Past History Of Anorexia Nervosa Research Articles

Emotional facial expression in women recovered from anorexia nervosa.

BackgroundRecent models of anorexia nervosa (AN) have emphasised the importance of social and emotional difficulties as maintenance factors of the disorder, however, empirical data are limited. The aim of this study was to examine whether altered emotional facial expression, previously observed in people currently ill with anorexia nervosa, is limited to the ill state or present in people recovered from the illness.MethodsThe sample consisted of 123 participants [49 AN, 21 recovered AN (RecAN) and 53 healthy controls (HC)]. Participants watched three films clips (amusing, neutral, sad) whilst their facial expressions were recorded and completed the positive and negative affect scale (PANAS) to record subjective experience. Facial expressions were subsequently coded for frequency of positive and negative expression and frequency of looking away.ResultsIn response to the amusing clip, AN participants showed significantly less positive expression than both HC and RecAN groups and both AN and RecAN showed more negative expression than HC with no difference between groups in looking away.In response to the sad clip there was no difference between groups in positive expression, but current AN participants showed significantly less negative expression than HC and looked away from the stimuli more than RecAN or HC.In terms of their subjective emotional experience, patients with current AN reported less positive emotion in response to both the amusing and the sad film clip. There was no difference between groups in subjective negative experience.ConclusionsAlterations in facial expression are present in people currently ill with AN contributing to the social difficulties found in AN and potentially exacerbating resistance to treatment. Some alterations in facial expression are found in women with a past history of AN but not to the same extent as those shown in the currently ill group. Future studies need to use a wider range of stimuli involving different emotions to corroborate findings.

A Season-of-Birth/DRD4 Interaction Predicts Maximal Body Mass Index in Women with Bulimia Nervosa

We have earlier reported that season of birth interacts with the hypofunctional 7-repeat (7R) allele of the dopamine-4 receptor gene (DRD4) to promote weight gain and obesity in women with seasonal affective disorder (SAD). This study examined whether this gene-environment interaction influences body weight regulation in women with bulimia nervosa (BN). In 188 female probands with BN, we performed an analysis of covariance predicting maximum lifetime body mass index (BMI) using season-of-birth, DRD4 genotype (7R present/absent), and past history of anorexia nervosa (yes/no) as independent variables, and age at maximum weight as the co-variate. Consistent with our SAD study, the birth-season x DRD4 interaction was a significant predictor of maximal BMI. Although in SAD, the spring-birth/7R+ group had markedly elevated maximal BMIs and high rates of obesity, in this BN sample, the fall-birth/7R+ group exhibited the highest BMI values (N=17: mean maximal BMI=28.2 kg/m(2) (SE 0.9) vs 25.2 kg/ m(2) (SE 0.3) for all other probands combined (N=171); p=0.002). The lifetime rate of obesity (BMI>30) was also higher in the fall-birth/7R+ vs 'other' group (29.9 vs 8.8%, respectively, p=0.008). These data offer further evidence that season of birth interacts with the 7R allele of DRD4 to influence body weight regulation in female overeating populations.

Reduced body fat in long-term followed-up female patients with anorexia nervosa

We aimed to evaluate both body composition and serum leptin levels in females with a past history of anorexia nervosa (AN) adjusted for their current body mass index (BMI). Twenty-three females with a past history of AN were followed-up 10 years after inpatient treatment and compared to 23 female controls of a similar age range matched for BMI on a one to one basis. Serum leptin levels were assessed and percent body fat (%BF) was determined via bioelectric impedance analysis. Differences of both %BF and leptin levels between cases and controls were tested under the hypothesis that cases have lower %BF and lower serum leptin levels than the controls. %BF was indeed lower in the cases compared to the controls ( p<0.05). However, differences in leptin levels between both groups just failed significance ( p=0.051). We conclude that body composition differs between long-term followed-up patients with AN and BMI- and gender-matched controls. Based on the finding that the former patients reported being more physically active, we assume that the higher physical activity levels in recovered patients with AN underlie the lower %BF.

Elevated sweet taste pleasantness ratings in bulimia nervosa

Recent studies suggest that some patients with bulimia nervosa may experience elevated pleasantness responses to sweet taste. This study explored possible associations between symptom patterns and pleasantness ratings for sucrose solutions in bulimic patients. Subjects included 15 women meeting DSM III-R criteria for narrowly defined bulimia nervosa (no history of other eating disorder); five patients with current bulimia nervosa and a past history of anorexia nervosa; and 20 healthy age-matched female controls. Subjects ate a standardized breakfast prior to the morning study visit. Sucrose-water solutions (0% to 40% sucrose) were rated for sweetness intensity and pleasantness. Patients with narrowly defined bulimia nervosa showed significantly higher pleasantness ratings for 40% sucrose solutions than controls and patients with a history of anorexia nervosa. Pleasantness ratings were not significantly correlated with frequency of binge eating or purging behaviors. These results extend previous evidence for altered sweet taste pleasantness responses in bulimia nervosa, and for differences in eating-related behaviors between patients with narrowly defined bulimia nervosa vs. those with past anorexia nervosa.

Self-induced abortion in a bulimic woman

We report the case of a woman with bulimia nervosa, several personality disorders, and a past history of anorexia nervosa who deliberately induced an abortion via self-imposed starvation and vigorous exercise. Her history reveals severe obsessive-compulsive and narcissistic personality disorders as well as a lifelong pattern of denial of affect and illness.

Genetic influences on eating attitudes in a normal female twin population

The Eating Attitudes Test (EAT) and the Eating Disorder Inventory (EDI) were administered to a female volunteer twin population aged 18 to 45 years. Both members of 147 monozygotic (MZ) and 99 dizygotic (DZ) twin pairs completed the questionnaires. Thirty-five subjects scored over the cut-off point of the EAT-26. Interviews of these high-scoring twins and their co-twins identified three subjects with a past history of anorexia nervosa, and three others with a history of a partial syndrome. A heritability value of 41% was obtained for the overall EAT scores, while factor analysis produced a 'dieting' factor with a heritability of 42%. The 'body dissatisfaction' and 'drive for thinness' subscales of the EDI had heritability values of 52 and 44% respectively. The genetic contribution to the variance in body mass index in the twin sample was estimated at 64%. For all the above phenotypes, an environmental model of transmission with heritability constrained to be zero, could be rejected. Conversely, we were unable to reject a purely additive genetic model with shared environmental variance constrained at zero, suggesting that family environment has little or no effect on the transmission of many of these traits.

Osteoporosis and normal weight bulimia nervosa— which patients are at risk?

This study assesses the degree of bone mineral loss in women with active DSM IIIR bulimia nervosa. The subjects in this study were 20 GP-referred female patients of normal weight who met criteria for bulimia nervosa and 16 healthy age, sex and weight matched controls. Dual energy X-ray densitometry of lumbar L1-L4 vertebrae was performed on all subjects. The patients with bulimia nervosa had a significantly lower mean lumbar bone mineral density (0.964 g/cm 2) than the control group (1.043 g/cm 2, p < 0.01). Within the patient group only subjects with a past history of anorexia nervosa had a significantly lower mean bone mineral density (BMD) than the controls. Small sample sizes limit the power of the study, however significant correlations were found between duration of amenorrhoea, low BMI and lumbar BMD. Bulimic patients do suffer from osteoporosis. Risk factors for this may be; a past history of anorexia nervosa, prolonged secondary amenorrhoea, and a persistently low body mass index.

The dexamethasone suppression test in bulimic outpatients without major depression

SummaryRecent studies have examined the effectiveness of the dexamethasone suppression test (DST) in the evaluation of bulimia. In a series of 18 female bulimic outpatients without major depression, 9 (50%) failed to suppress on the DST. No significant difference was found between suppressors and nonsuppressors in personal and family histories of affective disorder, levels of anxious and depressive symptoms, psychoactive substance abuse, and severity of abnormal eating-related behaviours. In contrast, non-suppression was significantly associated with low weight. There is a trend to differentiate non-suppressors from suppressors in the current diagnosis of anorexia nervosa and in past history of anorexia nervosa. Seven patients received fluvoxamine for 8 weeks. Five patients were suppressors and showed a significant decrease in the frequency of their binges while the 2 non-suppressors did not improve. These preliminary results suggest that DST non-suppression might be typical of bulimic patients with anorexia nervosa and that pretreatment DST results might predict the response of bulimic behaviour to treatment with fluvoxamine.

Diuretic Abuse and Central Pontine Myelinolysis

Patients with eating disorders often use diuretics to eliminate fluid to achieve lower body weight. Diuretic abuse can lead to severe hyponatremia. Central pontine myelinolysis, a disruption of the myelinated neurons of the pons, has been associated with rapid correction of severe hyponatremia. A case is presented of a 35-year-old woman who was brought to the emergency service by ambulance complaining of vomiting for 7 days and that she could not hear well because she was 'worn out'. Initial laboratory values included serum Na 91 mEq/l, K 1.6, Cl 46, bicarbonate 33, BUN 4 mg/dl, glucose 306 mg/dl. After 32 h of intravenous fluids, the serum Na was 126, K 4.0, Cl 89, bicarbonate 25, glucose 118 mg/dl. On the 3rd hospital day the serum Na was 139. On the 4th hospital day she was alert and appropriate. On the 5th hospital day, however, she was confabulating and chatty. The serum Na was 139. She progressed to develop a spastic quadriparesis, speech and swallowing difficulties. A magnetic resonance imaging scan showed central pontine myelinolysis. She acknowledged taking 400 mg daily of furosemide and drinking much water. She had a past history of anorexia nervosa. She had a residual weight phobia and strove to keep her weight below 106 lb. Her height was 5 feet, 6 inches. As illustrated by this case, diuretic abuse can cause severe hyponatremia and the subsequent risk of central pontine myelinolysis. In patients with severe chronic or subacute hyponatremia, a safe restoration rate for serum Na has been less than 0.55 mEq/l/h. Serum Na should be below 135 within the first 48 h and hypernatremia should be avoided.

Cranial computed tomography findings in bulimia.

In cranial computed tomography (CT), not only patients with anorexia nervosa but also patients suffering from bulimia, display enlarged external cerebrospinal fluid spaces. This was true for more than one third of the 28 bulimic patients studied, regardless of whether or not they had a past history of anorexia nervosa. As the bulimic patients had a near normal body weight, the observed structural changes cannot be attributed to underweight, as is commonly assumed to be the case in anorectic patients. These findings indicate that, in addition to underweight, other factors have to be considered as causing the morphological brain alterations present in patients with eating disorders.

Past history of anorexia nervosa in women with obsessive-compulsive disorder

The case notes of 280 patients with obsessive-compulsive disorder were examined retrospectively; 16 of the 151 females had a past history of anorexia nervosa. Not one male obsessive-compulsive had such a history, nor did any of 100 agoraphobics (83% female) studied as a contrasting anxiety disorder. Compared to nonanorexic cases of obsessive-compulsive disorder, the anorexics' were younger, their obsessive-compulsive problems began earlier, and they were more often single. No significant phenomenological differences were detected compared to nonanorexic obsessive-compulsive women. In conclusion, a history of anorexia is frequent among women (but not men) with obsessive-compulsive disorder but not agoraphobia.

Dietary follow-up patients treated for anorexia nervosa

Twelve adolescents hospitalized with a diagnosis of anorexia nervosa had their diet and nutritional history evaluated 5 years later. Detailed dietary history was obtained for the previous one year using a standard dietary questionnaire and compared to a matching control group. At follow-up the average age of anorexics was 19.7 years and controls 20.8 years. Average weight was the same in anorexics and controls. There were no statistically significant differences in intake of key nutrients, percent of the minimum daily recommended allowance of each nutrient ingested, and food source of calories between anorexics and controls. Both groups exceeded recommended allowances for all nutrients except iron. High levels of vitamin A and ascorbic acid in the diet indicated frequent use of fruits and vegetables by subjects and controls. Unlike previous studies results did not indicate carbohydrate avoidance or abnormal eating behavior. Continued inadequate intake was not typical of these young women with a past history of anorexia nervosa.

A Normal Cumulative Conception Rate after Human Pituitary Gonadotropin

Forty consecutive women were treated with human pituitary gonadotropin to induce ovulation. Thirty-seven patients (93%) ovulated and thirty (75%) conceived on at least one occasion. The cumulative conception rate for the series equaled that of the general population. Women with a past history of anorexia nervosa had the shortest average time to pregnancy. Of patients who did not conceive, four represented failures of patient selection in that they withdrew from treatment for a variety of psychiatric and social reasons, and six represented failures of treatment, not becoming pregnant despite the induction of ovulation. It is concluded that realistic goals for a contemporary human gonadotropin program include induction of ovulation in all patients and a cumulative conception rate equal to that of the general community.