Relentless Pursuit Of Thinness Research Articles

Genetic variants identified in novel candidate genes for anorexia nervosa and analysis of molecular pathways for diagnostic applications.

Anorexia nervosa (AN) is a severe psychiatric disorder characterized by an intense fear of gaining weight, a relentless pursuit of thinness, and a distorted body image. Recent research highlights the substantial contribution of genetics to AN's etiology, with genes like BDNF, SLC6A4, and DRD2 implicated. However, a comprehensive genetic test for AN diagnosis is lacking. This study aims to elucidate the biological foundations of AN, examining variants in genes associated with syndromic forms, rare variants in AN patients, and candidate genes from GWAS studies, murine models, or established molecular pathways. The study involved 135 AN patients from Italy, diagnosed based on DSM-V criteria. A specialized Next-Generation Sequencing panel targeting 163 genes was designed. Sequencing was performed on an Illumina MiSeq System, and variants were analyzed using bioinformatics tools. Data on clinical parameters, exercise habits, and AN types were collected. The AN cohort, predominantly female, exhibited diverse clinical characteristics. Our analysis identified gene variants associated with syndromic forms of AN, such as STRA6, NF1, MAT1A, and ABCC6. Variants were also found in known AN-related genes (CD36, DRD4, GCKR, GHRL, GRIN3B, GPR55, LEPR) and in other 16 candidate genes (A2M, AEBP1, ABHD4, ACBD7, CNTNAP, GFRAL, GRIN2D, LIPE, LMNA, NMU, PDE3B, POMC, RYR1, TNXB, TYK2, VPS13B), highlighting the complexity of AN's genetic landscape. The endocannabinoid and dopamine pathways play crucial roles. Skeletal muscle-related genes and appetite-regulating hormones also revealed potential connections. Adipogenesis-related genes suggest AN's association with subcutaneous adipose tissue deficiency. This study provides comprehensive insights into the genetic underpinnings of AN, emphasizing the importance of multiple pathways. The identified variants contribute.

A Longitudinal Magnetoencephalographic Study of the Effects of Deep Brain Stimulation on Neuronal Dynamics in Severe Anorexia Nervosa.

Anorexia Nervosa (AN) is a debilitating psychiatric disorder characterized by the relentless pursuit of thinness, leading to severe emaciation. Magnetoencephalography (MEG)was used to record the neuronal response in seven patients with treatment-resistant AN while completing a disorder-relevant food wanting task. The patients underwent a 15-month protocol, where MEG scans were conducted pre-operatively, post-operatively prior to deep brain stimulation (DBS) switch on, twice during a blind on/off month and at protocol end. Electrodes were implanted bilaterally into the nucleus accumbens with stimulation at the anterior limb of the internal capsule using rechargeable implantable pulse generators. Three patients met criteria as responders at 12 months of stimulation, showing reductions of eating disorder psychopathology of over 35%. An increase in alpha power, as well as evoked power at latencies typically associated with visual processing, working memory, and contextual integration was observed in ON compared to OFF sessions across all seven patients. Moreover, an increase in evoked power at P600-like latencies as well as an increase in γ-band phase-locking over anterior-to-posterior regions were observed for high- compared to low-calorie food image only in ON sessions. These findings indicate that DBS modulates neuronal process in regions far outside the stimulation target site and at latencies possibly reflecting task specific processing, thereby providing further evidence that deep brain stimulation can play a role in the treatment of otherwise intractable psychiatric disorders.

More by stick than by carrot: A reinforcement learning style rooted in the medial frontal cortex in anorexia nervosa.

Anorexia nervosa (AN) is characterized by a relentless pursuit of thinness, despite serious implications for health and social relations. In a previous study wielding the power of computational psychiatry, we found alterations in learning from negative feedback and in neural activity in the posterior medial frontal cortex (pMFC) in young acutely underweight AN patients (acAN). Here we ask whether these abnormalities are merely a state-related consequence of the illness or whether they might constitute a trait marker predisposing individuals to AN. To address this question, we employed the same reinforcement learning paradigm during fMRI with 31 female former AN patients after complete weight-recovery (recAN) and 31 age-matched healthy volunteers (15-28 years). Participants performed a decision task that required adaptation to changing reward contingencies. Data were analyzed within a hierarchical Gaussian filter model, which captures interindividual variability in feedback learning and decision-making under uncertainty. Similar to acute patients, individuals recovered from AN appear to emphasize negative over positive feedback when updating expectations regarding changing reward-punishment contingencies (difference in learning rate between punished and rewarded trials was increased in recAN: p = .006, d = .70. This behavioral pattern was mirrored in hyperactivation of the pMFC following negative feedback (FWE p < .001). Because the previously observed alterations in acANs are also evident after recovery and do not correlate with state variables like weight, altered feedback learning might be a trait marker of AN. The neural underpinnings of these alterations may lie in the pMFC. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Sociocultural Appearance Standards and Risk Factors for Eating Disorders in Adolescents and Women of Various Ages.

The main aim of the present study was to verify the level of impact of sociocultural appearance standards (passive awareness and active internalization) have on body dissatisfaction, the desire to engage in a relentless pursuit of thinness, the adoption of a perfectionistic attitude toward the body, and the development of a tendency to engage in bulimic eating behavior, which can develop in adolescent girls and women of varying ages. The study group comprised 234 individuals: 95 secondary school girls, 33 high school girls, 56 female students, and 50 employed women, all of whom were living in southern Poland. Participants were not diagnosed with any psychiatric disorders (including eating disorders). The variables were measured using the Polish version of Garner’s Eating Disorder Inventory and the Polish Sociocultural Attitudes Towards Physical Appearance and Body Image Inventory [based on the SATAQ-3 (Sociocultural Attitudes Towards Appearance Questionnaire Scale-3)]. The findings revealed that the youngest Polish girls (aged 12–15) reported the highest level of risk factors for eating disorders. Among the entire study group, the internalization of appearance standards and the pressure associated with various media messages were determined to be predictors of the pursuit of thinness, regardless of age and body mass index values. The second most significant variable explained by the internalization of sociocultural standards was body dissatisfaction. The internalization of sociocultural norms provided a significant explanation of bulimic tendencies only in the youngest girls. Perfectionism proved not to be affected by the sociocultural impact of mass media. The adult women had the lowest average scores over the entire study population regarding exposure frequency to body images in mass media and regarding the experience of pressure exerted by sociocultural norms. The high level of internalization of sociocultural appearance standards seems to be significantly linked to body satisfaction in women aged 30 and older. Young adolescent girls constitute a high-risk group for a specific psychological proneness to developing eating disorders as a result of the sociocultural influence exerted by mass media. The obtained study results can prove helpful in creating education programs in preventive healthcare aimed particularly at the youngest adolescents.

Altered Medial Frontal Feedback Learning Signals in Anorexia Nervosa

BackgroundIn their relentless pursuit of thinness, individuals with anorexia nervosa (AN) engage in maladaptive behaviors (restrictive food choices and overexercising) that may originate in altered decision making and learning. MethodsIn this functional magnetic resonance imaging study, we employed computational modeling to elucidate the neural correlates of feedback learning and value-based decision making in 36 female patients with AN and 36 age-matched healthy volunteers (12–24 years). Participants performed a decision task that required adaptation to changing reward contingencies. Data were analyzed within a hierarchical Gaussian filter model that captures interindividual variability in learning under uncertainty. ResultsBehaviorally, patients displayed an increased learning rate specifically after punishments. At the neural level, hemodynamic correlates for the learning rate, expected value, and prediction error did not differ between the groups. However, activity in the posterior medial frontal cortex was elevated in AN following punishment. ConclusionsOur findings suggest that the neural underpinning of feedback learning is selectively altered for punishment in AN.

The role of body image and self-perception in anorexianervosa: the neuroimaging perspective.

Anorexia nervosa is a severe psychiatric illness characterized by intense fear of gaining weight, relentless pursuit of thinness, deep concerns about food and a pervasive disturbance of body image. Functional magnetic resonance imaging tries to shed light on the neurobiological underpinnings of anorexia nervosa. This review aims to evaluate the empirical neuroimaging literature about self-perception in anorexia nervosa. This narrative review summarizes a number of task-based and resting-state functional magnetic resonance imaging studies in anorexia nervosa about body image and self-perception. The articles listed in references were searched using electronic databases (PubMed and Google Scholar) from 1990 to February 2016 using specific key words. All studies were reviewed with regard to their quality and eligibility for the review. Differences in brain activity were observed using body image perception and body size estimation tasks showing significant modifications in activity of specific brain areas (extrastriate body area, fusiform body area, inferior parietal lobule). Recent studies highlighted the role of emotions and self-perception in anorexia nervosa and their neural substrate involving resting-state networks and particularly frontal and posterior midline cortical structures within default mode network and insula. These findings open new horizons to understand the neural substrate of anorexia nervosa.

Anorexia nervosa in adolescents: challenges remain

Characterised by a relentless pursuit of thinness and rigidly held beliefs about body shape and weight,1 anorexia nervosa is associated with high rates of morbidity and mortality, and remains a challenging illness to treat.2,3 Traditional methods for the development and assessment of treatments present particular challenges in anorexia nervosa because the illness is rare, because patients' complex behaviours require multi-faceted, lengthy, and expensive treatments, and because patients are often reluctant to accept weight restoration as a treatment goal.

Treatment of anorexia nervosa

Anorexia nervosa is a serious mental illness characterized by the maintenance of an inappropriately low body weight, a relentless pursuit of thinness, and distorted cognitions about body shape and weight. The present review addresses the diagnosis, epidemiology, prognosis and considered extensive Iiterature about the treatment of anorexia nervosa. A literature search through a PUBMED search for the period from January 1994 to October 2009 was conducted for case reports and group studies with epidemiology, risk factor, prognosis, adequate treatment of anorexia nervosa. Data was reviewing reference lists, journals, and conference abstracts. And we reviewed textbooks, guidelines of eating disorders and reference lists of the sfudies selected. There is a growing evidence base for the treatment of eating disorders. Weight restoration is essential in treatment, but insufficient evidence is available for any single approach. Dealing with the psychiatric problems is not simple and much controversy remains. Family therapy is a valuable part of treatment, particularly for children and adolescents. but no particular approach emerges as superior to any other. Treatment of anorexia nervosa shifted from a purely medical approach to a strong emphasis on individual psychotherapy taking into account both a developmental and a biological framework and the need for a multifaceted treatment approach. Both behavioral and cognitive interventions were added to treatment programs SSRls in combination with psychotherapy are widely used in treating patients with anorexia nervosa. These medications may be considered for those with persistent depressive, anxiety or obsessive compulsive symptoms and for bulimic symptoms in weight-restored patients.

Mindfulness in the management of eating disorders

K. Halmi provides an excellent summary of recent advances in the treatment of eating disorders. There are no doubts concerning the usefulness of structured units for people with anorexia nervosa and cognitive behavioral therapy (CBT) for bulimia nervosa. Structured clinical units require a multi-disciplinary (multi-dimensional) team including nurses, dietitians and psychologists, as well as social and family therapists. However, these experienced staff can be recruited only in environments where the standing of our specialty is high. Even in university hospitals, it happens frequently that nursing staff are moved periodically to other departments, so that it may be difficult to retain well trained nurses. Further, most psychiatric units are general, and to set up a specialized unit or sub-unit may not be easy. On the other hand, an intensive outpatient program or residential treatment cannot be replaced by a structured unit: all of them should be part of a comprehensive service. CBT for patients who show bingeing/purging behavior within a normal weight range has become the standard. However, there are many non-responders and premature drop-outs. Most chronic eating disorder patients have already experienced the failure of CBT throughout their long history of illness, and do not improve through short-term motivational interviewing. Transdiagnostic therapy and enhanced CBT have shown promise 1, but it remains to be documented that they are more effective than routine CBT in ordinary clinical conditions. Eating disorders arise as a way of patients trying to escape from difficulties they may have. On facing these life-threatening disorders, we must be mindful 2,3, honest, and be aware of our limitations. Structured units and enhanced CBT aim to rapidly change behaviors or patterns of thought, but chronic patients are usually extremely inflexible, and change is slow. Psychological “Judo” in motivational interviewing focuses on the patients’ “moment of inertia” to change rather than confronting their relentless pursuit of thinness. In Asia, the relationship between mother and daughter is closer than in Western countries. Even though similar percentages of eating disorder patients are impulsive 4, most patients have family support. Family support is a double-edged sword (risks of over-involvement and being manipulated), but there is the possibility that the family be truly of help. Treating eating disorders is always challenging. However, using a heavy-handed approach will make the patients more rigid. We, psychiatrists dealing with eating disorder patients, should not treat aggressively, but rather share our understanding of patients’ painful experiences and hope of recovery. It is important to develop a small-scale system that just one psychiatrist is able to run, even though it may be difficult in several contexts.

Anorexia Nervosa

Anorexia nervosa (AN) is characterized by restricted eating and a relentless pursuit of thinness that tends to present in females during adolescence according to DSM-IV (Table 1). Individuals with AN exhibit an ego-syntonic resistance to eating and a powerful pursuit of weight loss, yet are paradoxically preoccupied with food and eating rituals to the point of obsession. Individuals have a distorted body image and, even when emaciated, tend to see themselves as “fat,” express denial of being underweight, and compulsively overexercise. Two types of eating-related behavior are seen in AN. In restricting-type anorexia (AN), individuals lose weight purely by dieting without binge eating or purging. In binge-eating/purging-type anorexia, individuals also restrict their food intake to lose weight but have a periodic disinhibition of restraint and engage in binge eating and/or purging, also seen in bulimia nervosa (BN). Anorexia nervosa is often kept hidden by patients who are excessively preoccupied by their current body weight/shape and are ashamed of any compensatory behaviors they engage in. Illness often becomes apparent when patients become emaciated from gradually losing weight or in the purging subtype when patients become physiologically unstable from excessive self-induced loss of fluids or electrolytes. Onset is typically around puberty and is usually preceded by anxiety disorders and followed by a prolonged clinical course with the highest mortality for any psychiatric illness. Outcome is often hindered by an unwillingness to seek treatment. A limited understanding of etiological mechanisms and the lack of powerful treatments are major impediments to providing effective care. Still, there is evidence supporting cautious optimism regarding the development of more effective therapy. For example, although there are no U.S. Food and Drug Administration (FDA) approved medications for AN, some short-term studies suggest that second-generation antipsychotics may be beneficial. For adolescents who develop AN before the age of 18, Maudsley family therapy may be an effective alternative.

Anorexia Nervosa

Anorexia Nervosa

Living in poverty: a qualitative inquiry of emaciated adolescents and young women coming from low‐income families in a Chinese context

ABSTRACTAnorexia nervosa (AN) is no longer a disease of the rich in the West. Hitherto, no study has been carried out in the West or in the Chinese context that documents the experiences of poor people suffering from AN. This qualitative study aims to identify the subjective experiences of seven Chinese emaciated adolescents and young women coming from low‐income families, their family difficulties and needs, and resilience in coping. The results of the study have shown that family poverty has significantly triggered the onset of AN for two emaciated adolescents, while factors such as parents’ marital discord and relentless pursuit of thinness have also been reported. Family difficulties experienced included problems in parenting, inadequate financial resources, and insufficient information and access to health and social services. Strong family motivation and filial piety are found to be important cultural assets conducive to recovery. Implications of this study for social work practice are discussed.

Eating disorders in adolescents

A. Biopsychosocial illness1.Medical, nutritional and social aspects2.Requires multidisciplinary treatment team3.Associated with significant morbidity and mortality4.“A relentless pursuit of thinness” (Hilde Bruch, MD)B. Facts1.Two million people suffer from an eating disorder2.90% are women, ages 12–25 years old3.Increasing incidence in males over the past decade4.Typical personality: bright, successful, high achieversa.A disorder of Western culture. All ethnicities are at riskb.Less than one third are overweight prior to the onset of the eating disorder (ED)C. Possible Mechanism(s) for Developing an ED1.Biological factorsa.Higher incidence in monozygotic twinsb.Increased relative risk among family members2.Pubertal changesa.Normal increase in body fat at menarche may be an uncomfortable body change for an adolescentb.Lack of control over physiology of puberty may evoke ED symptoms in an adolescentc.In those with prior sexual abuse, counteracting the more “womanly” appearance by dieting may be a protective or subconscious behavior3.Personality typea.High achiever, perfectionistic, goal oriented low self-esteem, high self-criticism4.Media influencea.Glamour and success equated with thinnessb.Role models often with “perfect” bodiesc.The thin, beautiful female appears to lead the “perfect life”

The human genetics of anorexia nervosa

Anorexia nervosa is a severe eating disorder characterised by restricted eating, the relentless pursuit of thinness and obsessive fears of being fat. The involved risk factors are probably numerous, but the existence of a genetic vulnerability has been proposed for decades. The heritability in the broad sense is computed on the basis of aggregation studies, treated twin samples and twin studies from the general population. Many difficulties make this heritability estimation problematic, but the convergence of the results (from family studies and two types of twin studies) gives the most convincing evidence in favour of a major role of genetics in the vulnerability to anorexia nervosa, with a heritability around 70%. Regarding the analysis of candidate genes, the most frequently studied is the 5-HT 2A gene, with positive and negative results. We thus propose a meta-analysis showing that a large heterogeneity between samples exists, but the main effect of the −1438A allele persists even when extracting this contaminating effect ( p=0.003). Furthermore, the absence of significant correlation between odds ratio and time after first publication of each sample, and size of each sample, is in accordance with the fact that the A allele is a risk factor. In order to explain the high heterogeneity between the nine studies yet performed, an alternative explanation such as a “modifying the phenotype” effect is proposed.

Anorexia nervosa and bulimia nervosa: An appraisal.

Anorexia nervosa (AN) and bulimia nervosa (BN) are eating disorders characterized by an aberrant pattern of eating behavior, relentless pursuit of thinness, an intense fear about weight gain and an altered perception of body shape. The pathobiology of eating disorders is complex. Several social, psychological and developmental phenomena are proposed to contribute to the etiology of eating disorders. The role of neuropeptide Y, corticotropin releasing hormone and leptin has also been investigated to understand the pathogenesis of eating disorders. However, most of the neuropeptide alterations noted in eating disorders are secondary to starvation. Several nonpharmacological approaches such as cognitive and behavior-based therapy and interpersonal therapy have been developed to assist weight gain and to modify the behavioral impairment associated with eating disorders. Pharmacotherapy serves as an adjunct in AN, whereas it plays a more significant role in the management of BN. Antidepressants are effective in a limited number of AN patients with comorbid depression. On the other hand, the efficacy of fluoxetine in BN patients in reducing the frequency of binge eating and in the severity of behavioral abnormalities is quite impressive. Several adjunct therapies such as prokinetics and anxiolytics have also been used in AN and BN to assist eating behavior. An insight into genetic and neurochemical abnormalities occurring in eating disorders will help to find better therapeutic agents for these disorders. (c) 2001 Prous Science. All rights reserved.

Die „Gewichtsphobie” - Ein Diskussionsbeitrag zum Problem der „atypischen” oder „nicht näher bezeichneten”Eß- und Gewichtsstörungen -

A number of authors have stated that the problem of classifying patients whose diagnosis does not meet all the criteria of anorexia and bulimia nervosa has not been satisfactorily solved. The question has been asked if it is justified to regard characteristics like "weight phobia" or body image disturbance as valid diagnostic criteria. In the present study the differences observed in three groups of patients with eating and weight disorders (anorexia: n = 42; bulimia: n = 29; atypical group without "weight phobia": n = 14) were compared using the Giessen-Test. The atypical group was shown to be significantly more "tractable" on scale 2 than the main groups, which achieved a higher score on "dominance". Significant differences between the atypical group and the "uncontrolled" group of patients with bulimia were noted for scale 3, with the atypical group showing comparable results to those recorded in the anorexic group on "compulsiveness". The authors discuss the significance of the results under an epistemological aspect. The description and classification of clinical phenomena which is based on the clinical manifestation of the disorder independently of theoretical concepts is therefore indispensible for realising a uniform basis for communication by researchers worldwide. Equally indispensible is the differentiation or "extension" of the classification to allow a more detailed systematic categorisation guided along specific theoretical concepts. This requires the operational definition of psychopathological and psychodynamic criteria as, e.g. "the struggle for identy" or the "relentless pursuit of thinness". The experiences with the OPD (Operationalized Psychodynamic Diagnosis; 1996) have shown this to be a difficult but viable approach.

“In hunger I am king”—Understanding anorexia nervosa from a psychoanalytic perspective: Theoretical and clinical implications

“In hunger I am king” (Kazantzakis, 1963) expresses the inner struggle of the anorectic. In the relentless pursuit of thinness, anorexia nervosa is a desperate search for autonomy and a self-respecting identity.

From eating disorders to women's situations: Extending the boundaries of psychological inquiry

Abstract This paper seeks to extend feminist critiques of the prevalent psychiatric approaches to the eating disorders. It also includes a critique of feminists' writings that make assumptions similar to, and hence suffer from some of the same theoretical weaknesses as, the prevalent clinical literature. The main purpose is to contribute to the development of a social-historical approach to the study of the relentless pursuit of thinness among women. The social-historical approach is contrasted with individualistic psychological, family systems and multidimensional accounts of anorexia nervosa and bulimia. Potential directions suggested by feminist and social-historical analyses of the relentless pursuit of thinness among women are briefly described.

Developmental considerations of anorexia nervosa and obesity.

The differentiation of the distinct clinical syndrome of anorexia nervosa from atypical cases is based on the following distinguishing features: a relentless pursuit of thinness; an almost delusional disturbance of body image; an inability to correctly identify hunger from other bodily or tension states; a lack of an identity awareness; and a paralyzing sense of ineffectiveness. This sense of ineffectiveness, pervasive of all thought and action, is connected with the perception of the self as acting only in response to the demands of others and is camouflaged by negativism and defiance. The core developmental issues of being unable to experience the control over one's own body and of lacking the conviction of living one's own life are based on the severe deficits in autonomy and initiative, originating from the distortion and mislabeling of feelings, sensation and moods in early childhood. The treatment process focuses on evoking awareness in these patients of their impulses, feelings and needs as originating within themselves as an essential step in the development of a sense of competence and self-esteem.

Problems of Treatment of Anorexia Nervosa

An effective treatment program involves measures for correction of both the malnutrition and the psychological disturbance in patients with anorexia nervosa. A novel approach to re-feeding, using motivational incentives in a controlled hospital setting, has been useful in the restoration of weight. The difficulty in maintenance of desirable weight after leaving hospital might be related to continuing disturbances in family relationships and to perceptual distortions. Treatment to prevent recurrence of symptoms should involve efforts to improve family communications and relationships, and correcting the patient's faulty perceptions. Both the disturbance in recognition of satiety and overestimation of the width of her trunk are reflected in limitation in caloric intake and relentless pursuit of thinness. Attention to correcting these perceptual disturbances might allow the patient to realize an accurate and acceptable sense of self, and to tolerate fears involving physical and psychological aspects of sexual maturation.