Development Of Anorexia Nervosa Research Articles

Come Play With Me: An Argument to Link Autism Spectrum Disorders and Anorexia Nervosa Through Early Childhood Pretend Play

This article builds on the argument of a link between behaviours observed in persons with autism spectrum disorders and persons with anorexia nervosa. In describing these behaviours, a link is made between deficits in social cognition, lack of flexible and creative thinking, theory of mind, and deficits in early pretend play ability. Early pretend play ability is a strong avenue to the development and strengthening of social cognition, problem solving, language, logical sequential thought, and understanding social situations. Currently, there is no literature on the pretend play ability of persons who develop anorexia nervosa. This article argues for research into this area which may potentially contribute to developments in new intervention strategies for these persons.

P-561 - Brazilian mothers of anorexic patients: a qualitative study about their influence to the development and prognosis of the anorexia nervosa of their daughters

Considering studies that have confirmed that family environment and some characteristics of parents, especially mothers, affect the development and maintenance of anorexia nervosa (AN) in their daughters, research on how to improve knowledge of therapeutic intervention for family members of patients became crucial. To understand the emotional experiences of mothers that affect the development and prognosis of AN. Qualitative study interviewing in depth mothers of female outpatients seen at the General Hospital of the State University of Campinas, Brazil. Mothers propose a fusional relationship with their daughters, in which aspects of individuality are ill-defined. The daughters’ attempts to become individuals are felt as an attack, and experienced by mothers as injustice and aggression. In this context, the daughters’ food symptoms can be understood as a desperate attempt at individuation. The mothers do not understand their daughters’ logic and try to remedy a qualitative deficiency with quantity, especially of food. The feelings of devotion/hostility that characterize these mothers express their violent attempt to annihilate the other as an individual, who can only exist as an opponent. These are mothers who cannot bear that their daughters are not extensions of themselves, and who have serious difficulties to understand their own real emotional needs. The attempt to meet these needs with food can only aggravate the alimentary symptoms of their daughters. The findings made it possible to identify important aspects in mothers of anorexic patients, which can improve knowledge of AN and clinical interventions to treat it.

P-550 - Multiple family therapy: together against the problem

The psychosomatic family model, developed by Minuchin hypothesizes that the prerequisite for the development of Anorexia Nervosa (AN) was a family process characterized by rigidity, enmeshment, over-involvement and conflict avoidance, which occurs alongside a physiological vulnerability in the child, but did not place blame on the parents, highlighting the evolving, interactive nature of this process and emphasizing that the psychosomatic model was more than an account of a familial origin for AN. Nowadays there is growing empirical evidence that family therapy is an effective treatment for AN, particularly in adolescence. Multiple family therapy (MFT), originally pioneered by Laqueur in the treatment of schizophrenia as a way to utilize the combined resources of families to improve family communication, learn by analogy, and expand their social repertoires, has been adapted for work with eating disorders. The authors describe two experiences of MFT - day programme organized in a Portuguese hospital with 25 families of patients with AN. Bringing several families together is a powerful therapeutic resource which helps to reduce the sense of isolation, diminishes stigmatisation, enhances opportunities to create new perspectives and addresses the pervasive sense of helplessness which families experience when trying to deal with the AN. The intensity of multiple-family day treatment leads to a strong sense of group cohesion and a highly collaborative relationship between the families and the clinical staff. In this process, many families regain their belief that they can find a way of conquering the problem, even if this may take some time.

Eating Disorder Finding May Be Prevention Road Map

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessEating Disorder Finding May Be Prevention Road MapJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:4 Nov 2011https://doi.org/10.1176/pn.46.21.psychnews_46_21_18_1AbstractBody dissatisfaction appears to be the major factor propelling young people on the road to eating disorders, an eight-year prospective study of adolescent girls suggests. Credit: Suzanne Tucker/ShutterstockThe study was headed by Eric Stice, Ph.D., a senior research scientist at Oregon Research Institute. The results were published in the October Behavior Research and Therapy. The research by Stice and his team "provides a sort of roadmap for prevention interventions," Michael Devlin, M.D., clinical codirector of eating disorders research at the New York State Psychiatric Institute, commented to Psychiatric News. "Preventing the onset of eating disorders among those at risk is certainly preferable to intervening only after the disorders have become established."The cohort in Stice's study included more than 400 middle-school girls with an average age of 14 who were recruited from four public schools and four private schools in the Austin, Texas, area.They were evaluated at baseline with a number of instruments designed to measure putative eating disorder risk factors—perceived sociocultural pressure to be thin, thin-ideal internalization, body dissatisfaction, dieting practices, negative affectivity, and depressive symptoms. Semi-structured interviews were used to evaluate the subjects annually throughout the study for three DSM-IV eating disorders—anorexia nervosa, bulimia nervosa, and binge eating disorder—as well as for subthreshold versions of these disorders and for what the researchers dubbed "purging disorder" in which an individual had to have engaged in self-induced vomiting or diuretic/laxative use for weight control purposes at least eight times a month for three months. By the end of the study, three subjects had developed anorexia nervosa, three subthreshold anorexia nervosa, six bulimia nervosa, 26 subthreshold bulimia nervosa, five binge eating disorder, 21 subthreshold binge eating disorder, and 22 purging disorder. Body dissatisfaction emerged as the most potent predictor of development of an eating disorder. Subjects in the upper 24 percent of the body dissatisfaction measurement showed a fourfold increase in the incidence of an eating disorder relative to all those with lower dissatisfaction scores—24 percent versus 6 percent.Furthermore, among the subjects in the high body dissatisfaction category, those in the upper 32 percent of depressive symptoms showed a threefold increased incidence of eating disorder relative to all those with lower depression scores—43 percent versus 15 percent.And among the participants in the low body dissatisfaction category, those in the upper 12 percent of dieting showed a fourfold increased incidence of eating disorder relative to all those with lower dieting scores—18 percent versus 5 percent."This three-way interaction suggests a body dissatisfaction pathway to eating-disorder onset that is amplified by depressive symptoms, as well as a pathway characterized by self-reported dieting among young women who are more satisfied with their bodies," Stice and his colleagues concluded in their paper."These results are novel because no prospective study has investigated risk factors for onset of any eating disorder during the entire period of adolescence or tested for interactions among risk factors," they noted.The researchers hope the results will "allow clinicians to identify youth at greatest risk for eating pathology, which can be a challenge because of the low incidence of these conditions. . . . The findings suggest that a brief body-dissatisfaction scale is the most sensitive method of identifying adolescent females at risk for onset of any eating disorder." But one also needs to keep in mind that even low body dissatisfaction accompanied by dieting is a risk factor. And the results, they pointed out, might also assist in the design of eating disorder prevention programs that target key vulnerability factors. They have designed a brief eating disorder prevention program for young women who are determined to pursue thinness regardless of what the mental or physical costs might be. Participants engage in verbal, written, and behavioral exercises designed to produce cognitive dissonance—that is, conflict between thin-ideal messages and the participants' underlying values and beliefs—and this cognitive dissonance is hoped to change participants' minds about wanting to be thin. "The program is being implemented by various organizations in the United States and several foreign countries," Stice told Psychiatric News. "The largest is Tri Delta Sorority, which is disseminating a version of this program … for sorority members."The study was funded by the National Institutes of Health.An abstract of "Risk Factors for Onset of Eating Disorders: Evidence of Multiple Risk Pathways From an Eight-Year Prospective Study" is posted at <www.sciencedirect.com/science/article/pii/S0005796711001306>. ISSUES NewArchived

Aetiology of anorexia nervosa: from a “psychosomatic family model” to a neuropsychiatric disorder?

Eating disorders and, in particular, anorexia nervosa (AN) have morbidity and mortality rates that are among the highest of any mental disorders and are associated with significant functional impairment. More than 25 years ago, several researchers hypothesised that the prerequisite for the development of AN was a family process characterised by an overprotective and conflict-avoiding parent-child interaction. Family studies, however, suggest that AN is a complex genetic disorder that is likely expressed primarily by temperament and specific traits during childhood, including inhibition, perfectionism and harm avoidance. Recent studies have described an impaired flexibility and deficits in social cognition that are independent of body weight and the current state of the eating disorder, providing further evidence for a genetic component of AN. The physiological and psychological alterations and the increasing societal demands that occur during puberty may trigger onset. The starvation process itself is associated with severe alterations of central and peripheral metabolism, especially neuroendocrine and neurotransmitter changes, which are thought to affect the adolescent brain during the vulnerable period of neural restructuring. Long-standing malnutrition during adolescence and young adulthood associated with hormonal and neuropeptide dysfunctions may produce "biological scars" that maintain and accelerate the disorder and likely result in chronic mental disorders in adulthood as well as poor social functioning.

A case of Klinefelter syndrome, mosaicism (46,XY/47,XXY), associated with anorexia nervosa

We report the case of a 12.4-yr-old boy who presented Klinefelter syndrome (KS) mosaicism (46,XY/47,XXY), associated with mental retardation and anorexia nervosa (AN). KS was undiagnosed before hospitalization in a psychiatric unit. The patient was referred to a child psychiatric unit for restrictive eating. The medical history showed long standing feeding difficulties and failure to thrive. The patient was pre-pubertal and other clinical characteristics were: microcephaly, short stature and dysmorphic traits. Cytogenetic analysis revealed a mosaicism, 46,XY[11] and 47,XXY[19] karyotype. The psychiatric assessment demonstrated the presence of AN and low mood. No specific pathophysiological links between the alterations of KS and the development of AN should be hypothesized on the basis of this case report. In pre-pubertal boys with mental disorders, the possibility of KS should be considered, independently of the presence of eating disorders. Nevertheless, the case shows that KS can be first detected during an assessment for eating disorders. Few cases of the association of KS with AN have been previously reported in literature. This is the first description of KS, mosaicism (46,XY/47,XXY), associated with AN and mental retardation. This case report illustrates the need, for clinicians who work with eating disorders, to investigate the possible association between AN and KS, a rare but intriguing one.

In uteroexposure to virus infections and the risk of developing anorexia nervosa

The study aims to explore, using indirect ecological measures of exposure, the role of viral infections in the development of anorexia nervosa (AN). The cohort of participants consisted of all female subjects born in the Veneto region in the period between 1970 and 1984, and residing in the urban and suburban area of Padua (27,682 female subjects in an area of 424 km2). The main outcome measure was the diagnosis of AN resulting from the Public Mental Health Database, the Register of Hospital Admissions, and the Register of the Eating Disorders Unit (n=402, 1.4%). The number of cases of rubella, chickenpox, influenza and measles was ascertained for each month for the 15-year period. Exposures during the sixth month of pregnancy to the peaks of chickenpox [odds ratio (OR) 1.6, 95% confidence interval (CI) 1.2-2.0] and rubella infections (OR 1.5, 95% CI 1.1-2.0) were significantly associated with an increased risk of developing AN, even after controlling for socio-economic status, urbanization and month of birth. We found weak evidence of a season-of-birth bias. In utero exposure to viral infection could be a risk factor for developing AN. We need further epidemiological and serological studies to confirm this hypothesis.

The incidence of anorexia nervosa in Netherlands Antilles immigrants in the Netherlands

Previously we found that the incidence of anorexia nervosa (AN) in the general population was much lower in the Netherlands Antilles than in the Netherlands. As a follow-up we compared the incidence of AN in the Netherlands in persons from the Netherlands Antilles to native Dutch. A national register of psychiatric hospital admissions was screened for cases of AN. Incidence rates (IR) and incidence rate ratios (IRR) were computed. The IR of AN was 1.32 per 100 000 person years (95% confidence interval (CI): 0.53-2.71) for Netherlands Antilleans and 1.09 (95% CI: 1.04-1.15) for native Dutch. The age- and sex-adjusted IRR was 1.21 (95% CI: 0.58-2.54). Contrary to the Netherlands Antilles, in the Netherlands AN is as common among Netherlands Antilleans as among native Dutch. Exposure to the Western idealization of thinness is a risk factor for the development of AN, possibly in interaction with migration-related stress.

The relationship between the age of onset of type 1 diabetes and the subsequent development of a severe eating disorder by female patients

To determine the age of onset of type 1 diabetes that is most closely related to the subsequent development of a severe eating disorder such as anorexia nervosa (AN) or bulimia nervosa (BN). Participants were 53 female type 1 diabetes patients with AN or BN referred to our outpatient clinic from the Diabetes Center of Tokyo Women's Medical University. Forty-nine female type 1 diabetes patients who regularly visited the Diabetes Center and had no eating disorder-related problems constituted the 'direct control' group, whereas 941 female patients who for the first time visited the Diabetes Center constituted the 'historical control' group. The kernel function method was used to generate a density estimation of the onset age of each group and the chi-square test was used to compare the distribution. The control groups had similar density shapes for the onset age of type 1 diabetes, but both differed from the 'eating disorder' group. For onset age 7-18 yr, the density of the 'eating disorder' group was higher than those of the control groups, but for the younger and older onset ages the densities were lower. The 'eating disorder' group developed type 1 diabetes significantly more frequently than the 'historical control' group between 7 and 18 yr of age (χ2 = 9.066, p < 0.011). The development of type 1 diabetes in preadolescence or adolescence seems to place girls at risk for the subsequent development of AN or BN. Careful attention should be paid to these high-risk patients.

Infant and Early Childhood Feeding Difficulties are Not Associated with Anorexia Nervosa Subtype

Infant and childhood feeding may be associated with adult weight. Picky childhood eating has been associated with development of Anorexia Nervosa (AN). AN has been divided into distinct subtypes; little was known about differential predictors of subtype. The aim of the current study was to explore the relation between AN subtype and infant feeding, gastrointestinal (GI) problems prior to AN, and picky‐eating in early childhood. Three AN subtypes were identified: restrictive type, purging type (no binging), and binging type. The study sample was 325 women from the Genetics of Anorexia Nervosa study who had a lifetime history of AN and whose mothers provided retrospective information regarding feeding from the infant and childhood feeding questionnaire. Three stepwise logistic regressions were applied to predict AN subtype. The predictors were: breastfed, feeding schedule, and age solid food was introduced; infant vomiting, colic, GI problems before AN onset; and picky eating at 1 year and picky eating between ages 1–5. No model predicted AN subtype in this sample. Infant and childhood feeding factors are unlikely to be predictive of AN subtype.Funding: NIH (MH66117), T32MH07669403.

Anorexia Nervosa: Current Status and Future Directions

Anorexia nervosa (AN) is a serious mental illness categorized by a failure to maintain a minimally normal weight, a fear of gaining weight or becoming fat, and preoccupations about body shape or weight. AN is associated with significant morbidity and a mortality rate as high as that seen in any psychiatric illness. Biological factors, including genetic predisposition, appear to play a role in the development of AN. Treatment is challenging both because interventions with clear empirical support have not been identified and because individuals affected by AN are typically reluctant to undergo weight restoration. Preliminary studies suggest that family-based treatment may be useful for younger patients with AN. Treatment development for adults with AN and pursuit of neurobiological correlates of AN remain high-priority research areas.

Eating Disorders: Hope Despite Mortal Risk

Eating Disorders: Hope Despite Mortal Risk

The interaction between perinatal factors and childhood abuse in the risk of developing anorexia nervosa

Perinatal factors seem to be implicated in the pathogenesis of anorexia nervosa (AN) and may be involved in the programming of stress response systems in humans. Our aim was to explore one of the possible pathways to explain the association between perinatal complications and a psychiatric disorder. In particular, we tested the hypothesis that neonatal immaturity may confer an enhanced vulnerability to AN after exposure to a severe stressful event, such as childhood abuse. The sample was composed of subjects who took part in a prevalence study carried out on a representative sample of the general population and cases of AN referred to an out-patient specialist unit. All subjects (n=663) were born in the two obstetric wards of Padua Hospital between 1971 and 1979. We analysed data using both a case-control and a cohort design. We found that functional signs of neonatal dysmaturity, but not a low birthweight or prematurity, had a significant additive interaction with childhood abuse in determining the risk for this illness. In normal subjects, but not in subjects with AN, neonatal dysmaturity was associated with being small, short or thin for gestational age at birth. The synergistic effect of neonatal dysmaturity and childhood abuse in increasing the risk for AN provides evidence for the hypothesis that a prenatal programming of stress response systems can result in an impairment of the individual's resilience to severe stressful events.

Conscious and unconscious identification of female anorectic patients in in-patient psychotherapy

Women are up to ten times more likely to develop anorexia nervosa (AN) than men. Psychoanalytic explanations of this disparity generally emphasize female identification problems due to unresolved conflicts with maternal representations. Based on clinical observation, we identify a subtype of AN patients characterized, first, by consistent idealization of the father who needs the patient for the fulfilment of his own narcissistic needs and, second, by the patient's need to be idealized by the father due to suffering in connection with early emotional malnutrition on the part of the mother. To illustrate this hypothesis, we present the case of a well-educated young woman displaying unconscious attachment to patriarchial family patterns and conflicting conscious ‘emancipated’ beliefs regarding sexual equality in terms of competence and rights. In concluding, we discuss our hypothesis and consider consequences for the psychodynamic treatment of such patients.

Anorexia Nervosa in Identical Triplets

The cause of anorexia nervosa (AN) is unclear, but is likely multifactorial, including psychological, familial, environmental, societal, genetic, and other biological factors. This case report of identical 12-year-old female triplets simultaneously concordant for AN illustrates the importance of addressing all these components in evaluation and treatment, and the difficulty of determining the relative importance of each factor in the cause of an individual's eating disorder. An overly close relationship and competitiveness between the girls, treated at times as a triplet group rather than as individuals, as well as stressful family dynamics, were probably important antecedents to the girls' AN. The girls encouraged each other and competed to lose weight. Brief individual and family psychotherapy, parent counseling, nutritional counseling, and psychoeducation led to successful treatment. The triplets were encouraged in treatment to compete with and encourage each other to obtain treatment goals, including eating more healthily and achieving healthy weights. A literature review of AN twins studies is also presented, as these studies add to our understanding of the relative importance of shared genes and shared environment in the development of AN. These studies also add insight into treating individuals from families with multiple affected relatives.

An integrative quantitative model of factors influencing the course of anorexia nervosa over time

To identify factors influencing the course of anorexia nervosa (AN) over time. Former female patients with AN (36 remitted and 24 nonremitted) and 31 healthy females responded to standardized interviews and self-rating questionnaires. Remitted patients maintained normal eating, normal weight, and regular menses for the past 12 months. Patients not fulfilling these criteria were considered nonremitted. Using logistic regression, we identified that number of hospitalizations, duration of ambulatory treatment, past vegetarianism, past anxiety, and childhood sexual abuse differentiated remitted from nonremitted patients, predicting nonremission. A similar analysis identified that elevated follow-up vegetarianism and eating-related concerns and lower body mass index (BMI) differentiated remitted from nonremitted patients, contributing to nonremission. Univariate analyses identified that remitted patients had elevated anxiety and eating-related obsessionality compared with the controls, suggesting these variables to potentially predispose to AN. Elevated anxiety and eating-related obsessionality may increase the risk for the development of AN and for nonremission.

Nature Against Nurture: Calcification in the Right Thalamus in a Young Man with Anorexia Nervosa and Obsessive-Compulsive Personality Disorder

This report describes the case of a young man with a large calcification in the right thalamus that was first diagnosed at 9 years of age. Case history reveals specific eating rituals and other obsessive-compulsive personality traits during the patient's childhood and adolescence, fulfilling diagnostic criteria of obsessive-compulsive personality disorder. After a critical life event the patient develops anorexia nervosa. We suggest that our case and further literature provide evidence for an involvement of specific thalamic structures, such as the dorsomedial nucleus, in the development of anorexia nervosa. Furthermore, the treatment of the patient by a combined psychotherapeutic and pharmacotherapeutic approach is described. We focus on the beneficial effect of the atypical antipsychotic olanzapine, which can induce weight gain by an increase of leptin levels.

“Ice” use and eating disorders: A report of three cases

To describe the use of crystal methamphetamine hydrochloride "ice," a powerful, synthetic stimulant drug associated with rapid weight loss. We report the first three cases of young women "ice" users requiring admission to a specialized eating disorders unit. Case one had no prior history of an eating disorder and became emaciated following regular use of "ice"; she regarded weight gain positively. Case 2 had polysubstance abuse since early adolescence and commenced binge eating and vomiting in response to weight gain when not using "ice"; she learned to maintain her weight without weight losing behaviors. Case 3 developed anorexia nervosa in early adolescence, required numerous inpatient admissions and commenced using stimulant drugs for weight loss in her late teens; she discharged prematurely. All patients had features of personality disorder on interview and drug abuse had impaired their work and social adjustment. "Ice" use may be associated with the onset of disordered eating or used as an efficient weight losing behavior in an established eating disorder.

Position of the New Zealand Dietetic Association (Inc): Nutrition for exercise and sport in New Zealand

Position of the New Zealand Dietetic Association (Inc): Nutrition for exercise and sport in New Zealand

Long‐Term Skeletal Effects of Eating Disorders with Onset in Adolescence

Anorexia nervosa (AN), an eating disorder characterized by severe undernutrition and associated with hypogonadotropic hypogonadism, causes marked deficits in bone mass accrual when the disorder begins in the teenage years. Although bone mass accrual improves with weight gain and menstrual recovery, residual deficits persist. Women with a history of teenage onset of AN are more likely to be osteopenic than age-matched women without this history, even after many years of weight and menstrual recovery. Non-recovered women with persistent low weight and amenorrhea have continued decreases in bone density, with a high prevalence of both osteopenia and osteoporosis. Unlike anorexia nervosa, normal-weight bulimia is not associated with low bone density, unless there is a past history of low weight or amenorrhea. A second possible skeletal effect of teenage-onset anorexia nervosa is short stature. Duration of illness and time of onset of anorexia nervosa in relation to the pubertal growth spurt are likely important determinants of statural growth. Adolescent boys with anorexia nervosa are more likely than adolescent girls to have short stature, possibly because growth potential persists for two years longer in boys than in girls. Thus, many adolescent girls may have completed growth or be close to growth completion at the time that they develop anorexia nervosa, whereas adolescent boys may still have significant growth potential remaining. This remaining growth potential may be impaired as a consequence of low levels of insulin-like growth factor-I (IGF-I) levels from persistent undernutrition.