Primary Anorexia Nervosa Research Articles

Personal constructs in anorexia

A repertory grid of 12 elements and 12 constructs was presented to 15 female subjects suffering from primary anorexia nervosa and 15 matched control subjects. Cluster analysis, as used by Makhlouf-Norris and Norris (1973) revealed that the anorexic group had a prevalence of segmented and monolithic structures and the normal group a prevalence of articulated structures. The relationships between the elements was examined and the anorexic group showed significantly more “ideal self” isolation, “social” and “present self” alienation than the control group. The average distance between the elements was significantly greater in the anorexic group than in the control group. Analysis of the first two components showed that the first component accounted for more variance than the second when compared to the normals. It is concluded that the repertory grid is a valid method of investigating the conceptual disturbance in anorexia nervosa.

Anorexia nervosa

The majority of patients with anorexia nervosa regain a normal body weight after appropriate treatment, but the relapse rate is high, and the long-term outcome remains uncertain. The present study attempted to trace 49 patients (47 female, 2 male) with primary anorexia nervosa, all of whom had been managed by refeeding and supportive psychotherapy. The patients were contracted on two occasions. At the 22-month follow-up, 46 (94%) of the patients responded to a questionnaire. At the 102-month follow-up, 34 (69%) were interviewed by telephone. The outcome was reported as "good" by 18 patients (37%), as "intermediate" by 9 patients (18%); it was "poor" in 5 patients (10%), including one who had killed herself. No information was available for 16 patients (33%) who either could not be contacted or refused to cooperate. One patient had died by accident.

Anorexia nervosa and nephrolithiasis

A patient with primary anorexia nervosa developed acute abdominal pain and hematuria. Cytoscopy and retrograde pyelography confirmed nephrolithiasis. A calcium oxalate stone was passed. The association between anorexia nervosa and nephrolithiasis has not been previously reported. Dietary factors and chronic dehydration are known to contribute to the development of renal stones; therefore, the association may not be coincidental.

A comparison between muscle function and body composition in anorexia nervosa: the effect of refeeding

Skeletal muscle function, body composition (total body nitrogen and total body potassium) and standard parameters of nutritional assessment were measured in six severely depleted patients with primary anorexia nervosa, both on admission and during oral refeeding. The function of the adductor pollicis muscle was assessed by electrical stimulation of the ulnar nerve. On admission muscle function was markedly abnormal in the patients with anorexia nervosa (n = 6) compared with normal subjects (n = 22), with a significant increase in the force of contraction at 10 Hz, with a mean ± SEM of 48.0 ± 3.7% and 28.8 ± 1.2%, respectively (p < 0.001). There was slowing of the maximal relaxation rate, 6.6 ± 0.6% and 9.6 ± 0.2%, respectively (p < 0.001) and increased muscle fatigue 18.6 ± 5.9% and 3.5 ± 0.8%, respectively (p < 0.01). Initially, the mean serum albumin was normal (4.0 ± 0.1 g/dl), although there was evidence of severe depletion of somatic protein stores, with a low total body nitrogen and creatinine-height index. Within 4 wk of oral refeeding, maximal relaxation rate and muscle fatigability were restored to normal, and within 8 wk all parameters of muscle function were normal. During the study total body nitrogen increased by only 13% and was still 19.4% below the predicted normal total body nitrogen, whereas total body potassium increased by 32% and body fat by 46%. Normalization of muscle function may be related to restoration of muscle electrolytes rather than repletion of body nitrogen.

A Double-Blind Trial of ??9-Tetrahydrocannabinol in Primary Anorexia Nervosa

Δ9-Tetrahydrocannabinol (Δ9-THC), the most prominent psychoactive cannabinoid in Cannabis sativa L. (marijuana), has been reported to have properties of appetite stimulation, promotion of weight gain, and antiemetic efficacy in selected patient populations. In this 4-week, double-blind, crossover study, 11 female patients with primary anorexia nervosa (PAN) were evaluated on Δ9-THC and on an active placebo, diazepam. All patients participated in a standardized behavior modification treatment program. The following data were obtained: (1) daily weight, (2) daily caloric intake, and (3) weekly psychiatric assessments. The two groups were comparable on all measures at baseline except for two items on the behavioral rating scales. The only significant differences found between the changes over time on Δ9-THC versus diazepam were more pathology on Δ9-THC for somatization, interpersonal sensitivity, and sleep disturbance. Three patients experienced severe dysphoric reactions consisting of paranoid ideation and feelings of loss of control during Δ9-THC administration. One week after the study ended, each subject was given the highest dose level of Δ8-THC achieved in the study, and periodic blood samples were obtained coincident with self-rated “subjective high” assessments and pulse measurements. Quantitative analyses of these samples indicated peak times of 1 to 5 hours postdose for Δ9- THC and for its primary active metabolite, 11-hydroxy-THC, which generally coincided with peak times for “subjective high” and pulse rate. The results of this clinical investigation suggest that Δ9-THC is not efficacious, in short-term administration, in the treatment of primary anorexia nervosa and is associated with significant psychic disturbance in some PAN patients.

Diagnosis of anorexia nervosa in the adolescent male

Sporadic cases of anorexia nervosa in the male patient have been described. We present three cases of weight loss in adolescent males. The first is a typical case of primary anorexia nervosa. The second illustrates weight loss in the competitive adolescent athlete. The third was mistakenly thought to have primary anorexia nervosa. At autopsy, he had regional enteritis. These patients are compared to call attention to the differential diagnosis of anorexia nervosa in the adolescent male.

Diagnostic issues in primary anorexia nervosa.

A literature review and clinical case presentation approach are employed to highlight unresolved diagnostic issues in Primary Anorexia Nervosa. The material is examined and discussed along a multidimensional list of variables considered important for the diagnosis, including definitions of weight loss, associated biological symptoms, eating patterns and body image disturbances.

Anorexia Nervosa: Three Case Studies of TA Treatment

Describes treatment of primary anorexia nervosa utilizing a Transactional Analysis orientation. The anorexic has a loser's script of the “Never” type. The personality pattern includes two cycles: “If I'm good enough, then they'll love me or I'll die in the effort,” and “I'll die first, and that will show them who is in control.” Injunctions found to be common in anorexic patients are Don't grow up, Don't be sexual, Don't exist, Don't feel sensations, Don't feel emotions. Drivers (T. Kahler) identified are Be perfect, Please me, and Try hard. Outlines a two-year treatment program, and discusses problems found to commonly arise during treatment. Verbatim extracts provide examples of the program in progress.

Anorexia nervosa und Schizophrenic bei einem eineiigen Zwillingspaar

The case report describes two 20-year-old monozygotic twin sisters who have been suffering from the symptoms of primary anorexia nervosa for the last 10 years. Usually the disease manifested itself in such a manner that the twin who was currently in the mother’s favour showed no signs of anorexia, whereas the other was severely afflicted. Occasionally, however, both girls suffered from the same anorectic symptoms at the same time. For the moment the condition of one of the twins seems to have become stable. Up to now the other twin has suffered three times from schizophrenic episodes which seem to be closely connected with the problems of anorexia. The most recent severe katatonic state, in particular, appeared to be a gradual transition from anorectic behaviour to psychotic experience so that the close relationship between primary anorexia and schizophrenic disturbances, as discussed in literature, becomes increasingly evident.

A comparison of anorexics and schizophrenics on psychodiagnostic measures

Much controversy has existed concerning the nosological category to which primary anorexia nervosa belongs. In this study 27 hospitalized anorexic and schizophrenic females at NIMH were compared on two commonly used psychodiagnostic measures, the Wechsler and Rorschach. Anorexics had higher IQ's than schizphrenics. Specifically, with the exception of similarities and vocabulary, anorexics showed a superiority on all subtests. On the other hand, anorexics, like schizophrenics, produced disturbed Rorshachs. The Delta Index means of the two groups were not statistically significant and clearly reflected pathological thought organization. However, on specific Rorschach dimensions, anorexics produced more shading, achromatic color and whole responses which suggests greater organizing abilities and awareness of affectional needs and depression. A unitary model of psychopathology is criticized for insufficient descriptive and differentiating power, and a model is presented that allows for the measuring of levels of psychopathology. Based on general test considerations (e. g. differential response to degree of structure) and specific test findings (e. g. shading and achromatic responses, whole responses, Delta Index), it is proposed that anorexics have a number of features in common with borderline personalities. These similarities include proclivity toward disturbed thought processes, sensitivity to depression and affective needs but cognitive organization on structured tests.

Abnormal gastric emptying in primary anorexia nervosa.

The gastric emptying rate was measured in 10 female patients with primary anorexia nervosa and 12 healthy volunteers, using a scinti-scanning technique for the simultaneous study of the liquid and solid components of a test meal. The emptying rate of both the liquid and the solid phase components of the meal was significantly slower in patients with anorexia nervosa. The aetiological and therapeutic implications of this finding are discussed.

A comparative analysis of primary anorexics and schizophrenics on the MMPI.

Although only a very small number of studies have described personality testing in primary anorexia nervosa (patients), they seem to suggest a deeper personality disturbance than commonly suggested by psychiatric interview. These results represent an attempt to define the contribution of psychological test data to differential diagnosis and personality organization in primary anorexia nervosa. Fourteen female schizophrenic and 14 female anorexic patients were compared on the MMPI. No significant differences were found on any of the validity or clinical scales. A product-moment correlation between the two profiles, obtained via a measure of distance between profiles, revealed remarkable similarities in their overall profiles (D2 = .83). The Depression, Psychopathic Deviate, Psychasthenia, Paranoia and Schizophrenia scales occupied the first five rankings for both groups (although in a different order) and were elevated over a T-score of 70 (for the anorexics, the Psychopathic Deviate scale score approached 70). The results are consistent with the few studies that utilized psychodiagnostic tests with anorexics and that point to extremely poor personality integration and to a more serious disorder than a neurotic disturbance.

Effect of bethanechol on gastric functions in primary anorexia nervosa.

We have shown previously that patients with primary anorexia nervosa (PAN) have decreased gastric emptying and acid output. The present studies were designed to explore the possibility that bethanechol, a parasympathomimetic agent, would acutely restore normal gastric function in those patients. We used a dye dilution technique to determine acid output and fractional emptying rate in 5 patients with PAN and 11 healthy controls during a basal period and following bethanechol (0.06 mg/kg, subcutaneously). Although bethanechol caused fractional emptying and acid output to increase threefold in PAN (P less than 0.05), it failed to produce stimulation of gastric emptying and acid output to levels similar to those achieved in controls. Therefore, gastric emptying and acid output were less in PAN than in controls, both basally and after bethanechol. Since bethanechol failed to completely restore acute gastric function, the defect of emptying and acid output in PAN does not appear to be caused by a deficiency of parasympathetic neurotransmitter but, instead, could reflect undetermined inhibitory influences or impaired function of the muscular and glandular cells. Following weight gain, fractional emptying rate and acid output were still slightly less in PAN patients than in controls, but the difference was statistically significant only for basal acid output.

Frequency of presentation of anorexia nervosa in Malaysia.

Primary anorexia nervosa appears to be a very rare condition in Malaysia, especially amongst Malays compared to Chinese and Indians. The reasons for the racial differences and the apparent infrequency of the condition are discussed.

Some recent observations on the pathogenesis of anorexia nervosa.

Studies of diagnostic subtypes within the anorexia nervosa syndrome has given rise to the differentiation of a bulimic subgroup as distinct from the restrictive type of anorexia nervosa. The bulimic subtype is characterized by the use of vomiting and laxatives to induce weight loss; a display of impulse-related behaviours; extraversion and sexual activity in contrast to the isolation of the restrictive group; and a family history of obesity in the mother, all suggesting a subcategory within the primary anorexia nervosa syndrome. Investigation of behaviours and attitudes related to anorexia nervosa in a group of dancers disclosed a significantly elevated attitude toward food and body image characteristic of anorexia nervosa in this group and ten times the expected prevalence of the disorder itself. This is suggestive of the relative importance of cultural pressures towards thinness and anorexia nervosa in certain populations as one factor amongst others in the multi-determined origin of this condition. This cultural pressure is consistent with a disturbance of body image perception in anorexia nervosa. This disturbance seems to be stable in the same individual over a period of one year, is related to a poor prognosis and is correlated with measures of psychopathology including helplessness, depression and anhedonia. It is also correlated with a satiety defect as reflected in a failure to develop an aversion to sucrose when directly tested.

Abnormalities of dexamethasone suppression test and urinary MHPG in anorexia nervosa.

Twenty-two patients with primary anorexia nervosa were assessed on variables of weight, mood, dexamethasone suppression test, and 24-hour urinary MHPG levels. Patients at less than 80% of their ideal weight had abnormally high cortisol levels after the test and low MHPG levels, regardless of their mood. The authors hypothesize that these abnormalities are not due to depression associated with anorexia nervosa and that decreased norepinephrine metabolism may be related to this illness.

Socio-cultural factors in the development of anorexia nervosa.

A population of professional dance (N = 183) and modelling (N = 56) students, who by career choice must focus increased attention and control over their body shapes, was studied. Height and weight data were obtained on all subjects. In addition, a questionnaire that is useful in assessing the symptoms of anorexia nervosa, the Eating Attitudes Test (EAT), was administered. Results of these tests were compared with those of normal female university students (N = 59), patients with anorexia nervosa (N = 68), and music students (N = 35). Anorexia nervosa and excessive dieting concerns were overrepresented in the dance and modelling students. Twelve cases (6.5%) of primary anorexia nervosa were detected in the dance group. All but one case developed the disorder while studying dance. Within the dance group those from the most competitive environments had the greatest frequency of anorexia nervosa. These data suggest that both pressures to be slim and achievement expectations are risk factors in the development of anorexia nervosa. The influence of socio-cultural determinants are discussed within the context of anorexia nervosa as a multidetermined disorder.

Anorexia nervosa: A group case conference

Four patients with primary anorexia nervosa were interviewed in order to demonstrate some of the characteristic features of this disorder. Although this disorder occurs only rarely in males, one of these four patients was a young man. Primary anorexia nervosa is discussed from a variety of perspectives, including descriptive, psychodynamic, and hormonal. A brief review of the theoretical rationale underlying a variety of psychotherapeutic approaches is offered, and reports of their effectiveness are considered. Primary anorexia nervosa is probably bets conceptualized as a complicated disorder with an admixture of serious psychological and somatic components, including the characteristic approach-avoidance conflict over eating. The authors speculate on the possibility of an underlying disorder of central catecholamine metabolism, particularly in relationship to dopamine transmission.

The heterogeneity of anorexia nervosa. Bulimia as a distinct subgroup.

Bulimia is a poor prognostic sign in anorexia nervosa. This raised the question of whether bulimia represented an "end stage" of chronic anorexia nervosa or whether bulimic patients were a distinct subgroup. All subjects seen by us personally from 1970 to 1978 were included in this study provided they met modified criteria of Feighner et al (1972). Of this group, 68 experienced bulimia and 73 did not (restricters). Bulimic patients had a history of weighing more and were more commonly premorbidly obese. Bulimic patients were those who vomited and misused laxatives. The bulimic group displayed a variety of impulsive behaviors, including use of alcohol and street drugs, stealing, suicide attempts, and self-mutilation. With regard to family history, the high frequency of obesity in the mothers of bulimic patients was noteworthy. The two groups share features common to patients with primary anorexia nervosa. However, these results suggest a different group of women are predisposed to have anorexia nervosa develop with bulimia.

Excessive Weight Loss and Food Aversion in Athletes Simulating Anorexia Nervosa

The dominant role of athletic activities in our society and the extent and intensity of sports participation by large numbers of young people create stresses causing a whole new constellation of health problems, both emotional and physical. One such problem is excessive weight loss and food aversion in athletes. The condition is in many ways similar to primary anorexia nervosa as commonly encountered in young women. The athlete avoiding food and experiencing extreme weight loss is most often a male, however, and does not suffer from severe, deep-seated emotional problems. He is typically a serious and outstanding student athlete fearing failure in meeting expectations of admiring coaches, teammates, and parents. The prognosis is excellent under the treatment by an informed, reassuring physician. The athlete's physician should provide a precise definition of optimum level of fatness for given sports participation. Guidance should be given in such a way that the desired level of fatness can be safely achieved, without threatening health and fitness.