Bulimia Research Articles

The Role of Self-Control in Anorexia Nervosa

Self-control, a key cognitive ability, facilitates the adjustment of behaviour to meet societal norms by overriding thoughts and emotions. Abnormal self-control can be detrimental, particularly in the context of Anorexia Nervosa (AN). AN is a disorder marked by extreme self-control, particularly in dietary intake, potentially leading to deficits in emotional regulation and cognitive abilities. The fear of weight gain can heighten anxiety levels, leading to more restrictive diets and potential comorbidity with other disorders when weight satisfaction is not achieved. However, the exact mechanism between self-control and AN is unclear. Therefore, this review aims to enhance understanding of AN and the role of self-control in its development and management from three perspectives: the cognitive aspects of self-control in AN, factors of social and emotion in AN and self-self, and effective interventions for AN. Through this examination, this review aims to deepen peoples understanding of AN and the role of self-control in its manifestation and management. This review investigates the multifaceted interplay between AN, self-control, emotional regulation, and cognitive rigidity, characterized by restrictive dietary practices and exceedingly low body weights, and presented in two distinct subtypes: restricting and binge-eating/purging. AN individuals exhibit high self-regulation but are prone to negative affective states, underscoring the complexity of emotional regulation in this disorder. A comparison with Bulimia Nervosa illuminates that enhancing self-control can have divergent effects: potentially reducing restrictive eating in AN, while escalating excessive eating in Bulimia Nervosa. The review also highlights the escalated social-cognitive sensitivity and cognitive rigidity in AN individuals, which often trigger restrictive eating. Further, it points to the low mentalizing abilities and high alexithymia levels in AN individuals, leading to cognitive and behavioural inflexibility. Finally, it proposes that neuro-modulatory interventions, such as transcranial magnetic stimulation, may enhance cognitive flexibility in food choices, providing a novel perspective on AN treatment. This review can provide some guidance for prevention and intervention progroms in high schools and colleges.

Understanding and Treating Eating Disorders in a Psychoanalytic Approach

Eating disorders are mental illnesses, including anorexia nervosa, bulimia nervosa, and binge-eating disorder. Psychoanalysis is a common approach applied in psychotherapies, which focuses on peoples unconsciousness. Projection, transference, and countertransference are defense mechanisms identified by psychoanalysis. This review mainly discusses the role of the psychoanalytic approach in understanding and treating eating disorder patients. The likelihood of developing eating disorders is closely related to peoples personalities, current life situations, and interpersonal relationships. Through early observational learning, young children tend to regulate their emotions in a similar manner to their parents. People form a secure attachment or an insecure attachment mainly in childhood. The attachment types are likely to predict ones probability of developing eating disorders in later life. The majority of patients experience eating disorders due to certain unconscious reasons. To treat eating disorders that are caused by past experiences, the key is to identify the meaning underlying their issues in eating that are related to their childhood. This review can provide some guidance to the development of parent education programs.

The prevalence of laxative and diuretic abuse in patients with anorexia nervosa and bulimia nervosa

The article is devoted to the study of laxative and diuretic abuse among patients with anorexia nervosa (AN) and bulimia nervosa (BN). The medical records of 152 patients with AN and NB, who were hospitalized in a specialized clinic for the treatment of eating disorders, were studied. Of 152 patients, 52 % (N=79) had restricting anorexia nervosa, 29.6 % (N=45) had purgative anorexia nervosa, and 18.4 % (N=28) had bulimia nervosa. The number of people abusing laxatives and diuretics in the groups with AN purgative type and BN did not differ significantly. Laxative abuse accounted for 42.2 % (N=19) and 42.9 % (N=12) in AN purgative type and BN, respectively. Diuretics abuse accounted for 20 % (N=9) and 17.9 % (N=5) in AN purgative type and BN, accordingly. The total number of laxative and diuretic abusers among the patients with eating disorders was 20.4 % (N=31) and 9.2 % (N=14), respectively.

Eating disorders associated with polycystic ovary syndrome, a literature review

Polycystic Ovary Syndrome (PCOS) is a common enigmatic, heterogenous endocrine disorder with multisystem consequences affecting women at reproductive age. Most associated dysfunctions in PCOS patients include ovarian dysmorphology, hormonal imbalances, metabolic disturbances, and neuropsychological impairments. Emerging studies have shown a relationship between women with PCOS and eating disorders (ED). ED is described as a psychological disorder characterized by extreme and constant disruptions in eating behaviors that can negatively impact one’s mental health and status. Types of EDs include binge eating disorder (BED), bulimia nervosa (BN), anorexia nervosa (AN), other specified feeding or eating disorders (OSFED), and unspecified feeding and eating disorders (UFED). Understanding the clinical relevance of these associations and adding correct assessments of ED as a key determinant of eating behavior may contribute to the successful treatment of women with PCOS. Thus, this review aims to outline a more profound connection between the involvement of multiple eating disorders and related disordered eating in women with PCOS; it also establishes a wider overview regarding the prevalence of comorbidities in eating disorders. Furthermore, the majority of researchers advised that screening for eating disorders, PCOS phenotyping, and neuroimaging modalities can be utilized to provide a better health outcome in PCOS patients.

Description of patients with eating disorders by general practitioners: a cohort study and focus on co-management with depression

BackgroundInternational guidelines often state that general practitioners (GPs) provide early management for most patients with eating disorders (EDs). GP management of EDs has not been studied in France. Depressive disorders are often a comorbidity of EDs. The aims of this study were to describe in France the characteristics of people with all subcategories of EDs (Anorexia Nervosa, Bulimia Nervosa, ED Not Otherwise Specified) managed by their GPs and to study the management temporality between depression and all subcategories of EDs.MethodsRetrospective cohort study of patients with EDs visiting French GPs. Data collected from 1994 through 2009 were extracted from the French society of general electronic health record. A descriptive analysis of the population focused on depression, medication such as antidepressants and anxiolytics, and the management temporality between depression and EDs.Results1310 patients aged 8 years or older were seen at least once for an ED by a GP participating in the database out of 355,848 patients, with a prevalence rate of 0.3%. They had a mean age of 35.19 years, 82.67% were women. 41.6% had anorexia nervosa, 26.4% bulimia nervosa, and 32% an ED not otherwise specified. Overall, 32.3% had been managed at least once for depression, and 18.4% had been prescribed an antidepressant of any type at least once. Benzodiazepines had been prescribed at least once for 73.9% of the patients treated for depression. Patients with an ED seen regularly by their GP (“during” profile) received care for depression more frequently than those with other profiles. 60.9% had a single visit with the participating GP for their ED Treatment and management for depression did not precede care for EDs.ConclusionsData extracted from the French society of general practice were the only one available in France in primary care about EDs and our study was the only one on this topic. The frequency of visits for EDs was very low in our general practice-based sample. Depressive disorders were a frequent comorbidity of EDs. GPs could manage common early signs of depression and EDs, especially if they improved their communication skills and developed collaborative professional management.

Examining trait-like factors as predictors of state-level responses to food intake in women with bulimia nervosa, purging disorder, and controls.

Theories suggest that elevated negative affect and weight/shape concerns explain both who is affected by bulimic symptoms as well as when bulimic symptoms occur, suggesting that individual differences predict within-subject differences. However, few studies have tested this theoretical premise. In the present study, participants (N = 119) diagnosed with bulimia nervosa (N = 57), purging disorder (N = 31), and non-eating disorder controls (N = 31) completed measures of negative affect and weight/shape concerns and later made momentary affect and weight/shape concerns ratings before and after an ad lib meal. State negative affect and weight/shape concerns increased post-meal. No moderating effect of trait negative affect was observed for state affect. In contrast, between-subject differences in weight/shape concerns moderated within-subject increases in state weight/shape concerns. Diagnostic group did not account for this effect. Findings point to viable treatment targets for disordered eating. Targeting elevated weight/shape concerns early in interventions could facilitate reductions in purging after food intake for bulimia nervosa and purging disorder. In the present study, individual differences in weight/shape concerns at baseline predicted greater increases in state weight/shape concerns following eating. These effects were maintained when considering possible differences related to presence and type of eating disorder. Results suggest that targeting weight/shape concerns earlier in treatment may be important for reducing maladaptive responses to eating across eating disorders.

Unconventional compensation methods used by patients with bulimia nervosa

Bulimia nervosa is an eating disorder that is more common among young girls and women. It bears a lot of life-long consequences for those affected by it and in most severe cases can be deadly. The aim of the study was to review the literature to help describe unconventional compensation methods used by patients with bulimia nervosa. The following methods were described: excessive and compulsive physical activity, induced vomiting, strict diets, enemas, use of pharmacy products, medication and dietary supplements, diabulimia and drunkorexia. Atypical compensation methods used by bulimics depend on the resources the patients have at their disposal. Bulimia nervosa is still a significant and complicated health problem, also effective prevention methods have not been developed. Therefore, it is particularly important to observe people at risk of such disorder.

The cerebellum plays more than one role in the dysregulation of appetite: Review of structural evidence from typical and eating disorder populations.

Dysregulated appetite control is characteristic of anorexia nervosa (AN), bulimia nervosa (BN), and obesity (OB). Studies using a broad range of methods suggest the cerebellum plays an important role in aspects of weight and appetite control, and is implicated in both AN and OB by reports of aberrant gray matter volume (GMV) compared to nonclinical populations. As functions of the cerebellum are anatomically segregated, specific localization of aberrant anatomy may indicate the mechanisms of its relationship with weight and appetite in different states. We sought to determine if there were consistencies in regions of cerebellar GMV changes in AN/BN and OB, as well as across normative (NOR) variation. Systematic review and meta-analysis using GingerALE. Twenty-six publications were identified as either case-control studies (nOB =277; nAN/BN =510) or regressed weight from NOR data against brain volume (total n=3830). AN/BN and OB analyses both showed consistently decreased GMV within Crus I and Lobule VI, but volume reduction was bilateral for AN/BN and unilateral for OB. Analysis of the NOR data set identified a cluster in right posterior lobe that overlapped with AN/BN cerebellar reduction. Sensitivity analyses indicated robust repeatability for NOR and AN/BN cohorts, but found OB-specific heterogeneity. Findings suggest that more than one area of the cerebellum is involved in control of eating behavior and may be differentially affected in normal variation and pathological conditions. Specifically, we hypothesize an association with sensorimotor and emotional learning via Lobule VI in AN/BN, and executive function via Crus I in OB.

Gastric acid challenge of lithium disilicate–reinforced glass–ceramics and zirconia-reinforced lithium silicate glass–ceramic after polishing and glazing—impact on surface properties

ObjectivesTo investigate the impact of simulated gastric acid on the surface properties of lithium disilicate–reinforced glass–ceramics and zirconia-reinforced lithium silicate glass–ceramic after certain polishing and glazing procedures.Materials and methodsFour different types of square-shaped specimens (10 × 10 × 2 mm3, n = 13) were manufactured: lithium disilicate–reinforced glass–ceramic milled and polished (LDS-P); milled, polished, and glazed (LDS-PG); milled, glazed, and no polishing (LDS-G); and milled and polished zirconia-reinforced lithium silicate glass–ceramic (ZR-LS). Specimens were immersed in hydrochloride acid (HCl 0.06 M, pH 1.2) to simulate gastric acid irritation and stored in the acid for 96 h in 37 °C. Specimen weight, surface gloss, Vickers surface microhardness and surface roughness (Ra, Rq, with optical profilometer), and surface roughness on nanometer level (Sq, Sal, Sq/Sal, Sdr, Sds with atomic force microscope) were measured before and after the acid immersion.ResultsZR-LS specimens lost significantly more weight after acid immersion (p = 0.001), also surface microhardness of ZR-LS was significantly reduced (p = 0.001). LDS-G and LDS-PG showed significantly lower surface roughness (Sa, Sq) values compared to LDS-P before (p ≤ 0.99) and after (p ≤ 0.99) acid immersion and ZR-LS after acid immersion (p ≤ 0.99).ConclusionsGastric acid challenge affects the surface properties of lithium disilicate–reinforced glass–ceramic and zirconia-reinforced lithium silicate glass–ceramic. Glazing layer provides lower surface roughness, and the glazed surface tends to smoothen after the gastric acid challenge.Clinical relevanceSurface finish of lithium disilicate–reinforced glass–ceramic and zirconia-reinforced lithium silicate glass–ceramic has a clear impact on material’s surface properties. Gastric acidic challenge changes surface properties but glazing seems to function as a protective barrier. Nevertheless, also glazing tends to smoothen after heavy gastric acid challenge. Glazing can be highly recommended to all glass–ceramic restorations but especially in patients with gastroesophageal reflux disease (GERD) and eating disorders like bulimia nervosa.

Childhood maltreatment, alexithymia and eating disorder psychopathology: A mediation model

BackgroundThe relationship between childhood maltreatment and eating disorder psychopathology has been under-investigated. ObjectiveThe purpose of this study was to investigate the role of alexithymia in mediating the relationship between childhood maltreatment experiences and eating disorder (ED) symptoms. Participants and settingOne-hundred-forty-three women with anorexia nervosa, 110 women with bulimia nervosa and 108 healthy women filled in the Eating Disorder Inventory-2, the Childhood Trauma Questionnaire and the Toronto Alexithymia Scale-20 (TAS-20). MethodsA mediator path model including childhood trauma types as predictors, the subscales of the TAS-20 as mediators and ED specific symptoms as dependent variables was conducted in individuals with EDs and in healthy women. ResultsIn women with EDs emotional abuse was directly associated with body dissatisfaction and was associated to drive to thinness, bulimia and body dissatisfaction through the mediation of difficulties to identify emotions. In healthy women, physical neglect was directly associated to drive to thinness and bulimia, but no significant mediation effect through alexithymia emerged. ConclusionImpaired emotion recognition mediates the association between childhood emotional abuse and ED symptoms. Individuals with early emotional abuse may experience ED symptoms to manage confused emotional perceptions. Improving emotional understanding and acceptance may be a treatment target in early maltreated individuals with EDs.

A randomised controlled trial of clinician supported vs self-help delivery of online cognitive behaviour therapy for Bulimia Nervosa

High dropout rates and poor adherence associated with digital interventions have prompted research into modifications of these treatments to improve engagement and completion rates. This trial aimed to investigate the added benefit of clinician support when paired alongside a ten-session, online cognitive behaviour therapy (CBT) self-help intervention for bulimia nervosa (BN). As part of a three-arm, phase II randomised controlled trial, 114 participants (16 years or over) with full or subthreshold BN were randomly assigned to complete the intervention in a self-help mode (with administrative researcher contact; n = 38), with adjunct clinician support (weekly 30-minute videoconferencing sessions; n = 37), or a no-treatment waitlist control (WLC; n = 39). Baseline to post-treatment (12-weeks) decreases in objective binge episode frequency were significantly greater for clinician-supported participants as compared to WLC, but not for self-help when compared to WLC. However, due to continued improvements for self-help across follow-up (24-weeks), both arms outperformed WLC when analysed as an overall rate of change across three timepoints. Clinician-supported participants outperformed self-help in regards to laxative use and dietary restraint. Our results demonstrate that good clinical outcomes can be achieved with a relatively brief online CBT-based program even in the absence of structured clinical support, indicating a possible overreliance upon clinician support as a primary adherence-facilitating mechanism.

A 12-month study of dialectical behavioral therapy for bοrderline patients suffering from eating disorders

PurposeIndividuals with eating disorders (ED) and comorbid borderline personality disorder (BPD) may benefit from therapies focusing on emotion regulation, such as dialectical behavioral therapy (DBT). The aim of the study was to evaluate the effectiveness of one-year standard DΒΤ enhanced with cognitive-behavioral therapy (CBT) strategies for patients suffering from ED and BPD.MethodsSeventy-two BPD and ED (anorexia and bulimia nervosa) participants were recruited from the eating disorders unit of the 1st Psychiatric Department of National and Kapodistrian University of Athens. All participants completed one year of standard DBT. ED-related behaviors were added to the treatment plan according to the DBT targeting hierarchy. Individual therapy and skills training group sessions were adapted to incorporate CBT strategies for nutritional and weight restoration. BPD and ED symptomatology were measured at the beginning and at the end of one year of treatment.ResultsThe major finding of the study was the significant improvement of patients in all the outcome measurements after one year of treatment. The study's second finding was that the severity of BPD symptomatology was significantly related to the severity of ED symptomatology. It was also shown that improvement of the patients coping skills was correlated with the reduction of ED and BPD symptomatology.ConclusionsThese results support previous studies on the effectiveness of DBT for comorbid BPD and EDs. Despite the promising results, randomized controlled trials are needed to establish the efficacy of DBT for BPD and ED patients.Level of evidenceLevel IV: Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

Microbiota-gut-brain axis drives overeating disorders

Overeating disorders (ODs), usually stemming from dieting history and stress, remain a pervasive issue in contemporary society, with the pathological mechanisms largely unresolved. Here, we show that alterations in intestinal microbiota are responsible for the excessive intake of palatable foods in OD mice and patients with bulimia nervosa (BN). Stress combined with a history of dieting causes significant changes in the microbiota and the intestinal metabolism, which disinhibit the vagus nerve terminals in the gut and thereby lead to a subsequent hyperactivation of the gut-brain axis passing through the vagus, the solitary tract nucleus, and the paraventricular nucleus of the thalamus. The transplantation of a probiotic Faecalibacterium prausnitzii or dietary supplement of key metabolites restores the activity of the gut-to-brain pathway and thereby alleviates the OD symptoms. Thus, our study delineates how the microbiota-gut-brain axis mediates energy balance, unveils the underlying pathogenesis of the OD, and provides potential therapeutic strategies.

Nutritional, anthropometric characteristics and the probability of suffering disorders of eating behavior in classical dancers in four academies of the central department

Background: Eating behavior disorders (EDs) are mental health disorders characterized by pathological behavior towards food intake and an obsession with weight control, accompanied by distortion of the perception of body image. Methods: An observational, descriptive and cross-sectional study with a quantitative approach was carried out, which included 4 classical dance academies in the Central department, specifically classical dance dancers within the age range 12 to 18 years, whose parents signed an informed consent. Poorly completed surveys and male dancers were excluded. Sociodemographic data, eating and anthropometric characteristics, and the probability of having eating behavior disorders were analyzed using two scales, SCOFF and BULIT. The work regarding the bioethical principles of research to manage the personal data of the participants, only those data strictly necessary to solve the research objectives were taken. A formal letter was provided to the parents to confirm that their daughters could be part of the investigation. The study was presented to the Ethics Committee of the Universidad del Pacifico. Results: Of 91 female classical dancers surveyed, 17 (19 %) were 12 years old; 27 (30 %) are from Academy A; 89 % (n=81) do eat fruit; 86 % (n=78) vegetables; 100 % (n=91) consume meat; dairy products and derivatives 98 % (n=89); legumes it was obtained that 82 % (n=75) consume it; 88 % (n=80) consume sugary drinks; and in terms of the consumption of pure water, 60 % (n=55) make adequate consumption. For the anthropometric data, 43 % (n=39) weigh between 50 and 59.9 kg; 57 % (n=52) measure between 151 and 160 cm, 85 % (n=77) have adequate height, 70 % (n=64) of classical dance students are at risk of suffering behavioral disorders food according to the SCOFF scale; while 99 % (n=90) of the dancers do not present any risk of suffering from Bulimia Nervosa according to the BULIT scale. Conclusion: We conclude that classical dance dancers are likely to suffer from eating disorders, since this population is considered highly exposed, especially in the adolescent stage, since even today there is social pressure on the canon of beauty that they must achieve and sustain to be accepted and included.

Alterations of interhemispheric functional homotopic connectivity and corpus callosum microstructure in bulimia nervosa.

Accumulating evidence indicates maladaptive neural information interactions between different brain regions underlie bulimia nervosa (BN). However, little is known about the alterations in interhemispheric communication of BN, which is facilitated by the corpus callosum (CC), the major commissural fiber connecting the two hemispheres. To shed light on the interhemispheric communications in BN, the present study aims to explore alterations of interhemispheric homotopic functional connectivity and the CC microstructure in BN. Based on magnetic resonance imaging (MRI) data collected from 42 BN patients and 38 healthy controls (HCs), the group differences of voxel-mirrored homotopic connectivity (VMHC) index and CC white matter microstructure were compared. Then brain regions with significant group differences in VMHC were selected as seeds for subsequent functional connectivity (FC) analysis. Seed-based fiber tracking and correlation analysis were used to analyze the relationship between VMHC and CC changes. And correlation analysis was used to reveal the correlation between abnormal imaging variables and the clinical features of BN. Compared with HCs, the BN group showed decreased fractional anisotropy (FA) in middle part of CC (CCMid) and increased VMHC in bilateral orbitofrontal cortex (OFC) and middle temporal gyrus (MTG) [false discovery rate (FDR) correction with a corrected threshold of P<0.05]. Subsequent FC analyses indicated increased FC between left OFC and right OFC, bilateral MTG, left middle occipital gyrus and right precuneus (PCUN); between right OFC and left cerebellum crus II and right PCUN; and between left MTG and right inferior temporal gyrus, right cerebellum lobule VI and right medial superior frontal gyrus (FDR correction with a corrected threshold of P<0.05). The VMHC values of OFC and MTG showed no correlations with FA values of the CCMid and the white fibers between the bilateral OFC and MTG were not through the CCMid. In addition, several regions with abnormal FC had a potential correlation trend with abnormal eating behaviors in BN patients (P<0.05, uncorrected). Aberrant interhemispheric homotopic functional connectivity and CC microstructure were observed in BN, and they may be independent of each other. Regions with aberrant interhemispheric homotopic functional connectivity showed hyperconnectivity with regions related to reward processing, body shape perception, and self-reference.

How to assess eating disorder severity in males?The DSM-5 severity index versus severity based on drive for thinness

ABSTRACT Using a male eating disorder (ED) sample, this study assessed the clinical utility of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) severity indices for males with anorexia nervosa (AN) and bulimia nervosa (BN) and compared it to an alternative transdiagnostic severity categorisation based on drive for thinness (DT). The participants included 143 males with an ED (60 [42.0%] AN and 83 [58.0%] BN) diagnosis, who were classified using these two severity classifications. The different severity categories were then compared based on ED symptoms, general psychopathology, and personality traits. Our results revealed that the DSM-5 “mild” and DT “low” severity categories were most prevalent in the AN and BN male patients. Clinically significant findings were strongest for the DT categorisation for both AN and BN. The current findings provide initial support for an alternative transdiagnostic DT severity classification for males that may be more clinically meaningful than the DSM-5 severity indices.

Effect of simulated gastric acid on aesthetical restorative CAD-CAM materials' microhardness and flexural strength.

Gastric acid, which is among erosive substances, gradually rises to the mouth in individuals with reflux and bulimia nervosa disorders, and this causes various effects on dental restorations. The objective of this study is in vitro investigation of gastric acid's effect on flexural strength and hardness on aesthetic restorative computer-aided design and computer-aided manufacturing (CAD-CAM) materials. For this study, four materials have been used, namely Enamic (Vita), Superfect Zir (Aidite) Zirconia, IPS e.max CAD (Ivoclar Vivadent), and Mark II (Vita). From these four different materials, 24 samples with 14 × 4 × 1 dimensions in rectangular prism form are used, which makes a total of 96 samples. One group was separated as the control group, while the rest was allowed to wait at 37°C, 5 ml gastric acid for 96 hours. Hardness value and flexural strengths were measured as pre-exposure and post-exposure to gastric acid. There is a statistically significant difference between the groups in terms of the amount of decrease in the mean hardness after exposure to gastric acid compared to pre-exposure values (p: 0,000; P < 0,05). There was no statistically significant difference between the groups in terms of the amount of decrease in the post-exposure average flexural strength compared to the pre-exposure value (p: 0.063; P > 0.05). There is a statistically significant difference between the groups in terms of the average flexural strength after exposure to the acid. According to the data obtained, it was concluded that exposure to gastric acid affects the hardness and flexural strength properties of dental restorative ceramic materials.

Increase in incidence of anorexia nervosa among 10- to 14-year-old girls: A nationwide study in the Netherlands over four decades.

This primary care study examined time trends in the incidence of anorexia nervosa (AN) and bulimia nervosa (BN) in the Netherlands across four decades. A nationwide network of general practitioners, serving approximately 1% of the total Dutch population, recorded newly diagnosed patients with AN and BN in their practices from 1985 to 2019 (2,890,978 person-years). DSM-IV diagnostic criteria were consistently used and the same psychiatrist was responsible for the final diagnostic decision. Incidence rates (IRs) were calculated for: the total population (all ages), females overall, and females per 5-year age category. Time trends in IRs were analyzed using JoinPoint regression analyses. In four decades, the incidence of AN among 10- to 14-year-old females increased significantly from 8.6 to 38.6 per 100,000 person-years (average period percentage change [APPC] = 56.7; 95% confidence interval [CI] = 6.5-130.6. The overall incidence of AN was stable, with IRs ranging from 6.0 (95% CI = 4.3-8.1) to 8.4 (95% CI = 6.4-10.8). The IR of BN decreased significantly from 8.7 (95% CI = 6.7-11.0) to 3.2 (95% CI = 2.0-4.9) in the 2000s, before leveling off in the 2010s (IR 3.2; 95% CI = 2.0-4.8). The incidence of AN among 10- to 14-year-old girls increased significantly over four decades. Both biological and sociocultural factors, for example, early pubertal timing and the impact of social media, might explain this. In other age groups and overall, the incidence of AN remained stable. The significant decrease of the incidence of BN in the previous decades halted in the last decade. An important finding of the present study is that for 10- to 14-year-old girls, the risk for developing anorexia nervosa has increased significantly over 40 years. More healthcare facilities for younger people are needed, and prevention programs could include social media use. For bulimia nervosa, the general decrease in the occurrence of new cases has halted in the 2010s.

Thyroid dysfunction in children and adolescents affected by undernourished and overnourished eating disorders.

Eating disorders (ED) are one of the most prevalent chronic disorders in adolescents and young adults, with a significantly increasing prevalence in younger children, particularly in girls. Even if obesity in essence is not framed as an eating disorder and has always been considered a separate pathology, ED and obesity could be considered part of a continuum. It has become evident that one condition can lead to another, such as binge eating disorder (BED) and bulimia nervosa, and that they share the same repercussions in terms of psychosocial, metabolic, and nutritional health. This narrative review aims to investigate the hypothalamic-pituitary-thyroid axis in undernourished and overnourished patients with ED, including obesity, in order to highlight the relationship between weight control and thyroid function and its effects and to consider therapeutic and preventive strategies in children and adolescents. Literature data report that thyroid alterations occur in patients with ED, both underweight and overweight, and represent a continuum of changes depending on the severity and time course of the disease involving the endocrine system. Considering the relevant role thyroid hormones (TH) play not only in energy expenditure (EE) but also in metabolic control and cardiovascular risks related to dysmetabolism and mood regulation, continuous monitoring of thyroid homeostasis in patients with ED is mandatory to prevent severe complications and to start early treatment when necessary.

EFFECTIVENESS OF AUTOGENIC TRAINING ON REDUCING ANXIETY DISORDERS: A COMPREHENSIVE REVIEW AND META-ANALYSIS

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Autogenic training (AT) is a relaxation technique that has garnered attention for its potential to reduce anxiety and improve psychological well-being. &lt;strong&gt;Objectives&lt;/strong&gt;: This study aims to synthesize the findings from a diverse range of studies investigating the relationship between autogenic training and anxiety disorder across different populations and settings. &lt;strong&gt;Methods:&lt;/strong&gt; A comprehensive review of 162 studies, including randomised controlled trials (RCTs), non-randomized controlled trials (N-RCTs), surveys, and meta-analysis, was conducted out of these 29 studies were selected which is directly related to the objectives of the studies. Participants in the studies had conditions such as cancer patients, bulimia nervosa, stroke survivors, coronary angioplasty, nursing students, healthy volunteers, athletes, and so on. Anxiety levels were measured before and after the AT intervention using a variety of anxiety assessment scales, including the State Trait Anxiety Inventory (STAI) and the Hospital Anxiety and Depression Scale (HADS). The formats, duration, and delivery of the interventions varied, with some studies utilising guided sessions by professionals and other self-administered practises. &lt;strong&gt;Results:&lt;/strong&gt; The combined findings of these studies revealed consistent trends in the beneficial effects of autogenic training on anxiety reduction. AT was found to be effective in reducing anxiety symptoms across a wide range of populations and settings. Following AT interventions, participants reported reduced anxiety, improved mood states, and improved coping mechanisms. AT was found to be superior to no treatment or a comparable intervention in a number of cases. &lt;strong&gt;Conclusion:&lt;/strong&gt; The body of evidence supports autogenic training as a non-pharmacological approach to reducing anxiety and improving psychological well-being. Despite differences in methodology and participant profiles, the studies show that AT has a positive impact on a wide range of populations. The findings merit further investigation and highlight AT's potential contribution to anxiety management strategies.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/soc/0071/a.php" alt="Hit counter" /&gt;&lt;/p&gt;