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Turton R, Bruidegom K, Cardi V, Hirsch CR, Treasure J. Novel methods to help develop healthier eating habits for eating and weight disorders: A systematic review and meta-analysis. Neurosci Biobehav Rev 2016; 61:132-55. [DOI: 10.1016/j.neubiorev.2015.12.008] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 11/12/2015] [Accepted: 12/10/2015] [Indexed: 12/21/2022]
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152
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Maria Monteleone A, Monteleone P, Dalle Grave R, Nigro M, El Ghoch M, Calugi S, Cimino M, Maj M. Ghrelin response to hedonic eating in underweight and short-term weight restored patients with anorexia nervosa. Psychiatry Res 2016; 235:55-60. [PMID: 26674388 DOI: 10.1016/j.psychres.2015.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/29/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
Abstract
Recently, anorexia nervosa (AN) has been conceptualized as a reward-related disorder, and alterations in brain reward processes have been documented in both acute and recovered AN patients. However, the role of endogenous biochemical mediators, such as ghrelin, in the modulation of reward processes has been poorly investigated in this eating disorder. Hedonic eating, that is the consumption of food exclusively for pleasure and not to maintain energy homeostasis, is a useful paradigm to investigate the physiology of food-related reward. Therefore, we assessed the response of peripheral ghrelin to hedonic eating in 7 underweight and 7 recently weight-restored AN patients and compared it to that of previously studied healthy controls. We found that in satiated underweight patients with AN plasma ghrelin levels progressively decreased after the exposure and the consumption of both the favorite and unfavorite food whereas in satiated weight-restored AN patients and satiated healthy controls plasma ghrelin concentrations significantly increased after the exposure to the favorite food and after eating it, but decreased after the unfavorite food. These results suggest a derangement in the ghrelin modulation of food-related pleasurable and rewarding feelings, which might sustain the reduced motivation toward food intake of acute AN patients.
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Affiliation(s)
| | - Palmiero Monteleone
- Department of Psychiatry, University of Naples SUN, Naples, Italy; Chair of Psychiatry, Neurosciences Section, Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | | | - Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | - Monica Cimino
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Naples SUN, Naples, Italy
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153
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O’Hara CB, Keyes A, Renwick B, Leyton M, Campbell IC, Schmidt U. The Effects of Acute Dopamine Precursor Depletion on the Reinforcing Value of Exercise in Anorexia Nervosa. PLoS One 2016; 11:e0145894. [PMID: 26808920 PMCID: PMC4726788 DOI: 10.1371/journal.pone.0145894] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 12/09/2015] [Indexed: 11/18/2022] Open
Abstract
This study investigated whether dopaminergic systems are involved in the motivation to engage in behaviours associated with anorexia nervosa (AN), specifically, the drive to exercise. Women recovered from AN (AN REC, n = 17) and healthy controls (HC, n = 15) were recruited. The acute phenylalanine/tyrosine depletion (APTD) method was used to transiently decrease dopamine synthesis and transmission. The effect of dopamine precursor depletion on drive to exercise was measured using a progressive ratio (PR) exercise breakpoint task. Both groups worked for the opportunity to exercise, and, at baseline, PR breakpoint scores were higher in AN REC than HC. Compared to values on the experimental control session, APTD did not decrease PR breakpoint scores in AN REC, but significantly decreased scores in HC. These data show that women recovered from AN are more motivated to exercise than HC, although in both groups, activity is more reinforcing than inactivity. Importantly, decreasing dopamine does not reduce the motivation to exercise in people recovered from AN, but in contrast, does so in HC. It is proposed that in AN, drive to exercise develops into a behaviour that is largely independent of dopamine mediated reward processes and becomes dependent on cortico-striatal neurocircuitry that regulates automated, habit- or compulsive-like behaviours. These data strengthen the case for the involvement of reward, learning, habit, and dopaminergic systems in the aetiology of AN.
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Affiliation(s)
- Caitlin B. O’Hara
- King’s College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, Section of Eating Disorders, London, United Kingdom
- * E-mail: caitlin.b.o’
| | - Alexandra Keyes
- King’s College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, Section of Eating Disorders, London, United Kingdom
| | - Bethany Renwick
- King’s College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, Section of Eating Disorders, London, United Kingdom
| | - Marco Leyton
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Iain C. Campbell
- King’s College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, Section of Eating Disorders, London, United Kingdom
| | - Ulrike Schmidt
- King’s College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, Section of Eating Disorders, London, United Kingdom
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154
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Abstract
UNLABELLED Adaptive decision making to eat is crucial for survival, but in anorexia nervosa, the brain persistently supports reduced food intake despite a growing need for energy. How the brain persists in reducing food intake, sometimes even to the point of death and despite the evolution of multiple mechanisms to ensure survival by governing adaptive eating behaviors, remains mysterious. Neural substrates belong to the reward-habit system, which could differ among the eating disorders. The present review provides an overview of neural circuitry of restrictive food choice, binge eating, and the contribution of specific serotonin receptors. One possibility is that restrictive food intake critically engages goal-directed (decision making) systems and "habit," supporting the view that persistent caloric restriction mimics some aspects of addiction to drugs of abuse. SIGNIFICANCE STATEMENT An improved understanding of the neural basis of eating disorders is a timely challenge because these disorders can be deadly. Up to 70 million of people in the world suffer from eating disorders. Anorexia nervosa affects 1-4% of women in United States and is the first cause of death among adolescents in Europe. Studies relying on animal models suggest that decision making to eat (or not) can prevail over actual energy requirements due to emotional disturbances resulting in abnormal habitual behavior, mimicking dependence. These recent studies provide a foundation for developing more specific and effective interventions for these disorders.
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155
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Steinglass JE, Walsh BT. Neurobiological model of the persistence of anorexia nervosa. J Eat Disord 2016; 4:19. [PMID: 27195123 PMCID: PMC4870737 DOI: 10.1186/s40337-016-0106-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/02/2016] [Indexed: 01/01/2023] Open
Abstract
Anorexia Nervosa (AN) is characterized by the maintenance of an undernourished, or starved, state. Persistent restrictive eating, or the recurrent intake of a diet that is inadequate to sustain a healthy weight, is the central behavior maintaining AN. To understand this disturbance, we need to understand the neural mechanisms that allow or promote the persistent choice of inadequate caloric intake. While a range of neural disturbances have been reported in AN, abnormalities in systems relevant to reward processing and the development of habit systems have been consistently described in both structural and functional neuroimaging studies. Most recently, brain and behavior have been directly examined by investigating the neural underpinnings of restrictive food choice. These recent data suggest that, among individuals with AN, dorsal frontostriatal circuits play a greater role in guiding decisions regarding what to eat than among healthy individuals. This line of research attempts to leverage advances in the field of cognitive neuroscience to further our understanding of persistent maladaptive choices of individuals with AN, in the hope that such advances will help in the development of novel treatments for this potentially fatal disorder.
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156
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Rosling A, Salonen Ros H, Swenne I. One-year outcome and incidence of anorexia nervosa and restrictive eating disorders among adolescent girls treated as out-patients in a family-based setting. Ups J Med Sci 2016; 121:50-9. [PMID: 26915921 PMCID: PMC4812058 DOI: 10.3109/03009734.2016.1141810] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aims To study the 1-year outcome and to analyse predictors of outcome of a cohort of adolescent girls with anorexia nervosa (AN) or restrictive eating disorders not otherwise specified (EDNOSr) treated as out-patients in a family-based programme at a specialized eating disorder service. To calculate the incidence of anorexia nervosa among treatment-seeking girls younger than 18 in Uppsala County from 2004 to 2006. Methods A total of 168 female patients were offered treatment, and 141 were followed-up 1 year after starting treatment, 29 with AN and 112 with EDNOSr. Results Of the 29 girls who initially had AN, 6 (20%) had a good outcome and were free of any form of eating disorder at follow-up; only 1 (3%) had AN. Of the patients with EDNOSr, 54 (48%) had a good outcome and were free of eating disorders. Three (3%) had a poor outcome and had developed AN. The incidence of AN was 18/100,000 person-years in girls younger than 12 and 63/100,000 in girls younger than 18. Conclusion Restrictive eating disorders, including AN, in children and adolescents can be successfully treated in a family-based specialized out-patient service without in-patient care.
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Affiliation(s)
- Agneta Rosling
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University Hospital, Uppsala, Sweden
- CONTACT Agneta Rosling, MD Department of Child and Adolescent Psychiatry, Uppsala University Hospital, S-751 85 Uppsala, Sweden
| | - Helena Salonen Ros
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University Hospital, Uppsala, Sweden
| | - Ingemar Swenne
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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157
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Bartholdy S, McClelland J, Kekic M, O'Daly OG, Campbell IC, Werthmann J, Rennalls SJ, Rubia K, David AS, Glennon D, Kern N, Schmidt U. Clinical outcomes and neural correlates of 20 sessions of repetitive transcranial magnetic stimulation in severe and enduring anorexia nervosa (the TIARA study): study protocol for a randomised controlled feasibility trial. Trials 2015; 16:548. [PMID: 26634828 PMCID: PMC4668644 DOI: 10.1186/s13063-015-1069-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/18/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious mental disorder with multiple comorbidities and complications. In those with a severe and enduring form of the illness (SEED-AN), treatment responsivity is poor and the evidence base limited. Thus, there is a need for novel treatment strategies. This paper describes the theoretical background and protocol of a feasibility randomised controlled trial (RCT) of real versus sham (placebo) therapeutic repetitive transcranial magnetic stimulation (rTMS) in SEED-AN. The aim of this trial is to obtain information that will guide decision making and protocol development in relation to a future large-scale RCT of rTMS in this group of patients, and also to assess the preliminary efficacy and neural correlates of rTMS treatment. DESIGN Forty-four adults from the community with a DSM-5 diagnosis of AN, an illness duration>3 years and a previous course of unsuccessful treatment will be randomly allocated to receive 20 sessions of either real or sham rTMS, in a parallel group design. As this is a feasibility study, no primary outcome has been defined and a broad range of outcome variables will be examined. These include weight/body mass index (BMI), eating disorder psychopathology, other psychopathology (for example, depression, anxiety), quality of life, neuropsychological processes (such as self-regulation, attentional bias and food choice behaviour), neuroimaging measures (that is, changes in brain structure or function), tolerability and acceptability of rTMS, and additional service utilisation. The feasibility of conducting a large-scale RCT of rTMS and the appropriateness of rTMS as a treatment for SEED-AN will be evaluated through: assessment of recruitment and retention rates, acceptability of random allocation, blinding success (allocation concealment), completion of treatment sessions and research assessments (baseline, post-treatment and follow-up assessments). The acceptability and tolerability of the treatment will be assessed via semi-structured interviews. DISCUSSION The effect sizes generated and other findings from this trial will inform a future large-scale RCT with respect to decisions on primary outcome measures and other aspects of protocol development. Additionally, results from this study will provide a preliminary indication of the efficacy of rTMS treatment for AN, the neural correlates of the illness, and potential biomarkers of clinical response. TRIAL REGISTRATION ISRCTN14329415 . Date of registration: 23 July 2015.
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Affiliation(s)
- Savani Bartholdy
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Jessica McClelland
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Maria Kekic
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Owen G O'Daly
- Centre for Neuroimaging Sciences, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. o.o'
| | - Iain C Campbell
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Jessica Werthmann
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Samantha J Rennalls
- Centre for Neuroimaging Sciences, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Anthony S David
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | | | - Nikola Kern
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
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158
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Zipfel S, Giel KE, Bulik CM, Hay P, Schmidt U. Anorexia nervosa: aetiology, assessment, and treatment. Lancet Psychiatry 2015; 2:1099-111. [PMID: 26514083 DOI: 10.1016/s2215-0366(15)00356-9] [Citation(s) in RCA: 423] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 02/07/2023]
Abstract
Anorexia nervosa is an important cause of physical and psychosocial morbidity. Recent years have brought advances in understanding of the underlying psychobiology that contributes to illness onset and maintenance. Genetic factors influence risk, psychosocial and interpersonal factors can trigger onset, and changes in neural networks can sustain the illness. Substantial advances in treatment, particularly for adolescent patients with anorexia nervosa, point to the benefits of specialised family-based interventions. Adults with anorexia nervosa too have a realistic chance of achieving recovery or at least substantial improvement, but no specific approach has shown clear superiority, suggesting a combination of re-nourishment and anorexia nervosa-specific psychotherapy is most effective. To successfully fight this enigmatic illness, we have to enhance understanding of the underlying biological and psychosocial mechanisms, improve strategies for prevention and early intervention, and better target our treatments through improved understanding of specific disease mechanisms.
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Affiliation(s)
- Stephan Zipfel
- Department of Psychosomatic Medicine, University of Tübingen, Tübingen, Germany.
| | - Katrin E Giel
- Department of Psychosomatic Medicine, University of Tübingen, Tübingen, Germany; Centre for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Cynthia M Bulik
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Phillipa Hay
- School of Medicine and Centre for Health Research Western Sydney University, Penrith, NSW, Australia
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159
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Treasure J, Cardi V, Leppanen J, Turton R. New treatment approaches for severe and enduring eating disorders. Physiol Behav 2015; 152:456-65. [DOI: 10.1016/j.physbeh.2015.06.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/22/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
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160
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Treasure J, Zipfel S, Micali N, Wade T, Stice E, Claudino A, Schmidt U, Frank GK, Bulik CM, Wentz E. Anorexia nervosa. Nat Rev Dis Primers 2015; 1:15074. [PMID: 27189821 DOI: 10.1038/nrdp.2015.74] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Anorexia nervosa (AN) is a psychiatric condition characterized by severe weight loss and secondary problems associated with malnutrition. AN predominantly develops in adolescence in the peripubertal period. Without early effective treatment, the course is protracted with physical, psychological and social morbidity and high mortality. Despite these effects, patients are noted to value the beliefs and behaviours that contribute to their illness rather than regarding them as problematic, which interferes with screening, prevention and early intervention. Involving the family to support interventions early in the course of the illness can produce sustained changes; however, those with a severe and/or protracted illness might require inpatient nursing support and/or outpatient psychotherapy. Prevention programmes aim to moderate the overvaluation of 'thinness' and body dissatisfaction as one of the proximal risk factors. The low prevalence of AN limits the ability to identify risk factors and to study the timing and sex distribution of the condition. However, genetic profiles, premorbid features, and brain structures and functions of patients with AN show similarities with other psychiatric disorders and contrast with obesity and metabolic disorders. Such studies are informing approaches to address the neuroadaptation to starvation and the other various physical and psychosocial deficits associated with AN. This Primer describes the epidemiology, diagnosis, screening and prevention, aetiology, treatment and quality of life of patients with AN.
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Affiliation(s)
- Janet Treasure
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London SE5 8AF, UK
| | - Stephan Zipfel
- Department of Psychosomatic Medicine, University of Tuebingen, Tuebingen, Germany
| | - Nadia Micali
- University College London, Institute of Child Health, Behavioural and Brain Sciences Unit, London, UK.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tracey Wade
- School of Psychology, Flinders University, Adelaide, Australia
| | - Eric Stice
- Oregon Research Institute, Eugene, Oregon, USA
| | - Angélica Claudino
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Ulrike Schmidt
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London SE5 8AF, UK
| | - Guido K Frank
- Eating Disorder Centre of Denver, University of Colorado, Denver, Colorado, USA
| | - Cynthia M Bulik
- University of North Carolina at Chapel Hill, North Carolina, USA.,Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Wentz
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg Sweden
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161
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Firk C, Mainz V, Schulte-Ruether M, Fink G, Herpertz-Dahlmann B, Konrad K. Implicit sequence learning in juvenile anorexia nervosa: neural mechanisms and the impact of starvation. J Child Psychol Psychiatry 2015; 56:1168-76. [PMID: 25623396 DOI: 10.1111/jcpp.12384] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Previous studies have reported that cognitive deficits occur in patients with anorexia nervosa (AN) and that these deficits may represent a predisposition towards developing AN or perpetuate the disorder. Specifically, dysfunctional implicit learning may contribute to the development of highly resistant dieting behaviours that are fundamental to the persistence of the disorder. Thus, the aims of this study were (a) to investigate implicit sequence learning in adolescent patients with AN before and after weight recovery and (b) to elucidate the associated neural mechanisms in acute AN relative to healthy controls. METHODS In a behavioural study, implicit sequence learning was assessed using a serial reaction time task in 27 adolescents with AN before (T1) and after weight recovery (T2) compared with age-matched healthy controls (HC) who were assessed at similar time intervals. The neural correlates of implicit sequence learning were subsequently investigated in 19 AN patients shortly after they were admitted to the hospital and 20 HC using functional magnetic resonance imaging (fMRI). RESULTS At T1, AN patients showed reduced sequence learning compared with HC. However, no behavioural differences between HC and AN patients were found at T2. At the neural level, acute AN patients showed reduced thalamic activation during sequence learning compared with HC subjects. CONCLUSIONS Our data suggest that the impaired implicit learning observed in adolescent AN patients before weight gain is a state-related dysfunction that normalises with weight gain. Thus, implicit learning deficits do not appear to represent a predisposition towards developing AN; rather, these deficits should be considered when planning psychotherapeutic interventions for acute AN. Reduced thalamic activation during the acute stage of AN may indicate a starvation-induced dysfunction of the neural circuitry that is involved in behavioural flexibility.
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Affiliation(s)
- Christine Firk
- Department of Child and Adolescent Psychiatry, University Hospital RWTH Aachen, Aachen, Germany
| | - Verena Mainz
- Department of Child and Adolescent Psychiatry, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Schulte-Ruether
- Department of Child and Adolescent Psychiatry, University Hospital RWTH Aachen, Aachen, Germany.,Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, Juelich, Germany
| | - Gereon Fink
- Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, Juelich, Germany.,Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, University Hospital RWTH Aachen, Aachen, Germany
| | - Kerstin Konrad
- Department of Child and Adolescent Psychiatry, University Hospital RWTH Aachen, Aachen, Germany.,Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, Juelich, Germany
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162
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On Weight and Waiting: Delay Discounting in Anorexia Nervosa Pretreatment and Posttreatment. Biol Psychiatry 2015; 78:606-14. [PMID: 25641636 PMCID: PMC4478277 DOI: 10.1016/j.biopsych.2014.12.016] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 12/08/2014] [Accepted: 12/11/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Individuals with anorexia nervosa (AN) override the drive to eat, forgoing immediate rewards in favor of longer-term goals. We examined delay discounting and its neural correlates in AN before and after treatment to test a potential mechanism of illness persistence. METHODS Inpatients with AN (n = 59) and healthy control subjects (HC, n = 39) performed a delay discounting task at two time points. A subset (n = 30 AN, n = 22 HC) participated in functional magnetic resonance imaging scanning during the task. The task consisted of a range of monetary choices with variable delay times, yielding individual discount rates-the rate by which money loses value over time. RESULTS Before treatment, the AN group showed a preference for delayed over earlier rewards (i.e., less steep discount rates) compared with HC; after weight restoration, AN did not differ from HC. Underweight AN showed slower response times for earlier versus delayed choices; this reversed with treatment. Underweight AN showed abnormal neural activity in striatum and dorsal anterior cingulate; normalization of behavior was associated with increased activation in reward regions (striatum and dorsal anterior cingulate) and decision-making regions (dorsolateral prefrontal cortex and parietal cortex). CONCLUSIONS The undernourished state of AN may amplify the tendency to forgo immediate rewards in favor of longer-term goals. The results suggest that behavior that looks phenotypically like excessive self-control does not correspond with enhanced prefrontal recruitment. Rather, the results point to alterations in cingulostriatal circuitry that offer new insights on the potential role of abnormalities in decision-making neural systems in the perpetuation of AN.
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163
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Godier LR, Park RJ. Does compulsive behavior in Anorexia Nervosa resemble an addiction? A qualitative investigation. Front Psychol 2015; 6:1608. [PMID: 26539148 PMCID: PMC4611244 DOI: 10.3389/fpsyg.2015.01608] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/05/2015] [Indexed: 12/26/2022] Open
Abstract
The characteristic relentless self-starvation behavior seen in Anorexia Nervosa (AN) has been described as evidence of compulsivity, with increasing suggestion of parallels with addictive behavior. This study used a thematic qualitative analysis to investigate the parallels between compulsive behavior in AN and Substance Use Disorders (SUD). Forty individuals currently suffering from AN completed an online questionnaire reflecting on their experience of compulsive behavior in AN. Eight main themes emerged from thematic qualitative analysis; compulsivity as central to AN, impaired control, escalating compulsions, emotional triggers, negative reactions, detrimental continuation of behavior, functional impairment, and role in recovery. These results suggested that individuals with AN view the compulsive nature of their behavior as central to the maintenance of their disorder, and as a significant barrier to recovery. The themes that emerged also showed parallels with the DSM-V criteria for SUDs, mapping onto the four groups of criteria (impaired control, social impairment, risky use of substance, pharmacological criteria). These results emphasize the need for further research to explore the possible parallels in behavioral and neural underpinnings of compulsivity in AN and SUDs, which may inform novel treatment avenues for AN.
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Affiliation(s)
- Lauren R Godier
- Oxford Brain-Body Research into Eating Disorders, Department of Psychiatry, University of Oxford Oxford, UK
| | - Rebecca J Park
- Oxford Brain-Body Research into Eating Disorders, Department of Psychiatry, University of Oxford Oxford, UK
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164
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Lavagnino L, Amianto F, Mwangi B, D'Agata F, Spalatro A, Zunta-Soares GB, Abbate Daga G, Mortara P, Fassino S, Soares JC. Identifying neuroanatomical signatures of anorexia nervosa: a multivariate machine learning approach. Psychol Med 2015; 45:2805-2812. [PMID: 25990697 DOI: 10.1017/s0033291715000768] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are currently no neuroanatomical biomarkers of anorexia nervosa (AN) available to make clinical inferences at an individual subject level. We present results of a multivariate machine learning (ML) approach utilizing structural neuroanatomical scan data to differentiate AN patients from matched healthy controls at an individual subject level. METHOD Structural neuroimaging scans were acquired from 15 female patients with AN (age = 20, s.d. = 4 years) and 15 demographically matched female controls (age = 22, s.d. = 3 years). Neuroanatomical volumes were extracted using the FreeSurfer software and input into the Least Absolute Shrinkage and Selection Operator (LASSO) multivariate ML algorithm. LASSO was 'trained' to identify 'novel' individual subjects as either AN patients or healthy controls. Furthermore, the model estimated the probability that an individual subject belonged to the AN group based on an individual scan. RESULTS The model correctly predicted 25 out of 30 subjects, translating into 83.3% accuracy (sensitivity 86.7%, specificity 80.0%) (p < 0.001; χ 2 test). Six neuroanatomical regions (cerebellum white matter, choroid plexus, putamen, accumbens, the diencephalon and the third ventricle) were found to be relevant in distinguishing individual AN patients from healthy controls. The predicted probabilities showed a linear relationship with drive for thinness clinical scores (r = 0.52, p < 0.005) and with body mass index (BMI) (r = -0.45, p = 0.01). CONCLUSIONS The model achieved a good predictive accuracy and drive for thinness showed a strong neuroanatomical signature. These results indicate that neuroimaging scans coupled with ML techniques have the potential to provide information at an individual subject level that might be relevant to clinical outcomes.
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Affiliation(s)
- L Lavagnino
- UT Center of Excellence on Mood Disorders,Department of Psychiatry and Behavioral Sciences,UT Houston Medical School,Houston,TX,USA
| | - F Amianto
- Department of Neuroscience,AOU San Giovanni Battista,Turin,Italy
| | - B Mwangi
- UT Center of Excellence on Mood Disorders,Department of Psychiatry and Behavioral Sciences,UT Houston Medical School,Houston,TX,USA
| | - F D'Agata
- Department of Neuroscience,AOU San Giovanni Battista,Turin,Italy
| | - A Spalatro
- Department of Neuroscience,AOU San Giovanni Battista,Turin,Italy
| | - G B Zunta-Soares
- UT Center of Excellence on Mood Disorders,Department of Psychiatry and Behavioral Sciences,UT Houston Medical School,Houston,TX,USA
| | - G Abbate Daga
- Department of Neuroscience,AOU San Giovanni Battista,Turin,Italy
| | - P Mortara
- Department of Neuroscience,AOU San Giovanni Battista,Turin,Italy
| | - S Fassino
- Department of Neuroscience,AOU San Giovanni Battista,Turin,Italy
| | - J C Soares
- UT Center of Excellence on Mood Disorders,Department of Psychiatry and Behavioral Sciences,UT Houston Medical School,Houston,TX,USA
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165
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Haynos AF, Crosby RD, Engel SG, Lavender JM, Wonderlich SA, Mitchell JE, Peterson CB, Crow SJ, Le Grange D. Initial test of an emotional avoidance model of restriction in anorexia nervosa using ecological momentary assessment. J Psychiatr Res 2015; 68:134-9. [PMID: 26228412 PMCID: PMC4522040 DOI: 10.1016/j.jpsychires.2015.06.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 05/31/2015] [Accepted: 06/19/2015] [Indexed: 10/23/2022]
Abstract
It has been hypothesized that restrictive eating allows individuals with anorexia nervosa (AN) to avoid contact with negative emotions; however, this presumption has not been directly tested. In this study, we conducted an initial investigation examining whether restrictive eating serves an emotional avoidance function among individuals with AN. Females with AN (n = 118) reported on negative and positive affect, anxiety/tension, and eating behaviors at multiple time points daily over a 2-week period using ecological momentary assessment methodology. Affective patterns were compared using generalized estimating equation models between days in which participants reported either: (1) relatively high restriction (without binge eating); (2) relatively low restriction (without binge eating); (3) binge eating; or (4) no restriction or binge eating. We hypothesized that, if restriction were functioning to avoid negative affect, average negative affect and anxiety/tension, as well as average negative and positive affect lability, would be lower and average positive affect would be higher on days characterized by high levels of restriction compared to other eating patterns. Contrary to hypotheses: (1) average negative affect, anxiety/tension, and positive affect were not significantly different between days characterized by high restriction and those characterized by low or no restriction; (2) Negative affect and anxiety/tension lability were higher on days characterized by high restriction compared to no restriction or binge eating days; (3) Anxiety/tension lability was higher on days characterized by high versus low levels of restriction. This patterns of findings does not support an avoidance model of restrictive eating for individuals with AN.
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Affiliation(s)
- Ann F. Haynos
- Department of Psychology, University of Nevada, Reno, Reno, NV
| | - Ross D. Crosby
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences and Neuropsychiatric Research Institute, Fargo, ND
| | - Scott G. Engel
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences and Neuropsychiatric Research Institute, Fargo, ND
| | - Jason M. Lavender
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences and Neuropsychiatric Research Institute, Fargo, ND
| | - Stephen A. Wonderlich
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences and Neuropsychiatric Research Institute, Fargo, ND
| | - James E. Mitchell
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences and Neuropsychiatric Research Institute, Fargo, ND
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota School of Medicine and the Emily Program, Minneapolis, MN
| | - Scott J. Crow
- Department of Psychiatry, University of Minnesota School of Medicine and the Emily Program, Minneapolis, MN
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
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166
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Selby EA, Cornelius T, Fehling KB, Kranzler A, Panza EA, Lavender JM, Wonderlich SA, Crosby RD, Engel SG, Mitchell JE, Crow SJ, Peterson CB, Grange DL. A perfect storm: examining the synergistic effects of negative and positive emotional instability on promoting weight loss activities in anorexia nervosa. Front Psychol 2015; 6:1260. [PMID: 26379588 PMCID: PMC4553383 DOI: 10.3389/fpsyg.2015.01260] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/06/2015] [Indexed: 11/13/2022] Open
Abstract
Growing evidence indicates that both positive and negative emotion potentially influence the development and maintenance of anorexia nervosa, through both positive and negative reinforcement of weight loss activities. Such reactive emotional experience may be characterized by frequent and intense fluctuations in emotion, a construct known as "emotional instability." The purpose of this study was to investigate the association between positive emotional instability and weight loss activities in anorexia nervosa, and to investigate the synergistic effects of positive and negative emotional instability on promoting weight loss activities. Using ecological momentary assessment methods, 118 participants with anorexia nervosa reported their emotional experiences and behaviors at least six times daily over 2 weeks using a portable digital device. Using generalized linear modeling, results indicated that high levels of both positive and negative emotional instability, and the interaction between the two, were associated with more frequent weight-loss activities, beyond anorexia subtype and mean levels of emotional intensity. These findings indicate that when women with anorexia exhibit both high levels of both positive and negative emotional instability they are more prone to a variety of weight loss activities. The importance of addressing the role of both positive and negative emotion in anorexia treatment is discussed.
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Affiliation(s)
- Edward A. Selby
- Department of Psychology, Rutgers University, Piscataway, NJ, USA
| | - Talea Cornelius
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Kara B. Fehling
- Department of Psychology, Rutgers University, Piscataway, NJ, USA
| | - Amy Kranzler
- Department of Psychology, Rutgers University, Piscataway, NJ, USA
| | - Emily A. Panza
- Department of Psychology, Rutgers University, Piscataway, NJ, USA
| | - Jason M. Lavender
- Neuropsychiatric Research Institute, Fargo, ND, USA
- School of Medicine, University of North Dakota, Bismarck, ND, USA
| | - Stephen A. Wonderlich
- Neuropsychiatric Research Institute, Fargo, ND, USA
- School of Medicine, University of North Dakota, Bismarck, ND, USA
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, Fargo, ND, USA
- School of Medicine, University of North Dakota, Bismarck, ND, USA
| | - Scott G. Engel
- Neuropsychiatric Research Institute, Fargo, ND, USA
- School of Medicine, University of North Dakota, Bismarck, ND, USA
| | - James E. Mitchell
- Neuropsychiatric Research Institute, Fargo, ND, USA
- School of Medicine, University of North Dakota, Bismarck, ND, USA
| | - Scott J. Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
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167
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Neimeijer RA, de Jong PJ, Roefs A. Automatic approach/avoidance tendencies towards food and the course of anorexia nervosa. Appetite 2015; 91:28-34. [DOI: 10.1016/j.appet.2015.03.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/14/2015] [Accepted: 03/16/2015] [Indexed: 11/29/2022]
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168
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Testing the disgust conditioning theory of food-avoidance in adolescents with recent onset anorexia nervosa. Behav Res Ther 2015; 71:131-8. [DOI: 10.1016/j.brat.2015.06.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 06/10/2015] [Accepted: 06/18/2015] [Indexed: 11/18/2022]
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169
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Haynos AF, Roberto CA, Attia E. Examining the associations between emotion regulation difficulties, anxiety, and eating disorder severity among inpatients with anorexia nervosa. Compr Psychiatry 2015; 60:93-8. [PMID: 25842195 PMCID: PMC4459906 DOI: 10.1016/j.comppsych.2015.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 02/26/2015] [Accepted: 03/17/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE There is growing interest in the role of emotion regulation in anorexia nervosa (AN). Although anxiety is also hypothesized to impact symptoms of AN, little is known about how emotion regulation, anxiety, and eating disorder symptoms interact in AN. In this study, we examined the associations between emotion regulation, anxiety, and eating disorder symptom severity in AN. METHODS Questionnaires and interviews assessing emotion regulation difficulties, anxiety, eating disorder symptoms, and eating disorder-related clinical impairment were collected from group of underweight individuals with AN (n=59) at admission to inpatient treatment. Hierarchical linear regressions were used to examine the associations of emotion regulation difficulties, anxiety, and the interaction of these constructs with eating disorder symptoms and eating disorder-related clinical impairment. RESULTS Emotion regulation difficulties were significantly positively associated with eating disorder symptoms and related clinical impairment only when anxiety levels were low and anxiety was significantly positively associated with eating disorder symptoms and related clinical impairment only when emotion regulation problems were not elevated. CONCLUSIONS This study adds to a growing literature suggesting that emotion regulation deficits are associated with eating disorder symptoms in AN. Certain individuals with AN may especially benefit from a focus on developing emotion regulation skills in the acute stages of illness.
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Affiliation(s)
- Ann F. Haynos
- Department of Psychology, University of Nevada, Reno, Reno, NV
| | - Christina A. Roberto
- Department of Social & Behavioral Sciences, Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Evelyn Attia
- Division of Clinical Therapeutics, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
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170
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Pearson CM, Wonderlich SA, Smith GT. A risk and maintenance model for bulimia nervosa: From impulsive action to compulsive behavior. Psychol Rev 2015; 122:516-35. [PMID: 25961467 PMCID: PMC4486518 DOI: 10.1037/a0039268] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article offers a new model for bulimia nervosa (BN) that explains both the initial impulsive nature of binge eating and purging, as well as the compulsive quality of the fully developed disorder. The model is based on a review of advances in research on BN and advances in relevant basic psychological science. It integrates transdiagnostic personality risk, eating-disorder-specific risk, reinforcement theory, cognitive neuroscience, and theory drawn from the drug addiction literature. We identify both a state-based and a trait-based risk pathway, and we then propose possible state-by-trait interaction risk processes. The state-based pathway emphasizes depletion of self-control. The trait-based pathway emphasizes transactions between the trait of negative urgency (the tendency to act rashly when distressed) and high-risk psychosocial learning. We then describe a process by which initially impulsive BN behaviors become compulsive over time, and we consider the clinical implications of our model. (PsycINFO Database Record
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Affiliation(s)
| | - Stephen A Wonderlich
- Department of Clinical Neuroscience, Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences
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171
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Treasure J, Stein D, Maguire S. Has the time come for a staging model to map the course of eating disorders from high risk to severe enduring illness? An examination of the evidence. Early Interv Psychiatry 2015; 9:173-84. [PMID: 25263388 DOI: 10.1111/eip.12170] [Citation(s) in RCA: 186] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 06/22/2014] [Indexed: 12/13/2022]
Abstract
AIM To examine the evidence to support using a staging heuristic for eating disorders, suggesting that the diagnosis of an eating disorder follows a trajectory across the life course. Specifically, to examine whether high-risk markers and prodromal features presenting in childhood and adolescence can later transition to the full manifestation of the illness in early adulthood, and whether over time, the illness can be described as becoming severe and enduring, often resistant to treatment. METHODS We conducted a comprehensive literature search on the MEDLINE, PubMed, PsycINFO, EMBASE and Cochrane databases from using the following terms: staging, duration of illness, early intervention, developmental epidemiology, neurobiological marker, phenotype, partial syndrome, severe enduring, chronic, prospective, longitudinal, cohort, epidemiology, adolescent, adult with anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder. The evidence was organized according to the staging heuristic defined by McGorry. RESULTS Evidence from epidemiological studies, neuropsychological findings, treatment responsivity and prognosis, support a specific staging trajectory for anorexia nervosa in that there is a longitudinal trajectory with evidence of neurobiological progression and evidence that interventions matched to stage of illness may optimize the benefit. There is less data at the moment to support such a model for bulimia nervosa and binge eating disorder. CONCLUSION The staging heuristic is a useful model for anorexia nervosa in terms of providing prognostic information and stage matched interventions. Although the evidence is encouraging, further research is needed before a similar model could be applied for bulimia nervosa and binge eating disorder.
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Affiliation(s)
- Janet Treasure
- PO59 Eating Disorder Unit, Kings College London, Institute of Psychiatry, London, UK
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172
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Emotion generation and regulation in anorexia nervosa: a systematic review and meta-analysis of self-report data. Clin Psychol Rev 2015; 39:83-95. [PMID: 26043394 DOI: 10.1016/j.cpr.2015.04.005] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 04/18/2015] [Accepted: 04/27/2015] [Indexed: 01/01/2023]
Abstract
This systematic review sought to examine the generation and regulation of emotion in people with Anorexia Nervosa (AN). Key databases (Medline, Embase, PsychINFO and Web of Science) were searched for peer-reviewed articles published by March 2015 yielding 131 studies relevant to emotion generation and emotion regulation (ER) processes as defined by Gross (1998). Meta-analyses determined pooled group differences between AN and healthy control (HC) groups. More maladaptive schemata were reported by people with AN than HCs, with largest pooled effects for defectiveness/shame (d=2.81), subjugation (d=1.59) and social isolation (d=1.66). Poorer awareness of and clarity over emotion generated and some elevated emotionality (disgust and shame) were reported. A greater use of 'maladaptive' ER strategies was reported by people with AN than HCs, alongside less use of 'adaptive' strategies. Pooled differences of particularly large effect were observed for: experiential avoidance (d=1.00), negative problem-solving style (d=1.06), external/social comparison (d=1.25), submissiveness (d=1.16), attention concentration (worry/rumination; d=1.44) and emotion suppression (d=1.15), particularly to avoid conflict (d=1.54). These data support the notion that emotion regulation difficulties are a factor in AN and support use of associated cognitive-affective models. The implications of these findings for further understanding AN, and developing models and related psychological interventions are discussed.
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173
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O’Hara CB, Campbell IC, Schmidt U. A reward-centred model of anorexia nervosa: A focussed narrative review of the neurological and psychophysiological literature. Neurosci Biobehav Rev 2015; 52:131-52. [DOI: 10.1016/j.neubiorev.2015.02.012] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/09/2015] [Accepted: 02/22/2015] [Indexed: 12/13/2022]
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174
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Wildes JE, Marcus MD. Application of the Research Domain Criteria (RDoC) framework to eating disorders: emerging concepts and research. Curr Psychiatry Rep 2015; 17:30. [PMID: 25773226 DOI: 10.1007/s11920-015-0572-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The Research Domain Criteria (RDoC) project was initiated by the National Institute of Mental Health as a heuristic for addressing the limitations of categorical, symptom-based psychiatric diagnoses. RDoC is conceptualized as a matrix, with the rows representing dimensional constructs or domains implicated in the expression of psychiatric symptoms and the columns representing units of analysis that can be used to assess dimensional constructs (i.e., genes, molecules, cells, circuits, physiology, behavior, and self-reports). Few studies in eating disorders have adopted an RDoC framework, but accumulating data provide support for the relevance of RDoC dimensions to eating disorder symptoms. Herein, we review findings from RDoC-informed studies across the five domains of functioning included in the RDoC matrix-negative valence systems, positive valence systems, cognitive systems, systems for social processes, and arousal and regulatory systems-and describe directions for future research utilizing RDoC to enhance study design and treatment development in eating disorders.
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Affiliation(s)
- Jennifer E Wildes
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic of UPMC, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA,
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175
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Cardi V, Ambwani S, Crosby R, Macdonald P, Todd G, Park J, Moss S, Schmidt U, Treasure J. Self-Help And Recovery guide for Eating Disorders (SHARED): study protocol for a randomized controlled trial. Trials 2015; 16:165. [PMID: 25885697 PMCID: PMC4435653 DOI: 10.1186/s13063-015-0701-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 04/01/2015] [Indexed: 02/07/2023] Open
Abstract
Background We describe the theoretical rationale and protocol for Self-Help And Recovery guide for Eating Disorders (SHARED), a trial investigating whether a guided self-care intervention (Recovery MANTRA) is a useful addition to treatment as usual for individuals with anorexia nervosa. Recovery MANTRA, a 6-week self-care intervention supplemented by peer mentorship, is a module extension of the Maudsley Model of Treatment for Adults with Anorexia Nervosa and targets the maintenance factors identified by the cognitive-interpersonal model of the illness. Methods Patients accessing outpatient services for anorexia nervosa are randomized to either treatment as usual or treatment as usual plus Recovery MANTRA. Outcome variables include change in body weight at the end of the intervention (primary) and changes in body weight and eating disorder symptoms at immediate and extended follow-up (6-months; secondary). Change is also assessed for the domains identified by the theoretical model, including motivation, hope, confidence to change, positive mood, cognitive flexibility, therapeutic alliance and social adjustment. Feedback from peer mentors is gathered to understand the impact on their own well-being of providing guidance. Discussion Results from this exploratory investigation will determine whether a larger clinical trial is justifiable and feasible for this affordable intervention, which has potential for high reach and scalability. Trial registration ClinicalTrials.gov NCT02336841.
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Affiliation(s)
- Valentina Cardi
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Suman Ambwani
- Department of Psychology, Dickinson College, P.O. Box 1773, Carlisle, PA, 17013, USA.
| | - Ross Crosby
- Neuropsychiatric Research Institute, 700 First Ave. South, Fargo, ND, 58103, USA.
| | - Pamela Macdonald
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Gill Todd
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Jinhong Park
- Department of Psychology, Carleton College, 1 N. College St., Northfield, MN, 55057, USA.
| | - Sara Moss
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Ulrike Schmidt
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Janet Treasure
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
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176
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Guarda AS, Schreyer CC, Boersma GJ, Tamashiro KL, Moran TH. Anorexia nervosa as a motivated behavior: Relevance of anxiety, stress, fear and learning. Physiol Behav 2015; 152:466-72. [PMID: 25846837 DOI: 10.1016/j.physbeh.2015.04.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 04/02/2015] [Indexed: 12/12/2022]
Abstract
The high comorbidity between anorexia nervosa (AN) and anxiety disorders is well recognized. AN is a motivated behavioral disorder in which habit formation is likely to contribute to the persistence of abnormal eating and exercise behaviors. Secondary alterations in brain circuitry underlying the reward value of food and exercise, along with disturbances in neuroendocrine hunger and satiety signaling arising from starvation and excessive exercise, are likely contributors to the maintenance of anorectic behaviors in genetically vulnerable individuals. The potential role of fear conditioning in facilitating onset of AN, or of impaired fear extinction in contributing to the high relapse rates observed following weight restoration, is of interest. Evidence from animal models of anxiety and human laboratory studies indicate that low estrogen impairs fear extinction. Low estradiol levels in AN may therefore play a role in perpetuating fear of food and fat in recently weight restored patients. Translational models including the activity based anorexia (ABA) rodent model of AN, and neuroimaging studies of fear extinction and conditioning, could help clarify the underlying molecular mechanisms and neurocircuitry involved in food avoidance behaviors in AN. Moreover, the adaptation of novel treatment interventions with efficacy in anxiety disorders may contribute to the development of new treatments for this impairing disorder.
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Affiliation(s)
- Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
| | - Gretha J Boersma
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
| | - Kellie L Tamashiro
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
| | - Timothy H Moran
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
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177
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Godier LR, Park RJ. A novel measure of compulsive food restriction in anorexia nervosa: validation of the Self-Starvation Scale (SS). Eat Behav 2015; 17:10-3. [PMID: 25528717 DOI: 10.1016/j.eatbeh.2014.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 10/06/2014] [Accepted: 12/03/2014] [Indexed: 11/16/2022]
Abstract
The characteristic relentless self-starvation behaviour seen in Anorexia Nervosa (AN) has been described as evidence of compulsivity, with increasing suggestion of transdiagnostic parallels with addictive behaviour. There is a paucity of standardised self-report measures of compulsive behaviour in eating disorders (EDs). Measures that index the concept of compulsive self-starvation in AN are needed to explore the suggested parallels with addictions. With this aim a novel measure of self-starvation was developed (the Self-Starvation Scale, SS). 126 healthy participants, and 78 individuals with experience of AN, completed the new measure along with existing measures of eating disorder symptoms, anxiety and depression. Initial validation in the healthy sample indicated good reliability and construct validity, and incremental validity in predicting eating disorder symptoms. The psychometric properties of the SS scale were replicated in the AN sample. The ability of this scale to predict ED symptoms was particularly strong in individuals currently suffering from AN. These results suggest the SS may be a useful index of compulsive food restriction in AN. The concept of 'starvation dependence' in those with eating disorders, as a parallel with addiction, may be of clinical and theoretical importance.
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Affiliation(s)
- Lauren R Godier
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford OX3 7JX, United Kingdom.
| | - Rebecca J Park
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford OX3 7JX, United Kingdom
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178
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Steinglass J, Foerde K, Kostro K, Shohamy D, Timothy Walsh B. Restrictive food intake as a choice--a paradigm for study. Int J Eat Disord 2015; 48:59-66. [PMID: 25130380 PMCID: PMC4276488 DOI: 10.1002/eat.22345] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 06/06/2014] [Accepted: 07/18/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Inadequate intake and preference for low-calorie foods are salient behavioral features of Anorexia Nervosa (AN). The neurocognitive mechanisms underlying pathological food choice have not been characterized. This study aimed to develop a new paradigm for experimentally modeling maladaptive food choice in AN. METHOD Individuals with AN (n = 22) and healthy controls (HC, n = 20) participated in a computer-based Food Choice Task, adapted for individuals with eating disorders. Participants first rated 43 food images (including high-fat and low-fat items) for Healthiness and Tastiness; an item rated neutral on both blocks was then selected as the Reference item. On each of 42 subsequent trials participants were asked to choose between the food item presented and the Reference item. RESULTS The AN group was less likely to choose high-fat foods relative to HC, as evidenced both in multilevel logistic regression (z = 2.59, p = .009) and ANOVA (F(1,39) = 7.80, p = .008) analyses. Health ratings influenced choice significantly more in AN relative to HC (z = 2.7, p = .006), and were more related to Taste among AN (χ(2) = 4.10, p = .04). Additionally, taste ratings declined with duration of illness (r = -.50, p = .02). DISCUSSION The Food Choice Task captures the preference for low-fat foods among individuals with AN. The findings suggest that the experience of tastiness changes over time and may contribute to perpetuation of illness. By providing an experimental quantitative measure of food restriction, this task opens the door to new experimental investigations into the cognitive, affective, and neural factors contributing to maladaptive food choices characteristic of AN.
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Affiliation(s)
- Joanna Steinglass
- Columbia University Medical Center, 622 West 168Street New York, NY 10032,New York State Psychiatric Institute, 1051 Riverside Drive New York, NY 10032,Corresponding Author: Joanna Steinglass, MD, 1051 Riverside Drive, Unit 98, New York, NY 10032 phone: 646-774-6345,
| | - Karin Foerde
- New York State Psychiatric Institute, 1051 Riverside Drive New York, NY 10032,New York University, 6 Washington Place, New York, NY 10003,Corresponding Author: Joanna Steinglass, MD, 1051 Riverside Drive, Unit 98, New York, NY 10032 phone: 646-774-6345,
| | - Katrina Kostro
- Columbia University Medical Center, 622 West 168Street New York, NY 10032
| | - Daphna Shohamy
- Columbia University, 1190 Amsterdam Avenue, New York, NY 10027
| | - B. Timothy Walsh
- Columbia University Medical Center, 622 West 168Street New York, NY 10032
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Favaro A, Tenconi E, Degortes D, Manara R, Santonastaso P. Effects of obstetric complications on volume and functional connectivity of striatum in anorexia nervosa patients. Int J Eat Disord 2014; 47:686-95. [PMID: 24938422 DOI: 10.1002/eat.22320] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/02/2014] [Accepted: 06/03/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the volume and functional connectivity of dorsal and ventral striatal nuclei in anorexia nervosa (AN) and their relationship with early exposure to obstetric complications. METHOD Fifty-one patients with lifetime AN (35 acute, 16 recovered) and 34 healthy controls underwent high-resolution and resting-state functional magnetic resonance imaging. RESULTS The AN group showed reduced functional connectivity of the putamen compared with healthy women, and this reduction was more evident in patients with lifetime binge eating/purging. Both acute and recovered AN groups showed a larger left accumbens area compared with that of healthy women. The functional connectivity of bilateral nucleus accumbens and putamen showed significant negative correlations with number of obstetric complications in the AN group. DISCUSSION This study supports the hypothesis that AN is associated with structural and functional alterations of striatal networks, and reveals the possible role of obstetric complications in the pathogenesis of striatal dysfunction.
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Affiliation(s)
- Angela Favaro
- Department of Neurosciences, University of Padova, Padova, Italy; Centro di Neuroscienze Cognitive, Università di Padova
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180
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Levinson CA, Rodebaugh TL. Negative Social Evaluative Fears Produce Social Anxiety, Food Intake, and Body Dissatisfaction: Evidence of Similar Mechanisms through Different Pathways. Clin Psychol Sci 2014; 3:744-757. [PMID: 26504674 DOI: 10.1177/2167702614548891] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Social anxiety and eating disorders are highly comorbid, suggesting there are shared vulnerabilities that underlie the development of these disorders. Two proposed vulnerabilities are fear of negative evaluation and social appearance anxiety (i.e., fear of negative evaluation regarding one's appearance). In the current experimental study (N=160 women) we measured these fears: (a) through a manipulation comparing fear conditions, (b) with trait fears, and (c) state fears. Results indicated that participants in the fear of negative evaluation condition increased food consumption, whereas participants in the social appearance anxiety condition and high in trait social appearance anxiety experienced the highest amounts of body dissatisfaction. Participants in the fear of evaluation and social appearance anxiety conditions experienced elevated social anxiety. These results support the idea that negative evaluation fears are shared vulnerabilities for eating and social anxiety disorders, but that the way these variables exert their effects may lead to disorder specific behaviors.
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181
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Park RJ, Godier LR, Cowdrey FA. Hungry for reward: How can neuroscience inform the development of treatment for Anorexia Nervosa? Behav Res Ther 2014; 62:47-59. [PMID: 25151600 DOI: 10.1016/j.brat.2014.07.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 07/04/2014] [Accepted: 07/16/2014] [Indexed: 12/29/2022]
Abstract
Dysfunctional reward from the pursuit of thinness presents a major challenge to recovery from Anorexia Nervosa (AN). We explore the neuroscientific basis of aberrant reward in AN, with the aim of generating novel hypotheses for translational investigation, and elucidate disease mechanisms to inform the development of targeted interventions. Relevant neuroimaging and behavioural studies are reviewed. These suggest that altered eating in AN may be a consequence of aberrant reward processing combined with exaggerated cognitive control. We consider evidence that such aberrant reward processing is reflected in the compulsive behaviours characterising AN, with substantial overlap in the neural circuits implicated in reward processing and compulsivity. Drawing on contemporary neuroscientific theories of substance dependence, processes underpinning the shift from the initially rewarding pursuit of thinness to extreme and compulsive weight control behaviours are discussed. It is suggested that in AN, weight loss behaviour begins as overtly rewarding, goal-directed and positively reinforced, but over time becomes habitual and increasingly negatively reinforced. Excessive habit formation is suggested as one underlying mechanism perpetuating compulsive behaviour. Ongoing research into the behavioural and neural basis of aberrant reward in AN is required to further elucidate mechanisms. We discuss clinical and transdiagnostic implications, and propose that future treatment innovation may benefit from the development of novel interventions targeting aberrant reward processing in AN.
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Affiliation(s)
- Rebecca J Park
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, United Kingdom.
| | - Lauren R Godier
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, United Kingdom
| | - Felicity A Cowdrey
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, United Kingdom
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182
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Godier LR, Park RJ. Compulsivity in anorexia nervosa: a transdiagnostic concept. Front Psychol 2014; 5:778. [PMID: 25101036 PMCID: PMC4101893 DOI: 10.3389/fpsyg.2014.00778] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 07/01/2014] [Indexed: 01/28/2023] Open
Abstract
The compulsive nature of weight loss behaviors central to anorexia nervosa (AN), such as relentless self-starvation and over-exercise, has led to the suggestion of parallels between AN and other compulsive disorders such as obsessive-compulsive disorder (OCD) and addictions. There is a huge unmet need for effective treatments in AN, which has high rates of morbidity and the highest mortality rate of any psychiatric disorder, yet a grave paucity of effective treatments. Viewing compulsivity as a transdiagnostic concept, seen in various manifestations across disorders, may help delineate the mechanisms responsible for the persistence of AN, and aid treatment development. We explore models of compulsivity that suggest dysfunction in cortico-striatal circuitry underpins compulsive behavior, and consider evidence of aberrancies in this circuitry across disorders. Excessive habit formation is considered as a mechanism by which initially rewarding weight loss behavior in AN may become compulsive over time, and the complex balance between positive and negative reinforcement in this process is considered. The physiological effects of starvation in promoting compulsivity, positive reinforcement, and habit formation are also discussed. Further research in AN may benefit from a focus on processes potentially underlying the development of compulsivity, such as aberrant reward processing and habit formation. We discuss the implications of a transdiagnostic perspective on compulsivity, and how it may contribute to the development of novel treatments for AN.
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Affiliation(s)
- Lauren R. Godier
- Oxford Brain-Body Research into Eating Disorders, Department of Psychiatry, University of OxfordOxford, UK
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183
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Selby EA, Wonderlich SA, Crosby RD, Engel SG, Panza E, Mitchell JE, Crow SJ, Peterson CB, Le Grange D. Nothing Tastes as Good as Thin Feels: Low Positive Emotion Differentiation and Weight Loss Activities in Anorexia Nervosa. Clin Psychol Sci 2014; 2:514-531. [PMID: 34888124 PMCID: PMC8654035 DOI: 10.1177/2167702613512794] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Positive emotion (PE) has not been well studied in anorexia nervosa. Low positive emotion differentiation (PED), which involves a diminished ability to distinguish between discrete positive emotions, may contribute to positive emotion dysregulation in anorexia. Specifically, low PED may interact with elevated PE intensity to both motivate and reinforce weight loss and evaluation behaviors. Using ecological momentary assessment, we examined PE and weight loss behaviors reported over two weeks. As hypothesized, low PED predicted more vomiting, laxative-use, exercising, weighing, checking for fat, and restricting. Furthermore, those with low PED who experienced elevated average PE intensity reported even more frequent behaviors. Within-person analyses indicated that, for those with low PED, more weight loss behaviors at one recording predicted elevated PE at the subsequent recording. Similarly, for those with low PED higher momentary PE predicted more subsequent weight loss behaviors. Thus, low PED in anorexia may reinforce and motivate weight loss behavior.
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Affiliation(s)
| | | | - Ross D. Crosby
- University of North Dakota and Neuropsychiatric Research Institute
| | - Scott G. Engel
- University of North Dakota and Neuropsychiatric Research Institute
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184
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Characterization of eating patterns among individuals with eating disorders: What is the state of the plate? Physiol Behav 2014; 134:92-109. [DOI: 10.1016/j.physbeh.2014.02.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/15/2014] [Accepted: 02/17/2014] [Indexed: 12/28/2022]
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185
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Goldschmidt AB, Wonderlich SA, Crosby RD, Cao L, Engel SG, Lavender JM, Mitchell JE, Crow SJ, Peterson CB, Le Grange D. Latent profile analysis of eating episodes in anorexia nervosa. J Psychiatr Res 2014; 53:193-9. [PMID: 24630466 PMCID: PMC4011391 DOI: 10.1016/j.jpsychires.2014.02.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 02/18/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite being characterized primarily by disturbances in eating behavior, relatively little is known about specific eating behaviors in anorexia nervosa (AN) and how they relate to different emotional, behavioral, and environmental features. METHODS Women with AN (n = 118) completed a 2-week ecological momentary assessment (EMA) protocol during which they reported on daily eating- and mood-related patterns. Latent profile analysis was used to identify classes of eating episodes based on the presence or absence of the following indicators: loss of control; overeating; eating by oneself; food avoidance; and dietary restraint. RESULTS The best-fitting model supported a 5-class solution: avoidant eating; solitary eating; binge eating; restrictive eating; and loss of control eating. The loss of control and binge eating classes were characterized by high levels of concurrent negative affect and a greater likelihood of engaging in compensatory behaviors. The restrictive eating class was associated with the greatest number of concurrently-reported stressful events, while the avoidant and solitary eating episode classes were characterized by relatively few accompanying stressful events. Body checking was least likely to occur in conjunction with restrictive eating behaviors. CONCLUSIONS Results support the presence of discrete types of eating episodes in AN that are associated with varying degrees of negative affect, stress, and behavioral features of eating disorders. Loss of control and dietary restriction may serve distinct functional purposes in AN, as highlighted by their differing associations with negative affect and stress. Clinical interventions for AN may benefit from targeting functional aspects of eating behavior among those with the disorder.
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Affiliation(s)
- Andrea B. Goldschmidt
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Stephen A. Wonderlich
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota, USA,Department of Clinical Neuroscience, University of North Dakota School of Medicine, Fargo, North Dakota, USA
| | - Ross D. Crosby
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota, USA,Department of Clinical Neuroscience, University of North Dakota School of Medicine, Fargo, North Dakota, USA
| | - Li Cao
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota, USA
| | - Scott G. Engel
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota, USA,Department of Clinical Neuroscience, University of North Dakota School of Medicine, Fargo, North Dakota, USA
| | - Jason M. Lavender
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota, USA
| | - James E. Mitchell
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota, USA,Department of Clinical Neuroscience, University of North Dakota School of Medicine, Fargo, North Dakota, USA
| | - Scott J. Crow
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA,The Emily Program, St. Paul, Minnesota, USA
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
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186
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Affiliation(s)
- Evelyn Attia
- Columbia University Medical Center, New York, NY 10032, USA; Weill Cornell Medical College, New York, NY, USA.
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187
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Lipsman N, Woodside DB, Lozano AM. Neurocircuitry of limbic dysfunction in anorexia nervosa. Cortex 2014; 62:109-18. [PMID: 24703713 DOI: 10.1016/j.cortex.2014.02.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 12/30/2013] [Accepted: 02/20/2014] [Indexed: 01/12/2023]
Abstract
Anorexia Nervosa (AN) is a serious psychiatric condition marked by firmly entrenched and maladaptive behaviors and beliefs about body, weight and food, as well as high rates of psychiatric comorbidity. The neural roots of AN are now beginning to emerge, and appear to be related to dysfunctional, primarily limbic, circuits driving pathological thoughts and behaviors. As a result, the significant physical symptoms of AN are increasingly being understood at least partially as a result of abnormal or dysregulated emotional processing. This paper reviews the nature of limbic dysfunction in AN, and how structural and functional imaging has implicated distinct emotional and perceptual neural circuits driving AN symptoms. We propose that top-down and bottom-up influences converge on key limbic modulatory structures, such as the subcallosal cingulate and insula, whose normal functioning is critical to affective regulation and emotional homeostasis. Dysfunctional activity in these structures, as is seen in AN, may lead to emotional processing deficits and psychiatric symptoms, which then drive maladaptive behaviors. Modulating limbic dysregulation may therefore be a potential treatment strategy in some AN patients.
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Affiliation(s)
- Nir Lipsman
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Canada.
| | - D Blake Woodside
- Department of Psychiatry, Toronto General Hospital, University Health Network, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Canada
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188
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Zipfel S, Wild B, Groß G, Friederich HC, Teufel M, Schellberg D, Giel KE, de Zwaan M, Dinkel A, Herpertz S, Burgmer M, Löwe B, Tagay S, von Wietersheim J, Zeeck A, Schade-Brittinger C, Schauenburg H, Herzog W. Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial. Lancet 2014; 383:127-37. [PMID: 24131861 DOI: 10.1016/s0140-6736(13)61746-8] [Citation(s) in RCA: 229] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Psychotherapy is the treatment of choice for patients with anorexia nervosa, although evidence of efficacy is weak. The Anorexia Nervosa Treatment of OutPatients (ANTOP) study aimed to assess the efficacy and safety of two manual-based outpatient treatments for anorexia nervosa--focal psychodynamic therapy and enhanced cognitive behaviour therapy--versus optimised treatment as usual. METHODS The ANTOP study is a multicentre, randomised controlled efficacy trial in adults with anorexia nervosa. We recruited patients from ten university hospitals in Germany. Participants were randomly allocated to 10 months of treatment with either focal psychodynamic therapy, enhanced cognitive behaviour therapy, or optimised treatment as usual (including outpatient psychotherapy and structured care from a family doctor). The primary outcome was weight gain, measured as increased body-mass index (BMI) at the end of treatment. A key secondary outcome was rate of recovery (based on a combination of weight gain and eating disorder-specific psychopathology). Analysis was by intention to treat. This trial is registered at http://isrctn.org, number ISRCTN72809357. FINDINGS Of 727 adults screened for inclusion, 242 underwent randomisation: 80 to focal psychodynamic therapy, 80 to enhanced cognitive behaviour therapy, and 82 to optimised treatment as usual. At the end of treatment, 54 patients (22%) were lost to follow-up, and at 12-month follow-up a total of 73 (30%) had dropped out. At the end of treatment, BMI had increased in all study groups (focal psychodynamic therapy 0·73 kg/m(2), enhanced cognitive behaviour therapy 0·93 kg/m(2), optimised treatment as usual 0·69 kg/m(2)); no differences were noted between groups (mean difference between focal psychodynamic therapy and enhanced cognitive behaviour therapy -0·45, 95% CI -0·96 to 0·07; focal psychodynamic therapy vs optimised treatment as usual -0·14, -0·68 to 0·39; enhanced cognitive behaviour therapy vs optimised treatment as usual -0·30, -0·22 to 0·83). At 12-month follow-up, the mean gain in BMI had risen further (1·64 kg/m(2), 1·30 kg/m(2), and 1·22 kg/m(2), respectively), but no differences between groups were recorded (0·10, -0·56 to 0·76; 0·25, -0·45 to 0·95; 0·15, -0·54 to 0·83, respectively). No serious adverse events attributable to weight loss or trial participation were recorded. INTERPRETATION Optimised treatment as usual, combining psychotherapy and structured care from a family doctor, should be regarded as solid baseline treatment for adult outpatients with anorexia nervosa. Focal psychodynamic therapy proved advantageous in terms of recovery at 12-month follow-up, and enhanced cognitive behaviour therapy was more effective with respect to speed of weight gain and improvements in eating disorder psychopathology. Long-term outcome data will be helpful to further adapt and improve these novel manual-based treatment approaches. FUNDING German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung, BMBF), German Eating Disorders Diagnostic and Treatment Network (EDNET).
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Affiliation(s)
- Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
| | - Beate Wild
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Gaby Groß
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Hans-Christoph Friederich
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Dieter Schellberg
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Erlangen, Germany
| | - Andreas Dinkel
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Technology Munich, Munich, Germany
| | - Stephan Herpertz
- Clinic for Psychosomatic Medicine and Psychotherapy, LWL University Hospital of the Ruhr, University of Bochum, Bochum, Germany
| | - Markus Burgmer
- Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Bernd Löwe
- Institute and Outpatient Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Tagay
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jörn von Wietersheim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Freiburg, Freiburg, Germany
| | | | - Henning Schauenburg
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolfgang Herzog
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
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189
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A history of the identification of the characteristic eating disturbances of Bulimia Nervosa, Binge Eating Disorder and Anorexia Nervosa. Appetite 2013; 71:445-8. [DOI: 10.1016/j.appet.2013.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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190
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Abstract
PURPOSE OF REVIEW This review summarizes recent evidence on psychological treatments for eating disorders. RECENT FINDINGS Eating disorders are serious psychiatric conditions requiring evidence-based intervention. Treatments have been evaluated within each eating disorder diagnosis and across diagnoses. For adults with anorexia nervosa, no one specialist treatment has been shown to be superior. Cognitive behavioral therapy and interpersonal psychotherapy remain the most established treatments for bulimia nervosa and binge eating disorder, with stepped-care approaches showing promise and new behavioral treatments under study. Enhanced cognitive behavioral therapy has improved symptoms in adults and youth. Maudsley family-based therapy is the most established treatment for youth with anorexia nervosa and may be efficacious for youth with bulimia nervosa. Interpersonal psychotherapy for the prevention of excess weight gain may be efficacious for reducing loss of control eating and weight gain in overweight youth. SUMMARY Significant advances in treatments have been made, including evaluation of long-term outcomes, novel approaches, and tailored extension for specific patient profiles. However, widespread access to effective eating disorder treatments remains limited. Increasing the potency and expanding the implementation of psychological treatments beyond research settings into clinical practice has strong potential to increase access to care, thereby reducing the burden of eating disorders.
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Affiliation(s)
- Andrea E. Kass
- Department of Psychology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rachel P. Kolko
- Department of Psychology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Denise E. Wilfley
- Department of Psychology, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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191
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Abstract
PURPOSE OF REVIEW To systematize new neurobiological findings on the cause and treatment of eating disorders. RECENT FINDINGS The conceptual framework of the cause of eating disorders has undergone great changes in the past decades. Recently, the National Institute of Mental Health proposed a new set of criteria for research purposes--the Research Domain Criteria (RDoC). We aim to structure this study as much as possible using these constructs across biological units of analysis, summarizing new findings. Brain imaging techniques have become sophisticated in identifying brain circuits related to illness behaviour and to fundamental traits such as reward and social processing. Genetic studies have moved from candidate gene studies onto genome-wide association studies; however, the field needs to cooperate to collect larger samples in order to benefit from this approach. Hormonal changes as the results of starvation or as underlying factors for behavioural changes still receive attention in both animal and human studies. Advances made in neuropsychology show problems in cognition (set shifting and central coherence) and in other RDoC domains. Some of these findings have been translated into treatment. SUMMARY New biological models are being developed which explain causal and maintaining factors. The RDoC construct may be used to systematize these findings.
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192
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Schmidt U, Campbell IC. Treatment of Eating Disorders can not Remain ‘Brainless’: The Case for Brain-Directed Treatments. EUROPEAN EATING DISORDERS REVIEW 2013; 21:425-7. [DOI: 10.1002/erv.2257] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 08/17/2013] [Indexed: 12/17/2022]
Affiliation(s)
- Ulrike Schmidt
- King's College London; Institute of Psychiatry, Section of Eating Disorders; London UK
| | - Iain C. Campbell
- King's College London; Institute of Psychiatry, Section of Eating Disorders; London UK
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193
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Treasure J, Ashkan K. Deep brain stimulation for anorexia nervosa: a step forward. EUROPEAN EATING DISORDERS REVIEW 2013; 21:507-8. [PMID: 24115472 DOI: 10.1002/erv.2253] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 08/15/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Janet Treasure
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, UK
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194
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Lipsman N, Woodside DB, Giacobbe P, Lozano AM. Neurosurgical Treatment of Anorexia Nervosa: Review of the Literature from Leucotomy to Deep Brain Stimulation. EUROPEAN EATING DISORDERS REVIEW 2013; 21:428-35. [DOI: 10.1002/erv.2246] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 06/29/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Nir Lipsman
- Division of Neurosurgery, University Health Network; University of Toronto; Toronto ON Canada
| | - D. Blake Woodside
- Department of Psychiatry, University Health Network; University of Toronto; Toronto ON Canada
| | - Peter Giacobbe
- Department of Psychiatry, University Health Network; University of Toronto; Toronto ON Canada
| | - Andres M. Lozano
- Division of Neurosurgery, University Health Network; University of Toronto; Toronto ON Canada
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195
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Heaner MK, Walsh BT. A history of the identification of the characteristic eating disturbances of Bulimia Nervosa, Binge Eating Disorder and Anorexia Nervosa. Appetite 2013; 65:185-8. [DOI: 10.1016/j.appet.2013.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 12/19/2012] [Accepted: 01/14/2013] [Indexed: 10/27/2022]
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