Anorexic Individuals Research Articles

Hooked on weight control: An economic theory of anorexia nervosa and its impact on health and longevity

In this paper, I integrate a theory of body image, weight control, and addiction in a life cycle model with health deficit accumulation in order to explain the phenomenon of anorexia nervosa and its impact on health and longevity. Individuals consume normal goods and foods and can work off excess calories with physical exercise. There exists a healthy body mass index and deviations from it increasingly cause health deficits due to obesity or underweight. There exists also a subjective target weight and being heavier than target weight causes a loss of utility from body image. Anorexia is initiated in individuals who are particularly successful in weight control and prone to addiction. Addiction to weight control motivates anorexic individuals to perpetually adjust their target weight downwards and to eat less and exercise more. With declining weight, health deficits accumulate faster and mortality risk rises. I calibrate the model to an average American woman with bmi 28. Due to weight loss addiction, the bmi declines to a level of 15 and causes an expected loss of 15 years of life. I also discuss potential therapies and recovery from the disease.

Progression of anorexia nervosa: An insight into neurological and biological mechanisms influencing the personality patterns of anorexics

Anorexia nervosa has emerged as a prominent eating disorder affecting young women. This disorder's fundamental characteristic is an abnormally low weight achieved by severe calorie restriction and refusal to maintain body weight at or above the minimally normal weight for age and height. It is a complex disorder with its origins still not explicitly defined. In anorexic individuals, an imbalance in the molecular signalling and hypothalamic neuropeptides is believed to be significantly responsible for alterations in the biological mechanisms associated with body weight, appetite and energy homeostasis. The imbalance between the genetic systems such as serotonin, dopamine, brain-derived neurotrophic factor, estrogen and their interactions are significantly observed in anorexic as well as recovered anorexic individuals. The dopaminergic pathway is involved in reward mechanisms but its dysfunction might cause weight loss, food aversion, hyperactivity, obsessive compulsive behaviours, distorted body image. An abnormal serotonin function reveals personality traits such as rigidity, inhibition, anxiety, inflexibility, perfectionism and harm avoidance. The Met66 variant of brain derived neurotrophic factor is strongly associated with the development of restricting-type anorexia nervosa. The development of anorexia has been linked to estrogen receptor beta gene variants, which also regulate food intake and states of anxiety and depression.This review discusses the neurobiological dysregulations because of which anorexics tend to have a distinct personality profile characterized by behaviour patterns comprising perfectionism, obsessive-compulsive disorder, harm avoidance, alexithymia, anger suppression, anxiety, rigidity, novelty seeking, anhedonia, depression, impulsivity, substance abuse, self harm etc. Heterogeneities in the characteristic profile are observed based on the subdivisions of anorexia nervosa. The impact of malnutrition has also been scrutinized.

Comparative analysis of the composition and function of fecal-gut bacteria in captive juvenile Crocodylus siamensis between healthy and anorexic individuals.

The Siamese crocodile (Crocodylus siamensis) is a freshwater, endangered crocodile with high economic value in the farming industry. Gut microflora plays an essential role in host physiological activity, and it contributes significantly to both the health and diseased states of animals. However, thus far, no study has focused on the correlation between diseases and intestinal bacterial communities in crocodilians. Here, we first compared the composition and function of gut microbial communities in captive juvenile C. siamensis suffering from anorexia and healthy crocodile controls using deep amplicon sequencing. The gut microbial diversity of anorexic crocodiles was much lower than the healthy individuals. Obvious changes in gut microbial composition were observed between sick and healthy crocodiles, except for Cetobacterium somerae of phylum Fusobacteria. In particular, the abundance of Bacteroides luti, Clostridium disporicum, Plesiomonas shigelloides, and Odoribacter sp. in the gut flora of healthy crocodiles was distinctly higher than the diseased group. Conversely, the species Edwardsiella tarda was overrepresented in the gut of anorexic crocodiles compared to the healthy group. Furthermore, in anorexic crocodiles, the predicted microbial functions that were related to amino acid metabolism, biosynthesis of other secondary metabolites, nucleotide metabolism, replication and repair, and translation were significantly reduced, while signal transduction was significantly enriched. These findings of the present study provide a reference to enrich the field of gut microorganism studies in crocodilians and suggest that alterations in the composition and function of gut bacteria in C. siamensis juveniles may be associated with anorexia in crocodiles.

MANIFESTAÇÕES ORAIS DOS TRANSTORNOS ALIMENTARES: REVISÃO DE LITERATURA

A pressão da mídia sobre a população faz com que algumas pessoas alterem o consumo alimentar, introduzindo dietas inadequadas e aumentando o risco de desencadear desordens alimentares. Diversos sinais desses distúrbios podem afetar a cavidade oral, e é papel do cirurgião-dentista diagnosticar precocemente, por meio da anamnese detalhada e do minucioso exame clínico. Nesse contexto, o estudo objetivou analisar as diferentes manifestações bucais dos transtornos alimentares, a fim de confirmar a hipótese de que o cirurgião dentista pode diagnosticar precocemente tais distúrbios. As estratégias de busca foram realizadas nas bases de dados do Pubmed e Biblioteca Virtual da Saúde (BVS). Os seguintes descritores foram obtidos por meio do dicionário Decs/Mesh: bulimia, anorexia e oral cavity. A avaliação dos estudos foi realizada em duas etapas por revisores independentes. Na primeira etapa, os títulos e resumos foram investigados, e aqueles que apresentassem os critérios de elegibilidade eram selecionados. Na segunda, os artigos foram lidos na íntegra e selecionados conforme os critérios de inclusão e exclusão. Identificaram-se 79 citações e 40 foram lidas na íntegra; seis artigos reuniram os critérios de inclusão. As manifestações orais citadas na literatura foram erosão dentária, parótidas, cárie, hipersensibilidade dentinária e alterações dos tecidos moles. Os estudos apontam que indivíduos anoréxicos e bulímicos apresentam alterações associadas à saúde bucal, e compete ao cirurgião dentista diagnosticar precocemente esses sinais clínicos.DOI: 10.12957/demetra.2018.31360

Orthorexic eating behaviour as a coping strategy in patients with anorexia nervosa.

Orthorexia nervosa is defined as the fixation on health-conscious eating behaviour and has recently been discussed as a new variant of disordered eating. The aim of the present study was to analyse orthorexic eating behaviour in an inpatient treatment sample of female anorexics to investigate the relation between anorexic and orthorexic eating behaviour. Female anorexic patients with low (n=29) and pronounced (n=13) orthorexic eating behaviour as well as a matched control group composed of healthy females (n=30) were compared with regard to several aspects of disordered eating, hypochondriacal traits, food consumption frequency and fulfilment of basic psychological needs in terms of eating. Orthorexic eating behaviour was assessed using the Düsseldorfer Orthorexie Skala. Fulfilment of basic psychological needs with respect to autonomy and competence is higher in anorexic individuals with pronounced orthorexic eating behaviour compared to patients with low orthorexic eating behaviour. Furthermore, patients with pronounced orthorexic eating behaviour state eating healthy food regardless of calorie content more often. No difference was found for hypochondriacal traits and eatingdisordered symptoms in general. Orthorexic eating behaviour enhances self-perception of eating behaviour as autonomous and competent, indicating that it might serve as a coping strategy in anorexic individuals. Further research is needed to investigate if this tendency in food selection strategy leads to positive effects in the long term.

A ESCOLHA PELO “NADA”: REFLEXÕES PSICANALÍTICAS SOBRE A ANOREXIA

This essay discusses the anorexic behavior as a symptom among young women and young men, based on the case of a young woman in the context of clinical experience in psychoanalysis. From the psychoanalytical point of view, eating nothing as an anorexic symptom can be construed/regarded as what Lacan refers to as dialectic of frustration, where the object nothing works as an object of symbolic satisfaction that separates the subject from the Other. In this sense, the psychological dynamic that falls within these cases is related to the satisfaction of the drive (pulsion) faced by both sexes. By bearing in mind that this dynamic is structural for all subjects, one may consider that it is the recovery of a place for discourse, where subjects build new barriers to the insatiable desire of the Other. It indicates the possibility of treatment of anorexic individuals. DOI: 10.12957/demetra.2016.22502

Altered cortical excitability in anorexia nervosa

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.

L’anorexie mentale à la lumière du fonctionnement neurocognitif : nouvelles perspectives théoriques et thérapeutiques

Anorexia nervosa is a serious psychiatric disorder, for which very few validated therapeutic strategies exist. The specific sociocognitive style of anorexic patients has already been described in the 1960s: it involves a concrete style with abstraction difficulties. Current neuropsychological tests have contributed to a more precise definition of these difficulties. IS THERE A SPECIFIC COGNITIVE PROFILE?: Contrary to common beliefs, these patients' intellectual performances are not superior to those of the general population. However, detailed comparisons of profiles on the Weschler Scales suggest difficulties in synthesizing information and better abilities in concrete problem solving. The dominant hypothesis concerning the attentional dimension is the existence of a weakness in central coherence, resulting in superior detail processing and a weakness in global integration. This trend appears to be stable even after the normalization of nutritional status. The impairment of set-shifting abilities leads to rigidity, expressed by inflexibility and perseveration, both in reasoning and behaviour. This reduced cognitive flexibility appears to persist after recovery, and may constitute a familial trait. In addition, this likely endophenotype seems to be independent from obsessional traits. Alexithymia is frequently described in anorexic individuals. It is the verbal description of feelings which seems to be particularly impaired. It may explain underlying difficulties in empathy. Indeed, these subjects have lower scores on emotional tests drawn from the theory of mind. These cognitive abnormalities are well documented in pervasive developmental disorders. NEUROANATOMICAL DATA: NEUROIMAGING IN SUPPORT OF LIMBIC AND FRONTO-STRIATAL ABNORMALITIES: Evidence from neuroimaging suggests abnormalities in cortical and subcortical structures, involving the temporal and orbito-frontal lobes. Various functional hypotheses are formulated, involving fronto-striatothalamic circuits, amygdala or insula. IS ANOREXIA NERVOSA A DEVELOPMENTAL DISORDER?: Pervasive developmental disorders are over-represented among anorexic subjects in comparison to the general population. Conversely, restrictive and selective eating disorders are more frequent among individuals presenting an autistic spectrum disorder. In view of the common cognitive and neuroanatomical data that are found in anorexia nervosa and neurodevelopmental disorders, we adhere to the hypothesis that anorexia nervosa may be similar to a neurodevelopmental disorder. Clinical observations suggest that this hypothesis may be especially relevant in the early forms of anorexia nervosa. These cognitive data confirm the potential relevance of new therapeutic modalities such as cognitive remediation. Initial results from its application to anorexia nervosa seem promising. A review of the recent literature highlights the possible existence of a developmental impairment of cortical and subcortical structures, associated with specific abnormalities in cognitive development such as a weakness in central coherence, reduced set-shifting ability and poor social skills. On this basis, cognitive remediation may be a promising therapeutic innovation.

Stimulation of food intake after central galanin is associated with arcuate nucleus activation and does not differ between genetically selected low and high body weight lines of chickens

Galanin, a 29 residue peptide found in the hypothalamus, causes orexigenic effects in a variety of species. In the present study, we investigated appetite-associated effects of galanin in chicks from lines which have been selected from a common founder population for either low or high body weight. The low line consists of some anorexic individuals and there are obese individuals in the high line. Central galanin caused increased food intake in both lines with the magnitude of response similar in both lines. We also quantified the number of c-Fos immunoreactive cells in several hypothalamic nuclei that are associated with appetite. Only the arcuate nucleus had an increase in the number of reactive cells, a response that was similar for both lines. From these results we concluded that selection for body weight likely did not affect galanin function on induction of feeding in either lines, and that the effect of galanin is associated with arcuate nucleus activation in chicks.

Differential Anorexigenic Effects of Beta‐Melanocyte Stimulating Hormone in Lines of Chickens Divergently Selected for Low or High Body Weight

The melanocortin system plays a key role in appetite and metabolic regulation in mammals and chicks. The present study was designed to investigate the appetite‐associated effects of beta‐melanocyte stimulating hormone (beta‐MSH) administered at 4 days post hatch in lines of chicks genetically selected from a common founder population for high (HWS) or low (LWS) juvenile body weight for 50 consecutive generations. The HWS chicks are hyperphagic and obese, while the LWS line contains some anorexic individuals. Centrally administered beta‐MSH dose‐dependently decreased food intake in HWS chicks whereas all doses (0.01, 0.1, and 1 nmol) caused a similar magnitude decrease in food intake in LWS chicks. Water intake was decreased in both lines. Central beta‐MSH did not affect whole blood glucose concentrations in either line. Plasma corticosterone was increased in LWS, but not HWS, in response to beta‐MSH. These data suggest that potential differential melanocortinergic appetite regulation between these lines may be due to either direct effects of beta‐MSH on food intake or secondary effects of beta‐MSH on appetite via alterations in the stress response.

Central α‐melanocyte stimulating hormone causes more potent anorexigenic effects in a line of chickens containing anorexic individuals as compared to a line that is obese

α‐melanocyte stimulating hormone (α‐MSH) causes potent anorexigenic effects in both mammals and birds when centrally administered. We evaluated the central effects of α‐MSH in lines of chickens selected for low (LWS) or high (HWS) body weight for 49 consecutive generations. LWS contains some anorexic individuals while the HWS chickens are hyperphagic. Central α‐MSH more potently reduced feed intake in LWS than HWS. In a second experiment, we found that central α‐MSH reduced exploratory pecking in LWS but not HWS chicks. α‐MSH more potently reduced locomotion and increased deep rest in the LWS than HWS line. Although feed intake was reduced in LWS, their feeding efficiency was increased by central α‐MSH. In conclusion, LWS and HWS lines of chickens responded differently to central α‐MSH; the central melanocortin system may contribute to their differential body weights.

Emotional Stroop via Internet among individuals with eating disorders

The present study investigated whether Stroop interference in eating disordered individuals for food - and body-related words, as repeatedly found previously using standard emotional Stroop tasks, would also be demonstrated when using an Internet based emotional Stroop task. Participants were anorexic women (n= 13), bulimic women (n= 20), non-clinically eating disordered women nevertheless over-concerned about eating and body appearance (n= 27) and normal control women (n= 31). Bulimic individuals showed Stroop interference for body-related words whereas anorexic individuals showed Stroop interference for food-related words. The present results thus suggest that administration of the emotional Stroop task is possible via the Internet. Furthermore, it is possible that the time consuming response delivery, relative to previous studies, could lead to Stroop interference only for the most emotionally significant information, in turn, differentiating between the core concerns of anorexic and bulimic individuals.

Group cognitive-behavioural therapy for anorexia nervosa: a case for treatment?

Objectives There is a lack of empirical data regarding the efficacy of cognitive behavioural therapy (CBT) in anorexia nervosa. In addition, the narrow focus of traditional CBT on food- and weight-related negative thoughts and dysfunctional assumptions has been questioned. This study aimed to investigate the effectiveness of a CBT group for anorexic individuals, and to determine whether or not treatment outcome is associated with non-specific underlying cognitions (core beliefs). Method Twenty anorexic women participated in a 10-week cognitive-behavioural group programme. Eating cognitions and behaviours were assessed at the beginning and end of the programme. Core beliefs were assessed at the beginning of the group and were used as predictors of changes in anorectic cognitions and symptoms. Results Group CBT was found to be ineffective in symptom reduction, and core beliefs were irrelevant to outcome. These findings do not appear to be methodological artefacts. Conclusion It is suggested that group CBT in its current short form is insufficient to induce changes, due to its failure to address some process issues central to anorexia nervosa (such as poor motivation, lack of insight, and ambivalence towards treatment). Copyright © 1999 John Wiley & Sons, Ltd and Eating Disorders Association.

An application of expectancy theory to eating disorders: Development and validation of measures of eating and dieting expectancies.

Instruments for measuring learned expectations for reinforcement from eating and from dieting and thinness were constructed and validated. Five eating reinforcement expectancies and 1 dieting-thinness reinforcement expectancy were identified and their factor structure replicated on an independent sample. The expectancy that dieting and thinness lead to overgeneralized self-improvement characterized bulimia nervosa and anorexia nervosa patients and correlated with dieting behavior in a general sample. Expectancies for negative reinforcement from eating (e.g., eating helps manage negative affect) characterized bulimic but not anorexic individuals and were correlated with indexes of restraint plus disinhibition in a general sample. Positive reinforcement expectancies (e.g., eating is pleasurable and rewarding) were unrelated to disinhibited eating, but anorexic patients expected significantly less positive reinforcement from eating than did bulimic patients or controls.

Stress, coping style, and problem solving ability among eating-disordered inpatients

Stress levels, coping style, and problem solving ability among bulimic and anorexic individuals were explored. Bulimics (n = 33) reported a greater number of negative life events and feelings of being pressured than did a non-eating-disordered group. Anorexics (n = 12) reported higher levels of anxiety and depression than the other groups. Both anorexics and bulimics reported higher levels of stress, lower levels of confidence in their ability to solve problems, a tendency to avoid confronting problems, a reluctance to share personal problems, and feelings of being driven. Implications are suggested.

Psychopathologie des troubles022 à expression colique de l'enfant

L’anorexie mentale est un trouble psychiatrique grave, pour lequel on ne dispose que de peu de stratégies thérapeutiques validées. Le style sociocognitif particulier de ces sujets a été décrit dès les années 1960 : un style concret avec des difficultés d’abstraction. Des évaluations neuropsychologiques permettent désormais de mieux le définir, mettant en évidence une attention excessive aux détails, une flexibilité mentale défaillante, ainsi qu’une perception et une expression émotionnelles altérées, en dépit de performances globales comparables à celles de la population générale. La neuro-imagerie apporte également des arguments dans le sens d’anomalies morphologiques et fonctionnelles de structures corticales et sous-corticales, impliquant en particulier les circuits fronto-striatothalamiques. Au vu de ces données récentes, qui demandent à être davantage étudiées, ce profil pose la question d’une analogie avec les troubles neurodéveloppementaux, et la remédiation cognitive déjà proposée dans certains d’entre eux apparaît alors comme une voie thérapeutique innovante.Anorexia nervosa is a serious psychiatric disorder, for which very few validated therapeutic strategies exist. The specific sociocognitive style of anorexic patients has already been described in the 1960s: it involves a concrete style with abstraction difficulties. Current neuropsychological tests have contributed to a more precise definition of these difficulties.Contrary to common beliefs, these patients’ intellectual performances are not superior to those of the general population. However, detailed comparisons of profiles on the Weschler Scales suggest difficulties in synthesizing information and better abilities in concrete problem solving.The dominant hypothesis concerning the attentional dimension is the existence of a weakness in central coherence, resulting in superior detail processing and a weakness in global integration. This trend appears to be stable even after the normalization of nutritional status.The impairment of set-shifting abilities leads to rigidity, expressed by inflexibility and perseveration, both in reasoning and behaviour. This reduced cognitive flexibility appears to persist after recovery, and may constitute a familial trait. In addition, this likely endophenotype seems to be independent from obsessional traits.Alexithymia is frequently described in anorexic individuals. It is the verbal description of feelings which seems to be particularly impaired. It may explain underlying difficulties in empathy. Indeed, these subjects have lower scores on emotional tests drawn from the theory of mind. These cognitive abnormalities are well documented in pervasive developmental disorders.Evidence from neuroimaging suggests abnormalities in cortical and subcortical structures, involving the temporal and orbito-frontal lobes. Various functional hypotheses are formulated, involving fronto-striatothalamic circuits, amygdala or insula.Pervasive developmental disorders are over-represented among anorexic subjects in comparison to the general population. Conversely, restrictive and selective eating disorders are more frequent among individuals presenting an autistic spectrum disorder.In view of the common cognitive and neuroanatomical data that are found in anorexia nervosa and neurodevelopmental disorders, we adhere to the hypothesis that anorexia nervosa may be similar to a neurodevelopmental disorder. Clinical observations suggest that this hypothesis may be especially relevant in the early forms of anorexia nervosa. These cognitive data confirm the potential relevance of new therapeutic modalities such as cognitive remediation. Initial results from its application to anorexia nervosa seem promising.A review of the recent literature highlights the possible existence of a developmental impairment of cortical and subcortical structures, associated with specific abnormalities in cognitive development such as a weakness in central coherence, reduced set-shifting ability and poor social skills. On this basis, cognitive remediation may be a promising therapeutic innovation.

The relevance of metabolic rate in behavioral medicine research.

This article reviews research relating metabolism to areas of interest to behavioral medicine. Metabolic rate has been investigated as a possible mediator of a variety of problems related to energy balance. Metabolic rate has also been utilized to investigate excessive cardiac activity that may be associated with cardiovascular disease. Although resting metabolic rate does not appear to be different in obese compared with nonobese, diet-induced thermogenesis is diminished in obese subjects. Caloric restriction produces a decline in metabolic rate in both obese and nonobese and further reduces the diet-induced thermogenic effect in obese. Exercise may prevent the decline in metabolic rate following caloric restriction. Anorexic individuals have a lowered metabolic rate that appears to increase rapidly after refeeding. Although bulimic individuals who purge via self-induced vomiting do not have a lower metabolic rate than matched control subjects, the frequency of purging has been found to be inversely related to resting metabolic rate. Metabolic rate has also been investigated as a possible mediator of weight regulation in individuals who smoke cigarettes and has been shown to decrease with smoking cessation. Tissue overperfusion, or an increase in cardiovascular activity above metabolic need, has been shown to increase peripheral resistance and may lead to hypertension.

Intensive psychotherapy of former anorexic individuals.

The intensive psychotherapy of six recovered anorexic females revealed consistent information regarding premorbid parental and familial interaction as well as particular difficulties surrounding the onset of the anorexic illness. Persistent personality problems, difficulties in relationships, and characteristic transference reactions in these adult individuals are described.

Hope for Binge-Eaters and Other Addicts: A Christian Psychoanalytic Perspective

The search for control is a common theme in the wide variety of current literature on the development and treatment of eating disorders (e.g., Bruch, 1978; Garfinkel & Garner, 1982; Minuchin, Rosman, & Baker, 1978). It is important that the psychotherapist treating anorexic and bulimic individuals grasp the deeper meaning of this pervasive symptom because it can create major therapeutic dilemmas. The present article suggests that the need to “take without cost” is central to understanding this search for control, and considers both implications for the therapeutic relationship as well as scriptural foundations.