Bulimia Nervosa Patients Research Articles

Childhood trauma and cortisol awakening response in eating disorders: A dose-dependent trauma effect

IntroductionA role for the hypothalamus-pituitary-adrenal (HPA) axis has been suggested in the pathophysiology of anorexia nervosa (AN) and bulimia nervosa (BN), and childhood trauma experiences have been detected frequently in patients with AN and BN. Since trauma exposure in the childhood may persistently affect HPA axis functioning, we explored HPA axis activity in AN and BN patients with and without childhood trauma history.Objectives and aimsWe aimed to examine possible associations between childhood traumatic experiences and HPA axis functioning, as assessed by the cortisol awakening response (CAR), in adult patients with AN or BN as compared to adult healthy controls.MethodsSaliva samples were collected by 41 patients with symptomatic AN, 32 with symptomatic BN and 45 healthy controls at wakening and after 15, 30 and 60 min. They filled in the Childhood Trauma Questionnaire (CTQ), which assesses five specific types of childhood trauma.ResultsAs compared to the control group, the no-maltreated AN patient group exhibited an enhanced CAR whereas the no-maltreated BN patient group showed a similar CAR. On the contrary, both AN and BN patients with a positive history of childhood maltreatment exhibited statistically significant blunted CAR as compared to no-maltreated patients. Moreover, in maltreated ED patients the CAR tended to decrease when the number of trauma types increased.DiscussionPresent findings confirm a dysregulation of the HPA axis activity in symptomatic patients with AN and BN and suggest a dose-dependent effect of childhood adverse experiences on the CAR of adult ED patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Oxytocin secretion in anorexia nervosa and bulimia nervosa: Investigation of its relationships to temperament personality dimensions

IntroductionSome temperament characteristics of personality seem to be modulated by oxytocin. Patients suffering from eating disorders (EDs) display aberrant personality traits.Objectives and aimsWe investigated the relationships between plasma oxytocin levels and personality dimensions of patients with anorexia nervosa (AN) and bulimia nervosa (BN) and compared them to those of healthy controls.MethodsPlasma oxytocin levels were measured in 23 women with AN, 27 women with BN and 19 healthy controls and assessed their personality traits by means of the Cloninger's Temperament and Character Inventory-Revised (TCI-R).ResultsAN patients showed plasma levels of the hormone significantly lower than BN and healthy controls. In healthy women, plasma oxytocin levels resulted significantly correlated negatively with novelty seeking scores and positively with both harm avoidance (HA) scores and the attachment subscale scores of the reward dependence: these correlations explained 82% of the variability in circulating oxytocin. In BN patients, plasma oxytocin resulted negatively correlated with HA, whereas no significant correlations emerged in AN patients.ConclusionsThese findings confirm a dysregulation of oxytocin secretion in AN but not in BN and show, for the first time, that the association of circulating oxytocin to patients’ temperament traits is totally lost in underweight patients with AN and partially lost or even inverted in women with BN. These findings suggest a role of oxytocin in certain deranged behaviours of ED patients, which are influenced by the subjects’ personality traits.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Functional Associations of Temperamental Predisposition and Brain Responses While Processing Stressful Word Stimuli Related to Interpersonal Relationships in Bulimia Nervosa Patients: an fMRI Study

Functional Associations of Temperamental Predisposition and Brain Responses While Processing Stressful Word Stimuli Related to Interpersonal Relationships in Bulimia Nervosa Patients: an fMRI Study

Type of setting for the inpatient adolescent with an eating disorder: Are specialized inpatient clinics a must or will the pediatric ward do?

There are a range of different services for treating adolescent eating disorders (ED) but there is no clinical consensus and a paucity of research indicating which type of treatment setting is the best. Although it would be ideal to have a specialized ward for these patients what happens when this is not possible? The aim of this study was to evaluate patients with ED hospitalized on a general pediatric ward. A retrospective chart review for 37 patients hospitalized for an ED and followed by a team consisting of an adolescent medicine specialist, a child and adolescent psychiatrist and a dietician on a pediatric ward were re-evaluated. Twenty-four (64.9%) patients were diagnosed with anorexia nervosa (AN) restricting type, 8 (21.6%) with anorexia nervosa binging purging type, 3 (8.1%) with bulimia nervosa (BN) and 2 (5.4%) with eating disorder otherwise not specified. The mean age at admission was 14.79 ± 1.75 years and 7 (20%) were males. A majority were hospitalized due to medical instability. Mean period of time from admittance to medical stabilization was 6.04 ± 4.79 days. The mean period of admittance was 26.4 ± 11.9 days for AN and 23.7 ± 15.03 days for BN patients. The mean calorie intake of the AN group was 607 ± 333 kcal and 2,358 ± 605 kcal at hospitalization and discharge, respectively. Hypophosphatemia occurred in 2 patients during refeeding. Mean total weight gained during the whole hospitalization period was 3,950 ± 3,524grs. This study shows that although not ideal, EDs can successfully be followed on general pediatric wards and could have implications at centers with no specialized wards.

Nutritional Rehabilitative Treatment in a Residential Centre for Eating Disorders: A Case Series Report

Purpose: Patients with Eating Disorders (ED) could benefit of temporary leaving from their family and social environment, hosting in specialized residential centers. Methods: Fifty-one female patients (23.5 ± 6.1 years), 22 with Anorexia Nervosa (AN), 14 with Bulimia Nervosa (BN), 9 with Binge Eating Disorders (BED) and 6 with not-otherwise specified eating disorders (EDNOS) were followed in a residential regimen for at least 3 months. Anthropometric, clinical, biochemical and body composition parameters were evaluated at entry, at 1, 3 and 5 months, while residents and 6 months after discharge. A multidisciplinary team, including specialized medical doctors, psychotherapists and dieticians was involved in the treatment. Results: A significant (p<0.001) and progressive weight gain in 22 AN patients, both at the end of the residential period and at 6 month follow-up was observed, with no signs of refeeding syndrome. Resting Energy Expenditure (REE) progressively increased, reaching significance (p<0.02) at 5 month treatment. Menses spontaneously recovered in 12 patients, after 17 (5-48) months amenorrhea. In 14 BN patients, binge eating and purging episodes were eliminated. Nine BED patients gradually lost weight (-14.5 ± 3.2 kg) and in particular Fat Mass (FM), with a significant (p<0.05) improvement in blood lipids and serum transaminases. No significant changes were observed in the 6 EDNOS patients, possibly due to the low number and wide variability of patients gathered in this disease definition. Conclusion: These observations suggest the safety, with the improvement of several clinical and nutritional parameters, of a multi-disciplinary and integrated approach carried out in a residential setting, in particular for AN patients.

Nutritional Rehabilitative Treatment in a Residential Centre for Eating Disorders: A Case Series Report

Purpose: Patients with Eating Disorders (ED) could benefit of temporary leaving from their family and social environment, hosting in specialized residential centers. Methods: Fifty-one female patients (23.5 ± 6.1 years), 22 with Anorexia Nervosa (AN), 14 with Bulimia Nervosa (BN), 9 with Binge Eating Disorders (BED) and 6 with not-otherwise specified eating disorders (EDNOS) were followed in a residential regimen for at least 3 months. Anthropometric, clinical, biochemical and body composition parameters were evaluated at entry, at 1, 3 and 5 months, while residents and 6 months after discharge. A multidisciplinary team, including specialized medical doctors, psychotherapists and dieticians was involved in the treatment. Results: A significant (p<0.001) and progressive weight gain in 22 AN patients, both at the end of the residential period and at 6 month follow-up was observed, with no signs of refeeding syndrome. Resting Energy Expenditure (REE) progressively increased, reaching significance (p<0.02) at 5 month treatment. Menses spontaneously recovered in 12 patients, after 17 (5-48) months amenorrhea. In 14 BN patients, binge eating and purging episodes were eliminated. Nine BED patients gradually lost weight (-14.5 ± 3.2 kg) and in particular Fat Mass (FM), with a significant (p<0.05) improvement in blood lipids and serum transaminases. No significant changes were observed in the 6 EDNOS patients, possibly due to the low number and wide variability of patients gathered in this disease definition. Conclusion: These observations suggest the safety, with the improvement of several clinical and nutritional parameters, of a multi-disciplinary and integrated approach carried out in a residential setting, in particular for AN patients.

Executive Functioning and Visuospatial Abilities in Bulimia Nervosa with or without a Previous History of Anorexia Nervosa.

The aim of the present study was to investigate executive functioning and visuospatial abilities in patients with bulimia nervosa (BN), with a particular interest in exploring the impact of a previous diagnosis of anorexia nervosa (AN). Several neuropsychological tasks were administered to 89 BN patients (52 with a previous history of AN and 37 without previous AN) and 160 healthy women. A poorer performance on set-shifting measures (Wisconsin Card Sorting Test) was found only in BN patients with a previous history of AN. Decision-making abilities (Iowa Gambling Task) were significantly impaired in the whole sample of BN patients, but difficulties were more pronounced in the subgroup with previous AN. Finally, we did not find any differences in response inhibition and visuospatial abilities between the two samples of BN patients and healthy women. Our findings support the idea that cognitive abilities in patients with BN are more impaired in the presence of a prior history of AN. The clinical and treatment implications of our findings should be explored in future studies.

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

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.

Psychodynamic profile and reflective functioning in patients with bulimia nervosa

ObjectiveThe aim of this study was to examine the general psychological functioning of patients suffering from bulimia nervosa (BN) using the Karolinska Psychodynamic Profile (KAPP). Furthermore, KAPP data and data from the Reflective Functioning scale (RF), measuring the ability to mentalize, were combined in order to examine differences in alexithymia, impulse control and affect regulation in patients with high or low RF. MethodSeventy patients with BN were interviewed with both the KAPP and the Adult Attachment Interview (AAI) from which RF is coded. Differences in KAPP scores of patients with high or low RF were analyzed. ResultsMost of the patients with BN were found to have a personality structure within the normal or neurotic range (n=50 of 70). BN patients with a high RF had significantly lower scores on KAPP's alexithymia scale than patients with a low RF score, demonstrating that poor mentalizing is related to alexithymia. Concurrently, patients with high RF showed problems with impulse control and coping with aggressive affects according to KAPP scores. ConclusionAlthough BN patients with high RF showed good capacities for describing their mental states, they still had difficulties regulating the emotions and impulses related to these states. Significant outcomeAmong patients suffering from BN, patients with high RF were significantly less alexithymic than low RF patients. LimitationsThe findings of this study are limited by the relatively small numbers of participants especially in the RF subgroups, posing a danger of not finding as significant existing differences in character pathology between high and low RF groups.

Childhood trauma and cortisol awakening response in symptomatic patients with anorexia nervosa and bulimia nervosa.

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.

Neurobiological and clinical variables associated with alcohol abuse in bulimia nervosa.

The study was aimed at analysing the reciprocal relationships of several clinical and neurobiological items in order to predict alcohol misuse in patients with bulimia nervosa (BN). Seventy BN patients and 70 healthy controls were assessed for depression, impulsivity, borderline personality traits and self-defeating behaviours using specific scales; serum cortisol and 24-hour urinary excretion of serotonin and 5-hydroxiindolacetic acid were also assessed. The study confirmed the implications of these clinical factors for alcohol misuse in BN patients, but the results suggested that depressive symptoms and hypercortisolism could lie behind these relationships.

Cortisol Awakening Response in Symptomatic Patients with anorexia Nervosa and Bulimia Nervosa Exposed to Childhood Trauma

Introduction Childhood trauma exposure is a risk factor for adult psychopathology in general. The biological mechanisms mediating this increased risk involve the endogenous stress response system, including the hypothalamus-pituitary-adrenal (HPA) axis, that undergoes trauma-induced functional changes, which may persist later in life. Since an association between stressful life events and the onset/course of anorexia nervosa (AN) or bulimia nervosa (BN) has been demonstrated, a role for the HPA axis in their pathophysiology seems likely. Objectives and Aims The cortisol awakening response (CAR) is a useful method to assess the functioning of HPA axis. Therefore, we conducted an explorative study aiming to examine possible associations between childhood maltreatments and HPA axis functioning, as assessed by the CAR, in adult patients with AN or BN. Methods Saliva samples were collected in 24 patients with acute AN, 22 with acute BN and 31 healthy controls at wakening and after 15, 30 and 60 min. They filled in the Childhood Trauma Questionnaire (CTQ), which assesses five specific forms of childhood maltreatment. Results As compared to control group, no-maltreated AN group exhibited an enhanced CAR whereas no-maltreated BN group showed a normal CAR. Moreover, both AN and BN patients with childhood maltreatment exhibited a statistically significant blunted CAR as compared to no-maltreated patients. Discussion Present findings suggest that childhood adverse experiences may affect the CAR in adults with AN or BN and this may represent a functional background of the endogenous stress response system, which may have relevant implications in the pathophysiology of EDs.

The Association of 5-HTTLPR Gene Polymorphisms and Eating Disorder: A Meta-Analysis

Background: Eating disorders (EDs), are characterized by abnormal eating habits, including insufficient or excessive food intake, and are detrimental to an individual’s physical and mental health. In this paper, we focus on AN (anorexia nervosa) and BN (bulimia nervosa), which are included in EDs. Some studies reported that there may be an association of 5-HTTLPR gene and eating disorders but without clear conclusion to solidify this relationship. Therefore, the goal of this study is to summarize on the reported data and meta-analytically investigate the relationship between the 5-HTTLPR gene polymorphisms and eating disorders. Method: We searched through all published papers indexed in MEDLINE, EMBASE, and CNKI from inception to May 2015. All studies that we examined regarding the relationship between 5-HTTLPR polymorphisms and EDs were identified to perform this meta-analysis. Odds ratio (OR) and 95% confidence intervals (CIs) were used to evaluate the EDs risk. Results: Fourteen studies met the inclusion criteria. We performed this meta-analysis involving 2238 subjects in total (including 1832 EDs patients, 779 AN patients, 722 BN patients and 406 control subjects). The 5-HTTLPR S allele was significantly more common in all EDs patients comparing to controls (S vs. L allele: OR=1.25, 95% CI: 1.02- 1.53, P=0.03). This significance was also revealed through the recessive model (SS vs. SL+LL: P=0.008) and the additive model (SS vs. LL: P=0.03). When the comparison was stratified by ethnicity (Caucasian and Asian), it shows that the significance only exists in recessive model among Caucasian population (P=0.03). Subsequently, the EDs patients were divided into two groups (AN and BN) to analyze the association between 5-HTTLPR polymorphism and AN or BN. The results showed that S allele was significantly more frequently discovered in the AN group than in the control group (P=0.006). Other comparison models suggest similar results. Ethnically stratified analysis suggested that 5-HTTLPR polymorphism only correlates with AN among Caucasians, but not Asians. However, no statistical difference was found between BN patients and controls in any comparative analysis. Conclusion: The 5-HTTLPR S allele can result in increased risk for AN but not BN. Of all the ethnical groups that we studied, Caucasian females appear to be the most likely to become susceptible to EDs/AN under the influence of 5-HTTLPR S allele. These results may be helpful to our clinical practice. However, further studies with larger sample sizes are needed for more reliable and conclusive results.

Impact of NEGR1 genetic variability on psychological traits of patients with eating disorders.

Genetics variants in the NEGR1 gene, strongly expressed in the brain, have been reported to affect the neuronal control of food intake therefore inducing obesity. With the same rationale, we hypothesized that this genetic variability may be associated with psychological traits commonly displayed by eating disorder (ED) patients and/or with the risk for the disorder. We analyzed 21 tag-single-nucleotide polymorphisms (SNPs) in the coding sequence and adjacent regions of the NEGR1 gene. A total of 169 ED patients (106 with anorexia nervosa (AN) and 63 with bulimia nervosa (BN)) and 312 healthy subjects were genotyped. Personality traits and general psychopathological symptoms were assessed by the Eating Disorders Inventory Test-2 (EDI-2) and Symptom Checklist 90 Revised inventories. None of the SNPs or haplotypes analyzed were associated with a greater risk of ED or correlated with anthropometric parameters. However, in patients with BN, four SNPs (rs12740031, rs10789322, rs6659202 and rs591540) correlated with the scores in Drive for Thinness (DT), Ineffectiveness (I) and Interoceptive Awareness (IA) (Bonferroni-P<0.05 in all instances). The first two SNPs along with rs954299 and rs2422021 formed a haplotype block, which showed a consistent association with the EDI-2 score in BN patients (Bonferroni-P=0.01). A subsequent three-SNP sliding-window approach identified a central area, encompassing both the haplotype block and the individually relevant SNPs that strongly correlated with the scores of BN patients in DT, I, IA and Bulimia. No associations were identified in the AN group. These preliminary results indicate that NEGR1 could be an important locus influencing certain personality dimensions in BN patients.

Improved planning abilities in binge eating.

ObjectiveThe role of planning in binge eating episodes is unknown. We investigated the characteristics of planning associated with food cues in binging patients. We studied planning based on backward reasoning, reasoning that determines a sequence of actions back to front from the final outcome.MethodA cross-sectional study was conducted with 20 healthy participants, 20 bulimia nervosa (BN), 22 restrictive (ANR) and 23 binging anorexia nervosa (ANB), without any concomitant impulsive disorder. In neutral/relaxing, binge food and stressful conditions, backward reasoning was assessed with the Race game, promotion of delayed large rewards with an intertemporal discounting task, attention with the Simon task, and repeating a dominant behavior with the Go/No-go task.ResultsBN and to a lower extent ANB patients succeeded more at the Race game in food than in neutral condition. This difference discriminated binging from non-binging participants. Backward reasoning in the food condition was associated with lower approach behavior toward food in BN patients, and higher food avoidance in ANB patients. Enhanced backward reasoning in the food condition related to preferences for delayed large rewards in BN patients. In BN and ANB patients the enhanced success rate at the Race game in the food condition was associated with higher attention paid to binge food.ConclusionThese findings introduce a novel process underlying binges: planning based on backward reasoning is associated with binges. It likely aims to reduce craving for binge foods and extend binge refractory period in BN patients, and avoid binging in ANB patients. Shifts between these goals might explain shifts between eating disorder subtypes.

Reduced resting-state functional connectivity of the somatosensory cortex predicts psychopathological symptoms in women with bulimia nervosa.

Background: Alterations in the resting-state functional connectivity (rs-FC) of several brain networks have been demonstrated in eating disorders. However, very few studies are currently available on brain network dysfunctions in bulimia nervosa (BN). The somatosensory network is central in processing body-related stimuli and it may be altered in BN. The present study therefore aimed to investigate rs-FC in the somatosensory network in bulimic women.Methods: Sixteen medication-free women with BN (age = 23 ± 5 years) and 18 matched controls (age = 23 ± 3 years) underwent a functional magnetic resonance resting-state scan and assessment of eating disorder symptoms. Within-network and seed-based functional connectivity analyses were conducted to assess rs-FC within the somatosensory network and to other areas of the brain.Results: Bulimia nervosa patients showed a decreased rs-FC both within the somatosensory network (t = 9.0, df = 1, P = 0.005) and with posterior cingulate cortex and two visual areas (the right middle occipital gyrus and the right cuneus) (P = 0.05 corrected for multiple comparison). The rs-FC of the left paracentral lobule with the right middle occipital gyrus correlated with psychopathology measures like bulimia (r = −0.4; P = 0.02) and interoceptive awareness (r = −0.4; P = 0.01). Analyses were conducted using age, BMI (body mass index), and depressive symptoms as covariates.Conclusion: Our findings show a specific alteration of the rs-FC of the somatosensory cortex in BN patients, which correlates with eating disorder symptoms. The region in the right middle occipital gyrus is implicated in body processing and is known as extrastriate body area (EBA). The connectivity between the somatosensory cortex and the EBA might be related to dysfunctions in body image processing. The results should be considered preliminary due to the small sample size.

Wide impairment of cerebral serotoninergic activity but inter-individual heterogeneity in bulimia nervosa patients: a pilot [18F]MPPF/PET study

Objectives. Bulimia nervosa (BN) is associated with abnormalities of serotoninergic system. Functional or ligand specific brain imaging studies revealed abnormalities in non-overlapping regions. [18F]MPPF (4-(2-methoxyphenyl)-1-[2-(N-2-pyridinyl)-p-fluorobenzamido]-ethylpiperazine) is a selective 5-HT1A receptor antagonist with a serotonin-like affinity, capable to assess changes of brain serotoninergic activity in BN patients. Methods. [18F]MPPF cerebral binding potential (BPND) was measured by positron emission tomography scan in nine purging-type BN patients and eleven age-matched controls. Voxel-based statistical parametric mapping (SPM) analyses were performed to assess BPND differences between the two groups and between each BN patient and controls group. Results. Mean [18F]MPPF BPND was overall increased in BN patients. SPM analysis with revealed symmetrical large clusters of increased [18F]MPPF binding in insula, temporo-parietal cortex, prefrontal cortex, in limbic, paralimbic cortex and raphe nuclei. SPM individual analysis indicated significant heterogeneity of [18F]MPPF mapping within BN group, including cases with isolated up to widespread increased binding. [18F]MPPF BPND did not covariate with depression or eating behaviour-related scores. Conclusions. Large clusters of increased [18F]MPPF binding in severe BN overlap previous results, separately described within fMRI or PET studies. The relationship between the inter-individual [18F]MPPF binding heterogeneity and serotoninergic modulators efficacy in these patients remains to be assessed.

Obstetric complications and eating disorders: a replication study.

To provide data about the role of obstetric complications (OCs) in a large and well-characterized sample of patients with anorexia nervosa (AN) or bulimia nervosa (BN). The new sample consists of 150 patients with AN and 35 patients with BN, and 73 healthy women; statistical analyses were performed on the new sample alone and on the larger sample created by merging the new dataset with the previous one (264 AN, 108 BN, and 624 healthy women). All data about OCs were collected blind to diagnostic status. OC rates in the replication sample were similar to those of our previous studies. In the whole sample, the risk of developing AN was significantly associated with the occurrence and number of pregnancy, delivery, hypoxic, and dysmaturity complications. The risk of developing BN was significantly associated with dysmaturity complications. Signs of retarded fetal growth (being small and short for gestational age, short head circumference) significantly distinguished BN patients from both AN and healthy individuals. Significantly higher number of OCs were found in the binge eating/purging type of AN, in comparison with restricting AN patients. Our study provides further evidence of the role of OCs as putative risk factors for the development of eating disorders, showing different pathways between AN and BN.

Eating attitudes of anorexia nervosa, bulimia nervosa, binge eating disorder and obesity without eating disorder female patients: differences and similarities

The objective was to compare eating attitudes, conceptualized as beliefs, thoughts, feelings, behaviors and relationship with food, of anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED) patients and a group of obese (OBS) without eating disorders (ED). Female patients from an Eating Disorder (ED) Unit with AN (n=42), BN (n=52) and BED (n=53) and from an obesity service (n=37) in Brazil answered the Disordered Eating Attitude Scale (DEAS) which evaluate eating attitudes with 5 subscales: relationship with food, concerns about food and weight gain, restrictive and compensatory practices, feelings toward eating, and idea of normal eating. OBS patients were recruited among those without ED symptoms according to the Binge Eating Scale and the Questionnaire on Eating and Weight Patterns. ANOVA was used to compare body mass index and age between groups. Bonferroni test was used to analyze multiple comparisons among groups. AN and BN patients presented more dysfunctional eating attitudes and OBS patients less dysfunctional (p<0.001). For DEAS total score, AN and BN patients were similar and all other were different (p<0.001). Similarities suggested between BN and BED were true just for the “Relationship with food” and “Idea of normal eating.” BED patients were worst than OBS for “Relationship with food” and as dysfunctional as AN patients — besides their behavior could be considered the opposite. Differences and similarities support a therapeutic individualized approach for ED and obese patients, call attention for the theoretical differences between obesity and ED, and suggest more research focused on eating attitudes.

The role of leptin, melanocortin, and neurotrophin system genes on body weight in anorexia nervosa and bulimia nervosa

ObjectiveAlthough low weight is a key factor contributing to the high mortality in anorexia nervosa (AN), it is unclear how AN patients sustain low weight compared with bulimia nervosa (BN) patients with similar psychopathology. Studies of genes involved in appetite and weight regulation in eating disorders have yielded variable findings, in part due to small sample size and clinical heterogeneity. This study: (1) assessed the role of leptin, melanocortin, and neurotrophin genetic variants in conferring risk for AN and BN; and (2) explored the involvement of these genes in body mass index (BMI) variations within AN and BN. MethodOur sample consisted of 745 individuals with AN without a history of BN, 245 individuals with BN without a history of AN, and 321 controls. We genotyped 20 markers with known or putative function among genes selected from leptin, melanocortin, and neurotrophin systems. ResultsThere were no significant differences in allele frequencies among individuals with AN, BN, and controls. AGRP rs13338499 polymorphism was associated with lowest illness-related BMI in those with AN (p = 0.0013), and NTRK2 rs1042571 was associated with highest BMI in those with BN (p = 0.0018). DiscussionTo our knowledge, this is the first study to address the issue of clinical heterogeneity in eating disorder genetic research and to explore the role of known or putatively functional markers in genes regulating appetite and weight in individuals with AN and BN. If replicated, our results may serve as an important first step toward gaining a better understanding of weight regulation in eating disorders.