling analyses indicated that perseverative errors (an index of reversal learning) predicted an increase in purging over time for individuals with AN-BP and BN. Set-shifting errors differentially predicted frequency of loss of control eating for individuals with AN-BP and BN; however, set-shifting was not related to loss of control eating when examined separately in AN-BP and BN. These findings suggest that disentangling facets of cognitive flexibility may help understand change in eating disorder symptoms.

An updated report on trauma in Anorexia Nervosa: Confirmation and novel data

ObjectiveLiterature reported a great occurrence of Traumatic Events (TEs) and post-traumatic symptoms in anorexia nervosa (AN). The present study aims to: a) describe the prevalence and the characteristics of TEs in AN, also comparing TEs related to Post-traumatic Stress Disorder (PTSD) to those without this link; b) compare patients with and without TEs and with and without PTSD in terms of clinical picture; c) compare patients who suffered the TE before AN onset to those with TE after AN onset. MethodsThe sample consisted of 126 patients with AN who were interviewed with the Structured and Clinical Interview for DSM 5 (SCID-5), and completed self-reported questionnaires to investigate the general and eating-related psychopathology. ResultsThe results showed that the majority of the patients with AN reported a TE, and TEs related to PTSD were more relational and sexual-related compared to TEs not leading to PTSD. Moreover, after Bonferroni correction was applied to the results, no significant differences emerged between patients with and without TEs, and between individuals with TEs before and after AN onset; differently, patients with PTSD presented a more severe global clinical picture than those without PTSD, partially independent of diagnostic AN subtype. ConclusionThe study highlights that, despite TEs are risk factors for AN, the diagnosis of PTSD makes the difference in terms of clinical presentation and severity, impacting not only eating-related symptoms but also general psychopathology. A careful screening for PTSD in patients with AN is suggestable, especially when relational trauma and sexual violence are reported.

An Intensive time series investigation of the relationships across eating disorder-specific fear responses and behavior urges in partially remitted anorexia nervosa

Anorexia nervosa (AN) is a serious and persistent psychiatric illness. Many individuals with AN cycle between stages of remission (i.e., relapse), with research documenting that cognitive remission generally lags behind nutritional/weight restoration. Yet, little is known about which mechanisms promote movement from partial remission in AN (defined as nutritional, but not cognitive, recovery) to full remission. Fear-based processes, including avoidance and approach behaviors, likely contribute to the persistence of cognitive-behavioral AN symptoms after nutritional restoration. The current study used intensive longitudinal data to characterize these processes during partial remission (N = 41 participants with partially remitted AN; 4306 total observations). We aimed to a) characterize frequency of fear-based processes in real-time, b) investigate associations across fear-based processes and behavioral urges, and c) test if real-time associations among symptoms differed across commonly feared stimuli (e.g., food, social situations). On average, participants endorsed moderate fear and avoidance, with weight-gain fears rated higher than other feared stimuli. Momentary fear, avoidance, approach, and distress were all positively associated with AN behavior urges at one time-point and prospectively. Central symptoms and symptom connections differed across models with different feared stimuli. These findings provide empirical support for the theorized fear-avoidance-urge cycle in AN, which may contribute to the persistence of eating pathology during partial remission. Fear approach may be associated with temporary increases in urges, which should be considered during treatment. Future research should explore these associations in large, heterogeneous samples, and test the effectiveness of exposure-based interventions during partial remission.

Randomised controlled trial of neurostimulation for symptoms of anorexia nervosa (TRENA study): study protocol

BackgroundAnorexia nervosa (AN) has amongst the highest mortality rates and the highest treatment costs of any psychiatric disorder. Recently, interest in non-invasive brain stimulation as a novel treatment for AN has grown. These include repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS).MethodsThis double-blind, randomised sham-controlled trial will compare the relative acceptability and efficacy of tDCS and rTMS in people with AN. 70 participants will be randomised to active or sham tDCS, or active or sham rTMS treatment (2:1:2:1 ratio) over an 8-week treatment period. Participants will receive treatment as usual across the study duration. The primary outcomes are change on the Eating Disorder Examination Questionnaire and treatment acceptability. Secondary outcomes will include change in weight, cognition, mood, interpersonal functioning, and quality of life. Following the 8-week assessment, all participants will have the option of receiving an additional 12 weeks of at-home tDCS. A follow-up assessment will be conducted at 20 weeks post treatment.DiscussionResearch into non-invasive brain stimulation as treatments for AN has potential to improve clinical outcomes for patients by comparing the relative efficacy and acceptability of both treatment modalities in the inpatient and at-home setting (i.e., for at-home tDCS) results from this study will provide important information for informing future larger clinical trials of these treatments for AN.Trial registrationClinicalTrials.gov Identifier: NCT05788042.