Symptoms Of Anorexia Nervosa Research Articles

The role of leptin in anorexia nervosa: clinical implications

Leptin is a hormone with pleiotropic functions affecting several tissues. Because leptin has a crucial role in the adaptation of an organism to semi-starvation, anorexia nervosa (AN) serves as a model disorder to elucidate the functional implications of hypoleptinaemia; vice versa, several symptoms in patients with this eating disorder are related to the low leptin levels, which are characteristic of acute AN. Weight gain in AN patients can induce relative hyperleptinaemia in comparison to controls matched for body mass index; circulating leptin concentrations in AN patients thus transverse from subnormal to supranormal levels within a few weeks. We review findings on leptin secretion in AN and focus on implications, particularly for the hypothalamus-pituitary-gonadal axis, bone mineral density and physical hyperactivity. Undoubtedly, the elucidation of leptin's function as a trigger of diverse neuroendocrine adaptations to a restricted energy intake has substantially advanced our knowledge of the pathogenesis of distinct symptoms of AN, including amenorrhoea that represents one of the four diagnostic criteria. The fact that hypoleptinaemia can induce hyperactivity in a rat model for AN has led to a series of studies in AN patients, which support the notion that application of leptin to severely hyperactive patients might prove beneficial.

Eating disordered behaviors and media exposure

This study examined this relationship between eating disordered behaviors and exposure to ideal-type media in a sample of South African university students, who could be expected to have reasonably high levels of media exposure. Possible underlying reasons for this complex relationship were also investigated. It examined the relationship via both quantitative (using a questionnaire that included the EAT-26 and a media composite variable) and qualitative methods (interviews) in the sample. In the quantitative part, sex and level of media exposure significantly predicted scores on the EAT-26. Women obtained scores that indicated they were more "at risk" for anorexia nervosa than men, especially women with higher levels of media exposure. In the qualitative part of the study grounded theory was used to explore how this relationship was formed. Results indicated that numerous factors, some related to the media, predispose women to disordered eating behaviors. The interviewees were then more likely to use ideal-type media heavily to sustain their disordered eating behaviors. Heavy use of the media led participants to attempt a number of strategies to change their appearance to resemble those in the media, with various degrees of success. The model developed by the qualitative research indicated that the media are not necessarily always the cause of pathological eating, but that they interact with other factors in the development of symptoms of anorexia nervosa for these women.

Self‐liking and self‐competence: relationship to symptoms of anorexia nervosa

Self-esteem has been hypothesised to play a pivotal role in the development and treatment, and outcome of anorexia nervosa (AN). Though this relationship is typically investigated by considering self-esteem as a unitary construct, research suggests that this comprises of two related but distinct components of self-liking and self-competence. This study investigates the association between self-liking, self-competence, and symptomatology of AN through the course of a defined treatment episode in 77 women. Self-liking was significantly associated with laxative abuse. Self-competence was significantly associated with elevated ineffectiveness, perfectionism and interpersonal distrust. Although self-competence and eating disturbance severity significantly improved over the treatment episode, one in three participants reported a reduced self-like or self-competence. Changes in both self-competence and self-liking at the end of treatment was associated with changes in drive for thinness. Such findings have implications for treatment models concerned with improving self-esteem.

Applying the Theory of Work Adjustment to Clients With Symptoms of Anorexia Nervosa

As women have gained entry and status in the workforce over the past century, societal focus on female beauty and thinness has intensified, and rates of eating disorders have risen. In tandem with these trends, many career women have come to associate success at work with the ability to maintain strict control over body weight. This control becomes life-threatening, however, to the individual who develops symptoms of anorexia nervosa. This article uses Dawis and Lofquist’s theory of work adjustment (TWA) as a way to conceptualize the precarious person-environment correspondence sometimes achieved by women with anorexic symptoms in their work environments. Practical suggestions, based in TWA and cognitive-behavioral theory, are suggested for career counselors working with these clients.

Treatment with 8-OH-DPAT attenuates the weight loss associated with activity-based anorexia in female rats

Serotonin (5-HT) plays an important role in controlling food intake and regulating body weight. In addition, clinical studies suggest a possible role for 5-HT in the etiology of anorexia nervosa. Recently, we have examined the effects of pharmacological manipulation of the 5-HT system in female rats exposed to conditions that promote activity-based anorexia (ABA). In this animal model of anorexia nervosa, rats are food restricted (2 h access/day) while given the opportunity to exercise in running wheels. These conditions promote symptoms of anorexia nervosa including hypophagia, hyperactivity, progressive weight loss, and disruptions of the ovarian reproductive cycle. Previously, we demonstrated that increased 5-HT activity increased the weight loss associated with ABA in female rats. Here, we investigated whether decreased 5-HT activity would attenuate symptoms of ABA. Food-restricted female rats received injections of 8-OH-DPAT, a drug that reduces serotonergic neurotransmission, or saline vehicle 40 min prior to food access. During this restricted-feeding phase, food intake was similar between groups; however, 8-OH-DPAT prevented the hyperactivity observed in saline-treated rats. This resulted in less weight loss in 8-OH-DPAT-treated rats, suggesting that decreased activation of the 5-HT system attenuates the development of ABA.

P.1.a.014 Expressed gene differences on .uoxetine treatment in rat hippocampus

Anorexia nervosa (AN) is a complex multi-factorial disease with high heritability. The psychological AN symptoms are poorly connected with specific molecular mechanisms. Here we review the molecular basis of AN with the focus on human genetic association studies; we put these in the experimental biological context with emphasis on molecular systems controlling food intake and body weight in a direct or indirect manner. We systematically searched for human genetic studies related to AN and grouped data into main categories/systems reflecting their major known roles: (1) Systems related to mental disorders (serotonin, brain-derived neurotrophic factor (BDNF), norepinephrine (NE), glutamate (NMDA) receptor and SK3 channel, KCCN3). (2) Hunger regulatory systems (leptin, AGRP, MSH, melanocortin 4 receptor (MC4R), NPY, ghrelin, cholecystokinin (CCK). (3) Feeding motivation- and reward-related systems (opioids, OPRD1, cannabinoids (anandamide (AEA), THC, CBR1), dopamine, DRD2, DRD3, DRD4, catecholamine-O-methyl transferase (COMT). (4) Systems regulating energy metabolism (uncoupling proteins 2 and 3 (UCP2 and UCP3). (5) Neuroendocrine systems with emphasis on sex hormones (estrogen receptor-β (ESR2). (6) The immune system and inflammatory response (tumor necrosis factor-alpha (TNF-α)). Overall, we found that in total 175 association studies have been performed on AN cohorts on 128 different polymorphisms related to 43 genes. We review the strongest associations, identify some genes that have an important role in regulating BMI whose possible relationship to AN has not been investigated and discuss the potential targets for pharmacological interventions.

Eating Disorders

Eating Disorders

Differences in diet composition of Brazilian adolescent girls with positive or negative score in the Eating Attitudes Test

Dieting, a behavioral phenomenon which is becoming more frequent among adolescents, is certainly involved in the pathogenesis of eating disorders, especially anorexia nervosa (AN), and may result in an unbalanced nutrition. Our study aimed at identifying girls with symptoms of AN and describing their diets. We assessed girls with symptoms by using the Eating Attitudes Test and considered girls with a score > or = 20 as having symptoms of AN. To evaluate their diets, a "modified" 24-hour recall was applied on three alternate days. Twenty-one percent of the 279 girls studied showed symptoms of AN. Analysis of the food intake showed that calories, calcium and iron were below the recommendations of the Standing Committee on the Specific Evaluation of Dietary Reference Intakes (DRI Committee) and the National Research Council, while protein and carbohydrate were within the recommended range and fat was above the percentage of recommended total energy intake. Compared to girls without symptoms, they had a significantly smaller intake of calories and iron, and a higher intake of protein. Findings shown in this paper point out the need for intervention in adolescents because their dieting behavior can predispose to an eating disorder.

Fenfluramine treatment in female rats accelerates the weight loss associated with activity-based anorexia

Serotonin plays an important role in controlling food intake and regulating body weight. Thus, altered serotonergic function may be involved in the etiology of anorexia nervosa. To investigate this hypothesis, we examined whether activation of the serotonin system increases the severity of activity-based anorexia, an animal model of anorexia nervosa in which food-restricted rats are housed with access to running wheels. This paradigm promotes symptoms of anorexia nervosa, including hypophagia, hyperactivity, and weight loss. Food-restricted rats received injections of a serotonin agonist, fenfluramine, or saline 1.5 h prior to their daily 2-h period of food access. A third saline-injected group was pair-fed to the fenfluramine group. Drug treatment and food restriction were terminated following a 25% weight loss. During food restriction, each group developed symptoms of activity-based anorexia. Although similar reductions in food intake were observed in fenfluramine-treated and pair-fed rats, only fenfluramine-treated rats displayed an accelerated rate of weight loss, relative to saline-treated rats. Thus, some other nonanorexic aspect of fenfluramine, perhaps its influence on metabolism, must underlie the accelerated rate of weight loss in this group. Our results suggest that increased activation of the serotonin system exacerbates the weight loss associated with activity-based anorexia.

Aspects comportementaux et biologiques de l’hyperactivité dans l’anorexie mentale

Anorexia nervosa is an eating disorder defined by a symptomatic triad, anorexia, emaciation and amenorrhoea. This disease mainly affects young women. Besides these three symptoms, hyperactivity is often associated with anorexia nervosa. Hyperactivity can be considered as a strategy to lose weight, but studies on animal models have shown that it could be explained by more complicated mechanisms. Hyperactivity is defined by an excess of physical activity, which can induce social, professional and family consequences. Hyperactivity can take different forms, most striking is the restless one. Patients with anorexia nervosa are not all hyperactive. Brewerton et al. have compared patients with anorexia nervosa and hyperactivity to patients without hyperactivity. Hyperactive patients are more dissatisfied by their body image, they use less means of purging (laxatives, vomiting), and they start starving earlier than patients without hyperactivity. Many factors can promote the emergence and maintenance of hyperactivity, especially social and cultural requirements, sports environment, family influences. Various models can explain the links between excessive exercise and anorexia nervosa. Epling and Pierce have exposed a behavioural model which shows how hyperactivity can lead to starvation, creating a self-maintained cycle. Eisler and Le Grande have described four models to explain the links between hyperactivity and anorexia nervosa. First, excessive exercise can be considered as a symptom of anorexia nervosa. It can also promote the development of eating disorders. Anorexia nervosa and hyperactivity can be a manifestation of an other psychiatric disorder. At least, hyperactivity can be a variant of anorexia nervosa, which has the same effects, as weight loss. Hyperactivity can also be considered as a kind of obsessive compulsive disorder. Hyperactivity and obsessive compulsive disorders actually share some clinical and neurochemical characteristics. An other model consists in comparing excessive exercise in anorexia nervosa to an addictive behaviour. Self-starvation exacerbated by hyperactivity can be considered as an addiction to endogenous opioid. Few studies are carried out in order to estimate the prevalence of high level exercise in the eating disorders. Davis et al. have achieved a prevalence study. The results indicate that a large majority of patients with anorexia nervosa (80,8%) were exercising excessively during an acute phase of the disorder. Research on animals, specially on rats, brings us an interesting model explaining interactions between anorexia nervosa and hyperactivity. With animal models, we have noticed that, when rats with access to a running wheel, are restricted in their food intake, they become excessively active, and paradoxically reduce food consumption. Many searchers have tried to explain this phenomenon. Morse et al. have pointed from animal models that the level of hyperactivity was linked to the severity of food restriction. This result can be explained by a failure of a part of the brain involved in rest and activity regulation. Animal research brings us explanations about the effects of starvation on the endocrine system and the neurotransmitters. Broocks et al. have shown that corticosterone concentration in plasma was synergistically increased by semi starvation and exercise, and the reduction of triiodothyronine by semi starvation was significantly greater in the running wheel group. An other study of Broocks et al. has revealed an increased hypothalamic serotonin metabolism with the combined effect of hyperactivity and food restriction. Tryptophan, an amid acid involved in serotonin synthesis, can also play a role in the maintenance of anorexia nervosa. In starvation conditions, opioid releasing caused by physical exercise would decrease food intake. Exner's study and Adan's one have shown that leptin would be involved in semi starvation induced hyperactivity mechanisms. In spite of animal models can not be entirely generalized to human, they are useful to try to explain biological supports of hyperactivity. Hyperactivity is not only a strategy to lose weight, but also a specific symptom which completes the clinical triad. Animal studies have led to promising results; we might use medicine, such as serotonin reuptake inhibitors or opioid antagonists in the treatment of hyperactivity in anorexia nervosa.

What about the Boys?: Addressing Issues of Masculinity within Male Anorexia Nervosa in a Feminist Therapeutic Environment

As a disorder, anorexia nervosa is associated mainly with young women. For centuries, girls have exhibited symptoms of anorexia nervosa and the disorder has exploded into a cultural, “female” problem. Feminist psychotherapy treatments address the problem of anorexia nervosa from a sociocultural perspective, which has been very effective for female patients. However, the number of cases found among men is rising and a gender-specific treatment that focuses on men’s issues related to anorexia nervosa is not available. Psychologists must begin to look at anorexia nervosa as a cultural issue for men that has unique features and issues related to the social construction of masculinity. By incorporating these ideas into a newly adapted feminist treatment approach that also employs concepts of empowerment and acceptance, psychologists will be able to treat male anorexia nervosa more effectively and possibly change the social stigmas that have plagued anorexic men for so long.

Frontotemporal Arachnoid Cyst Connected to Relapsing Stupor

Back to table of contents Previous article Next article LetterFull AccessFrontotemporal Arachnoid Cyst Connected to Relapsing StuporMilan Ličina, M.D., Ph.D., Sveto Vitorovic, M.D., and Ingrid Velikonja, M.D.Milan LičinaSearch for more papers by this author, M.D., Ph.D., Sveto VitorovicSearch for more papers by this author, M.D., and Ingrid VelikonjaSearch for more papers by this author, M.D.Published Online:1 Feb 2004https://doi.org/10.1176/jnp.16.1.120AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Case ReportSIR: A 45-year-old married woman was admitted to our hospital for the first time in January 1983. At first, she was depressed, hypo mimic, and she didn't speak. Since she had symptoms of major depression, we started the therapy with maprotiline and thioridazine. Her condition deteriorated, she began refusing food and liquid. We started with an i.v. treatment with maprotiline, but her condition still worsened along with the EPS (tremor, rigor). After that, she had three ECTs. She became febrile and dehydrated. There were no signs of improvement. We assumed that stupor was organic in origin, so we referred her to the CT scan, which revealed an arachnoid cyst 5cm by 7cm in the region of the left frontotemporal lobe. She was sent to Neurosurgery Clinic of Ljubljana, where the patient underwent an operation. Her condition improved immediately without any medication.The second admission was in 1986. She was in stupor again. The CT scan revealed arachnoid cyst in the same region as the first time. The cyst sized 3cm in diameter. The neurosurgeon decided for non-surgical procedure, since she already had an aqueduct by-pass done. Psychiatric therapy proceeded with the selection of sulpiride, which she was taking orally.In the following years, the same clinical picture appeared whenever she faced any minor stress life events (her sons wedding, conflicts with neighbors and similar). The successful therapy proved to be sulpiride, carbamazepine and lorazepam. After 1995, she became very religious, but no delusions were noticed.She was last admitted to our hospital in March of 2001. She had been denying food intake and liquids three days prior to admission; she was depressed and had auditory hallucinations and paranoid delusions. Her medication consisted of sulpiride, carbamazepine, lorazepam, tianeptine and finally olanzapine and doxepine. The neurological examination revealed no specific pathology. The CT scan showed again large frontotemporal cyst with the tip of catheter seen along with enlarged ventricles in close vicinity of limbic structures. She was to go to the neurosurgeon, but abruptly, although CPR was performed, died because of massive pulmonary embolism.In the past 20 years, we accidentally discovered 4 patients with arachnoid cysts. The literature describes catatonic symptoms in 14-year old boy with anorexia nervosa1 and mental disturbances are connected to arachnoid cysts in children.2 Case studies reported on differential diagnosis of schizophrenia in patients with bilateral temporal cysts.3,4,5We treated our patient for twenty years. There are no reports in available medical literature of such long treatment. We would like to emphasize the connection between cyst and symptoms, which, in our case, were always depression, which gradually developed to stupor.References1 Wolanczyk T, Komender J, Brozowska A: Catatonic syndrome preceded by symptoms of anorexia nervosa in a 14-year-old boy with arachoid cyst. Eur Child Adolesc Psychiatry. 1997 Sep; 6(3):166–169Google Scholar2 Sommer IE, Smit LM. Congenital supratentorial arachnoidal and giant cyst in children: a clinic study with arguments for conservative approach. Childs Nerv Syst. 1997 Jan; 13(1):8–12Google Scholar3 Shiraishi H et al. Differential diagnosis of schizophrenic symptoms complicated with brain anomalies including bilateral temporal arachnoid cysts by eye mark recorder and PET: a case study. Seishin Shinkeigaku Zasshi. 1999; 101(4):350–367Google Scholar4 Krzyzowski J et al. A case of schizophrenia-like psychosis in a patient with arachnoid cyst. Neurol Neurochir Pol. 1998 Mar-Apr; 32(2):433–440Google Scholar5 Gontard von A, Moeller. Psychiatrische und neuropsychologische Symptome bei Kindern mit Arachoidalzysten—eine Kasuistik. Z. Kinder-Jugendpsychiat. 1991; 19:30–37Google Scholar FiguresReferencesCited byDetailsCited ByInternational Psychogeriatrics, Vol. 26, No. 10 Volume 16Issue 1 February 2004Pages 120-120 Metrics History Published online 1 February 2004 Published in print 1 February 2004

Persistent amenorrhoea in weight-recovered anorexics: psychological and biological aspects

Demographic, psychopathological and hormonal parameters of 22 women with previous anorexia nervosa (AN) presently recovered, in a state of stabilized nutritional normalization for 3 months to 2 years but with persistent amenorrhoea, and of 20 psychophysically healthy age- and sex-matched normally menstruating controls were studied. Body mass index (BMI) values did not differ in patients and controls. Psychological examination, monitored by Eating Disorder Inventory 1, Bulimic Investigation Test Edinburgh, Yale-Brown-Cornell Eating Disorder Scale, and Tridimensional Personality Questionnaire rating scales, showed the persistence of some of the psychopathological symptoms of AN. Hormonal examinations included basal plasma concentrations of follicle stimulating hormone, luteotropic hormone, estrogens (E), progesterone, thyrotropic hormone, FT 3, FT 4 (immunoradiometric assays), leptin (LEP) (enzymatic-linked-immunosorbent assay) and 24 h urinary free cortisol (immunoradiometric assay). Hormone values were the same in patients and controls, except for E and LEP levels, which were significantly lower in patients than in controls. The concentrations of the two hormones were not correlated with the BMI of the patients, but LEP values were correlated negatively with the difference between the present BMI and the preanorexic one. The values of both hormones correlated negatively with some of the psychopathological aspects typical of AN, in particular with high ‘body dissatisfaction’, ‘ineffectiveness’, and ‘interpersonal distrust’ and with low ‘interoceptive awareness’.

Role of fluoxetine in anorexia nervosa.

To evaluate the efficacy of fluoxetine in the treatment of anorexia nervosa. Literature obtained through searching MEDLINE (1966-January 2003). Studies conducted on the efficacy of fluoxetine in treating anorexia nervosa have conflicting results. Study design and methodology should be carefully evaluated. Fluoxetine played a role in the reduction of symptoms of obsessive-compulsive disorder and depression in anorexic patients. While psychotherapy, nutritional therapy, and behavioral therapy should be the mainstays of treatment, fluoxetine should be considered as an option to prevent relapse or to treat associated symptoms of anorexia nervosa following adequate weight restoration as a part of maintenance therapy and not as a primary or acute therapy. Although fluoxetine appears to be promising for the treatment of patients with anorexia nervosa, further studies need to be performed with a larger sample size and/or better design.

Hábitos e comportamentos alimentares de adolescentes com sintomas de anorexia nervosa

Foram avaliados os hábitos e comportamentos alimentares de adolescentes do sexo feminino com sintomas de anorexia nervosa de uma escola particular. Foi identificada a presença de sintomas através do "Teste de Atitudes Alimentares". O recordatório de 24 horas "modificado" foi usado para avaliar os alimentos consumidos e um questionário foi aplicado para investigar as preferências e aversões alimentares. Das 279 alunas estudadas, 21,1% apresentaram sintomas. Os alimentos mais consumidos entre estas estudantes foram frutas, hortaliças, leite desnatado e bala, e os menos consumidos foram refrigerante, chocolate, massa e batata frita. Os alimentos de que "mais gostam" foram, em ordem decrescente: massas, carnes, hortaliças e doces; e os de que "menos gostam" foram: hortaliças, carnes e gorduras. Houve aversão maior por doces nas adolescentes com sintomas de anorexia nervosa. Concluiu-se ter havido um alto número de alunas com sintomas apresentando aversões alimentares semelhantes às de anoréxicas.

Identification of patients with eating disorders. The signs and symptoms of anorexia nervosa and bulimia nervosa

The optimal medical assessment of an eating disorder patient depends on a knowledge of the associated signs and symptoms, many of which are rarely seen in general medicine. Some of these signs are diagnostic of eating disorders. This paper presents a systematic review of the history and physical examination, including the special signs and symptoms in tabular form. In addition, the significance of the signs and symptoms of eating disorders is reviewed.

Encephalomyelitis Disseminata: A Rare, but Challenging Differential Diagnosis of Anorectic Disorder

Summary: The frequent occurrence of psychiatric syndromes in encephalomyelitis disseminata is known to obscure its diagnosis. We here report on the case of a 19-year-old female patient presenting symptoms of anorexia nervosa and subsequently diagnosed as suffering from encephalomyelitis disseminata. High dose corticoid treatment resulted in a nearly complete remission of the neurological symptoms as well as the normalization of her eating behaviour. Our case report underscores the importance of considering 'organic' aetiology in patients with symptoms of distinct eating disorders. The clinical course confirms recent findings, suggesting that acute inflammation in encephalomyelitis disseminata may induce behavioural symptoms, which precede the onset of neurological signs. To our knowledge, only one previous case has been reported to date.

Anorexia Nervosa Symptoms are Reduced by Massage Therapy

Nineteen women ( M age = 26) diagnosed with anorexia nervosa were given standard treatment alone or standard treatment plus massage therapy twice per week for five weeks. The massage group reported lower stress and anxiety levels and had lower cortisol (stress) hormone levels following massage. Over the five-week treatment period, they also reported decreases in body dissatisfaction on the Eating Disorder Inventory and showed increased dopamine and norepinephrine levels. These findings support a previous study on the benefits of massage therapy for eating disorders.

Could Reduced Cerebrospinal Fluid (CSF) Galanin Contribute to Restricted Eating in Anorexia Nervosa?

Galanin (GAL) and gamma amino butyric acid (GABA) are orexigenic neuropeptides that could contribute to the pathogenesis of anorexia nervosa (AN). To avoid the confounding effects of the ill state, we studied women who were recovered (> 1 year, normal weight, and regular menstrual cycles, no bingeing or purging) from AN (REC AN) and matched healthy control women (NC). CSF GAL was reduced in REC AN (64.4 ± 8.6 pg/ml) compared to NC (72.0 ± 11.6 pg/ml; p < .05), GABA was similar between groups. In the brain, GAL stimulates appetite and fat consumption. These data raise the question of whether alterations in brain GAL activity plays a role in clinical symptoms in AN, such as food restriction and fat avoidance.

Prevalence of thiamin deficiency in anorexia nervosa

Objective Deficiency of thiamin (vitamin B1) causes a range of neuropsychiatric symptoms that resemble those reported in patients with anorexia nervosa (AN) but the prevalence of thiamin deficiency in AN has not been reliably established. This study was designed to investigate the prevalence of thiamin deficiency in AN. Method Thirty-seven patients attending a specialist eating disorders unit and meeting all or some of the DSM-IV criteria for AN were compared with 50 blood donor controls. All subjects underwent measurement of erythrocyte transketolase activation following the addition of thiamin pyrophosphate, the standard biochemical test for thiamin deficiency. Deficiency was defined as a result more than 2 SD above the mean of the control population. Results Fourteen patients (38%) had results in the deficient range; 7 (19%) met the most stringent published criterion for deficiency. Deficiency was not related to duration of eating restraint, frequency of vomiting, or alcohol consumption. Discussion Thiamin deficiency may account for some of the neuropsychiatric symptoms of AN and routine screening or supplementation may be indicated. © 2000 by John Wiley & Sons, Inc. Int J Eat Disord 28: 451–454, 2000.