Personality traits after recovery from eating disorders: do subtypes differ?

Neurocircuity of eating disorders

OBJECTIVES

This chapter reviews brain imaging findings in anorexia and bulimia nervosa which characterize brain circuitry that may contribute to the pathophysiology of eating disorders (EDs).

SUMMARY OF RECENT FINDINGS

Recent imaging studies provide evidence of disturbed gustatory processing in EDs which involve the anterior insula as well as striatal regions. These results raise the possibility that individuals with anorexia nervosa have altered appetitive mechanism that may involve sensory, interoceptive, or reward processes. Furthermore, evidence of altered reward mechanisms is supported by studies that suggest that individuals with anorexia nervosa and bulimia nervosa share a trait toward similar anterior ventral striatal pathway dysregulation. This shared trait disturbance of the modulation of reward and emotionality may create a vulnerability for dysregulated appetitive behaviors. However, those with anorexia nervosa may be able to inhibit appetite and have extraordinary self-control because of exaggerated dorsal cognitive circuit function, whereas individuals with bulimia nervosa are vulnerable to overeating when they get hungry, because they have less ability to control their impulses.

FUTURE DIRECTIONS

Current therapeutic interventions have modest success. Better understanding of neurocircuits that may be related to altered appetite, mood, impulse control, and other symptoms underlying the pathophysiology of EDs might improve psychotherapeutic and drug treatment strategies.

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

OBJECTIVE

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.

METHOD

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.

RESULTS

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.

DISCUSSION

These findings support a neural basis for altered impulse control symptoms in AN.

Aberrant brain activation during a response inhibition task in adolescent eating disorder subtypes

OBJECTIVE

Behavioral and personality characteristics associated with excessive inhibition and disinhibition are observed in patients with eating disorders, but neural correlates of inhibitory control have not been examined in adolescents with these disorders.

METHOD

Thirteen female adolescents with binge eating and purging behaviors (i.e., bulimia nervosa or anorexia nervosa, binge eating/purging type);14 with anorexia nervosa, restricting type; and 13 healthy comparison subjects performed a rapid, jittered event-related go/no-go task. Functional magnetic resonance images were collected using a 3 Tesla GE scanner and a spiral pulse sequence. A whole-brain three-group analysis of variance in SPM5 was used to identify significant activation associated with the main effect of group for the comparison of correct no-go versus go trials. The mean activation in these clusters was extracted for further comparisons in SPSS.

RESULTS

The binge eating/purging group showed significantly greater activation than the healthy comparison group in the bilateral precentral gyri, anterior cingulate cortex, and middle and superior temporal gyri as well as greater activation relative to both comparison and restricting type anorexia subjects in the hypothalamus and right dorsolateral prefrontal cortex. Within-group analysis found that only the restricting type anorexia group showed a positive correlation between the percent correct on no-go trials and activation in posterior visual and inferior parietal cortex regions.

CONCLUSIONS

The present study provides preliminary evidence that during adolescence, eating disorder subtypes may be distinguishable in terms of neural correlates of inhibitory control. This distinction is consistent with differences in behavioral impulsivity in these patient groups.

Coping and social support as potential moderators of the relation between anxiety and eating disorder symptomatology

Trait anxiety and eating disorder (ED) symptomatology are often thought to be inextricably linked. Because anxiety often precedes an ED, predicts poor outcome, and persists even after recovery from an ED, it is important to examine whether certain factors have the ability to potentially attenuate anxiety's effect on eating pathology. In the current study, we examined two possible moderating factors: coping skills and social support. Participants were 96 females seen at one point for an ED at a Midwestern clinic, including 53 with a current ED diagnosis and 43 who no longer met criteria for an ED and who were at varying levels of recovery. Results revealed that emotion-oriented coping moderated the relation between anxiety and ED symptoms. Individuals who were high in trait anxiety and who reported low levels of emotion-oriented coping reported much lower levels of ED symptomatology than those with high trait anxiety and high emotion-oriented coping. Contrary to our hypotheses, task-oriented coping, avoidance-oriented coping, and perceived social support (total, family, friend, and special person) did not emerge as moderators of the relation between trait anxiety and eating pathology. Results provide growing support that factors that interact with anxiety can lessen anxiety's effect on eating pathology. Implications for treatment and future directions are discussed.

Serotonin: imaging findings in eating disorders

Anorexia nervosa (AN) and bulimia nervosa (BN) are disorders characterized by aberrant patterns of feeding behavior, weight regulation, and disturbances in attitudes and perceptions toward body weight and shape. Several lines of evidence nominate disturbances of serotonin (5-HT) pathways as playing a role in the pathogenesis and pathophysiology of AN and BN. For example, 5-HT pathways are known to contribute to the modulation of a range of behaviors commonly seen in individuals with AN and BN. New technology using brain imaging with radioligands offers the potential for understanding previously inaccessible brain 5-HT neurotransmitter function and its dynamic relationship with human behaviors. Recent studies using positron emission tomography and single photon emission computed tomography with 5-HT-specific radioligands have consistently shown 5-HT(1A) and 5-HT(2A) receptor and 5-HT transporter alterations in AN and BN in cortical and limbic structures, which may be related to anxiety, behavioral inhibition, and body image distortions. These disturbances are present when subjects are ill and persist after recovery, suggesting that these may be traits that are independent of the state of the illness. Effective treatments for AN and BN have been elusive. A better understanding of neurobiology is likely to be important for developing specific and more powerful therapies for these often chronic and deadly disorders.

Dialectical behaviour therapy and an added cognitive behavioural treatment module for eating disorders in women with borderline personality disorder and anorexia nervosa or bulimia nervosa who failed to respond to previous treatments. An open trial with a 15-month follow-up

There is evidence from case studies suggesting that adapted dialectical behavior therapy (DBT) for borderline personality disorder (BPD) and eating disorders (ED) might improve disorder related complaints. Twenty-four women with BPD (9 with comorbid anorexia nervosa [AN] and 15 with bulimia nervosa [BN]), who already had failed to respond to previous eating-disorder related inpatient treatments were consecutively admitted to an adapted inpatient DBT program. Assessment points were at pre-treatment, post-treatment, and 15-month follow-up. At follow-up, the remission rate was 54% for BN, and 33% for AN. Yet 44% of women with AN crossed over to BN and one woman additionally met the criteria of AN. For women with AN, the mean weight was not significantly increased at post-treatment, but had improved at follow-up. For women with BN, the frequency of binge-eating episodes was reduced at post-treatment as well as at follow-up. Self-rated eating-related complaints and general psychopathology, as well as ratings on global psychosocial functioning, were significantly improved at post-treatment and at follow-up. Although these findings support the assumption that the adapted DBT inpatient program is a potentially efficacious treatment for those who failed to respond to previous eating-disorder related inpatient treatments, remission rates and maintained eating-related psychopathology also suggest that this treatment needs further improvement.

Sensitivity to reward and punishment in eating disorders

The aim of this review was to collate and summarise the self-report data regarding anomalies in sensitivity to reward and punishment in eating disorders (ED) with use of a meta-analysis where possible. Electronic databases were searched to December 2008. Studies were required to have a non-eating disorder healthy control group and include at least one self-report measure of sensitivity to reward or punishment in an eating disorder population. Findings were very heterogeneous and inconsistencies between studies and measures were highlighted. In general, patients with anorexia nervosa (restricting type) were less sensitive to reward than healthy controls, whereas patients with bulimia nervosa and anorexia nervosa (binge/purge) type were more sensitive. All ED groups report higher sensitivity to punishment than healthy controls. Individuals with eating disorders differ from healthy controls in measures of reward and punishment sensitivity as measured using the Temperament and Character Inventory, Tridimensional Personality Questionnaire and BIS/BAS scales, but further work is required as there is some heterogeneity in the data. Generating more research using behavioural measures may increase understanding of the findings.

Altered striatal response to reward in bulimia nervosa after recovery

OBJECTIVE

It is possible that disturbances of systems modulating reward may contribute to a vulnerability to develop an eating disorder.

METHOD

This hypothesis was tested by assessing functional magnetic resonance brain imaging response to a monetary reward task known to activate the anterior ventral striatum (AVS), a region implicated in motivational aspects toward stimuli. To avoid the confounding effects of malnutrition, 10 women who had recovered from bulimia nervosa (BN) were compared with 10 healthy comparison women (CW).

RESULTS

For the AVS, CW distinguished positive and negative feedback, whereas recovered BN women had similar responses to both conditions. In addition, these groups had similar patterns of findings for the dorsal caudate.

DISCUSSION

We have previously shown that individuals recovered from anorexia nervosa (AN) also had altered striatal responses and difficulties in differentiating positive and negative feedback. Thus BN and AN individuals may share a difficulty in discriminating the emotional significance of a stimulus.

Brain activation during the perception of distorted body images in eating disorders

Eating disorder (ED) patients have severe disturbances in the perception of body shape and weight. The authors investigated brain activation patterns during the perception of distorted body images in various subtypes of ED. Participants comprised 33 patients with EDs (11 with restricting-type anorexia nervosa (AN-R), 11 with binging-purging type anorexia nervosa (AN-BP), 11 with bulimia nervosa (BN)) and 11 healthy women. Functional magnetic resonance imaging was used to examine cerebral response to morphed images of subjects' own bodies, as well as that of another woman. The amygdala was significantly activated in AN-R patients, AN-BP patients, and healthy women in response to their own fat-image, but this did not occur in BN patients. The prefrontal cortex (PFC) was significantly activated in AN-BP patients and healthy women, but not in AN-R and BN patients. Our results showed that the various EDs are different with respect to significant activation of the amygdala and PFC during the processing of participants' own fat-image. Brain activation pattern differences between the various EDs may underlie cognitive differences with respect to distorted body image, and therefore might reflect a general failure to represent and evaluate one's own body in a realistic fashion.

Defining recovery from an eating disorder: Conceptualization, validation, and examination of psychosocial functioning and psychiatric comorbidity

Conceptually, eating disorder recovery should include physical, behavioral, and psychological components, but such a comprehensive approach has not been consistently employed. Guided by theory and recent recovery research, we identified a "fully recovered" group (n = 20) based on physical (body mass index), behavioral (absence of eating disorder behaviors), and psychological (Eating Disorder Examination-Questionnaire) indices, and compared them with groups of partially recovered (n = 15), active eating disorder (n = 53), and healthy controls (n = 67). The fully recovered group was indistinguishable from controls on all eating disorder-related measures used, while the partially recovered group was less disordered than the active eating disorder group on some measures, but not on body image. Regarding psychosocial functioning, both the fully and partially recovered groups had psychosocial functioning similar to the controls, but there was a pattern of more of the partially recovered group reporting eating disorder aspects interfering with functioning. Regarding other psychopathology, the fully recovered group was no more likely than the controls to experience current Axis I pathology, but they did have elevated rates of current anxiety disorder. Results suggest that a stringent definition of recovery from an eating disorder is meaningful. Clinical implications and future directions regarding defining eating disorder recovery are discussed.

New insights into symptoms and neurocircuit function of anorexia nervosa

Individuals with anorexia nervosa have a relentless preoccupation with dieting and weight loss that results in severe emaciation and sometimes death. It is controversial whether such symptoms are secondary to psychosocial influences, are a consequence of obsessions and anxiety or reflect a primary disturbance of brain appetitive circuits. New brain imaging technology provides insights into ventral and dorsal neural circuit dysfunction - perhaps related to altered serotonin and dopamine metabolism - that contributes to the puzzling symptoms found in people with eating disorders. For example, altered insula activity could explain interoceptive dysfunction, and altered striatal activity might shed light on altered reward modulation in people with anorexia nervosa.

Brain-derived neurotrophic factor (BDNF) and set-shifting in currently ill and recovered anorexia nervosa (AN) patients

BACKGROUND

Studies of patients with anorexia nervosa (AN) have shown that they do not perform well in set-shifting tasks but little is known about the neurobiological correlates of this aspect of executive function. The aim of this study was to measure serum brain-derived neurotrophic factor (BDNF) and to establish whether set-shifting difficulties are present in people with current AN and in those recovered from AN, and whether serum BDNF concentrations are correlated with set-shifting ability.

METHOD

Serum BDNF concentrations were measured in 29 women with current AN (AN group), 18 women who had recovered from AN (ANRec group) and 28 age-matched healthy controls (HC group). Set-shifting was measured using the Wisconsin Card Sorting Test (WCST). Eating-related psychopathology and depressive, anxiety and obsessive-compulsive symptomatology were evaluated using the Eating Disorder Examination Questionnaire (EDEQ), the Hospital Anxiety and Depression Scale (HADS), and the Maudsley Obsessive-Compulsive Inventory (MOCI) respectively.

RESULTS

Serum BDNF concentrations (mean+/-s.d.) were significantly lower in the AN group (11.7+/-4.9 ng/ml) compared to the HC group (15.1+/-5.5 ng/ml, p=0.04) and also compared to the ANRec group (17.6+/-4.8 ng/ml, p=0.001). The AN group made significantly more errors (total and perseverative) in the WCST relative to the HC group. There was no significant correlation between serum BDNF concentrations and performance on the WCST.

CONCLUSIONS

Serum BDNF may be a biological marker for eating-related psychopathology and of recovery in AN. Longitudinal studies are needed to explore possible associations between serum BDNF concentrations, illness and recovery and neuropsychological traits.

The Yale-Brown-Cornell eating disorder scale in women with anorexia nervosa: what is it measuring?

OBJECTIVE

The Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS) assesses eating disorder preoccupations, rituals, and symptom severity. This study examines the YBC-EDS in relation to eating disorder psychopathology, obsessionality, and impulsivity variables in women with anorexia nervosa (AN) and sensitivity of the YBC-EDS to change after psychotherapy.

METHOD

Participants were 56 women with "spectrum" AN (14.5 < BMI < 19). Variables examined in relation to the YBC-EDS were as follows: eating pathology, obsessionality (obsessive compulsive disorder and personality diagnoses, perfectionism), and impulsivity (borderline personality, impulsive traits, and behaviors). YBC-EDS scores were examined pre- and post-treatment.

RESULTS

Eating Disorder Examination scores most strongly predicted the YBC-EDS. As expected, perfectionism was significantly associated, but so was impulsivity. YBC-EDS scores were significantly different in those with good versus poor global outcome after therapy. Unexpectedly, maximum lifetime BMI was correlated with the YBC-EDS.

DISCUSSION

The YBC-EDS most strongly measured eating disorder severity and reflected change after psychotherapy for AN.

Habitual response to stress in recovering adolescent anorexic patients

OBJECTIVE

Although previous research has investigated the stress response in acutely anorexic patients, there is currently little research addressing this response in recovering adolescent anorexic girls. Therefore, this study investigated partially and fully weight-restored anorexic adolescent girls' psychological and physiological response to a standardized stressor.

METHODS

We measured the heart rate and affect of 17 adolescent recovering anorexic patients and 40 healthy age-matched controls during two conditions of the Stress Induced Speech Task (SIST): Free Association and Stress Task. Recovering patients were either partially or fully weight-restored.

RESULTS

Compared to the controls, the recovering anorexic girls reported greater overall habitual psychological distress and higher levels of negative affect during the standardized stressor. However, recovering patients did not show a muted heart rate response during the stressor. Neither recovering anorexics nor controls demonstrated a correspondence between heart rate and positive or negative affect.

DISCUSSION

Although the physiological stress response of recovering adolescent anorexic patients was similar to controls, the psychological response of partially and fully weight-restored anorexic adolescents appears similar to that of acutely anorexic adolescents. Treatment implications are discussed in terms of the persistence of negative affect and treatment resistance.

Perplexities and provocations of eating disorders

BACKGROUND

Etiological hypotheses of eating disorders, anorexia nervosa and bulimia nervosa have not produced informative research for predictably effective treatment.

METHODS

The rationale for applying a model of allostasis, a dysregulation of reward circuits with activation of brain and hormonal stress responses to maintain apparent stability, is developed for eating disorders.

RESULTS

The neurotransmitter systems involved in the allostatic state of a reward system in anorexia nervosa and bulimia nervosa may be similar to those present in drug addiction.

CONCLUSION

The biological vulnerabilities underlying the unique features of eating disorders should be intensively investigated with the advancing techniques in genetics and neuroimaging. Preventing chronicity with early diagnosis and adequate treatment before age 18 is necessary.

Schmidt M, Poustka F. Psychiatrische Erkrankungen bei Verwandten von Patienten mit Anorexia nervosa und Bulimia nervosa

Zusammenfassung: Fragestellung: Im deutschen Raum gibt es kaum Familienuntersuchungen von Patienten mit Anorexia und Bulimia nervosa. Methodik: In einer Multizenter Studie wurde das Auftreten psychiatrischer Erkrankungen bei Familienangehörigen 1., 2. und 3. Grades von 65 anorektischen (n = 746) und 21 bulimischen Patienten (n = 265) mit denen von 37 gesunden Kontrollen (n = 480) sowie 11 depressiven Patienten (n = 157) verglichen. Messinstrumente waren u.a. das Diagnostische Interview für Genetische Studien bzw. das Familien Interview für Genetische Studien. Ergebnisse: Die Prävalenz von Anorexia nervosa (signifikant) sowie von depressiven Störungen (Trend) war bei Verwandten 1. und 2. Grades von Patienten mit Essstörungen gegenüber der gesunden Gruppe erhöht. Die meisten Ergebnisse waren eher bei den Familien bulimischer Patienten ausgeprägt. Die Prävalenzraten für psychiatrische Erkrankungen waren insgesamt prozentual niedriger als in vergleichbaren US amerikanischen Stichproben. Schlussfolgerung: Die Ergebnisse könnten für eine familiäre Vulnerabilität bzw. genetisches Risiko von Patienten mit Anorexia und Bulimia nervosa sprechen. Der Zusammenhang des niedrigen Alters der Indexpatienten auf die geringeren Prävalenzraten wird diskutiert.

The genetics of anorexia nervosa collaborative study: methods and sample description

OBJECTIVE

Supported by National Institute of Mental Health (NIMH), this 12-site international collaboration seeks to identify genetic variants that affect risk for anorexia nervosa (AN).

METHOD

Four hundred families will be ascertained with two or more individuals affected with AN. The assessment battery produces a rich set of phenotypes comprising eating disorder diagnoses and psychological and personality features known to be associated with vulnerability to eating disorders.

RESULTS

We report attributes of the first 200 families, comprising 200 probands and 232 affected relatives.

CONCLUSION

These results provide context for the genotyping of the first 200 families by the Center for Inherited Disease Research. We will analyze our first 200 families for linkage, complete recruitment of roughly 400 families, and then perform final linkage analyses on the complete cohort. DNA, genotypes, and phenotypes will form a national eating disorder repository maintained by NIMH and available to qualified investigators.

Neurobiology of anorexia and bulimia nervosa

Anorexia nervosa (AN) and bulimia nervosa (BN) are related disorders of unknown etiology that most commonly begin during adolescence in women. AN and BN have unique and puzzling symptoms, such as restricted eating or binge-purge behaviors, body image distortions, denial of emaciation, and resistance to treatment. These are often chronic and relapsing disorders, and AN has the highest death rate of any psychiatric disorder. The lack of understanding of the pathogenesis of this illness has hindered the development of effective interventions, particularly for AN. Individuals with AN and BN are consistently characterized by perfectionism, obsessive-compulsiveness, and dysphoric mood. Individuals with AN tend to have high constraint, constriction of affect and emotional expressiveness, ahendonia and asceticism, whereas individuals with BN tend to be more impulsive and sensation seeking. Such symptoms often begin in childhood, before the onset of an eating disorder, and persist after recovery, suggesting they are traits that create a vulnerability for developing an ED. There is growing acknowledgement that neurobiological vulnerabilities make a substantial contribution to the pathogenesis of AN and BN. Considerable evidence suggests that altered brain serotonin (5-HT) function contributes to dysregulation of appetite, mood, and impulse control in AN and BN. Brain imaging studies, using 5-HT specific ligands, show that disturbances of 5-HT function occur when people are ill, and persist after recovery from AN and BN. It is possible that a trait-related disturbance of 5-HT neuronal modulation predates the onset of AN and contributes to premorbid symptoms of anxiety, obsessionality, and inhibition. This dysphoric temperament may involve an inherent dysregulation of emotional and reward pathways which also mediate the hedonic aspects of feeding, thus making these individuals vulnerable to disturbed appetitive behaviors. Restricting food intake may become powerfully reinforcing because it provides a temporary respite from dysphoric mood. Several factors may act on these vulnerabilities to cause AN to start in adolescence. First, puberty-related female gonadal steroids or age-related changes may exacerbate 5-HT dysregulation. Second, stress and/or cultural and societal pressures may contribute by increasing anxious and obsessional temperament. Individuals with AN may discover that reduced dietary intake, by reducing plasma tryptophan availability, is a means by which they can modulate brain 5-HT functional activity and anxious mood. People with AN enter a vicious cycle which accounts for the chronicity of this disorder because caloric restriction results in a brief respite from dysphoric mood. However, malnutrition and weight loss, in turn, produce alterations in many neuropeptides and monoamine function, perhaps in the service of conserving energy, but which also exaggerates dysphoric mood. In summary, this article reviews findings in brain chemistry and neuroimaging that shed new light on understanding the psychopathology of these difficult and frustrating disorders.

Personality subtypes in adolescents with eating disorders: validation of a classification approach

BACKGROUND

Research has identified three personality subtypes in adults with eating disorders (EDs): a high-functioning, an undercontrolled, and an overcontrolled group. The current study investigated whether similar personality prototypes exist in adolescents with EDs, and whether these personality prototypes show relationships to external correlates indicative of diagnostic validity.

METHODS

Experienced clinicians from an adolescent practice-research network provided data on ED symptoms, DSM-IV comorbidity, personality pathology, and family and developmental history for 120 adolescent patients with EDs.

RESULTS

Consistent with the findings from the adult literature, three types of personality pathology emerged in adolescents: High-functioning/Perfectionistic, Emotionally Dysregulated, and Avoidant/Depressed. The High-functioning prototype showed negative associations with comorbidity and positive associations with treatment response. The Emotionally Dysregulated prototype was specifically associated with externalizing Axis I and Cluster B Axis II disorders, poor school functioning, and adverse events in childhood. The Avoidant/Depressed prototype showed specific associations with internalizing Axis I and Clusters A Axis II disorders, poor peer relationships, poor maternal relationships, and internalizing disorders in first-degree relatives.

CONCLUSIONS

These data support the presence of at least three diagnostically meaningful personality prototypes in adolescents with EDs, similar to those found previously in adults. Diagnosis of adolescents with EDs may be usefully supplemented by the assessment of personality style.

Altered insula response to taste stimuli in individuals recovered from restricting-type anorexia nervosa

Anorexia nervosa (AN) is an illness characterized by aversion to ingestion of normally palatable foods. We examined whether there is a primary disturbance of taste processing and experience of pleasure using a sucrose/water task in conjunction with functional magnetic resonance imaging (fMRI). To avoid confounding effects of illness, 16 women recovered from restricting-type AN were compared to 16 control women (CW). We used a region of interest-based fMRI approach to test the idea that individuals with AN have differential neural activation in primary and secondary taste cortical regions after sucrose and water administration. Compared to CW, individuals recovered from AN showed a significantly lower neural activation of the insula, including the primary cortical taste region, and ventral and dorsal striatum to both sucrose and water. In addition, insular neural activity correlated with pleasantness ratings for sucrose in CW, but not in AN subjects. Altered taste processing may occur in AN, based on differences in activity in insular-striatal circuits. These data provide the first evidence that individuals with AN process taste stimuli differently than controls, based on differences in neural activation patterns.

Definitions of the term 'recovered' in schizophrenia and other disorders

BACKGROUND

The use of the term 'recovered' in outcome studies of schizophrenia has for a long time been problematic because of the many different definitions in use. In the present study different definitions of recovered in schizophrenia are reviewed and compared with similar definitions in other fields of medicine.

SAMPLING AND METHODS

A literature search was done for criteria-based definitions of recovered as used in follow-up studies of patients with schizophrenia during the last 50 years and the current use of the term in other fields of medicine.

RESULTS

In medicine, only the field of psychiatry defines the term recovered to be synonymous with no or minimal signs of illness. Other fields only apply the term when studying the outcome of a specific function. In psychiatry, only the field of schizophrenia includes both symptoms and functioning in the definition. All but 1 of the 18 definitions found in use in the field of schizophrenia required minimal or no symptoms, while all differed in defining functional recovery. Recovered was seldom defined as following from a state of remission, and studies varied in requiring a stable phase.

CONCLUSION

When using the term in the field of schizophrenia, a distinction should be made between symptomatic and functional recovery in order to place it in line with other fields of medicine. To avoid confusing the process of recovery from the state of being recovered, the term recovered should be reserved for use in outcome studies, following from a time in remission. We suggest 2 years.

Serotonin transporter binding after recovery from eating disorders

RATIONALE

Several lines of evidence suggest that altered serotonin (5-HT) function persists after recovery from anorexia nervosa (AN) and bulimia nervosa (BN).

OBJECTIVES

We compared 11 subjects who recovered (>1 year normal weight, regular menstrual cycles, no binging or purging) from restricting-type AN (REC RAN), 7 who recovered from bulimia-type AN (REC BAN), 9 who recovered from BN (REC BN), and 10 healthy control women (CW).

MATERIALS AND METHODS

Positron emission tomography (PET) imaging with [11C]McN5652 was used to assess the 5-HT transporter (5-HTT). For [11C]McN5652, distribution volume (DV) values were determined using a two-compartment, three-parameter tracer kinetic model, and specific binding was assessed using the binding potential (BP, BP=DVregion of interest/DVcerebellum-1).

RESULTS

After correction for multiple comparisons, the four groups showed significant (p<0.05) differences for [11C]McN5652 BP values for the dorsal raphe and antero-ventral striatum (AVS). Post-hoc analysis revealed that REC RAN had significantly increased [11C]McN5652 BP compared to REC BAN in these regions.

CONCLUSIONS

Divergent 5-HTT activity in subtypes of eating disorder subjects may provide important insights as to why these groups have differences in affective regulation and impulse control.

Regional cerebral blood flow after recovery from anorexia or bulimia nervosa

OBJECTIVE

Abnormalities of regional cerebral blood flow (rCBF) have been found in individuals who are ill with anorexia (AN) or bulimia nervosa (BN). Little is known about whether rCBF normalizes after recovery from AN and BN.

METHOD

Eighteen control women (CW), 10 recovered restricting type AN, 8 recovered AN with a binging history, and 9 recovered BN participants without a history of AN were studied using positron emission tomography and [(15)O]water in order to assess rCBF.

RESULTS

Partial volume corrected rCBF values in cortical and subcortical brain regions were similar between groups. Neither current body mass index nor age correlated with rCBF values.

CONCLUSION

The results from this study indicate that rCBF normalizes with long-term recovery. Thus, altered rCBF is unlikely to confound functional imaging studies in AN or BN after recovery.

Exaggerated 5-HT1A but normal 5-HT2A receptor activity in individuals ill with anorexia nervosa

BACKGROUND

Many studies have found disturbances of serotonin (5-HT) activity in anorexia nervosa (AN). Because little is known about 5-HT receptor function in AN, positron emission tomography (PET) imaging with 5-HT receptor-specific radioligands was used to characterize 5-HT1A and 5-HT2A receptors.

METHODS

Fifteen women ill with AN (ILL AN) were compared with 29 healthy control women (CW); PET and [11C]WAY100635 were used to assess binding potential (BP) of the 5-HT1A receptor, and [18F]altanserin was used to assess postsynaptic 5-HT2A receptor BP. [15O] water and PET were used to assess cerebral blood flow.

RESULTS

The ILL AN women had a highly significant (30%-70%) increase in [11C]WAY100635 BP in prefrontal and lateral orbital frontal regions, mesial and lateral temporal lobes, parietal cortex, and dorsal raphe nuclei compared with CW. The [18F]altanserin BP was normal in ILL AN but was positively and significantly related to harm avoidance in suprapragenual cingulate, frontal, and parietal regions. Cerebral blood flow was normal in ILL AN women.

CONCLUSIONS

Increased activity of 5-HT1A receptor activity may help explain poor response to 5-HT medication in ILL AN. This study extends data suggesting that 5-HT function, and, specifically, the 5-HT2A receptor, is related to anxiety in AN.

Obsessive-compulsive characteristics in women who have recovered from bulimia nervosa

OBJECTIVE

The goal of this study was to follow up on reports that obsessive-compulsive characteristics, which are commonly elevated in bulimia nervosa (BN), may also be elevated in individuals who have recovered from BN (BN-R).

METHOD

Self-ratings on the Maudsley Obsessional-Compulsive Inventory (MOCI), the Restraint Scale (a measure of dieting behavior related to weight concerns), and questionnaires reflecting eating disorder-related symptoms were evaluated for women who met criteria for BN (n = 25) or BN-R (n = 21) and were free of obsessive-compulsive disorder, and for healthy female controls (n = 28).

RESULTS

MOCI scores for the BN-R group (5.5 +/- 5.4) were similar to those for the BN group (5.4 +/- 4.4) and were significantly elevated (p < 0.05, p < 0.02, respectively) in comparison to controls (2.5 +/- 1.9). Of note, MOCI scores for the BN-R group were significantly correlated with scores on the Restraint Scale (r = 0.60, p < 0.02).

CONCLUSION

Further studies are needed to assess the relationship between elevated obsessive-compulsive characteristics and eating patterns in individuals recovered from BN.