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Anorexia nervosa [keywords]
- Perception of transgenerational family relationships: Comparison of eating-disordered patients and their parents. [Journal Article]
- Med Sci Monit 2013.:1114-24.
Background Disturbances in various elements of transgenerational family functioning patterns are not uncommon in studies of eating disorders. We examined the relationship between patients' perception of autonomy and intimacy in their families of origin and that of their parents in their own families of origin. Material and Methods The sample consisted of 112 girls who had a diagnosis of an eating disoder and their parents; 54 of the girls were diagnosed with anorexia nervosa restrictive subtype, 22 as anorexia nervosa binge/purge subtype, and 36 were diagnosed with bulimia nervosa. We had 2 control groups: 1 group consisted of 36 girls diagnosed with a depressive episode, dysthymia, or adjustment disorder with depressed mood and the other group was 85 female students from schools in Cracow, Poland and their parents. We used the the Family of Origin Scale to assess perception of family relationships. Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS 20.0.PL; Chicago, IL, USA). Results There was a significant association between daughters' and fathers' perceptions of autonomy in their families of origin in all groups. There was no significant association between daughters' and mothers' perceptions in all groups. The strongest correlation was between the non-clinical sample of girls and their fathers and for the bulimic group. Conclusions We did not detect any link indicating the specificity of transgenerational transmission of autonomy and intimacy in eating disorders. The results point to the importance of the father figure in studies of family systems, including the context of family transmission.
- [The specific role of medical psychotherapy as seen by somatic physicians in general hospitals.] [JOURNAL ARTICLE]
- Z Psychosom Med Psychother 2013; 59(4):336-355.
Objectives: We examined the attitude towards the importance of medical psychotherapy among physicians working in a hospital. We focused on their opinion about the general role of medical psychotherapy within the health care system as well as on their opinion about the importance of medical psychotherapy in different clinical situations. Method: 105 physicians with various clinical specialtieswere interviewed using a questionnaire designed for this purpose. Results: From the point of view of the interviewed physicians, medical psychotherapy plays an important role. Especially medical psychotherapists are considered to be competent in cases of life-threatening situations resulting from mental disorders (such as suicide, anorexia nervosa), in psychopharmacological treatment as well as in cases of medically unexplained physical symptoms. Furthermore, medical competence in psychotherapy is requested wherever there is close connection to physical illness (such as stressful events in medical contexts). Conclusions: Especially in times of increasing specialization of physicians there is a need for medical psychotherapy in inpatient health care and clinical consultation.
- Altered insula response to sweet taste processing in recovered anorexia and bulimia nervosa: a matter of disgust sensitivity? [Journal Article]
- Am J Psychiatry 2013 Dec 1; 170(12):1497.
- Chronic starvation secondary to anorexia nervosa is associated with an adaptive suppression of resting energy expenditure. [JOURNAL ARTICLE]
- J Clin Endocrinol Metab 2013 Dec 3.
Background:Chronic starvation is accompanied by a reduction in resting energy expenditure (REE). It is unclear if this is due mainly to a reduction in body mass or also involves a significant reduction in the cellular metabolic rate of the fat-free mass (FFM).Objectives:The main goal was to compare measured REE (REEm) to that predicted by dual-energy X-ray absorptiometry (DXA) modeling of organ-tissue mass (REEp) in malnourished patients with severe anorexia nervosa (AN) and in healthy lean controls. REE adjusted for FFM and fat mass (FM) was also compared between the groups.Design:This was a cross-sectional study of 30 patients with AN and 25 lean controls. REE was measured by indirect calorimetry. Body composition was modeled using DXA and REE was predicted for each group based on organ-tissue mass.Results:REEm was significantly lower than REEp in AN subjects (854 ± 41 vs 1080 ± 25 kcal/d, p < 0.001), but not in controls. In addition, REE adjusted for both FFM and FM was significantly lower in the AN subjects (1031 ± 37 vs 1178 ± 32 kcal/d, p < 0.01). Finally, compared to the lean controls, both organ and skeletal muscle mass were approximately 20% smaller in AN subjects.Conclusions:Chronic starvation is accompanied by a significant reduction in the metabolic rate of the fat-free mass. The organs and/or tissues accounting for this are unknown. In addition, this study suggests that protein is mobilized proportionately from organs and skeletal muscle during starvation. This too may be an adaptive response to chronic starvation.
- Long-term effects of enteral feeding on growth and mental health in adolescents with anorexia nervosa-results of a retrospective German cohort study. [JOURNAL ARTICLE]
- Eur J Clin Nutr 2013 Dec 4.
Background/objective:Anorexia nervosa (AN) is a severe eating disorder with a high mortality rate. Treatment regimes show regional and global variation and are sometimes supported by enteral feeding (EF) via nasogastric tube, although risks and benefits are still unclear. We aimed to find out whether EF improves growth and AN recovery and prevents psychiatric comorbidities.Subjects/methods:Data were retrospectively collected from medical records and follow-up data were collected via questionnaires. Two hundred and eight female AN patients who were hospitalized below the age of 18 years with a mean follow-up of 6 years were analyzed. We calculated relative risks for the association between EF and suboptimal growth, remission of AN and the occurrence of psychiatric comorbidities, adjusting for potential confounders.Results:A third of the analyzed girls received EF at any time. In the adjusted analyses, we found no significant associations between EF and suboptimal growth, the persistence of AN and the occurrence of psychiatric comorbidities, respectively.Conclusion:Our data suggest EF to be neither a risk factor nor beneficial for growth, recovery or persistence of AN and the occurrence of psychiatric comorbidities.European Journal of Clinical Nutrition advance online publication, 4 December 2013; doi:10.1038/ejcn.2013.244.
- Resting-state synchrony between anterior cingulate cortex and precuneus relates to body shape concern in anorexia nervosa and bulimia nervosa. [JOURNAL ARTICLE]
- Psychiatry Res 2013 Nov 20.
Cortical areas supporting cognitive control and salience demonstrate different neural responses to visual food cues in patients with eating disorders. This top-down cognitive control, which interacts with bottom-up appetitive responses, is tightly integrated not only in task conditions but also in the resting-state. The dorsal anterior cingulate cortex (dACC) is a key node of a large-scale network that is involved in self-referential processing and cognitive control. We investigated resting-state functional connectivity of the dACC and hypothesized that altered connectivity would be demonstrated in cortical midline structures involved in self-referential processing and cognitive control. Seed-based resting-state functional connectivity was analyzed in women with anorexia nervosa (N=18), women with bulimia nervosa (N=20) and age matched healthy controls (N=20). Between group comparisons revealed that the anorexia nervosa group exhibited stronger synchronous activity between the dACC and retrosplenial cortex, whereas the bulimia nervosa group showed stronger synchronous activity between the dACC and medial orbitofrontal cortex. Both groups demonstrated stronger synchronous activity between the dACC and precuneus, which correlated with higher scores of the Body Shape Questionnaire. The dACC-precuneus resting-state synchrony might be associated with the disorder-specific rumination on eating, weight and body shape in patients with eating disorders.
- Prevalence of eating disorders in middle-aged women. [JOURNAL ARTICLE]
- Int J Eat Disord 2013 Nov 30.
Objective: Little is known about the prevalence and correlates of eating disorders (ED) in middle-aged women. Method: We mailed anonymous questionnaires to 1,500 Austrian women aged 40-60 years, assessing ED (defined by DSM-IV), subthreshold ED, body image, and quality of life. We broadly defined "subthreshold ED" by the presence of either (1) binge eating with loss of control or (2) purging behavior, without requiring any of the other usual DSM-IV criteria for frequency or severity of these symptoms. Results: Of the 715 (48%) responders, 33 [4.6%; 95% confidence interval (CI): 3.3-6.4%] reported symptoms meeting full DSM-IV criteria for an ED [bulimia nervosa = 10; binge eating disorder = 11; eating disorder not otherwise specified (EDNOS) = 12]. None displayed anorexia nervosa. Another 34 women (4.8%; CI: 3.4-6.6%) displayed subthreshold ED. These women showed levels of associated psychopathology virtually equal to the women with full-syndrome diagnoses. Discussion: ED appear common in middle-aged women, with a preponderance of binge eating disorder and EDNOS diagnoses as compared to the "classical" diagnoses of anorexia and bulimia nervosa. Interestingly, middle-aged women with even very broadly defined subthreshold ED showed distress and impairment comparable to women with full-scale ED. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013).
- BDNF genetic variability modulates psychopathological symptoms in patients with eating disorders. [JOURNAL ARTICLE]
- Eur Child Adolesc Psychiatry 2013 Nov 29.
The brain-derived neurotrophic factor (BDNF) gene may influence eating behavior, body weight and cognitive impairments. We aimed to investigate whether BDNF genetic variability may affect anthropometric and psychological parameters in patients with anorexia or bulimia nervosa (AN, BN) and/or modulate the risk for the disorder. A total of 169 unrelated female patients and 312 healthy controls were genotyped for two common BDNF single-nucleotide polymorphisms (SNPs), Val66Met and C-270T, and several selected tag-SNPs. Associated personality characteristics and psychopathological symptoms were assessed by the EDI-2 and SCL-90R inventories, respectively. No single SNP or haplotype played a relevant role in the risk for AN or BN. The rs16917237 TT genotype was significantly associated with increased weight (74.63 ± 16.58 vs. 57.93 ± 13.02) and body mass index (28.94 ± 6.22 vs. 22.23 ± 4.77) in the BN group after correcting for multiple testing. Haplotype analyses using a sliding window approach with three adjacent SNPs produced four loci of interest. Locus 3 (rs10835210/rs16917237/C-270T) showed a broad impact on the measured psychopathological symptoms. Haplotypes CGC and CGT in this locus correlated with scores in all three scales of the SCL-90R inventory, both in AN and BN patients. In contrast, the results of the EDI-2 inventory were largely unaffected. These preliminary results suggest that variability in the BDNF gene locus may contribute to anthropometric characteristics and also psychopathological symptoms that are common but not exclusive of ED patients.
- Alteration of intestinal barrier function during activity-based anorexia in mice. [JOURNAL ARTICLE]
- Clin Nutr 2013 Nov 15.
Anorexia nervosa is a severe eating disorder often leading to malnutrition and cachexia, but its pathophysiology is still poorly defined. Chronic food restriction during anorexia nervosa may induce gut barrier dysfunction, which may contribute to disease development and its complications. Here we have characterized intestinal barrier function in mice with activity-based anorexia (ABA), an animal model of anorexia nervosa.Male C57Bl/6 ABA or limited food access (LFA) mice were placed respectively in cages with or without activity wheel. After 5 days of acclimatization, both ABA and LFA mice had progressively limited access to food from 6 h/d at day 6 to 3 h/d at day 9 and until the end of experiment at day 17. A group of pair-fed mice (PF) was also compared to ABA.On day 17, food intake was lower in ABA than LFA mice (2.0 ± 0.18 g vs. 3.0 ± 0.14 g, p < 0.001) and weight loss was more pronounced in ABA and PF compared to LFA mice (23.6 ± 1.6% and 24.7 ± 0.7% vs. 16.5 ± 1.2%; p < 0.05). Colonic histology showed decreased thickness of the muscularis layer in ABA compared to LFA mice (p < 0.05). Colonic permeability was increased in both ABA and PF compared to LFA mice (p < 0.05) but jejunal paracellular permeability was not affected. Expression of claudin-1 in the colon was lower in the ABA than the LFA group (p < 0.05), whereas occludin expression remained unaffected.Increased colonic permeability and histological alterations found in ABA mice suggest that intestinal barrier dysfunction may also occur in anorexia nervosa. The role of these alterations in the pathophysiology of anorexia nervosa should be further evaluated.
- Interpreting genetics in the context of eating disorders: evidence of disease, not diversity. [JOURNAL ARTICLE]
- Sociol Health Illn 2013 Nov 28.
How is genetic involvement interpreted for disorders whose medicalisation is contested? Framing psychiatric and behavioural disorders in terms of genetics is expected to make them seem more medical. Yet a genetic aetiology can also be used to frame behaviour as acceptable human variation, rather than a medical problem (for example, sexual orientation). I analyse responses to the idea that there is a genetic component in anorexia and bulimia nervosa (AN or BN) via semi-structured interviews with a sample of 50 women diagnosed with an eating disorder (25 had recovered). All but three volunteered that genetics would medicalise AN or BN by (i) making eating disorders seem more like 'real diseases'; implying that these disorders need (ii) professional treatment or (iii) a biologically based treatment. The results also indicate there are several counter-logics by which genetic framing could support non-medical definitions of AN or BN. I argue that genetic framing reduces perceived individual responsibility, which can support definitions of behaviour as either a reflection of disease (which entails intervention) or a reflection of normal human diversity (which does not). In the context of public scepticism as to the 'reality' of AN or BN, genetic involvement was taken as evidence of disease in ongoing negotiations about the medical and moral status of people with eating disorders.