Symptoms Of Anorexia Nervosa Research Articles

Understanding the Neural Circuitry of Appetitive Regulation in Eating Disorders

There has been much confusion and speculation about the reasons for abnormal eating behaviors and other symptoms in anorexia nervosa (AN) and bulimia nervosa (BN) (1). For example, individuals with AN dramatically restrict their caloric consumption and achieve severe emaciation yet are often preoccupied with food or cook for others. Moreover, food, or even the anticipation of eating, tends to be anxiogenic, whereas avoiding eating often reduces these uncomfortable feelings. Individuals with BN tend to alternate between restrictive eating and overeating with loss of self-control, followed by purging behaviors.

Perfil antropométrico e sintomatologia anoréxica em adolescentes de escola pública

Identify adolescents with a presence of symptoms of anorexia nervosa and body image distortion at a public school. The sample included 58 adolescents of both sexes, 14 to 18 years old. The nutritional status assessment was performed using the Body Mass Index (BMI). To investigate symptoms of anorexia nervosa and body image distortion, the Eating Attitudes Test (EAT-26) and Body Shape Questionnaire (BSQ) were used, respectively. According to the nutritional status assessment, 74.14% were classified as having normal weight. The analysis of the BSQ showed that 24.24 and 4.00% of adolescent females and males had body image disturbance. According to the EAT-26, 9.09% of females and 8.00% of males were classified with symptoms of anorexia. It was also observed that 80.00% of adolescents, in addition to suffering from symptoms of anorexia, also had body image disturbance, which is statistically significant. The results showed the presence of symptoms of anorexia as well as a significant presence of body image distortion, with female adolescents as the most affected group.

Repetitive transcranial magnetic stimulation in anorexia nervosa: A pilot study

The search for new treatments to improve outcome in people with anorexia nervosa continues. This pilot study investigated whether one session of high frequency repetitive transcranial magnetic stimulation (rTMS) delivered to the left dorsolateral prefrontal cortex reduces eating disorder related symptoms following exposure to visual and real food stimuli. Safety and tolerability were also assessed. Ten right-handed people with anorexia nervosa underwent one session of rTMS. Subjective experiences related to the eating disorder (e.g. urge to restrict, feeling full etc.) were assessed before and after rTMS. Non-parametric repeated measures tests were used. rTMS was safe and well-tolerated, and resulted in reduced levels of feeling full, feeling fat and feeling anxious. Thus, rTMS may reduce core symptoms of anorexia nervosa. Future research should establish the therapeutic potential of rTMS in anorexia nervosa.

School counselors’ knowledge of eating disorders

Twenty years ago, Price published a survey identifying knowledge deficits of school counselors regarding eating disorders. Our study surveys current school counselors to determine whether knowledge has increased and determine the availability of school-based prevention programming. School counselors from a single metropolitan area were surveyed prior to a mandatory in-service on eating disorders. Of the 109 respondents, 55% felt eating disorders were a problem in their school. Very few felt "very competent" identifying (6%) or helping (2%) students with eating disorders. Today's school counselors were more likely to know a symptom of anorexia nervosa (AN) is missing at least three consecutive menstrual cycles and malnutrition is not a common cause of death for bulimia nervosa (BN). While knowledge of AN and BN appear to have increased, school counselors still lack some basic understanding and report very low confidence in identifying and helping students with eating disorders.

P02-147 - Food preferences and taste perception in anorexia nervosa

ObjectiveRestrictive and selective eating behavior with food preferences and aversions is a characteristic symptom in anorexia nervosa (AN). Typically fat-containing food is avoided. Furthermore, very often patients with AN replace food which is rich in calories by fruits and vegetable. The aim of the present study was to evaluate if there is a relationship between food preferences and taste perception in AN.Methods15 female patients with acute AN (ANacute) (BMI 16.5 ± 1.3 kg/m2, 20.4 ± 4.7 yrs.), 21 remitted female patients with AN (ANrem) (BMI 21.4 ± 2.9 kg/m2, 24.2 ± 3.2 yrs., remission period 6 ± 2.6 yrs.) and 15 female healthy controls (HC) (BMI 21.6 ± 3.1 kg/m2, 24.9 ± 2.7 yrs.) were included. Taste perception was evaluated using taste strips (sweet, sour, salty, bitter). Food practice and choice were assessed by self-report. Several blood parameters including hormones and leptin were analyzed. The number of fungiform papillae was quantified using digital photography and image processing.ResultsIn ANacute bitter tasting foods were significantly consumed more often when compared with ANrem and HC. Sensoric taste perception for salty and bitter was reduced in ANacute (n.s.). Hedonic taste perception for sour, salty and bitter was increased in ANacute (n.s.). The number of fungiform papillae was significantly decreased in ANacute compared with ANrem and HC. Taste perception for bitter tastes within a range of concentrations correlated with serum estrogen and leptin.ConclusionsOur results indicate a relationship between food selection and biological factors which can influence taste perception during the underweight stage of ANacute.

P02-130 - Characteristic prefrontal blood volume patterns when imaging body type, high-calorie food, and mother-child attachment in childhood anorexia nervosa: A near infrared spectroscopy study

IntroductionThe risk for developing and preserving symptoms of anorexia nervosa (AN) in children seems to be multifactorial: individual, familial, socio-cultural, and biological factors interact within the developmental framework. A disruption of attachment processes with the mother in an early stage of child development has been proposed as a contributing factor; however, the evidence is controversial.ObjectivesTo address the research question of how childhood AN patients recognize disorder-specific provocative factors such as body type, high-calorie food, and attachment between mother and child.AimsThe aim of this study was to investigate the prefrontal activation in childhood AN patients when imaging those symptom-provocative factors.MethodsThe prefrontal activations during each task, in terms of blood volume changes, were measured by near infrared spectroscopy. Twelve females with childhood AN (mean age, 14.4 years old) and 13 age-matched healthy female controls participated in this study.ResultsBoth groups showed increased prefrontal blood volume when viewing images of each symptom-provocative factor. Unexpectedly, there was no significant difference in the prefrontal blood volume increases between the control group and the childhood AN group when viewing images of slender and obese body types and high-calorie food. On the other hand, images of mother-child attachment resulted in significantly greater increases in prefrontal blood volume in the childhood AN group than in the control group.ConclusionsThese results indicated that prefrontal activation in AN might be associated with imaging attachment between mother and child, but not associated with imaging body type or high-calorie food.

Anorexia nervosa versus hyperinsulinism: therapeutic effects of neuropharmacological manipulation

Background:We have demonstrated that anorexia nervosa is underpinned by overwhelming adrenal sympathetic activity which abolishes the neural sympathetic branch of the peripheral autonomic nervous system. This physiological disorder is responsible for gastrointestinal hypomotility, hyperglycemia, raised systolic blood pressure, raised heart rate, and other neuroendocrine disorders. Therefore, we prescribed neuropharmacological therapy to reverse this central and autonomic nervous system disorder, in order to normalize the clinical and neuroendocrine profile.Methods:The study included 22 female patients with anorexia nervosa (10 restricted type, 12 binge-eating type) who received three months of treatment with amantadine 100 mg/day. We measured blood pressure, heart rate, and circulating neurotransmitters, (noradrenaline, adrenaline, dopamine, platelet serotonin, free plasma serotonin) during supine resting, one minute of orthostasis, and a five-minute exercise test before and after one, two, and three months of treatment with amantadine, a drug which abrogates adrenal sympathetic activity by acting at the C1(Ad) medullary nuclei responsible for this branch of the peripheral sympathetic activity.Results:We found the amantadine abolished symptoms of anorexia nervosa from the first oral dose onwards. Normalization of autonomic and cardiovascular parameters was demonstrated within the early days of therapy. Abrupt and sustained increases in the plasma noradrenaline:adrenaline ratio and disappearance of abnormal plasma glucose elevation were registered throughout the three-month duration of the trial. Significant and sustained increases in body weight were documented in all cases. No relapses were observed.Conclusion:We have confirmed our previously published findings showing that the anorexia nervosa syndrome depends on the hypomotility of the gastrointestinal tract plus hyperglycemia, both of which are triggered by adrenal sympathetic hyperactivity. The above neuroendocrine plus neuroautonomic and clinical disorders which underpinned anorexia nervosa were abruptly suppressed since the first oral dose of amantadine, a drug able to revert the C1(Ad) over A5(NA) pontomedullary predominance responsible for adrenal and neural sympathetic activity, respectively.

Community recognition and beliefs about anorexia nervosa and its treatment

Mental Health Literacy (MHL), namely recognition, and beliefs about treatment concerning Anorexia Nervosa (AN) were examined in a community sample of male and female (n = 983) aged 15-94 years. A vignette describing a women suffering from the symptoms of AN was presented, followed by a respondent-based structured interview concerning recognition of the problem and treatment beliefs. The majority of participants could identify the problem as that of an eating disorder, although only 16.1% could specifically identify it as AN. Many also believed the problem was primarily one of low self-esteem (32.5%). General practitioners and psychiatrists or psychologists were considered the most helpful treatment providers, while obtaining information about the problem and available services, followed by family therapy, were considered the most helpful treatments. Less than one-third of participants believed complete recovery was possible. Better AN MHL was found in younger, higher educated, and metropolitan domiciled females. This study offers encouraging results in regard to AN MHL. In particular, there was moderate regard for the use of mental health specialists in the treatment of the disorder. However, there appears to be a misconception that AN is largely the manifestation of low self-esteem and confusion concerning the distinction between AN and bulimia nervosa. AN MHL was poorer in males and those with higher social and health disadvantage.

Demand‐specific alteration of medial prefrontal cortex response during an inhibition task in recovered anorexic women

It is well known that individuals with anorexia nervosa (AN) are inhibited and over-controlled. This study investigated a prefrontal-cingulate network that is involved in inhibitory control. To avoid the confounds of malnutrition, 12 recovered (RAN) subjects were compared to 12 matched control women (CW) using a validated inhibition task (i.e., a stop signal task) during functional magnetic resonance imaging. Consistent with the a priori hypothesis, RAN subjects showed altered task-related activation in the medial prefrontal cortex (mPFC), a critical node of the inhibitory control network. Specifically, whereas RAN and CW showed similar mPFC activity during trials when inhibitory demand was low (i.e., easy trials), RAN relative to CW showed significantly less mPFC activation as inhibition trials became more difficult (i.e., hard trials), suggesting a demand-specific modulation of inhibitory control circuitry in RAN. These findings support a neural basis for altered impulse control symptoms in AN.

Effects of gustatory stimulation on brain activity during hunger and satiety in females with restricting-type anorexia nervosa: An fMRI study

Background Previous research has demonstrated altered neuronal responses to visual stimulation with food in anorexia nervosa, varying with the motivational state of hunger or satiety. The aim of the present fMRI study was to assess hunger- and satiety-dependent alterations in the gustatory processing of stimulation with food in anorexia nervosa. Methods After food abstention (hunger condition) and after eating bread rolls with cheese (satiety condition), 12 females with restricting-type anorexia nervosa and 12 healthy females drank chocolate milk and water via a tube in a blocked design during image acquisition. Additionally, heart rate was registered during the measurements, and subjective ratings of hunger/satiety and of the valence of chocolate milk were assessed using a Likert scale. Results In participants with anorexia nervosa, drinking chocolate milk in the hunger condition induced significant activations in the right amygdala and in the left medial temporal gyrus relative to healthy controls. When contrasting neuronal responses to drinking chocolate milk during satiety with those evoked during hunger, a significant activation was found in the left insula in healthy controls, whereas in participants with anorexia nervosa, neuronal activity in the inferior temporal gyrus, covering the extrastriate body area, was observed. Conclusions Neuronal responses evoked by gustatory stimulation differ depending on hunger and satiety. Activations located in the amygdala and in the extrastriate body area might reflect fear of weight gain, representing one of the core symptoms of anorexia nervosa.

Taste reactivity deficit in anorexia nervosa

Anorexia nervosa is a complex psychiatric disorder posing a rapidly increasing burden on modern societies. Our purpose was to clarify perceptual-motivational aspects of gustatory disturbances in the disease. A taste reactivity test, with the use of all five primary qualities in two concentrations, was performed in restrictive-type anorexic patients, and their hedonic evaluations were compared to those of age-matched healthy control subjects. The patients gave significantly lower pleasantness scores for pleasant taste stimuli compared with controls. The differences were the greatest for the lower concentration sucrose, umami and sodium chloride. Ratings given for the aversive taste stimuli were similar in both experimental groups. Our findings contribute to a better understanding of complex symptoms of anorexia nervosa, and may also help to develop more effective cognitive-behavioral therapies.

Pleasure for visual and olfactory stimuli evoking energy-dense foods is decreased in anorexia nervosa

Although patients with anorexia nervosa have been suggested to be anhedonic, few experiments have directly measured their sensory pleasure for a range of food and non-food stimuli. This study aimed to examine whether restrictive anorexia nervosa (AN-R) patients displayed: i) a generalized decline in sensory pleasure or only in food-related sensory pleasure; ii) a modification of hedonic responses to food cues (liking) and of the desire to eat foods (wanting) as a function of their motivational state (hunger vs. satiety) and energy density of foods (high vs. low). Forty-six female participants (AN-R n = 17; healthy controls (HC) n = 29) reported before/after lunch their pleasure for pictures/odorants representing foods of different energy density and non-food objects. They also reported their desire to eat the foods evoked by the sensory stimuli, and completed the Physical Anhedonia Scale and the Beck Depression Inventory. AN-R and HC participants did not differ on liking ratings when exposed to low energy-density food or to non-food stimuli. The two groups also had similar physical anhedonia scores. However, compared to HC, AN-R reported lower liking ratings for high energy food pictures regardless of their motivational state. Olfactory pleasure was reduced only during the pre-prandial state in the AN-R group. The wanting ratings showed a distinct pattern since AN-R participants reported less desire to eat the foods representing both low and high energy densities, but the effect was restricted to the pre-prandial state. Taken together these results reflect more the influence of core symptoms in anorexia nervosa (fear of gaining weight) than an overall inability to experience pleasure.

Influence of Biological, Social and Psychological Factors on Abnormal Eating Attitudes among Female University Students in Brazil

The objective of the study was to estimate abnormal eating attitudes influenced by associated factors among female students of the Universidade Federal de Santa Catarina, Florian6polis, southern Brazil. Abnormal eating attitudes were investigated using the eating attitudes test (EAT-26), according to the presence (EAT+) and absence (EAT-) of symptoms in a sample of 220 students. The body-image was assessed by the body-shape questionnaire (BSQ-34). Body mass index, body-fat percentage, waist-circumference, food intake (24-hour food recall), and socioeconomic characteristics (monthly household income, monthly per-capita income, and parental schooling) were also investigated. Statistical associations were tested by multivariate Poisson regression analysis. The prevalence of EAT+ and dissatisfaction with the body-image were 8.3% [confidence interval (CI) 95% 4.6-12.0] and 20.0% (CI 95% 14.7-25.3) respectively. Dissatisfaction with the body-image maintained its independent association with abnormal eating attitudes, indicating symptoms of anorexia nervosa. The results of this work highlight the importance of the planning of nutrition-education programmes in universities, aiming at assisting in the choices of food that comprise a healthful diet in a period of life of so many changes and decisions.

Body image distortion change during inpatient treatment of adolescent girls with restrictive anorexia nervosa

Body image distortion is one core symptom of anorexia nervosa. However, little is known concerning its fluctuation over time. This paper pursues two objectives: (1) to assess body image distortion change during inpatient treatment of adolescent girls with restrictive anorexia nervosa (n=10), and (2) to identify associations between this change and the change observed to other measures of eating and weight-related disorders. A Quantification of Body Image Distortion computerized tool (Q-BID) and paper-and-pencil questionnaires were used at both beginning and end of inpatient treatment. Pearson correlations and linear regression analyses were conducted to identify associations between body image distortion change and the change observed to other measures of eating and weight-related disorders. The results indicate that all adolescents experienced a body image distortion change. This change corresponds to a body image distortion decrease for 70% of them. The body image distortion change measure was highly correlated with the change observed in the score to the Eating Attitude Test (EAT-26) and to the Eating Disorder Examination Questionnaire (EDEQ-4) during the inpatient treatment. These two measures of change indeed explained 88.4% of the body image distortion change variance in the multivariate model. We concluded that the Q-BID is an interesting tool for the assessment of body image distortion change. More research is needed concerning the correlates of this outcome in order to elaborate appropriate interventions for both clinical and community settings.

P02-148 - Structural neural correlates of anorexia nervosa: a review of neuroimaging studies

ObjectivesMany research groups have used neuroimaging techniques in order to investigate brain abnormalities in patients with Anorexia Nervosa (AN). The results of structural studies, which utilised CT scan and MRI, have revealed both global brain abnormalities and region-specific brain abnormalities. The central disturbance in AN is that of a distorted body image and food refusal. The purpose of the present study was to analyze structural neuroimaging studies in order to revel the possible existence of a neural basis of AN symptoms.MethodsPublished reports from refereed journals of the last twenty years are collected, analyzed and synthesized into a summary of the most significant neuroimaging findings. We used as keywords “anorexia”, “neuroimaging”, “MRI”, “CT”, “manual measurement”, “voxel based morphometry” differently matched together.ResultsStructural studies have showed total decreases in both gray matter (GM) and white matter (WM), with an increase in cerebrospinal fluid (CSF). Several structural follow-up studies reported that GM, WM and CSF abnormalities are fully reversible after recovery, whilst other authors reported that GM decreases persists after recovery. Region-specific structural studies have principally revealed a decrease in extrastriate body area, precuneus, parietal lobe and, following recovery, the anterior cingulate cortex.ConclusionsThese results showed a global GM vulnerability in AN patients and that the specific GM regions affected are principally involved in the processing of body-image and mental images, and in the regulation of hunger and satiation. Although these results are still under debate, findings suggest that AN symptoms could have a neural substrate.

Separating two components of body image in anorexia nervosa using fMRI

Body image distortion is a key symptom of anorexia nervosa. In behavioral research two components of body image have been defined: attitudes towards the body and body size experience. Neuroimaging studies concerning own body image distortions in anorexia nervosa have revealed an inconsistent pattern of results and are constrained by the fact that no direct distinction between the different parts of body image has been made. The present study therefore set out to investigate the neural correlates of two parts of the own body image using functional magnetic resonance imaging (fMRI): satisfaction rating and size estimation for distorted own body photographs in patients with anorexia nervosa and controls. Anorectic patients were less satisfied with their current body shape than controls. Patients further demonstrated stronger activation of the insula and lateral prefrontal cortex during the satisfaction rating of thin self-images. This indicates a stronger emotional involvement when patients are presented with distorted images close to their own ideal body size. Patients also overestimated their own body size. We were able to show complex differential modulations in activation of the precuneus during body size estimation in control and anorectic subjects. It could be speculated that a deficit in the retrieval of a multimodal coded body schema in precuneus/posterior parietal cortex is related to body size overestimation. We were able to find specific behavioral responses and neural activation patterns for two parts of body image in anorexia nervosa and healthy controls. Thus, the present results underline the importance of developing research and therapeutic strategies that target the two different aspects of body image separately.

A Neural Signature of Anorexia Nervosa in the Ventral Striatal Reward System

Animal studies assessing mechanisms of self-starvation under conditions of stress and diet suggest a pivotal role for the mesolimbic reward system in the maintenance of core symptoms in anorexia nervosa, which is corroborated by initial empirical evidence in human studies. The authors examined activity in the ventral striatal system in response to disease-specific stimuli in women with acute anorexia nervosa. Participants were 14 women with acute anorexia nervosa and 14 matched healthy comparison women who underwent functional magnetic resonance imaging (fMRI) during evaluation of visual stimuli depicting a female body with underweight, normal weight, and overweight canonical whole-body features according to standardized body mass indices. Participants were required to process each stimulus in a self-referring way. Ratings for each weight category were used as the control task. Behaviorally, women with anorexia nervosa provided significantly higher positive ratings in response to underweight stimuli than in response to normal-weight stimuli, while healthy comparison women showed greater preference for normal-weight stimuli relative to underweight stimuli. Functionally, ventral striatal activity demonstrated a highly significant group-by-stimulus interaction for underweight and normal-weight stimuli. In women with anorexia nervosa, activation was higher during processing of underweight stimuli compared with normal-weight stimuli. The reverse pattern was observed in healthy comparison women. These findings are consistent with predictions in animal studies of the pivotal role of the human reward system in anorexia nervosa and thus support theories of starvation dependence in maintenance of the disorder.

Imagen Corporal y Trastornos de la Conducta Alimentaria

Assessing the association of age and weight with internalisation of the ideal of being thin, bodily dissatisfaction and eating disorder symptoms amongst three groups of females: teenage, young and adult women. 145 females participated, ranging in age from 12 to 46, who answered four self-reporting questionnaires aimed at measuring symptoms of anorexia nervosa, bulimia nervosa, the ideal of being thin and bodily dissatisfaction. The participants' weight and height were also recorded for calculating their body mass index. Data analysis included descriptive and inferential statistics, specifically Spearman correlation and Kruskal-Wallis test. Being an older woman was associated with high internalisation of ideally being thin and bodily dissatisfaction; however, it was not correlated with eating disorder symptoms. Comparisons between groups showed that adult females were more dissatisfied with their bodies and their attitudes towards being thin; however, their attitudes and behaviour concerning abnormal eating were just as inappropriate as that amongst teenagers. These findings show the need for research into attitudes towards eating amongst adult women because they use extreme methods for controlling weight which may result in higher health risks.

Clarifying criteria for cognitive signs and symptoms for eating disorders in DSM‐V

This article reviews literature relevant to challenges in clinical ascertainment of cognitively-based diagnostic criteria of anorexia nervosa (AN) and bulimia nervosa (BN) to examine whether revision might enhance their clinical utility. We performed a systematic literature search to identify publications relevant to clinical evaluation of cognitive symptoms of AN and BN. The literature supports several reasons that individuals with an eating disorder may not endorse cognitive symptoms, despite their presence. These include limited insight, minimization, or denial, as well as intentional concealment related to perceived stigma, social desirability, or investment in maintaining behavioral symptoms. We also identified reasons that the word "refusal" in AN criterion A may render its application problematic. We conclude that specific guidance for ascertainment of cognitive signs for AN and BN in the absence of patient disclosure or endorsement, longitudinal evaluation, and/or collateral data may improve clinical utility of these diagnostic criteria.

Spontaneous pneumomediastinum: A rare complication of anorexia nervosa

FIGURE 1. A and B, Thoracic computed tomographic scans of the patient. Diffuse subcutaneous emphysema, from the neck to the thorax, and pneumomediastinum are evident. Spontaneous pneumomediastinum (PM) usually results from alveolar wall rupture and must be distinguished from posttraumatic PM resulting from traumatic events (chest trauma, endobronchial or esophageal procedures with wall laceration, mechanical ventilation, or other invasive procedures). Spontaneous PM is a rare entity in anorexia nervosa (AN): approximately 20 cases have been described in the literature. Vomiting (a common symptom in AN) is often the cause of PM in patients with AN. We describe the case of spontaneous PM in a young anorexic woman in whom vomiting was not the cause of the PM.