Features Of Anorexia Nervosa Research Articles

Treating Body-Image Distortion in Anorexia Nervosa, One Hemisphere at a Time

Feeling too fat, a negative distortion of self-body image, is a key characteristic of anorexia nervosa (AN). Previous work has suggested

Self-Esteem Group: Useful Intervention for Inpatients with Anorexia Nervosa?

Low self-esteem is a common feature in Anorexia Nervosa (AN) and has been hypothesised to act as a predisposing, precipitating, and perpetuating factor. The aim of this study was to assess the effectiveness of a Cognitive Behavioural Therapy (CBT)-based self-esteem group in a naturalistic setting of patients with AN in an inpatient treatment programme. Included in this study were 119 female patients diagnosed with AN, with all participants completing self-report questionnaires before and after the intervention. The group consisted of five to six weekly sessions. The self-esteem group led to a statistically significant improvement in self-esteem, which could not be explained by an increase in BMI alone, suggesting that the group is facilitating positive changes within an AN group. The group also had a small effect on improving patients self-perceived ability to change. These findings suggest that the brief self-esteem group has some benefits in improving patients’ self-esteem/self-efficacy and should be replicated in the future with a control condition to confirm findings.

The delusional dimension of anorexia nervosa: phenomenological, neurobiological and clinical perspectives

Background Delusional characteristics have been largely ignored in patients suffering from anorexia nervosa (AN). Objectives To review the literature on delusional features in AN from phenomenological, neurobiological, and clinical viewpoints. Methods Data were obtained through searches of Medline, PubMed, SciELO and Cochrane Library. Results Distorted beliefs in AN may range from an overvalued idea to an overt delusion, involving affective, personality and/or psychotic disorders. Studies confirm alterations in monoaminergic systems. It has also been seen a decreased integration of visual/proprioceptive information, and alterations in neural networks involved in body processing. It is known that body image distortion may present “delusional proportions” as a consequence of great concern about body. Concomitantly, “embodied defence hypothesis” has been proposed. Restrictive AN exhibits higher levels of delusionality, and a particular delusional type of AN has been suggested, associated with a worse long-term outcome. Low doses of atypical antipsychotics are recommended combined with cognitive techniques. Discussion Delusional thinking in AN is likely a dynamic and dimensional phenomenon that can vary, both in nature and/or severity, whereas high insight levels, before and after refeeding, result in positive outcomes. Neurobiological research on this topic must be encouraged, since clinical and phenomenological approaches are comparatively more frequently reported.

Family-based intervention in adolescent restrictive eating disorders: early treatment response and low weight suppression is associated with favourable one-year outcome

BackgroundFamily-based treatments are first-line treatments for adolescents with restrictive eating disorders (ED) but have to be improved since outcome is poor for some. We have investigated the one-year outcome of a family-based intervention programme with defined and decisive interventions at the start of treatment.MethodData pertaining 201 adolescents with restrictive ED with features of anorexia nervosa but not fulfilling the weight criterion starting treatment 2010-2015, had a wide range of body mass index (BMI) and of weight loss at presentation, and completed a one-year follow-up was analysed. Recovery from the ED was defined as an Eating Disorder Examination-questionnaire (EDE-Q) score < 2.0 or as not fulfilling criteria for an ED at a clinical interview.ResultsBy EDE-Q 130 (65%) had recovered at 1 year and by clinical interview 106 (53%). According to the EDE-Q criterion recovery was independently associated with lower EDE-Q score at presentation, higher weight gain after 3 months of treatment and lower weight suppression at follow-up, weight suppression being defined as the difference between premorbid and current BMI. Not fulfilling criteria for an ED was associated with the same factors and also by higher BMI at presentation.ConclusionThe observations that low weight and high ED cognitions confer a poor prognosis but that rapid weight gain at the start of treatment predicts a better prognosis are presently extended to adolescents with restrictive ED with a wide range of BMI at presentation. High weight suppression at follow-up is associated with a poor prognosis and indicates the importance of taking premorbid BMI into account when setting weight targets for treatment.

Sleep disturbances in anorexia nervosa

IntroductionIn clinical practice, insomnia is a common feature in anorexia nervosa (AN). Sleep self-reports in AN suggest that these patients report poor sleep quality and reduced total sleep time. Weight loss, starvation and malnutrition can all affect sleep. Patients with eating disorders who have sleep disturbances have more severe symptomatology.ObjectivesThe authors intend to review sleep disturbances observed in AN, describe possible pathophysiological mechanisms and evaluate the clinical impact of sleep disturbances on the treatment and prognosis of the disease.MethodsIn this study, a non-systematic search of published literature from January 1970 and August 2015 was carried out, through PubMed, using the following keywords: ‘sleep’, ‘anorexia nervosa’ and ‘insomnia’.ResultsThese patients subjectively report having poor sleep quality, with difficulty falling asleep, interrupted sleep, early morning waking or reduced total sleep time. Sleep disturbances found in AN using polysomnography are: reduction in total sleep time, decrease in slow wave sleep, slow wave activity and reduced sleep efficiency.ConclusionsPrivation of adequate and restful sleep has a negative impact on the quality of life of patients, may contribute to the appearance of comorbidities, such as depression and anxiety, and to a poor prognosis for AN.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Reduced Resting-State Functional Connectivity in Current and Recovered Restrictive Anorexia Nervosa.

Functional connectivity studies based on resting-state functional magnetic resonance imaging (rs-fMRI) have shown alterations in brain networks associated with self-referential processing, cognitive control, and somatosensory processing in anorexia nervosa (AN). This study aimed to further investigate the functional connectivity of resting-state networks (RSNs) in homogenous subsamples of individuals with restrictive AN (current and recovered) and the relationship this has with core eating disorder psychopathology. rs-fMRI scans were obtained from 12 female individuals with restrictive AN, 14 females recovered from restrictive AN, and 16 female healthy controls. Independent components analysis revealed a set of functionally relevant RSNs, previously reported in the literature. Dual regression analysis showed decreased temporal coherence within the lateral visual and auditory RSNs in individuals with current AN and those recovered from AN compared to healthy individuals. This decreased connectivity was also found in regions associated with somatosensory processing, and is consistent with reduced interoceptive awareness and body image perception, characteristic of AN. Widespread gray matter (GM) reductions were also found in both the AN groups, and differences in functional connectivity were no longer significant when GM maps were added as a covariate in the dual regression analysis. This raises the possibility that deficits in somatosensory and interoceptive processing observed in AN may be in part underpinned or exacerbated by GM reductions.

Is overestimation of body size associated with neuropsychological weaknesses in anorexia nervosa?

Recent research indicates some evidence of neuropsychological weaknesses in visuospatial memory, central coherence and set-shifting in adults with anorexia nervosa (AN). The growing interest in neuropsychological functioning of patients with AN is based upon the assumption that neuropsychological weaknesses contribute to the clinical features of the illness. However, due to a paucity of research on the connection between neuropsychological difficulties and the clinical features of AN, this link remains hypothetical. The main objective of this study was to explore the association between specific areas of neuropsychological functioning and body size estimation in patients with AN and healthy controls. The sample consisted of 36 women diagnosed with AN and 34 healthy female controls. Participants were administered the continuous visual memory test and the recall trials of Rey Complex Figure Test to assess visual memory. Central coherence was assessed using the copy trial of Rey Complex Figure Test, and the Wisconsin Card Sorting Test was used to assess set-shifting. Body size estimation was assessed with a computerized morphing programme. The analyses showed no significant correlations between any of the neuropsychological measures and body size estimation. The results suggest that there is no association between these areas of neuropsychological difficulties and body size estimation among patients with AN. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Assessment of Dysfunctional Cognitions in Binge-Eating Disorder: Factor Structure and Validity of the Mizes Anorectic Cognitions Questionnaire-Revised (MAC-R).

Background: Dysfunctional cognitions regarding weight and shape and their implications for self-esteem are considered core features of anorexia nervosa and bulimia nervosa. However, they have also been associated with the severity of binge eating disorder (BED). Therefore, they should be screened with appropriate instruments to tailor treatment to individual patient needs. The Mizes Anorectic Cognitions-Revised (MAC-R) is a self-report questionnaire that lists dysfunctional cognitions related to three hypothesized core beliefs typical of the psychopathology of eating disorders: weight and eating as the basis of approval from others; the belief that rigid self-control is fundamental to self-worth; and the rigidity of weight- and eating-regulation efforts.Objectives: The goal of the study was to confirm the factor structure and to assess the validity of the MAC-R among a sample that met full-threshold and subthreshold criteria for BED.Methods: We used data of women meeting full-threshold (n = 94) and subthreshold (n = 22) criteria for BED to conduct confirmatory factor analyses and to compute Spearman's correlations, in order to assess factorial, convergent, and discriminant validity.Results: Two models having a structure of three factors with or without a total score proved to be acceptable. The MAC-R total score was correlated with questionnaires assessing dimensions related to eating disorder psychopathology, adding to the validity of the questionnaire.Conclusion: These results were similar to those found in studies on the psychometric properties of the MAC among samples with anorexia nervosa or bulimia nervosa, encouraging the use of the MAC-R as a research or clinical tool in order to further document the core beliefs underlying BED.

O papel da anedonia na anorexia nervosa

Anhedonia is a feature of anorexia nervosa. Inability to experience pleasure from eating has a crucial role in this disorder. However, the loss of pleasure in performing any other activity may play an even more important role in the maintenance of this disorder.

Sleep disturbances in anorexia nervosa

ABSTRACTIn clinical practice, insomnia is a common feature in anorexia nervosa (AN). Sleep self-reports in AN suggest that these patients report poor sleep quality and reduced total sleep time. Weight loss, starvation and malnutrition can all affect sleep. Patients with eating disorders who have sleep disturbances have more severe symptomatology. The authors intend to review sleep disturbances observed in AN, describe possible pathophysiological mechanisms and evaluate the clinical impact of sleep disturbances on the treatment and prognosis of the disease. In this study, a non-systematic search of published literature from January 1970 and August 2015 was carried out, through PubMed, using the following key words: ‘sleep’, ‘anorexia nervosa’ and ‘insomnia’. These patients subjectively report having poor sleep quality, with difficulty falling asleep, interrupted sleep, early morning waking or reduced total sleep time. Sleep disturbances found in AN using polysomnography are: reduction in total sleep time, ...

The Endocrinopathies of Male Anorexia Nervosa: Case Series

Anorexia nervosa (AN) is a serious disorder with associated morbidity and mortality, most commonly diagnosed in females. Existing literature on male anorexia is sparse, and a review of the endocrine effects of AN in males has not previously been published. Our objective is to highlight the clinical characteristics of AN in males as a routinely overlooked cause of multiple endocrinopathies and systemic illness in hospitalized patients. We present 4 cases (2 cases at The Mount Sinai Hospital; 2 cases at Long Island Jewish Hospital) of young men with hormonal dysfunction due to underlying AN. Pertinent de-identified data were collected from a chart review of cases seen on the endocrinology consult service at both hospitals. Institutional Review Board approval was not required for an observational report of the cases presented. Four young men with AN demonstrated evidence of multiple systemic complications from severe caloric and protein malnutrition. Varying degrees of endocrinopathies were present, including hypogonadotropic hypogonadism, hypercortisolemia, and nonthyroidal illness syndrome, resulting in bradycardia, gastroparesis, hypothermia, acute systolic heart failure, and erectile dysfunction. Ages at diagnosis were 20, 24, 23, and 20 years, with mean age 21.75 years. Most of the clinical effects from these endocrinopathies resolved with improved caloric intake and nutrition, although symptoms of hypogonadism persisted. This small case series highlights the importance of AN as a potential cause of multiple endocrinopathies in males. The heterogeneous presentations and varying degrees of clinical manifestations in our cohort emphasize the challenge in diagnosis. Increased awareness of AN in males is vital, as its prevalence is likely underestimated and appropriate diagnosis and treatment can ameliorate the metabolic dysfunction in a majority of cases. Further studies on males with eating disorders are needed to help guide diagnostic and therapeutic decisions.

Evidence for alterations of cortical folding in anorexia nervosa.

Anorexia nervosa (AN) is highly heritable, and the perspective on the etiology of AN has changed from a behavioral to a neurobiological and neurodevelopmental view. However, cortical folding as an important marker for deviations in brain development has yet rarely been explored in AN. Hence, in order to determine potential cortical folding alterations, we investigated fine-grained cortical folding in a cohort of 26 patients with AN, of whom 6 patients were recovered regarding their weight at the time point of MRI measurement. MRI-derived cortical folding was computed and compared between patients and healthy controls at about 150,000 points per hemisphere using a surface-based technique (FreeSurfer). Patients with AN exhibited highly significant increased cortical folding in a right dorsolateral prefrontal cortex region (DLPFC). Furthermore, a statistical trend in the same direction was found in the right visual cortex. We did not find a correlation of local cortical folding and current symptoms of the disease. In conclusion, our analyses provide first evidence that altered DLPFC cortical folding plays a role in the etiology of AN. The absence of correlations with clinical parameters implicates a relatively independence of cortical folding alterations from the current symptomatology and might thus be regarded as a trait characteristic of the disease potentially related to other neurobiological features of AN.

Cognitive style in anorexia nervosa: a preliminary investigation

Considerable research has been devoted to examining the content of cognition in eating disorders, which typically includes dysfunctional thoughts, attitudes and underlying assumptions about the importance of controlling eating, shape and weight. Far less is known about the style of cognition. An unhelpful cognitive style might include perseverative forms of thought (Nolen-Hoeksema, Parker & Larson, 1994); problem-oriented coping (Carver, Scheier & Weintraub, 1989); the tendency to become over-involved or “fused” with cognition (Hayes, Luoma, Bond, Masuda, & Lillis, 2006); and having a self-blaming attributional style (Anderson, Miller, Riger & Sedikides, 1994). The aim of the current study was to examine the extent to which aspects of cognitive style are associated with symptoms and features of anorexia nervosa. Participants from a specialist eating disorder clinic completed self-report questionnaires examining cognitive content, cognitive style, and symptoms. Preliminary findings demonstrate strong inverse relationships between eating disorder symptoms and reappraisal, problem-oriented coping, and cognitive defusion in particular. These results highlight the need to further investigate the role of cognitive style in anorexia nervosa. This aspect of cognition might help to explain why cognitive pathology tends to persist even in those who have recovered.

Body size overestimation and its association with body mass index, body dissatisfaction, and drive for thinness in anorexia nervosa.

Body size overestimation is a fundamental feature in anorexia nervosa (AN). There have been inconclusive findings about the extent to which this feature distinguishes psychopathology and some authors have argued that overestimation may be a function of lower body mass index (BMI). We examine body size estimation accuracy and body dissatisfaction in 74 females with AN and 11 age-matched female controls using two well-established psychophysical procedures. Participants with AN overestimated their body size more and had greater body dissatisfaction than controls. Size accuracy was found to be independent of BMI and correlated with body dissatisfaction and drive for thinness in participants with AN. We conclude that overestimation of body size in AN is related to the psychopathology associated with the disorder and is not due to any perceptual tendency for people with lower BMI to overestimate their body size. We discuss the implications of these findings for treatment of AN.

Are poor set-shifting abilities associated with a higher frequency of body checking in anorexia nervosa?

BackgroundThe rigid and obsessional features of anorexia nervosa (AN) have led researchers to explore possible underlying neuropsychological difficulties. Numerous studies have demonstrated poorer set-shifting in patients with AN. However, due to a paucity of research on the connection between neuropsychological difficulties and the clinical features of AN, the link remains hypothetical. The main objective of this study was to explore the association between set-shifting and body checking.MethodsThe sample consisted of 30 females diagnosed with AN and 45 healthy females. Set-shifting was assessed using the Wisconsin Card Sorting Test (WCST) and frequency of body checking was assessed using the Body Checking Questionnaire (BCQ).ResultsThe analysis showed no significant correlations between any of the WCST scores and the BCQ.ConclusionThe results suggest that there is no association between set-shifting difficulties and frequency of body checking among patients with AN. An alternative explanation could be that the neuropsychological measure included in this study is not sensitive to the set-shifting difficulties observed in clinical settings. We recommend that future studies include more ecologically valid measures of set-shifting in addition to standard neuropsychological tests.

Temporal delay discounting in acutely ill and weight-recovered patients with anorexia nervosa.

Patients with anorexia nervosa (AN) are characterized by a very low body weight but readily give up immediate rewards (food) for long-term goals (slim figure), which might indicate an unusual level of self-control. This everyday clinical observation may be quantifiable in the framework of the anticipation-discounting dilemma. Using a cross-sectional design, this study compared the capacity to delay reward in 34 patients suffering from acute AN (acAN), 33 weight-recovered AN patients (recAN) and 54 healthy controls. We also used a longitudinal study to reassess 21 acAN patients after short-term weight restoration. A validated intertemporal choice task and a hyperbolic model were used to estimate temporal discounting rates. Confirming the validity of the task used, decreased delay discounting was associated with age and low self-reported impulsivity. However, no group differences in key measures of temporal discounting of monetary rewards were found. Increased cognitive control, which has been suggested as a key characteristic of AN, does not seem to extend the capacity to wait for delayed monetary rewards. Differences between our study and the only previous study reporting decreased delay discounting in adult AN patients may be explained by the different age range and chronicity of acute patients, but the fact that weight recovery was not associated with changes in discount rates suggests that discounting behavior is not a trait marker in AN. Future studies using paradigms with disorder-specific stimuli may help to clarify the role of delay discounting in AN.

Dietetic Therapy aimed to restart menstrual period in patients affected by anorexia nervosa in weight recovery

Background Anorexia Nervosa (AN) is a severe eating disorder characterized by significantly low body weight and fear of gaining weight. It affects about 1 in 250 females and 1 in 2000 males and usually starts in adolescence or young adult life even if it can occur in childhood and later life. Amenorrhea is a very frequent feature in AN and it could persist after normalization of body mass index (BMI). A well represented fat mass and an adequate body composition (BC) are necessary for resumption of menstrual periods. Patients affected by AN, although in the remission phase, fear of becoming fat and refuse to gain weight.

Drive for activity in patients with anorexia nervosa

Hyperactivity and elevated physical activity are both considered symptom characteristics of anorexia nervosa (AN). It has been suggested that a drive for activity (DFA) may underlie these expressions, yet research into DFA in AN remains scant. This study investigated DFA levels in patients with AN and its relation to AN severity. Furthermore, as physical exercise may be a way to reduce negative affect, the influence of negative affect (anxiety) on the role of DFA in AN was tested. Two hundred and forty female patients with AN completed measures for DFA, eating disorder (ED) pathology, anxiety, and clinical parameters. A strong relation between DFA levels and ED pathology was found, which remained significant even after controlling for negative affect (anxiety). After much theorizing about DFA in AN this study provides empirical evidence for DFA as a hallmark feature of AN, independent of anxiety levels. Future research should shed light on the relationships between DFA, actual physical activity, and the course of AN.

Clinical Manifestations of Liver Dysfunction in Patients With Anorexia Nervosa

The number of Japanese patients with anorexia nervosa (AN) is increasing as society changes. Mild liver dysfunction is a complication of AN in around 30% of cases. In some rare instances, patients present with severe liver dysfunction similar to acute liver failure. However, there are numerous uncertainties over the clinical characteristics of this condition. The objective of the present study was to clarify the clinical characteristics of AN complicated by liver dysfunction and to investigate the factors related to hepatic complications.

The Clinical Implications of High Levels of Autism Spectrum Disorder Features in Anorexia Nervosa: A Pilot Study

This study examined autism spectrum disorder (ASD) features in relation to treatment completion and eating disorder psychopathology in anorexia nervosa (AN). Thirty-two adult women were recruited from specialist eating disorder services. Features of ASD and disordered eating were measured. Premature termination of treatment was recorded to explore whether ASD traits had impact on early discharge. A healthy control group was also recruited to investigate ASD traits between clinical and nonclinical samples. Significant differences were found between the AN group and the healthy control group in obsessive-compulsive disorder traits, depression and anxiety and ASD traits, with significant differences between groups in Social Skill and Attention Switching. The AN group reported no significant relationship between disordered eating severity and ASD traits. No significant effect was found between ASD features and treatment completion. Raw data on premature termination of treatment, despite no statistic impact, showed that seven out of the eight participants with high features of ASD completed treatment as planned compared with 50% of those with low ASD traits. Unexpectedly, this suggests enhanced treatment adherence in ASD.