Prognosis Of Anorexia Nervosa Research Articles

Preliminary study: cognitive behavioural therapy for insomnia in adolescents with anorexia nervosa

PurposeInsomnia and anorexia nervosa (AN) are frequently comorbid, negatively affecting the evolution and the prognosis of AN. Within this framework, the management of sleep disorders appears as critical. The aim of this retrospective study is to assess, for the first time, the efficacy of cognitive and behavioural therapy for insomnia (CBT-I) on sleep disturbances in adolescents with AN. To do so, we investigated the impact of CBT-I on sleep disturbances and sleep-related outcomes, in BMI, AN symptoms, anxiety and depressive symptoms, emotionality and quality of life. These features were compared between two groups of patients with AN, one following CBT-I, and the other receiving the regular treatment at the psychiatric unit.MethodsData collection occurred between January and May 2022. The study included 42 adolescents in-treatment at the Eating Disorders care specialised unit at Salvator Hospital in Marseille. They were randomly assigned to the CBT-I group (N = 31) or the control group (N = 11). Several clinical elements were assessed using sleep diaries and self-report questionnaires.ResultsParticipants undergoing CBT-I showed a significant improvement in sleep latency, total wake time and sleep efficacy, as well as in physical well-being. No significant effects were found regarding AN symptoms.ConclusionThese preliminary findings provide support for CBT-I effectiveness in adolescents with AN, as shown by significant improvements in several sleep parameters, as well as in physical well-being. These promising results, underline the relevance of this topic and its potential benefits for a more appropriate treatment for adolescents with AN.Level of evidence: Level V, retrospective study.

Anorexia Nervosa and Autism Spectrum Disorder: what links them?

IntroductionAccording to the literature, about 35% of patients with Anorexia Nervosa (AN) also have a diagnosis of Autism Spectrum Disorder (ASD), and this comorbidity occurs more frequently in males.ObjectivesWith this work, the authors intend to address the characteristics present in this comorbidity and what is the impact of this comorbidity in the diagnosis, approach and prognosis of AN.MethodsNon-systematic research of the literature through the PubMed database with the terms “autism spectrum disorder” and “anorexia nervosa”. Only surveys conducted in the last 10 years were considered for inclusion.ResultsAlthough AN and ASD may seem to be quite distinct conditions, the studies found suggest the existence of four characteristics that overlap the two diagnoses: deficits in theory of mind, inability to switch between courses of action fluently, inability to see the whole pictures to the detriment of detail and alexithymia. Studies also point to greater resistance to treatment in AN when an ASD is present in comorbidity.ConclusionsScientific evidence suggests that autistic characteristics in people with AN are not a consequence of being underweight, but rather stable characteristics present before and after the onset of AN. The studies thus conclude that comorbidity between the two disorders exists and is frequent enough to warrant greater attention to the diagnosis of ASD in people with AN. However, there are still no specific guidelines for the treatment of AN in people with ASD, which leads to a worse response to treatment, evolution and prognosis of AN in people with ASD.Disclosure of InterestNone Declared

Anorexia Nervosa as a Metabo-Psychiatric Disorder: Consequences for Assessment and Treatment in Childhood and Adolescence

Anorexia Nervosa (AN) has the highest mortality of all psychiatric disorders. Patients who experience the onset of AN in their teens suffer on average 10 years from an eating or other mental disorder. Recently many clinicians in the US and Europe have addressed the inadequacy of treatment for this disabling disease which – at least in adult patients - is mainly based on individual psychotherapeutic interventions. Against the background of a recent GWAS and genetic correlations with other mental disorders, but also inverse correlations with important metabolic parameters such as fasting insulin and leptin new treatment strategies must be developed. This presentation wants to elucidate two different interventions, a biological strategy, and a more pragmatic treatment setting in the “real world”. The biological strategy refers to the gut-brain axis which has been shown to be severely affected in AN. Patients show a deep perturbation of the gut microbiome with no significant improvement with weight rehabilitation. Thus, additional ways must be found such as nutritional strategies (e.g., administration of pre- or probiotics, stool transfer) to probably improve the outcome of this disorder. In addition, inpatient treatment which is still the gold standard for treatment of AN in Europe, has not been proven to alter the long-term prognosis of AN. Consequently, other interventions such as home treatment which involve the family and interrupt eating disorder associated habits as disease preserving factors will be introduced and the results of a pilot study in adolescent AN be presented.DisclosureEuropean Commission/ERA NET Research Grant Ministry of Labour, Health and Social Policies of Research Grant North-Rhine-Westfalia, Germany Joint Federal Committee (GBA) Rese

Unveiling Metabolic Phenotype Alterations in Anorexia Nervosa through Metabolomics

Anorexia nervosa (AN) is a mental disorder characterized by an intense fear of weight gain that affects mainly young women. It courses with a negative body image leading to altered eating behaviors that have devastating physical, metabolic, and psychological consequences for the patients. Although its origin is postulated to be multifactorial, the etiology of AN remains unknown, and this increases the likelihood of chronification and relapsing. Thus, expanding the available knowledge on the pathophysiology of AN is of enormous interest. Metabolomics is proposed as a powerful tool for the elucidation of disease mechanisms and to provide new insights into the diagnosis, treatment, and prognosis of AN. A review of the literature related to studies of AN patients by employing metabolomic strategies to characterize the main alterations associated with the metabolic phenotype of AN during the last 10 years is described. The most common metabolic alterations are derived from chronic starvation, including amino acid, lipid, and carbohydrate disturbances. Nonetheless, recent findings have shifted the attention to gut-microbiota metabolites as possible factors contributing to AN development, progression, and maintenance. We have identified the areas of ongoing research in AN and propose further perspectives to improve our knowledge and understanding of this disease.

Clinicians as a critical link: Understanding health professionals’ beliefs and attitudes toward anorexia nervosa, bulimia nervosa, and binge eating disorder

Understanding the perspectives of health professionals remains an understudied issue, yet may help bridge research-practice gaps and pinpoint important areas for education, training, and research. This study investigated attitudes toward anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) among Nordic health professionals specialized within the eating disorder (ED) field. Participants (n = 144) completed a modified ED-version of the Illness Perception Questionnaire which assessed attitudes and beliefs toward perceived symptom controllability, severity, treatment effectiveness, and views on the prognosis of AN, BN, and BED. Personal enjoyment and level of comfort working with AN, BN, and BED were also assessed. The majority agreed or strongly agreed that patients with AN, BN, and BED were not responsible for their illness, and viewed the illnesses as psychological rather than medical in etiology. AN was viewed as the most severe and enduring, followed by BN, then BED. Treatment for BN was viewed as being more highly effective than treatments for either AN or BED. Professionals rated significantly less enjoyment and less confidence working with BED. To conclude, both commonalities and differences in attitudes toward AN, BN and BED were found in terms of perceived symptom controllability, views on severity, treatment effectiveness, and anticipated prognosis. In particular, findings emphasized the need for additional training in the management of BED among Nordic healthcare professionals.

The role of leptin in patients recovering from Anorexia Nervosa

Abstract Introduction: Anorexia nervosa (AN) is a mental disorder with the highest death rate. The characteristic feature of AN is endocrine dysregulations, including changes in adipose-tissue secreted hormones, especially adipokines. The most widely studied of them is leptin whose role in the pathophysiology and prognosis of AN is confirmed in more and more studies. The aim of the study was to summarize the role of endocrine disruptions with particular emphasis on leptin in the pathophysiology of AN. Material and methods: For the literature review, the electronic databases PubMed, Cochrane and Google Scholar search were used with the following keywords: eating disorders, adipokines, leptin, metreleptin, satiety, hunger, anorexia, obesity, for studies listed from database inception to October 2021. Results: Leptin, produced mainly by white adipose tissue, inhibits the hunger center in the hypothalamus by negative feedback with ghrelin secreted by the gastrointestinal tract. Leptin is involved in numerous biological functions, including body weight regulation, innate and adaptive immunity regulation, reproduction, and bone formation. Studies confirm decreased leptin levels in AN individuals. In recent years, extensive experience has been gained with leptin as a drug in clinical trials. The studies suggested that treatment can restore menstrual function and bone health and improve mood with unclear body weight effects. Conclusions: Focusing on leptin-related changes is a promising approach to improve AN management. Assessment of leptin levels in AN patients could be a useful tool for therapy monitoring. Treatment with leptin could reverse unfavourable changes induced by diet restriction, including mood symptoms, loss of bone mass and menstrual function. However, the results of these studies need confirmation on larger groups of patients.

Shift Toward Randomness in Brain Networks of Patients With Anorexia Nervosa: The Role of Malnutrition.

No study to date investigated structural white matter (WM) connectome characteristics in patients with anorexia nervosa (AN). Previous research in AN found evidence of imbalances in global and regional connectomic brain architecture and highlighted a role of malnutrition in determining structural brain changes. The aim of our study was to explore the characteristics of the WM network architecture in a sample of patients with AN. Thirty-six patients with AN and 36 healthy women underwent magnetic resonance imaging to obtain a high-resolution three-dimensional T1-weighted anatomical image and a diffusion tensor imaging scan. Probabilistic tractography data were extracted and analyzed in their network properties through graph theory tools. In comparison to healthy women, patients with AN showed lower global network segregation (normalized clustering: p = 0.029), an imbalance between global network integration and segregation (i.e., lower small-worldness: p = 0.031), and the loss of some of the most integrative and influential hubs. Both clustering and small-worldness correlated with the lowest lifetime body mass index. A significant relationship was found between the average regional loss of cortical volume and changes in network properties of brain nodes: the more the difference in the cortical volume of brain areas, the more the increase in the centrality of corresponding nodes in the whole brain, and the decrease in clustering and efficiency of the nodes of parietal cortex. Our findings showed an unbalanced connectome wiring in AN patients, which seems to be influenced by malnutrition and loss of cortical volume. The role of this rearrangement in the maintenance and prognosis of AN and its reversibility with clinical improvement needs to be established by future studies.

Exome & precision medicine in eating disorders

Introduction Eating disorders (EDs) are complex and multifactorial psychiatric illnesses associated with significant and sustained pathological disruption of food intake. The Diagnostic and Statistical Manual of Mental Illnesses (DSM-5) distinguishes anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED). The neurobiological basis of food intake are well characterized. Epidemiological studies reported a heritability about 70% in AN and 60% in BN, suggesting that genetic factors are playing a significant role. AN is the most severe disorder in terms of morbidity in psychiatric illnesses, with the highest mortality rate increased by 23 fold. Treatments have a limited effectiveness, however, one third of the AN patients evolve to the remission. Goal We and collaborators from the Genetic Consortium for Anorexia Nervosa/Wellcome Trust Case Control Consortium-3 (GCAN/WTCCC3), the Anorexia Nervosa Genetics Initiative (ANGI) and the Eating Disorders Working Group of the Psychiatric Genomics Consortium (PGC-ED), are currently investigating molecular biology and physiology in AN patients, subjects in remission and healthy control women in the goal to identify and characterize biomarkers of diagnosis and prognosis of AN to propose precision medicine and adapted treatments. Methods Extensive clinical evaluation, genotyping of polymorphisms, exome sequencing of candidate genes or whole-exome sequencing (WES), and measure of DNA methylation levels of the whole genome or candidate genes, and blood concentration levels of candidate neuropeptides and hormones are performed in current AN patients, subjects in remission and healthy control women. Results Common genetic variants of vulnerability for AN are found by GWAS. Furthermore, rare variants or mutations are identified using the next-generation sequencing in the screening of sporadic cases or AN families. Significant differences are observed for specific DNA methylation sites and concentration levels of molecules between current AN patients compared to controls. Conclusions Convergent molecular and physiological studies suggest that the pathophysiological bases of eating disorder, and especially AN, involve both “psychiatric” and “metabolic” pathways. These omictools will allow us to enter in the precision medicine in eating disorders.

Small-world properties of brain morphological characteristics in Anorexia Nervosa

Cortical thickness and gyrification abnormalities in anorexia nervosa (AN) have been recently described, but no attempt has been made to explore their organizational patterns to characterize the neurobiology of the disorder in the different stages of its course. The aim of this study was to explore cortical thickness and gyrification patterns by means of graph theory tools in 38 patients with AN, 20 fully recovered patients, and 38 healthy women (HC). All participants underwent high-resolution magnetic resonance imaging. Connectome properties were compared between: 1) AN patients and HC, 2) fully recovered patients and HC, 3) patients with a full remission at a 3-year follow-up assessment and patients who had not recovered. Small-worldness was greater in patients with acute AN in comparison to HC in both cortical thickness and gyrification networks. In the cortical thickness network, patients with AN also showed increased Local Efficiency, Modularity and Clustering coefficients, whereas integration measures were lower in the same group. Patients with a poor outcome showed higher segregation measures and lower small-worldness in the gyrification network, but no differences emerged for the cortical thickness network. For both cortical thickness and gyrification patterns, regional analyses revealed differences between patients with different outcomes. Different patterns between cortical thickness and gyrification networks are probably due to their peculiar developmental trajectories and sensitivity to environmental influences. The role of gyrification network alterations in predicting the outcome suggests a role of early maturational processes in the prognosis of AN.

Gut-Brain Interactions: Implications for a Role of the Gut Microbiota in the Treatment and Prognosis of Anorexia Nervosa and Comparison to Type I Diabetes

Gut-Brain Interactions: Implications for a Role of the Gut Microbiota in the Treatment and Prognosis of Anorexia Nervosa and Comparison to Type I Diabetes

Extend, Pathomechanism and Clinical Consequences of Brain Volume Changes in Anorexia Nervosa.

Introduction: Brain volume deficits of grey matter (GM) and white matter (WM) are often found in patients with anorexia nervosa (AN). However, until recently, little was known about the influencing factors of these brain volume alterations, nor their exact quantification and rehabilitation.Methods: This review addresses these open questions and further explores what is now known about the underlying patho-biology and the clinical consequences including human studies as well as animal studies mimicking anorexia nervosa in ro-dents.Results: GM was reduced by 3.7% in adults and 7.6% in adolescents with AN. WM was reduced on average 2.2% in adult patients and 3.2% in adolescents. Most volume deficits in adults are reversible after long-term recovery; for adolescents, data are less clear. The main influencing factors for GM were absolute lowest weight at admission and illness duration. Cerebellar and WM reductions at admission predicted clinical outcome at one year follow-up. New studies found GABA receptor changes in GM and astrocyte loss in both GM and WM, as well as a possible role for oestrogen deficit. All three could part-ly explain clinical symptoms of anxiety, rigidity and learning impairments in patients with AN.Conclusion: Brain volume deficits in AN seem to play a causal role in the course and the prognosis of AN. A better under-standing of these brain changes could lead to more targeted therapies for patients with AN, including astrocyte-directed ap-proaches

Temporal discounting across three psychiatric disorders: Anorexia nervosa, obsessive compulsive disorder, and social anxiety disorder.

Temporal discounting refers to the tendency for rewards to lose value as the expected delay to receipt increases. Individuals with anorexia nervosa (AN) have been found to show reduced temporal discounting rates, indicating a greater preference for delayed rewards compared to healthy peers. Obsessive-compulsive disorder (OCD) and social anxiety disorder (SAD) commonly co-occur with AN, and anxiety has been related to development and prognosis of AN. We examined whether reduced temporal discounting is present across these potentially related disorders, and explored the relationship between temporal discounting and anxiety transdiagnostically. One hundred ninety six individuals (75 healthy controls (HC); 50 OCD; 27 AN; 44 SAD) completed two temporal discounting tasks in which they chose between smaller-sooner and larger-later monetary rewards. Two measures of discounting-discount rate and discount factor-were compared between diagnostic groups, and associations with anxious traits were examined. Individuals with AN showed decreased temporal discounting compared to HC. OCD and SAD groups did not differ significantly from HC. Across the sample, anxiety was associated with decreased discounting; more anxious individuals showed a greater preference for delayed reward. We replicated the findings that individuals with AN show an increased preference for delayed reward relative to HC and that individuals with OCD do not differ from HC. We also showed that individuals with SAD do not differ from HC in discounting. Across this large sample, two measures of anxious temperament were associated with temporal discounting. These data raise new questions about the relationship between this dimensional trait and psychopathology.

The DSM-5 diagnostic criteria for anorexia nervosa may change its population prevalence and prognostic value

The definition of anorexia nervosa was revised for the Fifth Edition of the Diagnostic and Statistical Manual (DSM-5). We examined the impact of these changes on the prevalence and prognosis of anorexia nervosa. In a nationwide longitudinal study of Finnish twins born 1975–1979, the women (N = 2825) underwent a 2-stage screening for eating disorders at mean age 24. Fifty-five women fulfilled DSM-IV criteria for lifetime anorexia nervosa. When we recoded the interviews using DSM-5 criteria, we detected 37 new cases. We contrasted new DSM-5 vs. DSM-IV cases to assess their clinical characteristics and prognosis. We also estimated lifetime prevalences and incidences and tested the association of minimum BMI with prognosis. We observed a 60% increase in the lifetime prevalence of anorexia nervosa using the new diagnostic boundaries, from 2.2% to 3.6%. The new cases had a later age of onset (18.8 y vs. 16.5, p = 0.002), higher minimum BMI (16.9 vs. 15.5 kg/m2, p = 0.0004), a shorter duration of illness (one year vs. three years, p = 0.002), and a higher 5-year probability or recovery (81% vs. 67%, p = 0.002). Minimum BMI was not associated with prognosis. It therefore appears that the substantial increase in prevalence of anorexia nervosa is offset by a more benign course of illness in new cases. Increased diagnostic heterogeneity underscores the need for reliable indicators of disease severity. Our findings indicate that BMI may not be an ideal severity marker, but should be complemented by prognostically informative criteria. Future studies should focus on identifying such factors in prospective settings.

Long-term outcome in anorexia nervosa in the community.

Few studies have assessed outcomes of anorexia nervosa (AN) outside clinical settings. We aimed to assess mortality, recovery, and socio-demographic outcomes of AN in a community sample. Women in the nationwide FinnTwin16 cohort (born 1975-1979) were followed for 10 years after baseline diagnostic assessment (mean age at follow-up 34 years, N = 2188). We compared women with lifetime DSM-IV AN (N = 40) with unaffected women from the same cohort. None of the women with AN had died and 88% were weight-recovered (BMI ≥ 18.5 kg/m(2) ), but their mean BMI (22.0 kg/m(2) ) was lower than among unaffected women (24.0 kg/m(2) , p = 0.008). University degrees (38 vs. 29%, p = 0.26), sickness absence during the past year (median 5 vs. 3 days, p = 0.21), or unemployment or disability pension (5 vs. 4%, p = 0.62) did not significantly differ between AN probands and their unaffected peers. More women with AN were still studying (15 vs. 4%, p = 0.003), and half of them had children, as compared to 66% of unaffected women (p = 0.05). The long-term prognosis of AN in the community appears promising. Weight-restoration is common and socio-demographic outcomes are generally favorable. However, women with a history of AN may be less likely to have children.

Dysregulation of soluble epoxide hydrolase and lipidomic profiles in anorexia nervosa.

Individuals with anorexia nervosa (AN) restrict eating and become emaciated. AN tend to have an aversion to foods rich in fat. Because Epoxide Hydrolase 2 (EPHX2) was identified as a novel AN susceptibility gene, and because its protein product, soluble epoxide hydrolase (sEH), converts bioactive epoxides of polyunsaturated fatty acid (PUFA) to the corresponding diols, lipidomic and metabolomic targets of EPHX2 were assessed to evaluate the biological functions of EPHX2 and their role in AN.Epoxide substrates of sEH and associated oxylipins were measured in ill AN, recovered AN, and gender- and race-matched controls. PUFA and oxylipin markers were tested as potential biomarkers for AN. Oxylipin ratios were calculated as proxy markers of in vivo sEH activity. Several free- and total PUFAs were associated with AN diagnosis and with AN recovery. AN displayed elevated n-3 PUFAs and may differ from controls in PUFA elongation and desaturation processes. Cytochrome P450 pathway oxylipins from arachidonic acid, linoleic acid, alpha-linolenic acid, and docosahexaenoic acid PUFAs are associated with AN diagnosis. The diol:epoxide ratios suggest the sEH activity is higher in AN compared to controls. Multivariate analysis illustrates normalization of lipidomic profiles in recovered ANs.EPHX2 influences AN risk through in vivo interaction with dietary PUFAs. PUFA composition and concentrations as well as sEH activity may contribute to the pathogenesis and prognosis of AN. Our data support the involvement of EPHX2-associated lipidomic and oxylipin dysregulations in AN, and reveal their potential as biomarkers to assess responsiveness to future intervention or treatment.

Genetics and Epigenetics of Eating Disorders.

Eating disorders (EDs) are serious psychiatric conditions influenced by biological, psychological, and sociocultural factors. A better understanding of the genetics of these complex traits and the development of more sophisticated molecular biology tools have advanced our understanding of the etiology of EDs. The aim of this review is to critically evaluate the literature on the genetic research conducted on three major EDs: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). We will first review the diagnostic criteria, clinical features, prevalence, and prognosis of AN, BN, and BED, followed by a review of family, twin, and adoption studies. We then review the history of genetic studies of EDs covering linkage analysis, candidate gene association studies, genome-wide association studies, and the study of rare variants in EDs. Our review also incorporates a translational perspective by covering animal models of ED-related phenotypes. Finally, we review the nascent field of epigenetics of EDs and a look forward to future directions for ED genetic research.

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

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

P02-139 - Psychological characteristics of anorexic patients’ mothers in the Southeast Brazil: Implications for treatment and prognosis of anorexia nervosa in a public service

IntroductionConsidering both the complexity of factors that composes the anorexia nervosa (AN) and the recommendation of important organizations related to health, it becomes fundamental the reflection on psychotherapeutic interventions proposed to patient's relatives.ObjectivesExpand the knowledge about the mother-daughter relationship in AN in order to develop a conceptual framework that improves the way to handle with this disorder, to reduce the factors that maintain it and to improve the prognosis.MethodClinical method, through clinical observation regarding a group of patients’ relatives with eating disorders at an outpatient service at a university hospital in the Southeast Brazil.ResultsWe have identified common characteristics in the mother-daughter relationship in AN, that maintain the structure of anorexic patients, influencing directly on the severity of each case and therapeutic possibilities. The mutual control: anorexic's mothers showed the need of controlling their daughters, denying the daughter's individuality, trying to become tutors of their actions and thus also become controlled by them; The dialectic between omnipotence and impotence: sense of powerlessness in face of numerous failed attempts to help their daughters, with feelings of guilt, as if they were fully responsible for the daughter's disorder; The relationship of devotion, passion and hostility between mother and daughter: with a fused attitude with her daughter, the mother is even more limited to understand their real needs, invading their personal space.ConclusionsThe findings allowed to identify important aspects of mother-daughter relationship in AN, that can improve clinical interventions for the treatment.

Exploring Experience of Family Relations by Patients with Anorexia Nervosa and Bulimia Nervosa Using a Projective Family Test

Elements of family dynamics have been shown to be related to onset, course, as well as prognosis of anorexia nervosa and bulimia nervosa. The goal was to explore the experience of family relations in a group of patients with eating disorders using a projective family test. The Patient group (anorexia=21, bulimia=16), as well as a healthy Control group, were given a projective family test, the Eating Disorder Inventory-2, as well as Karolinska Scales of Personality. The Patient group expressed more discord within the family picture than the Control group, such as cold and loveless relationships and not feeling validated. The group of patients reporting the most family discord did not show more eating disorder pathology or general psychopathology. They did, however, have higher scores on the Eating Disorder Inventory-2 subscale Maturity Fears, as well as higher values on the Karolinska Scales of Personality subscale Socialization. These results are interpreted within the background of methodological challenges in this area of research.

Heart Rate and Blood Pressure Variability and Baroreflex Sensitivity in Patients With Anorexia Nervosa

Anorexia nervosa (AN) is considered to have a significant risk for sudden death because of cardiac complications, and abnormalities of the autonomic nervous system might be a cause of cardiac dysfunction. The aim of this study was to investigate autonomic nervous system function in AN patients by analyzing heart rate variability (HRV), blood pressure variability (BPV), and baroreflex sensitivity (BRS). The subjects were 32 AN patients without other psychiatric comorbidities and 37 healthy controls. Beat-to-beat R-R interval and systolic blood pressure recorded in the supine position were analyzed using power spectral analysis and cross-spectrum analysis to quantify the frequency domain properties of HRV, BPV, and BRS. In addition, detrended fluctuation analysis was used to quantify the fractal correlation properties from the scaling exponent alpha1 of HRV. High frequency power and total power of HRV and BRS were significantly higher in AN patients and low frequency power of BPV, low frequency/High frequency ratio of HRV, and the scaling exponent alpha1 of HRV were significantly lower in AN patients, compared with controls. These findings suggest that AN patients have reduced cardiovascular sympathetic nervous responsiveness, increased parasympathetic nervous responsiveness, and increased complexity of the interbeat interval time series compared with healthy controls. Regarding the relationship to prognosis of AN, the study showed conflicting results, and further prospective studies are needed to determine if these results are related to high mortality in AN patients.