DSM-IV Criteria For Anorexia Nervosa Research Articles

Impairments among DSM-5 eating disorders: A systematic review and multilevel meta-analysis.

Previous research revealed that people who did not meet full DSM-IV criteria for anorexia nervosa (AN), bulimia nervosa (BN), or binge-eating disorder (BED) but met criteria for eating disorder not otherwise specified (EDNOS) display high levels of psychiatric and physical morbidity commensurate with full criteria eating disorders. The DSM-5 introduced significant changes to eating disorder diagnostic criteria, so the present study aimed to determine whether the revised diagnostic criteria better distinguish between full criteria eating disorders, and other specified feeding or eating disorder (OSFED) and unspecified feeding or eating disorder (UFED). We present a series of meta-analyses comparing eating pathology, general psychopathology, and physical health impairments among those with AN, BN, and BED, compared to those with OSFED or UFED (n=69 eligible studies). Results showed significantly more eating pathology in OSFED compared to AN, no difference in general psychopathology, and greater physical health impairments in AN. BN had greater eating pathology and general psychopathology than OSFED, but OSFED showed more physical health impairments. No differences were found between BN and purging disorder or low-frequency BN, or between BED and OSFED. Findings highlight the clinical severity of OSFED and suggest the DSM-5 criteria may not appropriately account for these presentations.

An investigation of the process of change in psychopathology and exercise during inpatient treatment for adults with longstanding eating disorders

BackgroundExcessive exercise is recognized as a predictor of poor outcome in eating disorders. However, little is known about how excessive exercise might affect the treatment process. The aim of this study was to describe process of weekly changes in eating disorder psychopathology, general psychopathology and exercise, and the possible interactive effects of excessive exercise on these changes during inpatient treatment of longstanding eating disorders.MethodsEighty-four patients meeting the DSM-IV criteria for Anorexia Nervosa, Bulimia Nervosa, or Eating Disorders Not Otherwise Specified received inpatient cognitive-behavioural therapy including, physical activity and nutritional counselling treatment over 12 weeks. Excessive exercise was defined as having ≥6 episodes of driven exercise during week 1 of treatment. Excessive exercisers received one additional session of individual counseling with the clinical exercise physiologist. The study used repeated measurements during treatment and collected measures of eating disorders: psychopathology (EDE-Q), general psychopathology (SCL-5), and frequencies of exercise and body mass index (BMI). Statistical analysis was performed using repeated measures ANOVA.ResultsBoth eating disorders and general psychopathology were reduced from admission to discharge in excessive exercisers and non-exercisers. There was an overall interaction effect between time (week) and excessive exercise for the process of exercise and eating disorders psychopathology reduction. This interaction effect was also found in week 10 vs 11 regarding general psychopathology. The excessive exercisers showed steep reduction at first, followed by a smaller increase towards the end of treatment in both eating disorder and general psychopathology; this pattern was not found among the non-exercisers.ConclusionThe process of change in exercise and psychopathology during inpatient treatment of longstanding eating disorders differs across excessive and non-excessive exercisers. Although excessive exercisers were given special attention for their exercise cognition and behavior during treatment, it is apparent that this part of treatment must be further developed.

Outcome of childhood anorexia nervosa-The results of a five- to ten-year follow-up study.

Although admissions of children with anorexia nervosa (AN) are increasing, there remains a dearth of up-to-date knowledge of the course and outcome of early-onset AN. The aim of the present study was to investigate the outcomes of patients with AN onset before the age of 14. Sixty-eight consecutive former patients who met the DSM-IV criteria for AN and who had been treated at one of three German university hospitals were asked to participate in a follow-up study. Body mass index, body height, outcome of the eating disorder (ED), psychiatric morbidity, and health related quality of life (HRQoL) were assessed through a personal examination after an average time span of 7.5 years (range: 4.5-11.5 years) after admission. One patient had died. Fifty-two subjects with a mean age of 12.5 (SD 1.0) years at admission and of 20.2 (SD 2.0) years at follow-up agreed to participate in the follow-up assessment, aggregating to 77.9% of the original sample. Approximately 41% of the participants had a good outcome, while 35% and 24% had intermediate and poor outcomes, respectively. Twenty-eight percent of the sample met the DSM-IV criteria for a current non-ED psychiatric disorder, and 64% met the criteria for a past non-ED psychiatric disorder. Mental HRQoL and ED-specific psychopathology was strongly associated with the outcome of AN. Average body height was below the normal range. A higher weight at admission was the only significant positive indicator of outcome. Childhood AN is a serious disorder with an unfavorable course in many patients and high rates of chronicity and psychiatric comorbidity in young adulthood. Early detection and intervention are urgently needed.

Are eating disorders and their symptoms increasing in prevalence among adolescent population?

Background: A debate concerns whether eating disorders are increasing in prevalence. The role of socio-economic status (SES) for adolescent eating disorders (ED) is another matter of debate.Aims: To ascertain whether self-reported eating disorders or their symptoms have increased in prevalence in adolescent population from the early 2000s to early 2010s.Methods: A person-identifiable classroom survey, Adolescent Mental Health Cohort study, was carried out among the 9th graders in comprehensive schools in Tampere, Finland, during academic year 2002–2003, and replicated among then 9th graders during academic years 2012–2013. Eating disorders were elicited with questionnaires tailored according to DSM-IV criteria for anorexia nervosa and bulimia nervosa.Results: No changes were observed between 2002–2003 and 2012–2013 in the prevalence of anorexia and bulimia, most of the symptoms of anorexia and bulimia, or the proportion of adolescents having received treatment due to eating disorders among the girls or the boys. Eating disorders, treatment contacts due to eating disorders, and eating disorder symptoms were not systematically associated with either low or high parental socio-economic status.Conclusion: Based on this dataset, eating disorders are not increasing in the adolescent population. Adolescent eating disorders are not associated with socio-economic status of their family.

Examining the utility of narrowing anorexia nervosa subtypes for adults

ObjectiveThe purpose of this investigation was to examine whether narrowing the criteria of anorexia nervosa (AN) subtypes among adults based on further delineations of current binge eating and purging (i.e., binge eating only, purging only, binge eating and purging, and restricting only) improves the potential clinical utility of the current DSM-5 system that specifies two types (i.e., current binge eating and/or purging and restricting, specified as the absence of current binge eating and/or purging). MethodSelf-reported eating disorder and psychiatric symptoms based on the Eating Disorder Questionnaire were examined in 347 adults from a multisite clinical sample who met DSM-IV criteria for AN. Classification based on binge eating and purging symptoms yielded the following subtypes: 118 restricting only (AN-R; no current binge eating or purging); 133 binge eating and purging (AN-B & P; current binge eating and purging); 43 binge eating only (AN-B; current binge eating and no current purging); and 53 purging only (AN-P; current purging and no current binge eating). ResultsThe AN-R group had lower current body mass index compared to AN-B & P and AN-P with no group differences in highest, lowest, or desired body mass index. The probability of amenorrhea was higher for the AN-R and AN-B & P groups than the AN-P group. The probability of diet pill use was elevated for the AN-B & P and AN-P groups compared to the AN-R group. The AN-P group also had a higher probability of fasting than the AN-R group. The probability of substance use including tobacco was lower in the AN-R group than the other three groups. No group differences were found on measures of hospitalization, body image, physical symptoms, exercise, or dieting behaviors. ConclusionsThese findings do not support the validity or clinical utility of classifying AN into narrower subtypes based on current binge eating, purging, and binge eating with purging given that few differences were found among groups who reported any combination of current binge eating and purging. Future research is needed to replicate these findings and to further examine the AN subtype classification schemes.

EPA-0586 – Comparison of sensitivity to facial emotions between patients with anorexia nervosa and matched controls using a morphing test (multimorph): a prospective study

In patients with Anorexia Nervosa (AN), troubles in facial emotion recognition (FER) have been reported using methodologies relying mainly on static tests. The morphing technique allows new perspectives in experimentation, by using dynamic expressions of emotions. To compare prospectively FER using Multimorph, a morphing technique previously described (Robin, 2012) in anorexic patients and matched controls. Population: 27 female patients with DSM-IV criteria for AN and 27 healthy individually matched controls were prospectively studied. Multimorph protocol: Participants had to identify as rapidly as possible the 6 basic emotions. Emotions were displayed progressively by 2.5% incremental stages from neutral (0%) to a full-blend (100%) facial emotion (40 stages were displayed by trial). Each subject completed 36 trials (6 face x 6 emotions). Results are expressed as mean number of stages until the first correct response. Data were analyzed with a 2 (AN versus control) × 6 (anger, disgust, fear, happiness, sadness and surprise) factorial design. Comparisons were made with ANOVA for repeated measurements using Generalized Estimating Equations approach (Lipsitz, 1994). A p value < 0.05 was considered as significant. AN Patients (n=27) Controls (n=27) Mean difference Std Err p value Anger 28.8 30.3 -1.4245 1.0016 0.1609 Disgust 29.2 28.9 0.3228 0.9818 0.7437 Sadness 29.0 30.0 -0.9854 0.9274 0.2929 Fear 31.8 31.2 0.6057 0.8024 0.4538 Surprise 25.9 27.5 -1.6409 0.9578 0.0926 Happiness 18.7 21.4 -2.7248 0.8690 0.0028 ALL 27.0 28.0 -1.0266 0.3768 0.0088 Anorexic patients have an increased sensitivity to facial emotions, compared to controls.

Identifying Eating Disorder Risk Factors in Those with Dysmotility Symptoms

Purpose: Eating disorders (ED) are strongly associated with disturbing gastrointestinal sensitivity and motor physiology. Consequently, patients with EDs develop functional gastrointestinal disorders (FGIDs). The purpose of our study is to determine if patients with dysmotility symptoms have an underlying ED, if there is a specific motility disorder that is common and identify ED risk factors that should be screened for in patients with FGIDs. Methods: We performed a prospective study of patients referred to our motility lab with a variety of upper and lower gastrointestinal dysmotility symptoms. Patients were included if they had any of the following studies: esophageal manometry, anal manometry, impedance pH study, or SmartPill. Enrolled patients were screened for an underlying ED with a self-reporting questionnaire that contained ED risk factors as well as three validated diagnostic scales: 1) Eating Attitude Test (EAT); 2) DSM-IV Criteria for Anorexia Nervosa (AN) and Bulimia Nervosa (BN); 3) Eating Disorder Diagnostic Scale (EDDS) for AN, BN, and Binge Eating Disorder (BED). Significant findings were defined as the following: Eat Score ≥19, ≥3 of 4 AN DSM-IV criteria for females, ≥2 of 3 AN DSM-IV criteria for males, ≥5 of 6 BN DSM-IV criteria, ≥3 of 4 AN EDDS criteria for females, ≥2 of 3 AN EDDS criteria for males, ≥2 of 3 BN EDDS criteria, and ≥5 of 6 BED EDDS criteria. Results: One hundred patients were enrolled. Mean age was 48.4±13.7 years, 80 (80%) were female, and 47 (47%) were non-Hispanic white. Eleven (11%) were found to have a previously undiagnosed eating disorder. Of these 11 patients, 9 (81.8%) were female with a mean age of 50.5±12.5 years and 6 (54.5%) were non-Hispanic white. No difference was noted in the demographics of the two groups. ED patients were significantly more likely to report a previous or current attempt of dieting (90.9% vs. 38.2%; p=0.001) as well as compensatory behaviors (diet pill, laxatives, diuretics, self-induced vomiting, fasting; 73% vs. 13.4%; p=0.0001). Parental stress was also noted to be more common in ED patients (81.8% vs. 41.5%; p=0.02). In addition, a college education (81.8% vs. 39.3%; p=0.01) and abuse (55% vs. 22.5%; p=0.03) was significantly more frequent in the ED group. On average, ED patients were evaluated by two gastroenterologists in the outpatient setting. Discussion of neither an eating disorder nor its associated risk factors was elicited. Conclusion: Eleven (11%) of patients presenting for motility testing were found to have an ED. ED patients had a significantly increased prevalence of the following risk factors: dieting, abuse, parental stress, college education, and compensatory behaviors. These risk factors become important to ascertain in patients with dysmotility symptoms as it may indicate an underlying ED and alter the management strategy.

Predicting premature termination of hospitalised treatment for anorexia nervosa: The roles of therapeutic alliance, motivation, and behaviour change

ObjectivesThis study aims to investigate treatment drop-out, and the associated roles of motivation, alliance, and behaviour change exhibited over the first four weeks of hospitalised treatment for anorexia. Methods90 participants meeting DSM-IV criteria for anorexia nervosa completed questionnaires at admission, and four weeks into treatment. Weight data was collected over this same time period. At the end of treatment, participants were categorised into completer or premature termination groups. ResultsThe overall rate of premature termination was 57.8%. Those who prematurely terminated treatment demonstrated lower discharge BMI (p<.0005), and weight gain (p<.0005) than those who completed. Therapeutic alliance proved significantly different between outcome groups at admission (p=.004). DiscussionEnd-of-treatment outcomes for those who do not complete treatment are invariably poor. Therapeutic alliance appears to be a particularly important factor in this area.

Plasma Sodium Level Is Associated With Bone Loss Severity in Women With Anorexia Nervosa

Anorexia nervosa is a psychiatric disorder characterized by restrictive eating, low body weight, and severe bone loss. Recent data show a deleterious relationship between low circulating sodium levels and bone mass, and relative or absolute hyponatremia is a known complication of anorexia nervosa. Clinical studies of other medical conditions associated with hyponatremia suggest that detrimental effects of low sodium levels on health are seen even within the normal range. We hypothesized that women with anorexia nervosa and relatively low plasma sodium levels would have lower bone mineral density (BMD) than those with higher plasma sodium levels. In a cross-sectional study (January 1, 1997-December 31, 2009) of 404 women aged 17 to 54 years (mean ± standard error of the mean [SEM] age = 25.6 ± 0.3 years) who met DSM-IV criteria for anorexia nervosa, we measured BMD using dual-energy x-ray absorptiometry. Bone mineral density was compared in women with plasma sodium levels < 140 mmol/L (midpoint of normal range) versus those with plasma sodium levels ≥ 140 mmol/L and in women with hyponatremia (plasma sodium < 135 mmol/L) versus those without. The study was conducted at the Neuroendocrine Unit of Massachusetts General Hospital, Boston. Women with plasma sodium levels < 140 mmol/L had significantly lower BMD and t and z scores versus those with plasma sodium levels ≥ 140 mmol/L at the anterior-posterior (AP) spine (mean ± SEM z scores = -1.6 ± 0.1 vs -1.3 ± 0.1, P = .004) and total hip (mean ± SEM z scores = -1.2 ± 0.1 vs -0.9 ± 0.1, P = .029). In a model controlling for age, BMI, psychiatric drug use, and disease duration, differences in BMD and t and z scores remained significant at the AP spine. Women with hyponatremia had significantly lower BMD and t and z scores versus those without hyponatremia at the AP spine (mean ± SEM z scores = -2.2 ± 0.3 vs -1.3 ± 0.1, P = .009), lateral spine (mean ± SEM z scores = -2.4 ± 0.4 vs -1.5 ± 0.1, P = .031), and total hip (mean ± SEM z scores = -2.5 ± 0.5 vs -1.0 ± 0.1, P < .0001). In a model controlling for age, BMI, psychiatric drug use, and disease duration, differences in BMD and z and t scores remained significant at all sites. These data suggest that relative plasma sodium deficiency may contribute to anorexia nervosa-related osteopenia.

Eating disorder not otherwise specified presentation in the US population

To examine prevalence and clinical correlates of eating disorder not otherwise specified (EDNOS) in the US population. Two cross-sectional surveys of adults and adolescents used the WHO CIDI to assess DSM-IV criteria for anorexia nervosa (AN), bulimia nervosa (BN), and EDNOS. Lifetime prevalence of EDNOS was 4.78% in adolescents and 4.64% in adults. The majority of adolescents and adults with an eating disorder presented with EDNOS. Three-quarters of participants with EDNOS met criteria for comorbid disorders, while one-quarter endorsed suicidality. Severity correlates were equally prevalent in EDNOS and AN, whereas comparisons between EDNOS and BN varied by specific correlate and sample. Adolescents with subthreshold AN (SAN) endorsed more anxiety than AN (p < .05), and adolescents and adults with SAN endorsed more suicidal plans than AN (p's < .05). Findings increase our understanding of the clinical relevance of EDNOS. Eating disorder diagnostic nomenclature requires modification to capture the full spectrum. © 2012 by Wiley Periodicals, Inc. Int J Eat Disord 2012.

Babies of Recovered Anorexics Show Few Negative Outcomes

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessBabies of Recovered Anorexics Show Few Negative OutcomesJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:20 Nov 2009https://doi.org/10.1176/pn.44.22.psychnews_44_22_024AbstractAlthough anorexia nervosa is a serious mental disorder for many, a study out of Sweden offers hope to female teens who have it—recovery is possible.The study was headed by Elisabet Wentz, M.D., Ph.D., an associate professor of child and adolescent psychiatry at the University of Gothenburg in Sweden. It included 48 women, average age 32, whom the researchers had diagnosed with anorexia as teens. It also included 48 women matched on age and school attended, but whom the researchers had not diagnosed with anorexia as teens. The latter served as a control group. The researchers had been following the outcomes of both groups since the subjects were teens.Of the 48 subjects with a history of anorexia, only six still had an eating disorder by the time of the study—three with anorexia and three with another type. In their paper, published in the September International Journal of Eating Disorders, the researchers referred to this finding as “encouraging” and pointed out that it was comparable to what some other studies on the subject have found in recent years.Other results from this new study should offer encouragement to teens with anorexia regarding later reproduction. Over half the women with an anorexia history had given birth to at least one child.Moreover, as far as weight gain during pregnancy, delivery complications, or severe infant-feeding problems were concerned, there were no statistically significant differences between subjects who had been diagnosed with anorexia and the control subjects. And complications during the neonatal period were rare among children in both the anorexia and control groups.Still, the study did find that anorexia subjects bore babies who, on average, were of lower weight than were the babies born to control mothers. The difference was statistically significant. Women who had experienced anorexia were also significantly more likely to have infants with sleeping problems than control subjects.Perhaps most notably, none of the six subjects who still had an eating disorder at the time of the study had become a mother.On the whole, though, “The outcome regarding fertility, pregnancy, and delivery was better than expected in women with a history of teenage-onset anorexia nervosa,” Wentz told Psychiatric News. “Previous studies have reported many serious complications.”One reason why she and her colleagues obtained more positive results than previous researchers have, she conjectured, may have been because “clinical studies often include severe cases with several inpatient episodes, whereas in our group, where all the participants had met DSM-III-R and DSM-IV criteria for anorexia nervosa, only 1 in 4 had ever received inpatient treatment.”The study was funded by the Swedish Council, Swedish Institute for Health Sciences, and Soderstrom-Konigska Nursing Home Foundation.An abstract of “Reproduction and Offspring Status 18 Years After Teenage-Onset Anorexia Nervosa—A Controlled Community-Based Study” is posted at <www3.interscience.wiley.com/journal/121683460/abstract>. ISSUES NewArchived

A 4‐year prospective study of eating disorder NOS compared with full eating disorder syndromes

To examine the course of Eating Disorder NOS (EDNOS) compared with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Prospective study of 385 participants meeting DSM-IV criteria for AN, BN, BED, and EDNOS at three sites. Recruitment was from the community and specialty clinics. Participants were followed at 6-month intervals during a 4-year period using the Eating Disorder Examination as the primary assessment. EDNOS remitted significantly more quickly that AN or BN but not BED. There were no differences between EDNOS and full ED syndromes, or the subtypes of EDNOS, in time to relapse following first remission. Only 18% of the EDNOS group had never had or did not develop another ED diagnosis during the study; however, this group did not differ from the remaining EDNOS group. EDNOS appears to be a way station between full ED syndromes and recovery, and to a lesser extent from recovery or EDNOS status to a full ED. Implications for DSM-V are examined.

Parenting styles and eating disorder pathology

Our objective was to investigate the association between parenting style and eating disorder symptoms in patients treated in an intensive outpatient center for eating disorders. The study design is a cross-sectional survey set in a community-based facility for eating disorders. Participants included 53 families, including 32 with a child meeting the DSM-IV criteria for anorexia nervosa, 18 for bulimia nervosa, and 3 diagnosed ED-NOS. Data was collected using the Parental Authority Questionnaire (PAQ), the Eating Disorders Inventory-2 (EDI-2) and the Eating Attitudes Test (EAT-26). Significant, negative correlations were found between drive for thinness scores and body dissatisfaction scores and the patient's perception of the father as authoritative. Total patient EDI score was significantly and positively correlated with patient's perception of the father as authoritarian and inversely correlated with her perception of him as authoritative. These results emphasize the importance of fathers’ role in the eating disorder pathology, a relatively untapped area of research.

The clinical significance of amenorrhea as a diagnostic criterion for anorexia nervosa

Amenorrhea is a DSM-IV criterion for the diagnosis of anorexia nervosa (AN). Several studies have reported few differences between patients who meet the full DSM-IV criteria for AN and those who meet all but the amenorrhea criterion. Although this suggests that the absence of menses does not provide critical diagnostic information, many of these studies are limited by small sample sizes. This study aims to examine the clinical utility of amenorrhea as a criterion for the diagnosis of AN. A chart review was conducted of 240 consecutive patients admitted for inpatient treatment at the NY State Psychiatric Institute from 1993 to 2006. Menstrual data were collected from the Eating Disorder Examination conducted upon admission. Independent samples t-tests were performed to evaluate differences in clinical variables, including age, lifetime lowest body mass index (BMI), admission and discharge BMI, previous number of hospitalizations, duration of illness, Beck Depression Inventory total score, Beck Anxiety Inventory total score, and Eating Disorder Examination subscale scores. The amenorrheic and menstruating groups differed significantly only on lowest lifetime BMI and admission BMI, with individuals with amenorrhea having lower BMIs on both measures. These results indicate that amenorrhea does not distinguish between groups on a number of important measures of clinical severity. It may be that amenorrhea reflects weight and nutritional status, rather than providing useful diagnostic information. Future studies are needed to examine the potential prognostic value of menstrual status.

Toward an understanding of risk factors for anorexia nervosa: a case-control study

Prospective, longitudinal studies of risk factors for anorexia nervosa (AN) are lacking and existing cross-sectional studies are generally narrow in focus and lack methodological rigor. Building on two studies that used the Oxford Risk Factor Interview (RFI) to establish time precedence and comprehensively assess potential risk correlates for AN, the present study advances this line of research and represents the first case-control study of risk factors for AN in the USA. The RFI was used for retrospective assessment of a broad range of risk factors, while establishing time precedence. Using a case-control design, 50 women who met DSM-IV criteria for AN were compared to those with non-eating disorder DSM-IV psychiatric disorders (n=50) and those with no psychiatric disorder (n=50). Women with psychiatric disorders reported higher rates of negative affectivity, maternal and paternal parenting problems, family discord, parental mood and substance disorder, and physical and sexual abuse than women with no psychiatric disorder. Women with AN specifically reported greater severity and significantly higher rates of negative affectivity, perfectionism and family discord, and higher parental demands than women with other psychiatric disorders. The role of weight and shape concerns was most salient in the year preceding onset of AN. Convergent data identifying common risk factors as well as those more severe in the development of AN are emerging to inform longitudinal risk factor and prevention studies for this disorder.

The patient's account of relapse and recovery in anorexia nervosa: a qualitative study

The purpose of this study was to explore the subjective accounts of weight-recovered female patients, who met DSMIV criteria for anorexia nervosa (AN), regarding their views of their illness following weight restoration. Qualitative semi-structured interviews were administered to 15 participants to ascertain their perspective of the factors that either contributed to their maintaining a healthy weight, or the factors involved in their having relapsed over the follow-up period. Qualitative analyses revealed six core categories: internal motivation to change, recovery as a work in progress, the perceived value of the treatment experience, developing supportive relationships, awareness and tolerance of negative emotion and self-validation. This study provides valuable information about the way in which AN patients experience their illness and highlight the factors that help or hinder recovery. These findings may help enhance relapse prevention programs and potentially enhance our ability to identify and target those individuals at the greatest risk of relapsing.

A Preliminary Study of Negative Self-Beliefs in Anorexia Nervosa: A Detailed Exploration of Their Content, Origins and Functional Links to “Not Eating Enough” and Other Characteristic Behaviors

Objective: The study explored the semantic content and origins of negative self-beliefs, and their functional links to “not eating enough” and other behaviors, in participants with anorexia nervosa (AN). Method: Fifteen women meeting DSM-IV criteria for AN were compared with 17 dieting and 18 non-dieting women matched on age and number of years of education. The main outcome measure was a semi-structured interview. Results: Six themes were identified in the beliefs of participants with AN. These were, in order of decreasing frequency, powerlessness (present in all but three AN participants), failure, defectiveness, unattractiveness, worthlessness and emptiness. Importantly, powerlessness and failure beliefs were consistently present independent of Beck Depression Inventory-II scores. The negative early life experiences associated with these beliefs had high distress and responsibility ratings. Participants with AN reported that they employed specific behaviors, particularly ‘not eating enough,’ and ‘placating others,’ to try to reduce the cognitive and emotional impact of their negative self-beliefs. Discussion: The findings are discussed in relation to the role of powerlessness and the function of “not eating enough” in cognitive theory and therapy for AN.

Further Evidence of Association of OPRD1 & HTR1D Polymorphisms with Susceptibility to Anorexia Nervosa

A recent study reported strong evidence for the involvement of a region on human chromosome 1 and genetic susceptibility to anorexia nervosa (AN). A more detailed analysis of this region has suggested 2 genes that may account for this susceptibility. These data suggest that polymorphisms in both the serotonin 1D (HTR1D) and opioid delta 1 (OPRD1) receptor genes show a significant association with restricting AN (RAN). In the current study, we have conducted an independent association study on 226 females meeting DSM-IV criteria for AN and 678 matched volunteers. We genotyped 4 SNPs in HTR1D and 6 SNPs in OPRD1. 3 SNPs were found to be associated with both RAN and binge-purge AN (BPAN) within the gene for OPRD1. We also found evidence of association between 2 polymorphisms within HTR1D and RAN. These data support the hypothesis that polymorphisms within this region form a component of the genetic basis to susceptibility to RAN. However, further work is required to understand the processes that may be mediated by these genes.

Reduced platelet [ 3H]paroxetine binding in anorexia nervosa: Relationship to eating symptoms and personality pathology

Alterations in serotonin function have been implicated in both anorexia and bulimia nervosa, and previous studies suggest associations between serotonin function and variations in pathological personality traits. Women meeting DSM-IV criteria for anorexia nervosa (AN, 16 with the restricting subtype and 14 with the binge–purge subtype) and 49 healthy control women (CW) provided blood samples for analyses of platelet [ 3H]paroxetine binding. Participants also filled out questionnaires tapping eating disorder symptoms, depression, and personality pathology. Compared with CW, women with restricting and binge–purge AN had significantly lower levels of paroxetine binding (respectively: 1012 + 487 vs. 560 + 253 vs. 618 + 217 fmol/mg protein). Simple correlation analyses showed that, within AN but not within controls, paroxetine binding was inversely related to dieting preoccupations, affective instability, anxiousness, compulsivity, restricted expression and social avoidance but independent of age, body mass index, depression, and other eating symptoms. Findings suggest that reduced peripheral serotonin transporter density in AN relates to increased dieting preoccupations, affective instability and anxiousness–fearfulness.

What may underlie differing perceptions of family functioning between mothers and their adolescent daughters with eating disorders?

Daughters with eating disorders (ED) were found to perceive family functioning more negatively than their mothers. This study examined variables that may underlie these differences in a subgroup of adolescent girls and their mothers from the original study. Participants were 77 mother-adolescent daughter dyads. Daughters met current DSM-IV criteria for Anorexia Nervosa, Bulimia Nervosa or ED Not Otherwise Specified. Daughters and mothers completed the Family Assessment Device (FAD), which measures perceptions of family functioning with seven subscales. Daughters also completed the Eating Disorders Inventory (EDI). Backward elimination stepwise regressions were conducted on difference scores between mothers and daughters for each FAD subscale. Daughter's EDI subscales (except Bulimia) were entered as possible predictors. Interpersonal Distrust was the only predictor of the differences between daughters and mothers on Problem Solving, Communication, Affective Responsiveness and General Functioning, accounting for 24%, 14%, 10% and 23% of the variance, respectively. Differences in viewpoints between mothers and daughters regarding the family environment may be understood in terms of the daughters' level of distrust of people in general and their overall feelings of inadequacy. Addressing these psychological difficulties may have powerful implications both for individual and family treatment in the recovery from an eating disorder. Could this be part of the dynamic that led to the eating disorder, a result of the stress on the whole family related to the eating disorder or some combination?