Restrictive Anorexia Nervosa Research Articles

Food cravings discriminate between anorexia and bulimia nervosa. Implications for “success” versus “failure” in dietary restriction

Food cravings are subjective, motivational states thought to induce binge eating among eating disorder patients. This study compared food cravings across eating disorders. Women (N=135) diagnosed with anorexia nervosa, restrictive (ANR) or binge–purging (ANBP) types, or bulimia nervosa, non-purging (BNNP) or purging (BNP) types completed measures of food cravings. Discriminant analysis yielded two statistically significant functions. The first function differentiated between all the four group pairs except ANBP and BNNP, with levels of various food-craving dimensions successively increasing for ANR, ANBP, BNNP, and BNP participants. The second function differentiated between ANBP and BNNP participants. Overall, the functions improved classification accuracy above chance level (44% fewer errors). The findings suggest that cravings are more strongly associated with loss of control over eating than with dietary restraint tendencies.

P03-34 Anger expression in obsessive-compulsive spectrum disorders (SOGS): Common and differential traits

Objective:The objective of this study was to examine the experience and expression of anger in eating disorders (EDs) including bulimia nervosa purging (BN-P) and anorexia nervosa restrictive (AN-R) subtypes, impulsive disorders such as pathological gambling (PG), obsessive-compulsive disorder (OCD) and a non psychiatric healthy control group.Method:The sample comprised 80 female SODs individuals (20 BN-P, 21 AN-R, 19 PG, 21 TOC) consecutively admitted to our Department and 21 healthy controls. Patients were diagnosed according to DSM-IV-R criteria. We administered the State-Trait Anger Expression Inventory-2 (STAXI-2). in the control group, the GHQ-28 was also employed.Results:Compared to the healthy control group, elevated Trait Anger scores were revealed for the BN-P (p< .011) and OCD (p< .003) groups. in addition, the OCD group scored higher on this scale than the PG patients (p< .039). as regards to State Anger, higher scores were uncovered for the OCD patients than for the control group (p< .017). Finally, when Anger Expression was assessed, higher scores were found for the OCD (p< .001) and BN (p< .001) individuals when compared to healthy controls. in addition, compared to AN-R, the BN-P and OCD exhibited higher scores on this scale (p< .001 and p< .037, respectively).Conclusions:Our results indicate that, OCD and BN-P patients may have inadequate anger expressions and deficits in coping with anger and frustration when compared to a healthy control group. Conversely, no significant differences were revealed between AN-R, PG and controls. Finally, some differences across diagnoses were also obtained.

Regional cerebral blood flow patterns of change following the own body image exposure in eating disorders: A longitudinal study

Objective The aim of the present study is to see if the changes in the regional cerebral blood flow (rCBF) experienced by restrictive anorexia nervosa (AR) and bulimia nervosa (BN) patients, following the exposure to their own body image, persist at follow-up. Methods Three single photon emission computed tomography (SPECT) were performed on nine patients with a DSM-IV diagnosis of AR, 13 with BP, and 12 controls: at rest, following a neutral stimulus, and after exposure to their previously filmed whole body image. Body dissatisfaction was measured by means of the Body Dissatisfaction Questionnaire (BSQ). One year later the same assessment was repeated. Results Following the exposure to their own body image, BN showed an increase in body dissatisfaction, which was associated with the increase in the rCBF of the Right Temporal Area. Those changes persisted at follow-up. Discussion More specific long term therapies are needed for the treatment of the averse response showed by ED patients to their own body image exposure that is associated with the hyperactivation of the right temporal area when they are confronted with their whole body image.

Emotional perception in eating disorders

It remains an open question whether there are basic emotional perception and emotional processing deficits in eating disorders (ED). The aim of this study was to explore deficits in emotional perception in restrictive anorexia nervosa (AN-R) and bulimia nervosa (BN), using visual emotional stimuli. Thirty-four patients with ED (19 with BN and 15 with AN-R) were compared with 25 controls. Visual stimuli from the international affective picture system were used. Patients with AN-R showed increased fear when confronted with stimuli containing anger, whereas patients with BN showed a tendency towards decreased fear. There were no other fundamental differences in the emotional perception of fear, happiness, sadness, and anger. The finding of increased fear when exposed to the emotion of anger might be attributed to introversion and conflict avoidance of anorectic patients. No other basic deficiency of emotional perception was found.

Oral Health and Bone Density in Adolescents and Young Women with Anorexia Nervosa

To evaluate the dental and periodontal health of adolescents and young women with restrictive anorexia nervosa (AN), and relationship between bone mineral density (BMD) assessed by dual energy Xray absorptiometry (DXA) and dental radiographs. Twenty-three young women, median age 17.6 years (range 14.4-27.2), were studied within three months of entering a clinical trial. DXA BMD measurements were obtained and subjects underwent a comprehensive dental examination, including panoramic and bitewing dental radiographs. Three observers assessed mandibular cortical width (MCW) in the mental foramen region on panoramic radiographs. Dental findings included very good to excellent oral hygiene. Gingival recession was evident in 10 participants (43%). Dental erosion was not seen and the mean decayed missing or filled teeth (DMFT) was 8.6. There was a weak positive correlation between BMD by DXA and MCW on radiographs. We report dental manifestations associated with restrictive AN, and the association between bone assessments by DXA and dental radiographs in this patient group. Despite subnormal DXA measurements in most patients, essentially all adolescents had a normal dental examination. Dental providers should be cognizant of the fact that many patients with eating disorders may not display the "classic" findings reported in the literature.

Surged Leptin/Ghrelin Secretion Associated With Anorexia Nervosa

Surged Leptin/Ghrelin Secretion Associated With Anorexia Nervosa

Grossesse et anorexie mentale évolutive : une observation inhabituelle

We report the case of a pregnancy associated with severe restricting anorexia nervosa in a 33-year-old patient who weighed 41 kg for 1.61 m at conception. She continued to lose weight during pregnancy and she gave birth to an eutrophic child by cesarean section at 34 weeks of amenorrhea. Because of complications induced by the chronic food restriction, anorectic pregnant women should be viewed as being at high risk and also monitored closely both during and after pregnancy to optimize maternal and fetal outcomes.

Genetic Susceptibility to Eating Disorders: Associated Polymorphisms and Pharmacogenetic Suggestions

Anorexia nervosa (AN), bulimia nervosa (BN) and binge-eating disorder (BED) are characterized by abnormal eating behaviors often resulting in dramatic physical consequences for the patients. The etiology of eating disorders (EDs) is currently unknown; however, a strong genetic contribution is likely to be involved. To date, the majority of genetic studies have focused on candidate genes, and polymorphic variants of genes coding for substances likely to be involved in the etiopathogenesis of EDs have been assessed for association with AN, BN, BED and/or ED-related phenotypic traits. Results have been generally inconsistent and cannot be considered conclusive because of several methodological flaws and differences, such as small sample sizes, ethnic heterogeneity of studied populations, lack of statistical correction for multiple testing, adoption of different diagnostic criteria and population stratification. Although, at present, no convincing evidence for associations of candidate genes with EDs has been provided, the 5-HT(2A) receptor gene and the BDNF gene seem to be promising candidates for genetic influences on AN, since polymorphic variants of these genes have been found quite consistently, although not specifically, linked to AN restricting subtype in large sample studies. Moreover, pharmacogenetic investigations have suggested a possible role of some gene polymorphisms in predicting the response to treatment with selective serotonin reuptake inhibitors in BN, but results are still preliminary. The heterogeneity of ED phenotypes is believed to represent the most relevant variable responsible for contradictory and not conclusive results. Future studies should focus on more homogeneous subgroups, either relying on specific ED traits or identifying endophenotypes. This will be useful also for prevention and treatment of EDs.

Correspondence between Self-Reported and Parent-Reported Psychopathology in Adolescents with Eating Disorders

Background: This study examined parent/youth self-report agreement on emotional and behavioral symptoms among adolescents with eating disorders (ED). Sampling and Methods: Eighty-three parent-adolescent pairs participated. All adolescents (age 11–18 years) were females and met diagnostic criteria according to the DSM-IV for anorexia nervosa restricting type (n = 53) or bulimia nervosa (n = 30). Diagnoses were confirmed using the Structured Inventory for Anorectic and Bulimic Syndromes. Parents completed the Child Behaviour Checklist, and the adolescents completed the corresponding Youth Self-Report. Results: Results of the interclass correlation provide very poor coefficients between parents and adolescents, especially for the internalizing subscale. Analyses of variance of repeated measures revealed significant differences in the total problem score and the internalizing subscore between parents and adolescents. Parents reported significantly more internalizing problems than adolescents. Conclusions: Agreement between parents and adolescents regarding the presence and severity of psychiatric symptoms in adolescents with ED is low. In contrast to previous studies in non-ED samples, adolescents with ED reported lower levels of internalizing problems than their parents. Denial and minimization may be underlying reasons for our findings and represent obstacles in the psychological assessment of adolescents with ED.

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.

Lifetime course of eating disorders: design and validity testing of a new strategy to define the eating disorders phenotype

Aetiological studies of eating disorders would benefit from a solution to the problem of instability of eating disorder symptoms. We present an approach to defining an eating disorders phenotype based on the retrospective assessment of lifetime eating disorders symptoms to define a lifetime pattern of illness. We further validate this approach by testing the most common lifetime categories for differences in the prevalence of specific childhood personality traits. Ninety-seven females participated in this study, 35 with a current diagnosis of restricting anorexia nervosa, 32 with binge/purging subtype of anorexia nervosa and 30 with bulimia nervosa. Subjects were interviewed by a newly developed EATATE Lifetime Diagnostic Interview for a retrospective assessment of the lifetime course of eating disorders symptoms and childhood traits reflecting obsessive-compulsive personality. The data illustrate the extensive instability of the eating disorders diagnosis. Four most common lifetime diagnostic categories were identified that significantly differ in the prevalence of childhood traits. Perfectionism and rigidity were more common in groups with a longer duration of underweight status, longer episodes of severe food restriction, excessive exercising, and shorter duration of binge eating. The assessment of lifetime symptoms may produce a more accurate definition of the eating disorders phenotype. Obsessive-compulsive traits in childhood may moderate the course producing longer periods of underweight status. These findings may have important implications for nosology, treatment and future aetiological studies of eating disorders.

The inability to ignore: distractibility in women with restricting anorexia nervosa

Attentional difficulties reported in individuals with anorexia nervosa (AN) may be due to preferential processing of disease-salient stimuli at a pre-attentive or at a conscious level or to a general problem in attention. Attentional difficulties may be associated with duration of illness. Female participants with AN (restricting subtype; n=24) and healthy comparison women (n=24) were randomly allocated to subliminal or supraliminal exposure to visual stimuli (food, neutral and aversive images) while performing the 1-back and 2-back working-memory tasks. Participants with AN made fewer errors than the healthy comparison group in the subliminal condition but significantly more errors in the supraliminal condition [condition x group interaction, F(1, 44)=6.82, p<0.01]: this was irrespective of stimulus type (food, neutral and aversive) and task (1-back or 2-back). The total number of errors made correlated positively with the duration of the AN for both the 1-back task (rs=0.46, p<0.05) and for the 2-back task (rs=0.53, p<0.01). Decreased ability to concentrate in the presence of explicit distracters is a feature of AN and is associated with longer duration of illness. This phenomenon could be addressed in psychological interventions.

Psychiatric Comorbidities among Female Adolescents with Anorexia Nervosa

This study investigated current comorbid Axis I diagnoses associated with Anorexia Nervosa (AN) in adolescents. The sample included 101 female adolescents treated at a psychiatric unit for primary DSM-IV diagnoses of AN. 73.3% of the AN patients were diagnosed as having a current comorbidity of at least one comorbid Axis I diagnosis, with no differences across AN subtypes. Mood disorders (60.4%) were most commonly identified, followed by the category anxiety disorders without obsessive-compulsive disorders (OCD) (25.7%), OCD (16.8%) and substance use disorders (7.9%). Two specific diagnoses differed across the two subtypes of AN. Substance use disorder was 18 times, and the category anxiety disorder without OCD was three times as likely to co-occur with AN binge-eating disorder and purging type than with AN restricting type. Clinicians should be alerted to the particularly high rate of psychiatric comorbidities in adolescents suffering from AN.

Regional fat distribution in adolescents with anorexia nervosa: effect of duration of malnutrition and weight recovery

This study addresses the influence of the duration of malnutrition and the effect of weight recovery on regional fat mass distribution in moderately malnourished adolescents with anorexia nervosa (AN). We measured total and regional fat mass and leptin levels in 42 restrictive AN female adolescents and 23 controls. AN patients, followed over 2 years, were divided into three groups: prolonged moderate malnutrition (PM; secondary amenorrhea for over 1 year, n = 14); SM, short period of moderate malnutrition (secondary amenorrhea for less than 1 year, n = 13); and R, recovered from AN (BMI, body mass index and menses recovered for over 6 months, n = 15). Total, trunk, and extremity fat mass were reduced in the PM and SM groups (P < 0.05), whereas only PM patients showed altered regional fat distribution with a low trunk to extremity fat ratio (P < 0.05). BMI increased after 12 months only in the SM group (P < 0.05), with menses resumption in 69% of these patients and BMI normalization at 24 months. Their regional fat distribution was similar to controls throughout the study. No difference in any parameter was found between the R group and the controls. Prolonged malnutrition, but not weight recovery, is associated with an abnormal regional fat distribution pattern in moderately malnourished AN adolescents.

Relational competence and eating disorders

Eating Disorders are very widespread within the adolescent population. A possible interpretation and the comprehension of such forms of psychopathology may revolve around the failure to develop a well-defined personal identity, an incapacity to achieve a sense of differentiation with respect to others, an incapacity to measure oneself against others, dependence on others, the fear of rejection and a sense of inadequacy. This study explores the relational styles and behaviour of individuals suffering from eating disorders and their influence on the development of the personality, with reference being made in particular to self-valuation, dependence on others and levels of differentiation. A sample population of 90 women with eating disorders was studied. The subjects were subdivided into 3 groups (30 with restricting anorexia nervosa, 30 with binge-eating/purging anorexia nervosa and 30 with bulimia nervosa), overlapping in terms of age, duration of disorders and interrelation style, using the Relational Competence Test. The most significant results of this study concern the question of the definition of an autonomous personal identity. This process seems to be in progress in young women suffering from bulimia nervosa who appear to be driven towards a "definition of the self in opposition" with the consequent tendency towards relational experiences outside their own family. In women with binge-eating/purging AN moreover an awareness of the difference between the self and others and of their state of dependence would appear to be present, however behaviour aimed at the determination of an autonomous self is not evident. In women with restricting anorexia nervosa a definition of the identity is totally absent; these women develop an omnipotent self in their 'oneness' with others. These relational aspects lead to the identification of a continuum between restricting anorexia nervosa, binge-eating/purging anorexia nervosa and bulimia nervosa in an evolutionary perspective regarding the self-with-others.

Constitutional thinness and lean anorexia nervosa display opposite concentrations of peptide YY, glucagon-like peptide 1, ghrelin, and leptin

Background:Food intake is controlled by the arcuate nucleus through integration of peripheral hormonal signals such as leptin, ghrelin, peptide YY (PYY), and glucagon-like peptide 1 (GLP-1). The most common condition resulting in underweight young women in the developed world is restrictive anorexia nervosa (AN). However, constitutional thinness (CT) is also known to exist in the same low-weight range. Women with CT have normal menstrual periods and do not have the psychological or hormonal features of AN. Little is currently known about regulation of food intake in subjects with CT.Objective:We tested the hypothesis that concentrations of leptin, ghrelin, PYY, and GLP-1 in persons with AN are significantly different from those in persons with CT.Design:Concentrations of PYY, GLP-1, ghrelin, and leptin were measured in 3 groups of young women: normal weight (n= 7), CT (n= 10), and AN (n= 12). Samples were collected every 4 h for 24 h.Results:PYY concentrations were significantly higher in CT subjects than in AN or control subjects. GLP-1 concentrations were significantly higher in AN than in CT subjects, whereas ghrelin was significantly higher in AN subjects than in control and CT subjects. CT subjects had the lowest ghrelin concentrations. Leptin concentrations were significantly lower in AN subjects. PYY and leptin circadian variations were not significantly different between CT and control subjects, whereas these profiles were blunted in AN subjects.Conclusions:Orexigenic and anorexigenic hormones in CT contrast with an adaptative profile characterizing AN. The hormones appear to be valuable biomarkers for distinguishing these 2 categories of severely underweight subjects.

MMPI–2 Profiles of Women With Eating Disorders in a Dutch Day Treatment Sample

In this study, we examined the MMPI–2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) profiles of 324 Dutch patients with eating disorders at an eating disorder day treatment program. We studied the MMPI–2 profiles in 5 diagnostic eating disorder groups. All diagnostic subgroups showed high mean elevations of the T scores on the same 6 or 7 scales. Remarkable similarities existed between the mean profile configurations. The MMPI–2 distinguished especially in that patients with restricting anorexia nervosa scored lower on one Validity scale (F), two Clinical scales (1 and 2) and several Supplementary and Content scales of the MMPI–2 compared to the other groups. Only on the validity Scale L did they score higher. The MMPI–2 also distinguished patients with the bulimia nervosa purging type who scored higher on Scale 9 and different on several Content and Supplementary scales. We discuss results with regard to other studies of MMPI (Hathaway & McKinley, 1983) and MMPI–2 profiles of women with anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified in inpatient and outpatient settings.

Assessment of body image distortion in eating and weight disorders: The validation of a computer-based tool (Q-BID)

Quantification of Body Image Distortion (Q-BID) is a computerized tool developed to quantify body image distortion in eating and weight disorders. This paper presents information on the psychometric properties of this computerized tool. Three samples of adolescents were recruited and completed the Q-BID, paper and pencil questionnaires and anthropometric measurements, namely a group of hospitalized anorectic patients (n=18), girls following outpatient treatment (n=22) for restrictive anorexia nervosa, and control group of 200 teenager girls. Analyses showed that Q-BID is a valid and reliable tool in that test-retest reliability was high and Q-BID accurately discriminates between hospitalized anorexics and control non-anorexic girls. Also, Q-BID contributes to the multivariate classification of subjects into the 3 sampled groups. The possible uses of this tool for clinical and public health research are discussed as are future research directions.

Regional Skeletal Bone Deficit in Female Adolescents with Anorexia Nervosa: Influence of the Degree of Malnutrition and Weight Recovery in a Two Year Longitudinal Study

To analyze changes in bone mineral density (BMD) and the effect of weight recovery on the restoration of bone mass in adolescent females with anorexia nervosa (AN) with moderate malnutrition. We evaluated lumbar and femoral BMD in 27 females with restrictive AN with malnutrition and amenorrhea for over (M+PA) or less than (M+SA) one year and 12 with normal nutrition and amenorrhea for over one year (N+PA) followed for 24 months. BMI remained below -1.5 SD in M+PA and increased at 24 months in M+SA. M+PA had low lumbar and femoral neck BMD at diagnosis, decreasing at 24 months. Lumbar BMD in N+PA and M+SA was reduced, with an increase in M+SA at 24 months. Moderate malnutrition in AN induces loss of bone mass at the lumbar and femoral levels. Weight gain and resumption of menses increases bone mass, especially in the lumbar spine.

Should bulimia nervosa be subtyped by historyof anorexia nervosa? A longitudinal validation

To determine whether a past diagnosis of anorexia nervosa (AN) predicts longitudinal course and outcome among women with bulimia nervosa (BN). A subset (n = 176) of participants in the Longitudinal Study of Anorexia and Bulimia Nervosa who met DSM-IV criteria for BN either at study intake (n = 144) or during follow-up (n = 32; 4 had restricting AN at intake, 28 had binge/purge AN at intake) were included in this report. Over a median of 9 years, weekly eating disorder symptom data were collected from participants using the Longitudinal Interview Follow-up Examination, Eating Disorders Version. While there were no between-group differences in likelihood of partial recovery, women with BN who had a history of AN were more likely to have a protracted illness, relapsing into AN during follow-up, compared to those with no AN history who were more likely to move from partial to full recovery. Lifetime AN is an important prognostic indicator among women with BN and these longitudinal data would support the subtyping of BN on the basis of AN history.