Restrictive Anorexia Nervosa Patients Research Articles

Blunted cortisol response to stress in patients with eating disorders: Its association to bulimic features.

Clinical research on cortisol response to stress in patients with eating disorders has provided controversial and even contradictory results. As this might be the consequence of the inclusion in the studies of heterogeneous clinical populations, 3 highly selected samples were studied. Dexamethasone suppression test was performed on 15 restricting anorexia nervosa patients without history of bulimia nervosa (BN), 17 BN patients with normal weight and no history of anorexia nervosa, and 22 healthy controls. Three days later, the Trier Social Stress Test was applied, and 8 saliva samples were collected along the trial for cortisol assessment. When the patients were considered as a single group, a slightly blunted cortisol response to stress was observed, but when the 3 groups were considered separately, the blunted response was observed only in the BN patients. The results support the association between blunted cortisol response and bulimic features.

Impaired decision-making in symptomatic anorexia and bulimia nervosa patients: a meta-analysis.

Impaired decision-making is a potential neurocognitive phenotype of eating disorders. It is therefore important to disentangle the decision-making deficits associated with the eating disorder subtypes and determine whether this putative impairment is a state or trait marker of the disease or more related to starvation. We systematically reviewed the literature on decision-making in eating disorders and conducted a meta-analysis to explore its role in anorexia nervosa (AN), bulimia nervosa (BN) and binge-eating disorder (BED). A search of the Medline and EMBASE databases and article references was performed. A total of 23 studies (2044 participants) met the selection criteria. When the Iowa gambling task (IGT) was used in at least three of the studies, a meta-analysis was run. IGT performance was significantly worse in patients with an eating disorder diagnosis (AN, BN or BED) compared with healthy controls, indicating that eating disorders have a negative effect on decision-making. Hedges' g effect sizes were moderate to large (-0.72 in AN, -0.62 in BN, and -1.26 in BED). Recovered AN patients had IGT scores similar to those of healthy controls. Restrictive AN patients had significantly lower IGT net scores than purging AN patients, and both AN subtypes had worse performances than healthy controls. Age and body mass index did not explain results. Decision-making was significantly altered in patients with eating disorders. Poor decision-making was more pronounced during the acute phase than in the recovered state of AN. Nutritional status during the acute phase of the disease did not seem to influence decision-making skills.

Implicit Bodily-self Recognition and Interoceptive Sensitivity in Restrictive Anorexia Nervosa

Introduction Anorexia Nervosa (AN) is characterized by body-size overestimation that reflects a distortion of body-representation. Self-body recognition can be both implicit and explicit. The former is based on cognitive and perceptual mechanisms, the latter relies on motor simulation. Previous studies showed that participants, when submitted to a hand laterality judgment task (Implicit task) that required mental rotation showed better performances when the stimuli consisted of their own rather than other's hand (self-advantage). By contrast, the self-advantage was absent when self-recognition (Explicit task) was explicitly required. Objectives This study aimed to investigate whether the overestimation of anorexic's own body size extended to the motor representation of the bodily-self influencing the implicit self-advantage. Furthermore, we assessed the possible relationship between the implicitly recognition of one's own body part and Interoceptive Sensitivity (IS; sensitivity to stimuli originating inside of the body). Methods Healthy Controls (HC) and restrictive AN patients were submitted both to Implicit and Explicit tasks with self and other's hands presented in the original size or modified to look fatter or thinner. We also assessed participants’ IS by means of a heartbeat perception task. Results As previously reported, HC showed specific self-advantage effect only when a motor simulation is required. Furthermore higher IS is related to faster performances only in the implicit task in which a mental motor rotation. The differences between AN patients and HC concerning IS and bodily-self recognition will be also discussed.

Physical activity: benefit or weakness in metabolic adaptations in a mouse model of chronic food restriction?

In restrictive-type anorexia nervosa (AN) patients, physical activity is usually associated with food restriction, but its physiological consequences remain poorly characterized. In female mice, we evaluated the impact of voluntary physical activity with/without chronic food restriction on metabolic and endocrine parameters that might contribute to AN. In this protocol, FRW mice (i.e., food restriction with running wheel) reached a crucial point of body weight loss (especially fat mass) faster than FR mice (i.e., food restriction only). However, in contrast to FR mice, their body weight stabilized, demonstrating a protective effect of a moderate, regular physical activity. Exercise delayed meal initiation and duration. FRW mice displayed food anticipatory activity compared with FR mice, which was strongly diminished with the prolongation of the protocol. The long-term nature of the protocol enabled assessment of bone parameters similar to those observed in AN patients. Both restricted groups adapted their energy metabolism differentially in the short and long term, with less fat oxidation in FRW mice and a preferential use of glucose to compensate for the chronic energy imbalance. Finally, like restrictive AN patients, FRW mice exhibited low leptin levels, high plasma concentrations of corticosterone and ghrelin, and a disruption of the estrous cycle. In conclusion, our model suggests that physical activity has beneficial effects on the adaptation to the severe condition of food restriction despite the absence of any protective effect on lean and bone mass.

1426 – Anorexia nervosa restrictive type and visuospatial and visuoconstructive abilities. From a clinical study of hospitalized patients

Introduction Recently the cognitive profile of restrictive anorexia nervosa patients, particularly visuospatial and constructive abilities, raised the interest of researchers as a maintenance factor of the disorder. This study focuses specifically on the impairment of these complex executive functions. Materials and methods Only patients hospitalized in our department for restrictive anorexia nervosa restrictive type (AN-R) could participate in the study. They had to fulfill self-report questionnaires assessing anxiety and depression and had to achieve a battery of neuropsychological tests (the Rey Complex Figure (RCF), the Hayling Sentence Completion Test (HSCT) and the span test). Results 21 patients participated in the study. The average age was 20.62 years (σ = 5.39) and body mass index (BMI) was 14.67 (σ = 0.93). In this sample, the distribution of the copy of the RCF corresponds to the normal distribution for age 7 to 12 years. Visual memory (recall of the RCF) is impaired. The inhibition score of the HSCT is higher than normal. The mean score on the span task is at −0.68 standard derivation. Only the inhibition score of the HSCT is positively correlated with BMI (r = 0.46). Discussion These results highlight a lack of visuospatial and visuoconstructive capacities and a lack of cognitive inhibition in patients with AN-R. These results can be integrated in an impairment of central coherence. Therapeutic perspectives that emerge would focus on the central coherence, i.e cognitive remediation. It is then necessary to improve knowledge on the cognitive profile.

Intact sensory function in anorexia nervosa

In anorexia nervosa (AN), taste and smell are believed to be anhedonic, hunger and pain are muted, and body-image distortion obscures wasting, which together facilitate self-starvation. However, the emphasis on these deficits may be biased because other sensory systems have been sparsely investigated. Objectives of the study were to clarify whether these dysfunctions are specific or part of a pattern of sensory-perceptual deficits in AN patients and to test the gustatory senses dissociated from ingestion to clarify whether any deficit is sensory or affective. In 15 adolescent, first-episode, hospitalized, restrictive AN patients and 15 matched healthy controls who responded to gustatory stimuli (intensity and hedonics of 5 basic tastes and tastes and odors of foods and nonfoods), size estimation (manual and oral judgment of size and shape, kinesthesia, and body size and esthetics), cold pain, and auditory and visual processing were compared. AN patients did not differ on most tests, were better at odor recognition, were less successful in central auditory processing and oral assessment of size and shape, and may have been more sensitive to cold. Body-image dissatisfaction in AN patients was not related to dysfunctional size estimation. There is no systematic sensory-perceptual deficit in AN patients, and specifically, not in gustatory function. The few differences shown might be due to fear of food-related stimuli or comorbidity.

Reduced automatic motivational orientation towards food in restricting anorexia nervosa.

A striking and characteristic feature of the restricting subtype of anorexia nervosa (AN) is that they are extremely successful in regulating their food intake in a destructive manner. A possible explanation for the persistent character of their restricted food intake could be a loss of the motivational saliency of food in restricting AN patients. The present study aimed to investigate motivational orientation for food in the restricting subtype of anorexia nervosa with an indirect performance-based measure and a self-report measure of craving. An indirect approach avoidance task was administered to measure automatic approach tendencies for high-fat and low-fat food in restricting adolescent AN-like patients (n=89) and a group of healthy adolescents (n=76). As predicted, restricting AN-like patients showed less automatic motivational orientation toward food than healthy controls. In a similar vein, AN-like patients reported less craving for food than the group of healthy controls. The loss of an automatic motivational orientation toward food together with the deliberate strategy to avoid food might help explain the ability of restricting AN-like patients to regulate their food intake.

Amygdala hyperreactivity in restrictive anorexia nervosa

Functional imaging studies had often investigated heterogeneous samples of anorexia nervosa (AN) patients with varying paradigms and methodologies that had resulted in divergent results. The present study aimed to examine these issues by studying a well-defined sample of restrictive AN patients with a disorder-specific paradigm which had been used previously. Subjects showed increased blood oxygen level dependent responses of the cingulate, frontal, insular and parietal cortices. Group comparisons demonstrated increased activity of the right amygdala in the sample of restrictive AN patients. Our results are in support of other recently published functional imaging studies and point to a pivotal role of the right amygdala in AN. Signals of the midcingulum were reduced in comparison to healthy controls. The constellation of increased activity of the amygdala and decreased activity of the cingulate cortex likely represents parts of a negative feedback loop of emotional processing. Disgust ratings correlated with the amygdala signal negatively, which points to the complex role of this structure within eating disorders.

Voxel-based morphometry in eating disorders: Correlation of psychopathology with grey matter volume

Twenty-nine adult female patients with eating disorders (17 with bulimia nervosa, 12 with restrictive anorexia nervosa) were compared with 18 age-matched female healthy controls, using voxel-based morphometry. Restrictive anorexia nervosa patients showed a decrease of grey matter, particularly affecting the anterior cingulate cortex, frontal operculum, temporoparietal regions and the precuneus. By contrast, patients with bulimia nervosa did not differ from healthy controls. A positive correlation of “drive for thinness” and grey matter volume of the right inferior parietal lobe was found for both eating disorder groups. The strong reduction of grey matter volume in adult patients with restrictive anorexia nervosa is in line with results of adolescent patients. Contrary to other studies, this first voxel-based morphometry report of bulimic patients did not find any structural abnormalities. The inferior parietal cortex is a critical region for sensory integration of body and spatial perception, and the correlation of “drive for thinness” with grey matter volume of this region points to a neural correlate of this core psychopathological feature of eating disorders.

P02-314 - Temperament and character in outpatients with Anorexia and Bulimia Nervosa

ObjectivesThe aim of this study is to assess the personality traits in a sample of Spanish anorexic and bulimic outpatients.MethodThe revised version of the Temperament and Character Inventory was administered to 76 women attended in an Eating Disorders Unit and to 46 healthy controls. Both groups were matched by gender, age and instruction.ResultsDiagnoses in the sample were distributed as follows: bulimia nervosa (BN) 33, binging-purging type anorexia nervosa (BPAN) 23 and restricting anorexia nervosa (RAN) 18. RAN patients were significantly younger (21.6 vs. 26.3 p < 0.01). Differences in the harm avoidance, persistence and selfdirectedness subscales of the TCI were found (see table). RANBPANBNCp Novelty seeking89.397.399.697.40.15n. s.Harm avoidance116.1118.3118104.40.002BPAN, BN > CReward dependence112.5111.7103.7110.50.12n. s.Persistence120.7113.7108.4102.90.005RAN > CSelfdirectedness125.5120.8117149.5< 0.001C > RAN, BPAN, BNCooperativeness141.4145.9138.3142.90.34n. s.Selftranscendence63.867.266.959.50.17n. s.[Results]ConclusionsIn concordance with previous reports, compared with healthy controls, patients show lower scores in self-directedness. Persistence seems to be associated with restricting behaviours, whereas harm avoidance with binging and purging. RAN trends to have low scores in novelty seeking items and BN shows lower reward dependence, but this differences are not statistically significant, perhaps because of sample size.

Organic Background of Restrictive-Type Anorexia Nervosa Suggested by Increased Serotonin 1A Receptor Binding in Right Frontotemporal Cortex of Both Lean and Recovered Patients: [ 18F]MPPF PET Scan Study

Serotonin (5-HT) pathway abnormalities were demonstrated in anorexia nervosa (AN). Brain imaging studies on 5-HT receptors support this evidence. 4-(2-methoxyphenyl)-1-[2-(N-2-pyridinyl)-p-fluorobenzamido]-ethylpiperazine ([(18)F]MPPF) is a selective 5-HT(1A) receptor antagonist with an affinity close to that of endogenous 5-HT. In 24 subjects including 8 lean restrictive-type AN patients, 9 recovered from restrictive-type AN subjects and 7 age-matched control subjects, we assessed in vivo brain [(18)F]MPPF binding by positron emission tomography and eating-related psychopathological traits. Inter-groups differences in [(18)F]MPPF binding were evaluated by voxel-based analyses. Restrictive AN patients presented increased [(18)F]MPPF binding in a selective area of the right cortex including part of the superior temporal gyrus, inferior frontal gyrus, parietal operculum, and temporoparietal junction. Striking regional similarities of increased [(18)F]MPPF binding were found in recovered from AN subjects. Most of the psychiatric scores were increased in restrictive AN patients, and elevated perfectionism and interpersonal distrust scores were noticed in subjects recovered from AN. The persistent increased 5-HT(1A) receptor binding in frontotemporal region of recovered AN concomitantly with specific psychopathological traits support the hypothesis of an organic dysfunction of this area and corroborates with previous literature reports of AN cases induced by temporal lesions.

Predictors of Binge Eating in Restrictive Anorexia Nervosa Patients in Italy

The aim of the present study was to investigate the predictive factors for the development of binge eating in restricting anorexia nervosa patients who underwent an outpatient treatment. The sample was a group of 168 patients with restricting anorexia nervosa, consecutively admitted to an outpatient unit. All the patients underwent a routine baseline assessment. Information regarding binge eating onset and duration of treatment was prospectively recorded in clinical records. Twenty-three patients developed binge episodes during outpatient treatment. High scores on the Eating Disorders Inventory body dissatisfaction subscale and early age at menarche significantly predict the risk of developing binge eating. High levels of ineffectiveness, as measured by the Eating Disorders Inventory, and early age at menarche are significant predictors of a shortened time to develop binge eating. The identification of subjects at risk for developing binge eating should be considered an important step for a successful treatment of restricting anorexic patients.

Impulsiveness and lack of inhibitory control in eating disorders

Eating disorders are considered to lie on a spectrum of disorders with varying degrees of obsessive–compulsive and impulsive traits. Restrictive anorexia nervosa patients (AN-R) are thought to belong to the obsessive pole of the spectrum, and purging-anorexia (AN-P) and bulimia nervosa (BN) patients to the impulsive pole. In this study we have compared impulsive traits in three groups of eating disordered patients (total N = 56) and a control group of 83 female students. Information about impulsive traits and lack of inhibitory control was gathered by means of standardized rating scales (Eysenck's Impulsiveness Scale, Barrett's Impulsiveness Scale, and Carver and White's BIS/BAS scale) and a behavioral measure of impulsiveness (stop–go task). On the questionnaires AN-R patients reported to be less impulsive than controls, AN-P and BN patients. In the stop–go task, we did not find significant differences between the different groups. Correlations between self-reported measures of impulsiveness and behavioral measures were not significant. In conclusion: Our results from the self-report measures are at odds with the behavioral measures certainly in the AN-R group. Perhaps the latter patients' distorted self-perception and/or self-description may explain this discrepancy.

Differences of cortical 5-HT 2A receptor binding index with SPECT in subtypes of anorexia nervosa: Relationship with personality traits?

Using single photon emission computed tomography and the 5-HT2A receptor antagonist, 123I-5-I-R91150, we explored differences in 5-HT2A binding index in anorexia nervosa patients with and without bulimic features. We also searched for associations between temperament dimensions and cortical 5-HT2) binding. About 9 restrictive and 7 bulimic anorexia nervosa patients were examined and cortical 123I-5-I-R91150 binding index values were compared between the two subgroups. Open explorative correlation analysis was used to examine any relationships between binding index values and temperament scores, as assessed with the Temperament and Character Inventory. 5-HT2A binding index was significantly reduced in the parietal cortex in bulimic anorexia nervosa patients in comparison with restrictive anorectics. Further, a positive correlation was documented between reward dependence and parietal 5-HT2A binding index across patients in the two subgroups. Restrictive anorexia nervosa patients differ from binging/purging anorexia nervosa patients on the basis of a reduced parietal 5-HT2A binding index in the latter. We speculate that the finding of a positive correlation between parietal 5-HT2A binding and reward dependence might reflect an association between these two variables, at least in anorexia nervosa patients.

Impulsivity-related traits in eating disorder patients

Whiteside and Lynam (2001) have proposed a new model for understanding personality pathways to impulsive behavior. In this model four personality dimensions (UPPS) are related differentially to impulsive behaviors: Urgency, Sensation Seeking, (Lack of) Premeditation, and (Lack of) Perseverance. Furthermore, the UPPS model suggests very specific ways in which the dimensions might be related to psychopathology and other problematic behaviors. In the present study, we have assessed 146 eating-disordered patients with respect to the four impulsivity-related personality traits in the purpose of testing the specific hypotheses offered by the UPPS model. The diagnostic subtypes of eating-disordered patients did differ on the four impulsivity-related traits, and these traits were differentially related to various behaviors and forms of psychopathology confirming many of Whiteside and Lynam’s (2001) predictions. Bulimia nervosa patients showed consistently more Urgency and Sensation Seeking and less Premeditation and Perseverance than restrictive anorexia nervosa patients, with the bingeing-purging anorexics being situated in between. Both in assessment and treatment of eating-disordered patients specific attention should be paid to impulsivity-related personality traits.

Assessing quality of life in eating disorder patients

To examine quality of life among subgroups of eating disorder patients. Self-report questionnaires which included two quality of life measures were completed by 87 individuals referred for treatment to the Australian Capital Territory Eating Disorders Day Program. Health-related quality of life, as measured by the Medical Outcomes Study 12-item Short Form Mental Component Summary scale, and subjective quality of life, as measured by subscales of the World Health Organization Brief Quality of Life Assessment Scale (WHOQOL-BREF), were compared among individuals who received the diagnosis of anorexia nervosa purging subtype (n = 15), anorexia nervosa restricting subtype (n = 19), bulimia nervosa (n = 40) and binge eating disorder (n = 10), and among a general population sample of young adult women employed as a control group (n = 495). Eating disorder patients, when considered together, showed marked impairment in both health-related and subjective quality of life relative to normal control subjects. However, in both domains, restricting anorexia nervosa patients reported significantly better quality of life than other patient groups, after controlling for levels of general psychological distress. Scores on the Social Relationships subscale of the WHOQOL-BREF among individuals in this subgroup were similar to those of normal control subjects. Reliance on any one instrument is likely to be misleading in assessing the quality of life of eating disorder patients. Careful consideration needs to be given to the assessment of restricting anorexia nervosa patients in particular.

Personality-related characteristics in restricting versus binging and purging eating disordered patients

The current study sought to examine differences in personality-related characteristics between restricting anorexia nervosa (RAN), binging/purging anorexia (BPAN), and purging bulimia nervosa (BN) patients. Scores on the Temperament and Character Inventory (TCI) and on the Dutch Eating Behaviour Questionnaire (DEBQ) were compared for 166 RAN, 78 BPAN, and 151 BN patients. Bingers/purgers showed a higher score for restrained, external and emotional eating and a lower score for a subscale of “self-directedness” compared to patients who never binge and purge. Personality differences were most marked between RAN and BN patients, while personality characteristics of BPAN patients tended to be similar to those of BN patients. BN patients showed higher scores on “novelty seeking” and the subscales “exploratory excitability,” “impulsivity,” and “extravagance,” and lower scores on “self-directedness,” compared to restricting patients. Moreover RAN patients also showed higher scores on subscales of character dimensions, compared to BN patients. The higher the scores on novelty seeking, the lower the scores on several character scales, which has important implications for the reinforcement of behavior and the treatment of eating disorders.

Depression influences the EDI scores in anorexia nervosa patients

Aim. – To study the influence of the severity of depression on the eating disorder’s inventory (EDI) scores in anorexia nervosa (AN) patients. Method. – We compared by variance analysis the EDI scores from three groups of AN patients: 55 patients having a major depression (as assessed by a Beck’s depression inventory (BDI) ≥ 16); 77 patients having a less severe depression (BDI < 16); 32 patients with mild or non-existent depression (BDI ≤ 7) and the EDI scores from a control group of 29 French healthy young women. Results. – Higher EDI scores were elicited in the more severely depressed AN patients than in the less- or non-depressed AN patients ( P < 0.01). In non-depressed AN patients, none of the scores was different from those of the control group. This was particularly true for the scores “Slimness wish”, “bulimia”, “body image dissatisfaction”, “perfectionism” and “fear of maturity”. The non-depressed restrictive AN patients had no score which differ from healthy controls. Discussion. – The present results suggested that the EDI scores are clearly influenced by the severity of depression. Among the psychopathological and behavioural traits assessed with the EDI, only a few were not related to depressive symptoms: “feeling of inefficiency” and “distrust in interpersonal relations”.

Modest familial aggregation of eating disorders in restrictive anorexia nervosa with adolescent onset in a Romanian sample

The study of the familial psychopathology in relatives of restrictive anorexia nervosa (AN) probands whose diagnosis was verified during a long-term follow-up was aimed at determining behavioural phenotypes with which AN could share the genetic liability. A total of 185 first degree relatives of 68 restrictive AN patients with adolescent onset followed up for 5 to 18 years and 198 first degree relatives of 68 normal women were investigated. DSM-III-R criteria were used. The lifetime rate of clinical AN was 1% and the rate of any eating disorders was 2% in female proband relatives versus 0 in control relatives. No case of bulimia nervosa (BN) was found in proband relatives. The heritability of AN was low (0.18) when only the full-blown AN was considered in relatives and modest (0.36) when also a case of subthreshold AN was added. There were significantly higher rates of anxiety disorders (14.6%) and unipolar major depression (8.3%) in female proband relatives and "schizo"-spectrum disorders (8.3%) and alcoholism (13.1%) in male proband relatives compared to relatives of controls. Restrictive AN might share partial liability with phenotypes expressing emotional restraint and anxiety. A sex effect of the heterotypically affected relative on the vulnerability for AN was suggested.

Subjective family image in anorexia nervosa and bulimia nervosa in adolescence: a controlled study

The family environments of patients with eating disorders have been studied extensively in recent decades. The "Subjective Family Image Test" is an instrument developed especially to measure differential perceptions by family members. Assessments of subjective family image in families of adolescents by means of this test have been carried out in only a few samples. We aimed first to investigate subjective perceptions by adolescents of their family relations in a larger clinical sample of female adolescents (n = 118) suffering from anorexia nervosa of either subtype or from bulimia nervosa and to compare these perceptions with those of healthy controls (n = 96). Second we investigated intra-familial differences in perception. The main findings were that bulimia nervosa patients perceived lower individual autonomy and lower emotional connectedness than all other groups, the adolescents with bulimia perceived significantly lower autonomy and emotional connectedness within the family than their fathers, and the restrictive anorexia nervosa patients perceived higher connectedness than their fathers. The relevance of these findings for understanding family dynamics are discussed.