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Dang AB, Kiropoulos L, Castle D, Jenkins Z, Phillipou A, Rossell S, Krug I. Psychiatric comorbidity and severity in anorexia nervosa: a comparative study of the DSM-5, the ICD-11, and overvaluation of Weight/Shape severity ratings. Eat Disord 2024:1-17. [PMID: 38709163 DOI: 10.1080/10640266.2024.2346001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
This study assessed the rate of a.) the total and b.) specific psychiatric comorbidities among the three severity ratings for Anorexia Nervosa (AN): DSM-5, ICD-11 and overvaluation of weight and shape (OWS). The sample comprised 312 treatment-seeking patients with AN (mean age = 26.9). Weight and height were taken at intake to calculate BMI, the foundation for the DSM-5 and ICD-11 severity indices. The EDE-Q was used to assess OWS, and the Mini International Neuropsychiatric Interview was conducted to assess psychiatric comorbidities. For the DSM-5, the mild severity group showed a higher total number of psychiatric comorbidities, especially for panic, social anxiety, generalised anxiety, and post-traumatic stress disorders compared to the severe and extremely severe groups. ICD-11 and OWS severity groups did not significantly differ in total comorbidities, except for major depressive disorder and obsessive-compulsive disorders being more prevalent in the "significantly low BMI" ICD-11 group. The high OWS group displayed a notably higher rate of major depressive disorder than the low OWS group. The study underscores inconsistent patterns across the three severity systems, emphasising the need to recognise the current limitations of the assessed severity classification systems in AN assessment and guiding treatment.
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Affiliation(s)
- An Binh Dang
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Litza Kiropoulos
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - David Castle
- Department of health, Tasmanian Centre for Mental Health Service Innovation Hobart, Tasmania, Australia
- Department of Psychiatry, University of Tasmania, Hobart, Tasmania, Australia
| | - Zoe Jenkins
- Department of Mental Health, St Vincent's Hospital, Melbourne, Australia
- Iverson Institute, Swinburne University of Technology, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Andrea Phillipou
- Centre for Youth Mental Health, Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
- Department of Mental Health, Austin Health, Melbourne, Australia
| | - Susan Rossell
- Department of Mental Health, St Vincent's Hospital, Melbourne, Australia
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
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Aygün Ari D, Pehlivantürk Kizilkan M, Derman O, Akgül S. Menstrual characteristics of atypical anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2024; 32:493-502. [PMID: 38265941 DOI: 10.1002/erv.3065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE While menstrual irregularities are acknowledged in restrictive-type eating disorders (EDs), the menstrual characteristics specific to atypical anorexia nervosa (AAN) remain inadequately defined. This study aims to compare the menstrual features of anorexia nervosa (AN) and AAN. METHOD Adolescents diagnosed with AN or AAN who exhibited secondary amenorrhoea at presentation and had their menstrual cycles restored during follow-up were eligible for this study. Clinical and menstrual data at admission and during follow-up were obtained from patient files, and compared between the AN and AAN cohorts. RESULTS The study included a total of 77 patients (38 with AN and 39 with AAN). The extent of weight loss and the disease duration until the onset of amenorrhoea were comparable in the two groups. However, the duration of illness and the time since the last menstrual period at admission were shorter in the AAN group. Moreover, amenorrhoea manifested at a higher body mass index, and the return of menses occurred more rapidly with less weight gain in the AAN group after the onset of clinical follow-up. Additionally, the AAN group exhibited a shorter overall duration of amenorrhoea. CONCLUSIONS This study highlights the significance of recognising amenorrhoea in restrictive disorders, even when individuals maintain a normal weight. The faster return of menstrual cycles and shorter duration of amenorrhoea observed in adolescents with AAN emphasise the significance of early diagnosis and prompt initiation of treatment. Regardless of the patient's presenting complaint and weight status, obtaining a comprehensive ED history is essential when addressing concerns regarding amenorrhoea or menstrual irregularities.
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Affiliation(s)
- Demet Aygün Ari
- Department of Pediatrics, University of Health Sciences Ankara Dr. Sami Ulus Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Melis Pehlivantürk Kizilkan
- Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Orhan Derman
- Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sinem Akgül
- Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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3
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Pescosolido BA, Green HD. Who has mental health problems? Comparing individual, social and psychiatric constructions of mental health. Soc Psychiatry Psychiatr Epidemiol 2024; 59:443-453. [PMID: 37069339 PMCID: PMC10108793 DOI: 10.1007/s00127-023-02474-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/30/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE The persistent gap between population indicators of poor mental health and the uptake of services raises questions about similarities and differences between social and medical/psychiatric constructions. Rarely do studies have assessments from different perspectives to examine whether and how lay individuals and professionals diverge. METHODS Data from the Person-to-Person Health Interview Study (P2P), a representative U.S. state sample (N ~ 2700) are used to examine the overlap and correlates of three diverse perspectives-self-reported mental health, a self/other problem recognition, and the CAT-MH™ a validated, computer adaptive test for psychopathology screening. Descriptive and multinominal logit analyses compare the presence of mental health problems across stakeholders and their association with respondents' sociodemographic characteristics. RESULTS Analyses reveal a set of socially constructed patterns. Two convergent patterns indicate whether there is (6.9%, The "Sick") or is not (64.6%, The "Well") a problem. The "Unmet Needers" (8.7%) indicates that neither respondents nor those around them recognize a problem identified by the screener. Two patterns indicate clinical need where either respondents (The "Self Deniers", 2.9%) or others (The "Network Deniers", 6.0%) do not. Patterns where the diagnostic indicator does not suggest a problem include The "Worried Well" (4.9%) where only the respondent does, The "Network Coerced" (4.6%) where only others do, and The "Prodromal" (1.4%) where both self and others do. Education, gender, race, and age are associated with social constructions of mental health problems. CONCLUSIONS The implications of these results hold the potential to improve our understanding of unmet need, mental health literacy, stigma, and treatment resistance.
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Affiliation(s)
- Bernice A Pescosolido
- Department of Sociology, College of Arts & Sciences and the Irsay Institute, Indiana University, IN, Bloomington, USA.
| | - Harold D Green
- Department of Applied Health, School of Public Health and the Irsay Institute, Indiana University, IN, Bloomington, USA
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Charrat JP, Massoubre C, Gay A, Ravey B, Germain N, Galusca B. The value of a multidisciplinary consensus meeting in achieving agreement on eating disorders diagnosis at a specialized referral center. Int J Eat Disord 2024; 57:463-469. [PMID: 38135878 DOI: 10.1002/eat.24114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE This study aimed to evaluate the concordance of eating disorders (EDs) diagnoses within a multidisciplinary team in a specialized hospital unit dedicated to the medical care of ED. METHODS The study analyzed data from 608 female patients who sought consultation at the Eating Disorders Referral Center between 2017 and 2021. The diagnoses were established according to the DSM-5 criteria by endocrinologists, psychiatrists, and finally confirmed or discussed within a monthly multidisciplinary consensus meeting (MCM). Fleiss' Kappa tests were conducted to assess inter-raters' agreement. RESULTS Overall, substantial agreement was observed between endocrinologists and psychiatrists and the MCM. A more detailed analysis revealed variations in agreement across different disorders. Certain EDs demonstrated substantial agreement (e.g., anorexia nervosa restrictive subtype), while others approached near-perfect agreement (e.g., binge-eating disorder). In contrast, agreement was fair to poor for anorexia nervosa binge-purge subtype (ANBP) and slight for other specified feeding and ED. A period of temporary disagreement was noted for ANBP, partially attributed to practitioner turnover. An improvement in interdisciplinary agreement was observed for all ED diagnoses by the end of the study period. DISCUSSION Variations or lower levels of inter-rater agreement may stem from atypical cases that fall on the border between two diagnoses or complex cases, as well as fluctuating symptoms. The progress observed throughout the study can be attributed in part to interdisciplinary learning, particularly facilitated by the MCM. The findings underscore the significance of striving for optimal concordance among different medical specialties to enhance patient care in ED treatment. PUBLIC SIGNIFICANCE This study scrutinizes the agreement levels of ED diagnoses among endocrinologists and psychiatrists within a multidisciplinary team at an Eating Disorders Referral Center. While substantial overall agreement was achieved, disparities or lower agreement levels were evident for certain diagnoses such as anorexia nervosa binge-purge subtype. However, collaborative meetings led to a progressive enhancement in agreement over time. This research underscores the crucial role of a multidisciplinary team working collectively to ensure precise diagnoses and improved care for patients with EDs.
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Affiliation(s)
- Jean Philippe Charrat
- TAPE (Eating Disorders, Addictions & Extreme Bodyweight) Laboratory, University Jean Monnet, Saint Etienne, France
| | - Catherine Massoubre
- TAPE (Eating Disorders, Addictions & Extreme Bodyweight) Laboratory, University Jean Monnet, Saint Etienne, France
- Psychiatry Department, Saint Etienne University Hospital, Saint Etienne, France
- Referral Center for Eating Disorders, Saint Etienne University Hospital, Saint Etienne, France
| | - Aurelia Gay
- TAPE (Eating Disorders, Addictions & Extreme Bodyweight) Laboratory, University Jean Monnet, Saint Etienne, France
- Psychiatry Department, Saint Etienne University Hospital, Saint Etienne, France
| | - Baptiste Ravey
- TAPE (Eating Disorders, Addictions & Extreme Bodyweight) Laboratory, University Jean Monnet, Saint Etienne, France
- Psychiatry Department, Saint Etienne University Hospital, Saint Etienne, France
- Referral Center for Eating Disorders, Saint Etienne University Hospital, Saint Etienne, France
| | - Natacha Germain
- TAPE (Eating Disorders, Addictions & Extreme Bodyweight) Laboratory, University Jean Monnet, Saint Etienne, France
- Referral Center for Eating Disorders, Saint Etienne University Hospital, Saint Etienne, France
- Endocrinology Department, Saint Etienne University Hospital, Saint Etienne, France
| | - Bogdan Galusca
- TAPE (Eating Disorders, Addictions & Extreme Bodyweight) Laboratory, University Jean Monnet, Saint Etienne, France
- Referral Center for Eating Disorders, Saint Etienne University Hospital, Saint Etienne, France
- Endocrinology Department, Saint Etienne University Hospital, Saint Etienne, France
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Merino D, Gérard AO, Destere A, Askenazy F, Dor E, Benoit M, Cherikh F, Drici MD. Iatrogenic triggers for anorexia nervosa and bulimia nervosa: A WHO safety database disproportionality analysis. Psychiatry Res 2023; 327:115415. [PMID: 37611327 DOI: 10.1016/j.psychres.2023.115415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/31/2023] [Accepted: 08/11/2023] [Indexed: 08/25/2023]
Abstract
Eating disorders, characterized by abnormal eating, weight control behaviors or both include anorexia nervosa (AN) and bulimia nervosa (BN). We investigated their potential iatrogenic triggers, using real-world data from the WHO safety database (VigiBase®). VigiBase® was queried for all AN and BN reports. The reports were classified as `pediatric' or `adult' according to age. Disproportionality analyses relied on the Information Component (IC), in which a 95% confidence interval lower-end positivity was required to suspect a signal. Our queries yielded 309 AN and 499 BN reports. Isotretinoin was disproportionately reported in pediatric AN (IC 3.6; [2.6-4.3]), adult AN (IC 3.1; [1.7-4.0]), and pediatric BN (IC 3.9; [3.0-4.7]). Lamivudine (IC 4.2; [3.2-4.9]), nevirapine (IC 3.7; [2.6-4.6]), and zidovudine (IC 3.4; [2.0-4.3]) had the highest ICs in adult AN. AN was associated with isotretinoin, anticonvulsants in minors, and antiretroviral drugs in adults. In adults, BN was related to psychotropic and hormonally active drugs. Before treatment initiation, an anamnesis should seek out mental health conditions, allowing the identification of patients at risk of developing or relapsing into AN or BN. In addition to misuse, the hypothesis of iatrogenic triggers for AN and BN should also be considered.
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Affiliation(s)
- Diane Merino
- Department of Psychiatry, University Hospital of Nice, Nice, France; Department of Pharmacology and Pharmacovigilance Center of Nice, University Hospital Center of Nice, Nice, France
| | - Alexandre Olivier Gérard
- Department of Pharmacology and Pharmacovigilance Center of Nice, University Hospital Center of Nice, Nice, France; Université Côte d'Azur Laboratory of Molecular Physio Medicine (LP2M), UMR 7370, CNRS, Nice, France
| | - Alexandre Destere
- Department of Pharmacology and Pharmacovigilance Center of Nice, University Hospital Center of Nice, Nice, France; Université Côte d'Azur, Inria, CNRS, Laboratoire J.A. Dieudonné, Maasai team, Nice, France
| | - Florence Askenazy
- Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice, CHU-Lenval Nice, France; CoBTek Laboratory, Université Côte d'Azur, 06000 Nice, France
| | - Emmanuelle Dor
- Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice, CHU-Lenval Nice, France; CoBTek Laboratory, Université Côte d'Azur, 06000 Nice, France
| | - Michel Benoit
- Department of Psychiatry, University Hospital of Nice, Nice, France
| | - Faredj Cherikh
- Department of Addiction, University Hospital of Nice, Nice, France
| | - Milou-Daniel Drici
- Department of Pharmacology and Pharmacovigilance Center of Nice, University Hospital Center of Nice, Nice, France.
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6
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First MB. What to do about atypical anorexia nervosa? Commentary on Walsh et al. (2023). Int J Eat Disord 2023; 56:821-823. [PMID: 36722504 DOI: 10.1002/eat.23903] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/10/2023] [Accepted: 01/15/2023] [Indexed: 02/02/2023]
Abstract
Changes made to the DSM Eating Disorders over the years have aimed to reduce the prevalence of the residual DSM Eating Disorder categories (e.g., Other Specified Eating Disorder). Atypical Anorexia Nervosa (AN), included since DSM-IV as an example of a presentation not meeting criteria for a specific eating disorder, appears to be more prevalent than AN. It is defined as meeting all of the criteria for AN except that, after significant weight loss, weight is at or above normal. As suggested by the Walsh et al. review, lack of definitional precision will likely complicate efforts to determine whether atypical AN is best considered a variant of AN or a distinct category. Problems with the current definition of atypical AN include (1) a lack of precision regarding what constitutes "significant" weight loss; (2) whether the weight loss can occur at any point in the individual's lifetime; and (3) whether there an upper limit to weight being above normal. It is suggested that researchers develop consensus diagnostic criteria and assessment tools to facilitate the collection of empirical data about atypical AN in order to lay the groundwork for future decisions about its nosological status.
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Affiliation(s)
- Michael B First
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
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Huckins LM, Signer R, Johnson J, Wu YK, Mitchell KS, Bulik CM. What next for eating disorder genetics? Replacing myths with facts to sharpen our understanding. Mol Psychiatry 2022; 27:3929-3938. [PMID: 35595976 PMCID: PMC9718676 DOI: 10.1038/s41380-022-01601-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 02/07/2023]
Abstract
Substantial progress has been made in the understanding of anorexia nervosa (AN) and eating disorder (ED) genetics through the efforts of large-scale collaborative consortia, yielding the first genome-wide significant loci, AN-associated genes, and insights into metabo-psychiatric underpinnings of the disorders. However, the translatability, generalizability, and reach of these insights are hampered by an overly narrow focus in our research. In particular, stereotypes, myths, assumptions and misconceptions have resulted in incomplete or incorrect understandings of ED presentations and trajectories, and exclusion of certain patient groups from our studies. In this review, we aim to counteract these historical imbalances. Taking as our starting point the Academy for Eating Disorders (AED) Truth #5 "Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses", we discuss what we do and do not know about the genetic underpinnings of EDs among people in each of these groups, and suggest strategies to design more inclusive studies. In the second half of our review, we outline broad strategic goals whereby ED researchers can expand the diversity, insights, and clinical translatability of their studies.
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Affiliation(s)
- Laura M Huckins
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Mental Illness Research, Education and Clinical Centers, James J. Peters Department of Veterans Affairs Medical Center, Bronx, NY, 14068, USA
| | - Rebecca Signer
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Jessica Johnson
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ya-Ke Wu
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karen S Mitchell
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Saldanha N, Fisher M. Menstrual disorders in adolescents and young adults with eating disorders. Curr Probl Pediatr Adolesc Health Care 2022; 52:101240. [PMID: 35909056 DOI: 10.1016/j.cppeds.2022.101240] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Although amenorrhea is no longer a specific criterion required to make the diagnosis of anorexia nervosa (AN), the relationship between restrictive eating and menstrual status remains important in the diagnosis, treatment, and consequences for patients with eating disorders. Clinicians should understand the relationship between menstrual irregularities and malnutrition due to eating disorders, as it may be possible to intervene sooner if the diagnosis is made earlier. Treatment of AN (in those who are underweight) and atypical AN (in those who are not underweight) is aimed at cessation of restrictive thoughts and behaviors, restoration of appropriate nutrition and weight, and normal functioning of the body. While eating disorder thoughts and behaviors are helped by both therapy and nutrition, regular functioning of the body, including regular menstruation, is linked to both appropriate nutrition and weight. Patients who are not underweight based on their body mass index (BMI) may still have oligo/amenorrhea due to their caloric restriction; thus any patient who has irregular menses should have a detailed dietary evaluation as part of their workup. Timely diagnosis and treatment of patients with eating disorders and amenorrhea is important due to the impact on bone mass accrual for adolescents who have prolonged amenorrhea. Menstrual abnormalities may also be seen in patients with bulimia nervosa (BN).
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Affiliation(s)
- Nadia Saldanha
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, 410 Lakeville Road, Suite 108, New Hyde Park, New York 11042, USA; Donald and Barbara Zucker, School of Medicine at Hofstra / Northwell, Hempstead, New York, USA.
| | - Martin Fisher
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, 410 Lakeville Road, Suite 108, New Hyde Park, New York 11042, USA; Donald and Barbara Zucker, School of Medicine at Hofstra / Northwell, Hempstead, New York, USA
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9
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Raval CM, Bhatt RB, Tiwari DS, Panchal BN. Prevalence and characteristics of eating disorders among college students of a nonmetro city of Gujarat. Ind Psychiatry J 2022; 31:74-80. [PMID: 35800878 PMCID: PMC9255602 DOI: 10.4103/ipj.ipj_28_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/13/2021] [Accepted: 10/11/2021] [Indexed: 11/06/2022] Open
Abstract
CONTEXT There is a relative paucity of prevalence data about eating disorders (EDs) in India among young population. AIMS We aimed to estimate the prevalence and characteristics of EDs and abnormal eating behaviors among college students of a nonmetro city of Gujarat. SETTING AND DESIGN A cross-sectional survey was done among five colleges of a nonmetro city in Gujarat from February to September 2019. SUBJECTS AND METHODS Total 790 college students were assessed using a semi-structured format, Eating Attitudes Test-26, and Bulimic Investigatory Test Edinburgh followed by structured clinical interview as per DSM-5 criteria for EDs. STATISTICAL ANALYSIS Outcomes were expressed in frequency, proportion, mean, and standard deviation. P values were calculated by Pearson Chi-square test or Fisher's exact test to determine the significance of the result. RESULTS The prevalence of abnormal eating behaviors was 25.2% (n = 199). Anorexia nervosa (AN) was not detected. The prevalence of bulimia nervosa (BN) was 0.2% and other specified feeding or eating disorder (OSFED) was 0.6%. "Being aware of calorie content" (53.7%) and "preoccupation with desire of thinness" (46.3%) were commonly found. "Impulse to vomit after meals" (2.5%) was least common. Lower body mass index was found among subjects with abnormal eating behavior. None of the subjects had amenorrhea. CONCLUSIONS The prevalence of disordered eating behaviors, BN, and OSFED was 25.2%, 0.2%, and 0.6%, respectively. AN was not detected. OSFED was the most common ED and the characteristic "body image disturbance" was the most common symptom.
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Affiliation(s)
| | | | - Deepak S Tiwari
- Department of Psychiatry, M P Shah Medical College, Jamnagar, Gujarat, India
| | - Bharat N Panchal
- Department of Psychiatry, Government Medical College, Bhavnagar, Gujarat, India
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10
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Halbeisen G, Brandt G, Paslakis G. A Plea for Diversity in Eating Disorders Research. Front Psychiatry 2022; 13:820043. [PMID: 35250670 PMCID: PMC8894317 DOI: 10.3389/fpsyt.2022.820043] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/21/2022] [Indexed: 12/22/2022] Open
Abstract
Eating disorders (EDs) are often stereotyped as affecting the SWAG, that is, as affecting mostly skinny, White, affluent girls. Over the last decade, however, significant progress has been made toward increasing diversity in ED research. There is consensus that EDs affect individuals of all genders, ages, sexual orientations, ethnic, and socio-economic backgrounds, with recent studies exploring social determinants of ED etiology, ED presentation, and developing diversity-affirming ED assessments. This article provides a brief summary of current developments related to diversity as a research theme, and proposes different perspectives toward further improving diversity in ED research. Specifically, we argue for exploring the role of diversity in ED treatment settings and outcomes, for pursuing diversity-oriented research pro-actively rather than as a reaction to issues of under-representation, and for integrating diversity across different areas of medical education and trainings in psychotherapy. Limitations with respect to the paucity of research, and the link between diversity as a research theme and ED-related workforce diversity are discussed.
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Affiliation(s)
- Georg Halbeisen
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Luebbecke, Germany
| | - Gerrit Brandt
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Luebbecke, Germany
| | - Georgios Paslakis
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Luebbecke, Germany
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11
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Harshman SG, Jo J, Kuhnle M, Hauser K, Murray HB, Becker KR, Misra M, Eddy KT, Micali N, Lawson EA, Thomas JJ. A Moving Target: How We Define Avoidant/Restrictive Food Intake Disorder Can Double Its Prevalence. J Clin Psychiatry 2021; 82:20m13831. [PMID: 34496463 PMCID: PMC8493963 DOI: 10.4088/jcp.20m13831] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: The DSM-5 criteria for avoidant/restrictive food intake disorder (ARFID) include ambiguities. Diagnostic criteria that allow for clinical judgment are essential for clinical practice. However, ambiguities can have major implications for treatment access and comparability and generalizability of research studies. The purpose of this study was to determine the degree to which distinct operationalizations of the diagnostic criteria for ARFID contribute to differences in the frequency of individuals who are eligible for the ARFID diagnosis. Methods: Because criteria B, C, and D are rule-outs, we focused on criterion A, identified 19 potential operational definitions, and determined the extent to which these different methods impacted the proportion of individuals who met criteria for ARFID in a sample of children, adolescents, and young adults (n = 80; September 2016-February 2020) enrolled in an avoidant/restrictive eating study. Results: Within each criterion, the proportion of individuals meeting diagnostic criteria differed significantly across the methodologies (all P values < .008). Using the strictest definition of each criterion, 50.0% (n = 40) of participants met criteria for ARFID. In contrast, under the most lenient definition of each criterion, the number nearly doubled, resulting in 97.5% (n = 78) meeting ARFID criteria. Conclusions: Comparison of diagnostic definitions for ARFID among children, adolescents, and young adults confirmed a broad range of statistically distinct proportions within a single sample. Our findings support the need for additional contextual support and consensus among disciplines on operationalization in both research and clinical settings.
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Affiliation(s)
- Stephanie G Harshman
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts.,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Corresponding author: Stephanie G. Harshman, PhD, Massachusetts General Hospital, Neuroendocrine Unit, 55 Fruit St, Boston, MA 02114
| | - Jenny Jo
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, 02114 USA,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, 02114 USA
| | - Megan Kuhnle
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, 02114 USA,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, 02114 USA
| | - Kristine Hauser
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, 02114 USA,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, 02114 USA
| | - Helen Burton Murray
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, 02114 USA,Department of Medicine, Harvard Medical School, Boston, MA, 02114 USA
| | - Kendra R. Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, 02114 USA,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114 USA
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, 02114 USA,Department of Medicine, Harvard Medical School, Boston, MA, 02114 USA,Division of Pediatric Endocrinology, Massachusetts General Hospital for Children, Boston, MA, 02114 USA
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, 02114 USA,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114 USA
| | - Nadia Micali
- Great Ormond Street Institute of Child Health, University College London, London, UK,Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland,Department of Paediatrics Gynaecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Elizabeth A. Lawson
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, 02114 USA,Department of Medicine, Harvard Medical School, Boston, MA, 02114 USA
| | - Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, 02114 USA,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114 USA
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12
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Dardennes R, Tolle V, Lavoisy G, Grouselle D, Alanbar N, Duriez P, Gorwood P, Ramoz N, Epelbaum J. Lower leptin level at discharge in acute anorexia nervosa is associated with early weight-loss. EUROPEAN EATING DISORDERS REVIEW 2021; 29:634-644. [PMID: 33880836 DOI: 10.1002/erv.2830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 02/16/2021] [Accepted: 03/14/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Predictive values of acute phase metabolic abnormalities of anorexia nervosa (AN) have seldom been studied. As early postrestoration weight loss is associated with poor outcome, discharge biologic parameters were assessed to detect an association with 2-month follow-up weight loss as a proxy to poor outcome. METHOD Fasting plasma levels of leptin, acyl-ghrelin, obestatin, PYY, oxytocin and BDNF were measured in 26 inpatients, at inclusion, at discharge and 2 months later. A body mass index less than 18 2-month postdischarge was considered a poor outcome. RESULTS Nineteen patients (73%) had a fair outcome and seven (27%) had a poor one with a mean loss of 0.69 versus 4.54 kg, respectively. Only discharge leptin levels were significantly higher in fair versus poor outcome patients (14.1 vs. 7.0 ng/ml, p = 0.006). The logistic regression model using discharge leptin, acyl-ghrelin, obestatin, oxytocin, PYY and BDNF levels as predictors of outcome disclosed a nearly significant effect of leptin (p < 0.10). Receiver operating characteristic analysis showed 11.9 ng/ml was the best value of threshold. Neither clinical variables differed according to outcome. CONCLUSION Leptin level may be a biomarker of early weight relapse after acute inpatient treatment of AN. Its clinical usefulness in monitoring care in AN should further be determined.
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Affiliation(s)
- Roland Dardennes
- Faculté de Médecine, Université de Paris Descartes, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France.,Clinique des Maladies Mentales et de l'encéphale, Hospital Sainte-Anne, Paris, France
| | - Virginie Tolle
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France
| | - Guillaume Lavoisy
- Faculté de Médecine, Université de Paris Descartes, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France.,Clinique des Maladies Mentales et de l'encéphale, Hospital Sainte-Anne, Paris, France
| | - Dominique Grouselle
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France
| | - Nebal Alanbar
- Faculté de Médecine, Université de Paris Descartes, Paris, France
| | - Philibert Duriez
- Faculté de Médecine, Université de Paris Descartes, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France.,Clinique des Maladies Mentales et de l'encéphale, Hospital Sainte-Anne, Paris, France
| | - Philip Gorwood
- Faculté de Médecine, Université de Paris Descartes, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France.,Clinique des Maladies Mentales et de l'encéphale, Hospital Sainte-Anne, Paris, France
| | - Nicolas Ramoz
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France
| | - Jacques Epelbaum
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France
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13
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Fertility and Reproduction after Recovery from Anorexia Nervosa: A Systematic Review and Meta-Analysis of Long-Term Follow-Up Studies. Diseases 2020; 8:diseases8040046. [PMID: 33339411 PMCID: PMC7768504 DOI: 10.3390/diseases8040046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 12/26/2022] Open
Abstract
Reproductive health is compromised during anorexia nervosa (AN). However, it is still unclear whether this medical complication is reversible after recovery from AN. The purpose of this paper was to conduct a systematic review of the major reproductive health outcomes in females after recovery from AN. The review was conducted in adherence to preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines. Data were collated using meta-analysis and a narrative approach. Of the 1186 articles retrieved, five studies met the inclusion criteria and were reviewed. These studies monitored weight-restored females who had recovered from AN for a follow-up period of between six and 18 years. Their narrative analysis revealed that appropriate treatment of AN leads to the normalization of reproductive function, especially in terms of fertility, pregnancy, and childbirth rates. The meta-analysis confirmed this finding, where the pooled odds of childbirth rates between the AN group and the general population was not statistically significant (OR = 0.75, 95% CI: 0.43–1.29, p = 0.41). We conclude that if patients undergo appropriate eating-disorder treatment and weight restoration, it appears to be unlikely that reproductive health is affected by AN. However, since this finding is derived from only a few studies, it requires replication and confirmation.
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14
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Loeb KL, Weissman RS, Marcus S, Pattanayak C, Hail L, Kung KC, Schron D, Zucker N, Le Grange D, Lock J, Newcorn JH, Taylor CB, Walsh BT. Family-Based Treatment for Anorexia Nervosa Symptoms in High-Risk Youth: A Partially-Randomized Preference-Design Study. Front Psychiatry 2020; 10:985. [PMID: 32038326 PMCID: PMC6987468 DOI: 10.3389/fpsyt.2019.00985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
This pilot study adapted family-based treatment (FBT) for youth with potentially prodromal anorexia nervosa (AN). Fifty-nine youth with clinically significant AN symptom constellations, but who never met full Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) (DSM-IV) criteria for AN, were enrolled in a partially randomized preference design study. Participants were offered randomization to FBT or supportive psychotherapy (SPT); those who declined to be randomized because of a strong treatment preference were entered into a parallel, non-randomized self-selected intervention study. Without accessing outcome data, an observational analysis with three diagnostic subclasses was designed based on AN symptom severity profiles, combining randomized and non-randomized participants, such that participants receiving FBT and SPT within each subclass were similar on key baseline characteristics. Outcomes of this pilot study were explored by calculating effect sizes for end-of-treatment values within each subclass, and also with a longitudinal mixed effect model that accounted for subclass. Weight trajectory was measured by percent expected body weight. Psychological outcomes were fear of weight gain, feeling fat, importance of weight, and importance of shape. Results show that the pattern of symptom observations over time was dependent on subclass of SAN (least symptomatic, moderately symptomatic, or most symptomatic) and on the target outcome variable category (weight or psychological). Results from this study, which should be considered in the context of the small sample sizes overall and within groups, can generate hypotheses for future, larger research trials on early treatment strategies. Feasibility findings illustrate how the innovative partially randomized preference design has potential broader application for AN intervention research. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, identifier NCT00418977.
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Affiliation(s)
- Katharine L. Loeb
- School of Psychology, Fairleigh Dickinson University, Teaneck, NJ, United States
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Sue Marcus
- Consultant, Philadelphia, PA, United States
| | - Cassandra Pattanayak
- Department of Mathematics, Quantitative Reasoning Program, and the Quantitative Analysis Institute at Wellesley College, Wellesley, CT, United States
| | - Lisa Hail
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Kelly C. Kung
- Department of Mathematics, Boston University, Boston, MA, United States
| | - Diana Schron
- School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
| | - Nancy Zucker
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, United States (Emeritus)
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Jeffrey H. Newcorn
- Departments of Psychiatry and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Center for mHealth, Palo Alto University, Palo Alto, CA, United States
| | - B. Timothy Walsh
- Department of Psychiatry, Columbia University, New York, NY, United States
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15
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IS BODY FAT PERCENTAGE A GOOD PREDICTOR OF MENSTRUAL RECOVERY IN FEMALES WITH ANOREXIA NERVOSA AFTER WEIGHT RESTORATION? A SYSTEMATIC REVIEW AND EXPLORATORY AND SELECTIVE META-ANALYSIS. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY 2019; 26:e25-e37. [PMID: 31577083 DOI: 10.15586/jptcp.v26i2.601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/11/2019] [Indexed: 01/11/2023]
Abstract
The resumption of menses (ROM) is an important outcome in anorexia nervosa treatment and is considered as a sign of recovery. Identification of relevant factors in its prediction is important in clinical practice. Therefore we aimed to conduct a systematic review and exploratory meta-analysis of the association between total body fat percentage (%BF) and ROM after weight restoration in adolescents and young adults with anorexia nervosa. The study was conducted by adhering to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Data were collated using meta-analysis and a narrative approach. Of the 604 articles retrieved, only seven studies comprising a total of 366 adolescent and young adult females with anorexia nervosa met the inclusion criteria and were reviewed, and preliminary results revealed three main findings. Firstly, patients who resumed their menstrual cycle had a significantly higher mean %BF when compared to those who did not, an overall effect confirmed by the meta-analysis (SMD: 3.74, 95% CI: 2.26-5.22). Secondly, %BF was found to be an independent predictor of the ROM in this population and an increase of only one unit of %BF can increase the odds of menstruation by ≈15-20%. Thirdly, despite the paucity of data, a cut-off point of %BF≈21was suggested as the minimum needed for ROM. In conclusion, a higher %BF seems to be associated with the ROM in weight-restored adolescent and young adult females with anorexia nervosa. Its assessment is important in a clinical setting, especially after complete weight restoration. The PROSPERO Registry - A systematic review and meta-analysis of the factors associated with the resumption of the menstrual cycle in females with anorexia nervosa after weight restoration (CRD42019111841).
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16
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Tokatly Latzer I, Kidron-Levy H, Stein D, Levy AE, Yosef G, Ziv-Baran T, Dubnov-Raz G. Predicting Menstrual Recovery in Adolescents With Anorexia Nervosa Using Body Fat Percent Estimated by Bioimpedance Analysis. J Adolesc Health 2019; 64:454-460. [PMID: 30528301 DOI: 10.1016/j.jadohealth.2018.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/24/2018] [Accepted: 10/15/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To identify the threshold of total body fat percentage (TBF%) required for the resumption of menses (ROM) in hospitalized female adolescents with anorexia nervosa (AN) using bioimpedance analysis (BIA). METHODS All female adolescents hospitalized with AN in our medical center were evaluated in a longitudinal prospective study during the years of 2012-2017. Anthropometric data, body fat measured by BIA, and hormonal determinants were collected periodically, in addition to routine medical and gynecological assessments. RESULTS Sixty-two participants presented with secondary amenorrhea, of which 20 remained with amenorrhea and 42 had ROM during hospitalization. At discharge, participants with ROM regained significantly more weight, and had higher mean body mass index (BMI), BMI standard deviation scores, and TBF% than those who remained with amenorrhea. Receiver operating characteristic analysis identified that a TBF% of 21.2% had the highest discriminative ability for ROM (sensitivity = 88%, specificity = 85%, positive predictive value = 93%). Compared with the anthropometric parameters, TBF% had the highest area under curve (AUC = .895), which significantly differed from that of BMI standard deviation scores (AUC = .643, p = .007) and body weight (AUC = .678, p = .03). CONCLUSIONS BIA is a safe and relatively simple method to assess the TBF% required for the return of balanced menstrual cycles in female adolescents with AN. The TBF% with the highest discriminative ability for menstrual resumption as assessed by BIA is 21.2%.
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Affiliation(s)
- Itay Tokatly Latzer
- Department of Pediatrics A, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hila Kidron-Levy
- Pediatric Psychosomatic Department, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Stein
- Pediatric Psychosomatic Department, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Enoch Levy
- Pediatric Psychosomatic Department, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galit Yosef
- Pediatric Psychosomatic Department, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Dubnov-Raz
- Exercise, Nutrition and Lifestyle Clinic, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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17
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Abstract
The Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) for 6 feeding and eating disorders were published in 2013 and were notable for officially recognizing binge-eating disorder and for articulating criteria for avoidant/restrictive food intake disorder. The criteria and the rationale for them are briefly described, and current and future challenges are discussed.
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Affiliation(s)
- B Timothy Walsh
- New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA.
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18
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Xin M, He J, Zhang Y, Wu Y, Yang W, Liang X, Yin X. Chinese herbal decoction of Wenshen Yangxue formula improved fertility and pregnancy rate in mice through PI3K/Akt signaling. J Cell Biochem 2018; 120:3082-3090. [PMID: 30474873 DOI: 10.1002/jcb.27483] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 07/18/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Traditional Chinese medicine (TCM) is an effective management to infertility. The association between TCM-mediated fertility and inhibition of phosphatidylinositol-3-kinase (PI3K) would be investigated. METHODS Institute of Cancer Research mice were treated with three herbal decoctions, named Wenshen Yangxue formula, Wenshen formula, and Yangxue formula, plus with human gonadotropins. PI3K inhibitor wortmannin was administrated to half of mice. Some index such as body weight, fertility ability would be investigated. The expression of P13K/Akt signaling was detected by using Western blot analysis. RESULTS No difference was observed in body weight among groups. Mice receiving the administration of human gonadotropins and herbal decoctions showed increased follicle numbers, percentage of fertilization, and promoted embryonic development. The treatment of Wenshen Yangxue formula decoction showed the highest efficiency, significant higher than Wenshen and Yangxue formulas. And increased the expression of p-PI3K and p-Akt proteins. CONCLUSION These results suggested the herbal decoctions promoted the fertilization of mice, which was related to the charge of PI3K/Akt activation.
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Affiliation(s)
- Mingwei Xin
- Department of Traditional Chinese Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Junqin He
- Department of Traditional Chinese Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Ying Zhang
- Department of Traditional Chinese Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Ying Wu
- Department of Traditional Chinese Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Wei Yang
- Department of Traditional Chinese Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Xinyun Liang
- Department of Traditional Chinese Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Xiaodan Yin
- Department of Traditional Chinese Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
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19
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Boyd HK, Bodell LP, Jennings KM, Graham AK, Crosby RD, Wildes JE. Relationship between desired weight constructs and eating disorder severity following treatment for anorexia nervosa. Int J Eat Disord 2018; 51:870-878. [PMID: 29734468 PMCID: PMC6222021 DOI: 10.1002/eat.22879] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/13/2018] [Accepted: 04/14/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Desired weight is an indicator of illness severity in youth with anorexia nervosa (AN), but its impact on eating disorder symptoms over time and in adults is unknown. This study examined longitudinal associations between two desired weight constructs (desired weight percentage, weight difference percentage) and eating disorder severity and body mass index (BMI) in patients aged 16-62 years old with AN presenting for inpatient or day hospital treatment. METHOD Participants (N = 160) completed the Eating Disorder Examination and measures of height and weight at treatment admission, discharge, and 3, 6, and 12 months post-discharge. Desired weight percentage was calculated as [desired BMI(desired weight in kg/height in meters2 )/healthy BMI] × 100. weight difference percentage was calculated as [(actual weight-desired weight)/actual weight] × 100. RESULTS At admission, participants were approximately 78.6% of a healthy BMI and desired to be 81% of a healthy BMI. During the year following treatment, participants were 89% of a healthy BMI, but wanted to be 86% of a healthy BMI. Individuals with lower desired weight percentage (wanting to be a lower percentage of a healthy BMI) or higher weight difference percentage (wanting to lose a larger percentage of weight) at treatment admission endorsed greater eating disorder severity across time. Additionally, individuals with higher desired weight percentage or weight difference percentage had higher BMIs at intake, and greater increases in BMI over time. DISCUSSION Results highlight that desired weight constructs represent correlates of illness severity in AN and may inform an individual's likely weight trajectory during and after treatment.
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Affiliation(s)
- Hope K. Boyd
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience
| | - Lindsay P. Bodell
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience
| | - Karen M. Jennings
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience
| | - Andrea K. Graham
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience
| | - Ross D. Crosby
- Neuropsychiatric Research Institute,University of North Dakota School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Science
| | - Jennifer E. Wildes
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience
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20
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Fichter MM, Quadflieg N, Crosby RD, Koch S. Long-term outcome of anorexia nervosa: Results from a large clinical longitudinal study. Int J Eat Disord 2017. [PMID: 28644530 DOI: 10.1002/eat.22736] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Assessment of the long-term outcome of anorexia nervosa (AN) in a very large sample of inpatients (N = 1,693) and identification of predictors for poor outcome. METHOD Over 25 years (mean 10 years), consecutively admitted inpatients of a specialized hospital were followed. A subsample of 112 patients with 20-year follow-up was defined. Bivariate comparisons and logistic regression analysis identified risk factors of poor outcome. RESULTS Body mass index (BMI) increased during the follow-up period. Eating behavior as well as general psychopathology improved but did not reach the level of healthy controls. Remission was found in 30% (total sample) and in 40% (20-year follow-up subsample). Crossover from AN to binge-eating disorder or obesity was rare. The predictors of a negative course of illness included lower BMI at admission; a higher score on the Eating Disorder Inventory Maturity Fears subscale at admission; fewer follow-up years; and higher age at admission. The main diagnostic crossover occurred from AN to eating disorder not otherwise specified. Motherhood was related to better outcome. DISCUSSION Many patients with very severe AN recover from their illness but AN also shows considerable long-term negative consequences. Over long time periods, survivors show improvement but better treatments for severe cases are still needed. Predictors of outcome included symptom severity, chronicity, and length of follow-up but not psychiatric comorbidity.
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Affiliation(s)
- Manfred Maximilian Fichter
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University (LMU), Munich, 80336, Germany.,Schön Klinik Roseneck affiliated with the Medical Faculty of the University of Munich (LMU), Prien, 83209, Germany
| | - Norbert Quadflieg
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University (LMU), Munich, 80336, Germany
| | - Ross D Crosby
- Neuropsychiatric Research Institute, Fargo, North Dakota.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Sonja Koch
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University (LMU), Munich, 80336, Germany
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21
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Bruneau M, Colombel A, Mirallié S, Fréour T, Hardouin JB, Barrière P, Grall-Bronnec M. Desire for a child and eating disorders in women seeking infertility treatment. PLoS One 2017; 12:e0178848. [PMID: 28586392 PMCID: PMC5460847 DOI: 10.1371/journal.pone.0178848] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 05/21/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the prevalence of EDs in women seeking treatment for infertility, and to better characterize their clinical profile. STUDY DESIGN Sixty participants completed self-report measures that assessed EDs, desire for a child, body preoccupations, quality of life, anxiety and depression. RESULTS Ten patients (17%) met criteria for a past or current ED. We showed a significant association between greater body dissatisfaction and a more ambivalent desire for a child. Furthermore, an ED was associated with (i) a lower quality of life, and (ii) more anxiety disorders. CONCLUSION Screening for a history of ED in infertile women is recommended to plan for adapted care regarding infertility but also regarding ED and psychiatric comorbidities. Therefore, the assessment has to take into account the desire for a child and the body satisfaction, that are essential parts of the ED process on the one hand and infertility process on the other. This could help with the infertility treatment and the prevention of negative maternal and fetal outcomes.
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Affiliation(s)
- Mélanie Bruneau
- CHU Nantes, Department of Addictology and Psychiatry, Nantes, France
- Université Nantes, EA 4275 SPHERE "bioStatistics, Pharmacoepidemiology and Human sciEnces Research tEam", Faculties of Medicine and Pharmaceutical Sciences, Nantes, France
| | - Agnès Colombel
- CHU Nantes, Department of Reproductive Medicine, Nantes, France
| | - Sophie Mirallié
- CHU Nantes, Department of Reproductive Medicine, Nantes, France
| | - Thomas Fréour
- CHU Nantes, Department of Reproductive Medicine, Nantes, France
| | - Jean-Benoit Hardouin
- Université Nantes, EA 4275 SPHERE "bioStatistics, Pharmacoepidemiology and Human sciEnces Research tEam", Faculties of Medicine and Pharmaceutical Sciences, Nantes, France
- CHU Nantes, Unit of Methodology and Biostatistics, Nantes, France
| | - Paul Barrière
- CHU Nantes, Department of Reproductive Medicine, Nantes, France
| | - Marie Grall-Bronnec
- CHU Nantes, Department of Addictology and Psychiatry, Nantes, France
- Université Nantes, EA 4275 SPHERE "bioStatistics, Pharmacoepidemiology and Human sciEnces Research tEam", Faculties of Medicine and Pharmaceutical Sciences, Nantes, France
- * E-mail:
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22
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Abstract
Anorexia nervosa has the highest mortality rate among all psychiatric illnesses, as it can result in significant psychopathology along with life-threatening medical complications. Atypical anorexia nervosa is a new variant described in the latest DSM edition, which has much in common with anorexia nervosa and also can result in significant morbidity and mortality. The evolution of the criteria for these illnesses is reviewed, and the two are compared and contrasted in this article. Important labs to monitor for in those with these illnesses, along with an emphasis on the monitoring of vital signs and weight, are reviewed here. The necessity for close psychiatric monitoring of safety concerns, including suicidal thoughts, is also stressed. The etiology and the treatment of these illnesses are reviewed from a biopsychosocial approach; and lastly, the prognosis of these illnesses is discussed.
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Affiliation(s)
- Lindsay Moskowitz
- Department of Psychiatry, Northwell Health, New Hyde Park, NY; Hofstra-Northwell School of Medicine, Hempstead, NY
| | - Eric Weiselberg
- Division of Adolescent Medicine, Cohen Children׳s Medical Center, Northwell Health, New Hyde Park, NY; Hofstra-Northwell School of Medicine, Hempstead, NY
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23
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Berner LA, Feig EH, Witt AA, Lowe MR. Menstrual cycle loss and resumption among patients with anorexia nervosa spectrum eating disorders: Is relative or absolute weight more influential? Int J Eat Disord 2017; 50:442-446. [PMID: 28263397 DOI: 10.1002/eat.22697] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Prior research suggests that both body mass index (BMI) and weight suppression (highest past weight minus current weight; WS) are important in determining adult anorexia nervosa (AN) severity. We examined associations between amenorrhea and WS, DSM-5 BMI severity category, and highest premorbid BMI among patients with AN. METHOD Participants (N = 69) were adult female AN-spectrum patients at two residential treatment facilities. At admission, height, and weight were measured, and participants completed questionnaires assessing menstrual status and weight history. RESULTS Greater WS, adjusted for BMI, was associated with menstrual function at admission. First amenorrhea onset occurred at a normal BMI for 38.5% of participants. Premorbid highest BMI positively correlated with BMI at amenorrhea onset, and higher BMI at amenorrhea onset was associated with higher BMI at menses resumption. DISCUSSION These findings add to the literature indicating that relative and absolute weight status are dual indicators of illness severity in AN, and preliminarily suggest that a large proportion of adults who present for treatment initially may have shown symptoms of starvation at a normal BMI. Results underscore the need to focus on weight loss in early detection efforts and may inform target weight setting in the treatment of AN.
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Affiliation(s)
| | | | | | - Michael R Lowe
- Drexel University, Philadelphia, Pennsylvania.,The Renfrew Center for Eating Disorders, Philadelphia, Pennsylvania
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Pentz I, Nakić Radoš S. Functional hypothalamic amenorrhea and its psychological correlates: a controlled comparison. J Reprod Infant Psychol 2017. [DOI: 10.1080/02646838.2016.1278201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Sandra Nakić Radoš
- Department of Psychology, Catholic University of Croatia, Zagreb, Croatia
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25
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Weissman RS. Fifty volumes of scholarship on eating disorders. Int J Eat Disord 2017; 50:3-8. [PMID: 28025874 DOI: 10.1002/eat.22653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/16/2016] [Indexed: 11/08/2022]
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26
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Reassessment of patients with Eating Disorders after moving from DSM-IV towards DSM-5: a retrospective study in a clinical sample. Eat Weight Disord 2016; 21:617-624. [PMID: 27573908 DOI: 10.1007/s40519-016-0314-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To compare the relative prevalence of eating disorders moving from DSM-IV to DSM-5, and to reassess the overall medical impairment in the revised diagnostic classes. METHODS We applied DSM-5 to 206 patients (age 15-56 years) previously studied and classified according to DSM-IV. Medical impairment was classified as low, medium, or high, based on a cumulative score of clinical severity (SCS), computed as the sum of specific weights assigned to different pathological conditions and their ascertained prognostic impact. RESULTS Application of DSM-5 produced a decrease in Eating Disorders Not Otherwise Specified (EDNOS) by 17 %, an increase in anorexia (AN) by 14 % and bulimia (BN) by 2.4 %; 44.6 % of EDNOS migrated to AN, 8 % to BN, and 30.8 % was reclassified as Other Specified Feeding and Eating Disorders (OSFED). Mean SCS was higher in AN than in other diagnoses independent of classification. Differently from EDNOS, no high score was found in OSFED. BMI (OR 0.74, 95 % CI 0.56-0.98) and duration of amenorrhea >1 year (OR 6.63, 95 % CI 1.29-34.16) resulted significantly associated with the risk for medium-high SCS level in AN classified with DSM-5. CONCLUSION The results confirmed that DSM-5 reduces the number of EDNOS. DSM-5 seems to better represent the clinical picture in OSFED than in EDNOS. The clinical relevance of BMI and duration of amenorrhea should be considered even more now that they are no longer used as diagnostic hallmarks of AN.
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27
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Bodell LP, Racine SE, Wildes JE. Examining weight suppression as a predictor of eating disorder symptom trajectories in anorexia nervosa. Int J Eat Disord 2016; 49:753-63. [PMID: 27084065 DOI: 10.1002/eat.22545] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/06/2016] [Accepted: 03/08/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Research in individuals with bulimia nervosa has highlighted the clinical significance of weight suppression (WS), defined as the difference between one's highest and current weight. More recently, studies have suggested that WS also may play a role in symptom maintenance and weight gain during treatment in anorexia nervosa (AN) and that the influence of WS on AN outcomes may depend on an individual's body mass index (BMI). However, no study has investigated whether WS or the interaction between WS and BMI is associated with the longer-term course of eating pathology following treatment discharge in patients with AN. METHOD The current study examined a sample of females with AN (N = 180) who completed interviews and self-report questionnaires at discharge from intensive treatment and at 3, 6, and 12-months after discharge. Latent growth curve models tested whether WS, BMI, or the WS by BMI interaction significantly predicted the trajectory of eating disorder symptoms (i.e., Eating Disorder Examination global score, BMI, frequency of loss of control eating, frequency of purging) over the year following discharge. RESULTS WS at discharge predicted change in BMI, and the interaction between WS and BMI predicted growth in eating disorder severity and purging frequency over time. Neither WS nor its interaction with BMI predicted growth in loss of control eating frequency. DISCUSSION Results provide further support for the clinical significance of WS in AN symptom maintenance, but suggest that the influence of WS likely depends on an individual's BMI as well as the outcome being measured. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:753-763).
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Affiliation(s)
- Lindsay P Bodell
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213
| | - Sarah E Racine
- Department of Psychology, Ohio University, Athens, OH, 45701
| | - Jennifer E Wildes
- Department of Psychiatry, University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic of UPMC, Pittsburgh, PA, 15213
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Errichiello L, Iodice D, Bruzzese D, Gherghi M, Senatore I. Prognostic factors and outcome in anorexia nervosa: a follow-up study. Eat Weight Disord 2016; 21:73-82. [PMID: 26253365 DOI: 10.1007/s40519-015-0211-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 07/27/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND AIMS Anorexia nervosa is an eating disorder characterized by food restriction, irrational fear of gaining weight and consequent weight loss. High mortality rates have been reported, mostly due to suicide and malnutrition. Good outcomes largely vary between 18 and 42%. We aimed to assess outcome and prognostic factors of a large group of patients with anorexia nervosa. Moreover we aimed to identify clusters of prognostic factors related to specific outcomes. METHODS We retrospectively reviewed data of 100 patients diagnosed with anorexia nervosa previously hospitalized in a tertiary level structure. Then we performed follow-up structured telephone interviews. RESULTS We identified four dead patients, while 34% were clinically recovered. In univariate analysis, short duration of inpatient treatment (p = 0.003), short duration of disorder (p = 0.001), early age at first inpatient treatment (p = 0.025) and preserved insight (p = 0.029) were significantly associated with clinical recovery at follow-up. In multiple logistic regression analysis, duration of first inpatient treatment, duration of disorder and preserved insight maintained their association with outcome. Moreover multiple correspondence analysis and cluster analysis allowed to identify different typologies of patients with specific features. Notably, group 1 was characterized by two or more inpatient treatments, BMI ≤ 14, absence of insight, history of long-term inpatient treatments, first inpatient treatment ≥30 days. While group 4 was characterized by preserved insight, BMI ≥ 16, first inpatient treatment ≤14 days, no more than one inpatient treatment, no psychotropic drugs intake, duration of illness ≤4 years. CONCLUSIONS We confirmed the association between short duration of inpatient treatment, short duration of disorder, early age at first inpatient treatment, preserved insight and clinical recovery. We also differentiated patients with anorexia nervosa in well-defined outcome groups according to specific clusters of prognostic factors. Our study might help clinicians to evaluate prognosis of patients with anorexia nervosa.
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Affiliation(s)
- Luca Errichiello
- Section of Psychotherapy, Section of Psychiatry, Department of Neurosciences, "Federico II" University, Naples, Italy.
| | - Davide Iodice
- Local Health Authority of Matera, Operating Unit Adult Mental Health, Policoro Hospital, Policoro (Matera), Italy
| | - Dario Bruzzese
- Department of Public Health, "Federico II" University, Naples, Italy
| | - Marco Gherghi
- Department of Economics and Statistics, "Federico II" University, Naples, Italy
| | - Ignazio Senatore
- Section of Psychotherapy, Section of Psychiatry, Department of Neurosciences, "Federico II" University, Naples, Italy
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29
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Haynos AF, Snipes C, Guarda A, Mayer LE, Attia E. Comparison of standardized versus individualized caloric prescriptions in the nutritional rehabilitation of inpatients with anorexia nervosa. Int J Eat Disord 2016; 49:50-8. [PMID: 26769581 PMCID: PMC4717916 DOI: 10.1002/eat.22469] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Sparse research informs how caloric prescriptions should be advanced during nutritional rehabilitation of inpatients with anorexia nervosa (AN). This study compared the impact of a standardized caloric increase approach, in which increases occurred on a predetermined schedule, to an individualized approach, in which increases occurred only following insufficient weight gain, on rate, pattern, and cumulative amount of weight gain and other weight restoration outcomes. METHOD This study followed a natural experiment design comparing AN inpatients consecutively admitted before (n = 35) and after (n = 35) an institutional change from individualized to standardized caloric prescriptions. Authors examined the impact of prescription plan on weekly weight gain in the first treatment month using multilevel modeling. Within a subsample remaining inpatient through weight restoration (n = 40), multiple regressions examined the impact of caloric prescription plan on time to weight restoration, length of hospitalization, maximum caloric prescription, discharge BMI, and incidence of activity restriction and edema. RESULTS There were significant interactions between prescription plan and quadratic time on average weekly weight gain (p = .03) and linear time on cumulative weekly weight gain (p < .001). Under the standardized plan, patients gained in an accelerated curvilinear pattern (p = .04) and, therefore, gained cumulatively greater amounts of weight over time (p < .001). Additionally, 30% fewer patients required activity restriction under the standardized plan. DISCUSSION Standardized caloric prescriptions may confer advantage by facilitating accelerated early weight gain and lower incidence of bedrest without increasing the incidence of refeeding syndrome.
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Affiliation(s)
- Ann F. Haynos
- Department of Psychiatry, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Cassandra Snipes
- Department of Psychiatry, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Angela Guarda
- Department of Psychology, University of Nevada, Reno, Reno, Nevada
| | - Laurel E. Mayer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Evelyn Attia
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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30
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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: 432] [Impact Index Per Article: 48.0] [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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31
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Javaras KN, Runfola CD, Thornton LM, Agerbo E, Birgegård A, Norring C, Yao S, Råstam M, Larsson H, Lichtenstein P, Bulik CM. Sex- and age-specific incidence of healthcare-register-recorded eating disorders in the complete swedish 1979-2001 birth cohort. Int J Eat Disord 2015; 48:1070-81. [PMID: 26769444 PMCID: PMC5028825 DOI: 10.1002/eat.22467] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the sex- and age-specific incidence of healthcare-register-recorded anorexia nervosa (AN) and other eating disorders (OED) in a complete birth cohort, and assess whether incidence varies by diagnostic period and (sub-) birth cohort. METHOD We used the actuarial method and Poisson models to examine the incidence of AN and OED from 1987 to 2009 (when individuals were 8-30 years old) for a cohort of 2.3 million individuals (48.7% female) born from 1979 to 2001 in Sweden, identified using Swedish registers. RESULTS For both sexes, incidences of AN and OED increased considerably for diagnostic periods after 2000, but differed little by birth cohort. In 2009, AN incidence in the peak age category was 205.9 cases/100,000 persons (95% CI: 178.2, 233.5) for females (14-15 years), versus 12.8 cases/100,000 (95% CI: 5.6, 20.1) for males (12-13 years). OED incidence in the peak age category was 372.1 cases/100,000 (95% CI: 336.4, 407.9) for females (16-17 years), versus 22.2 cases/100,000 (95% CI: 13.3, 31.1) for males (14-15 years). DISCUSSION Our finding of an increase in healthcare-register-recorded eating disorders for diagnostic periods after 2000 likely reflects improved detection and expanded register coverage in Sweden. The peak of eating disorder incidence in adolescence, which began unexpectedly early for AN in males, suggests the importance of vigilance for signs of AN in young boys and early primary prevention efforts. Waiting until later could miss critical windows for intervention that could prevent disorders from taking root.
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Affiliation(s)
- Kristin N Javaras
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina.,Division of Women's Mental Health, McLean Hospital, Belmont, Massachusetts and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Cristin D Runfola
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Esben Agerbo
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark.,CIRRAU-Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Andreas Birgegård
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Claes Norring
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Shuyang Yao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Råstam
- Department of Clinical Sciences, University of Lund, Lund, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
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32
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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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Herpertz-Dahlmann B, van Elburg A, Castro-Fornieles J, Schmidt U. ESCAP Expert Paper: New developments in the diagnosis and treatment of adolescent anorexia nervosa--a European perspective. Eur Child Adolesc Psychiatry 2015; 24:1153-67. [PMID: 26226918 PMCID: PMC4592492 DOI: 10.1007/s00787-015-0748-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 07/15/2015] [Indexed: 01/20/2023]
Abstract
Anorexia nervosa is a potentially life-threatening disorder with a typical onset in adolescence and high rates of medical complications and psychiatric comorbidity. This article summarizes issues relating to classification in DSM-5 and presents a narrative review of key evidence-based medical and behavioral interventions for adolescent AN and subthreshold restricting eating disorders, mainly, but not exclusively published between 2012 and 2014. In addition, it systematically compares the clinical guidelines of four European countries (Germany, Spain, The Netherlands, and United Kingdom) and outlines common clinical practice, in relation to treatment settings, nutritional rehabilitation, family-oriented and individual psychotherapy, and psychopharmacological treatment. With the exception of family-based treatment, which is mainly evaluated and practiced in Anglo-American countries, the evidence base is weak, especially for medical interventions such as refeeding and pharmacological intervention. There is a need for common European research efforts, to improve the available evidence base and resulting clinical guidance.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child & Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics, RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Germany.
| | - Annemarie van Elburg
- Department of Social Sciences, Rintveld, Center for Eating Disorders, Altrecht Mental Health Institute, Utrecht University, Utrecht, The Netherlands
| | - Josefina Castro-Fornieles
- Department of Child & Adolescent Psychiatry, Neurosciences Institute, Hospital Clinic of Barcelona, CIBERSAM, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Abstract
Eating disorders, especially anorexia nervosa and bulimia nervosa have been classically described in young females in Western population. Recent research shows that they are also seen in developing countries including India. The classification of eating disorders has been expanded to include recently described conditions like binge eating disorder. Eating disorders have a multifactorial etiology. Genetic factor appear to play a major role. Recent advances in neurobiology have improved our understanding of these conditions and may possibly help us develop more effective treatments in future. Premorbid personality appears to play an important role, with differential predisposition for individual disorders. The role of cultural factors in the etiology of these conditions is debated. Culture may have a pathoplastic effect leading to non-conforming presentations like the non fat-phobic form of anorexia nervosa, which are commonly reported in developing countries. With rapid cultural transformation, the classical forms of these conditions are being described throughout the world. Diagnostic criteria have been modified to accommodate for these myriad presentations. Treatment of eating disorders can be quite challenging, given the dearth of established treatments and poor motivation/insight in these conditions. Nutritional rehabilitation and psychotherapy remains the mainstay of treatment, while pharmacotherapy may be helpful in specific situations.
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Affiliation(s)
- Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - A Shyam Sundar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
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35
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Hartmann AS, Thomas JJ, Greenberg JL, Elliott CM, Matheny NL, Wilhelm S. Anorexia nervosa and body dysmorphic disorder: A comparison of body image concerns and explicit and implicit attractiveness beliefs. Body Image 2015; 14:77-84. [PMID: 25920044 DOI: 10.1016/j.bodyim.2015.03.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 03/27/2015] [Accepted: 03/27/2015] [Indexed: 11/16/2022]
Abstract
Although body image is central to the etiological models of anorexia nervosa and body dysmorphic disorder, studies comparing body image and beliefs about attractiveness between the disorders are rare. Sixty-nine individuals (anorexia nervosa: n=24, body dysmorphic disorder: n=23, healthy controls: n=22) completed self-report measures (body image and general psychopathology), diagnostic interviews, and Go/No-Go Association tasks measuring implicit associations. Compared to controls, both clinical groups exhibited greater negative body image, a more negative attitude toward their physical selves, and more dysfunctional coping strategies (ps<.001). Also, both clinical groups shared greater explicit beliefs about the importance of attractiveness (ps<.001). In addition to supporting previous research with regard to comparable body image disturbance, this study also showed that beliefs regarding the importance of appearance (e.g., "one must be attractive to be successful") might be a fruitful target for therapy across both disorders.
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Affiliation(s)
- A S Hartmann
- Department of Psychiatry, Massachusetts General Hospital, Simches Research Building, 2nd Floor, 185 Cambridge Street, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Simches Research Building, 2nd Floor, 185 Cambridge Street, Boston, MA, USA.
| | - J J Thomas
- Department of Psychiatry, Massachusetts General Hospital, Simches Research Building, 2nd Floor, 185 Cambridge Street, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Simches Research Building, 2nd Floor, 185 Cambridge Street, Boston, MA, USA.
| | - J L Greenberg
- Department of Psychiatry, Massachusetts General Hospital, Simches Research Building, 2nd Floor, 185 Cambridge Street, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Simches Research Building, 2nd Floor, 185 Cambridge Street, Boston, MA, USA.
| | - C M Elliott
- Department of Psychiatry, Massachusetts General Hospital, Simches Research Building, 2nd Floor, 185 Cambridge Street, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Simches Research Building, 2nd Floor, 185 Cambridge Street, Boston, MA, USA.
| | - N L Matheny
- Department of Psychiatry, Massachusetts General Hospital, Simches Research Building, 2nd Floor, 185 Cambridge Street, Boston, MA, USA.
| | - S Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Simches Research Building, 2nd Floor, 185 Cambridge Street, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Simches Research Building, 2nd Floor, 185 Cambridge Street, Boston, MA, USA.
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36
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Silén Y, Raevuori A, Jüriloo E, Tainio VM, Marttunen M, Keski-Rahkonen A. Typical Versus Atypical Anorexia Nervosa Among Adolescents: Clinical Characteristics and Implications for ICD-11. EUROPEAN EATING DISORDERS REVIEW 2015; 23:345-51. [DOI: 10.1002/erv.2370] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/21/2015] [Accepted: 04/27/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Yasmina Silén
- Department of Public Health; University of Helsinki; Finland
- Department of Adolescent Psychiatry; Helsinki University Central Hospital; Helsinki Finland
| | - Anu Raevuori
- Department of Public Health; University of Helsinki; Finland
- Department of Adolescent Psychiatry; Helsinki University Central Hospital; Helsinki Finland
- Institute of Clinical Medicine, Child Psychiatry; University of Turku; Finland
- Department of Mental Health and Substance Abuse Services; National Institute for Health and Welfare; Helsinki Finland
| | - Elisabeth Jüriloo
- Department of Adolescent Psychiatry; The Hospital District of Helsinki and Uusimaa; Hyvinkää Finland
- Finnish Student Health Service; Helsinki Finland
| | - Veli-Matti Tainio
- Department of Adolescent Psychiatry; Helsinki University Central Hospital; Helsinki Finland
| | - Mauri Marttunen
- Department of Adolescent Psychiatry; Helsinki University Central Hospital; Helsinki Finland
- Department of Mental Health and Substance Abuse Services; National Institute for Health and Welfare; Helsinki Finland
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Abstract
Eating disorders (EDs) are serious psychiatric conditions influenced by biological, psychological, and sociocultural factors. A better understanding of the genetics of these complex traits and the development of more sophisticated molecular biology tools have advanced our understanding of the etiology of EDs. The aim of this review is to critically evaluate the literature on the genetic research conducted on three major EDs: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). We will first review the diagnostic criteria, clinical features, prevalence, and prognosis of AN, BN, and BED, followed by a review of family, twin, and adoption studies. We then review the history of genetic studies of EDs covering linkage analysis, candidate gene association studies, genome-wide association studies, and the study of rare variants in EDs. Our review also incorporates a translational perspective by covering animal models of ED-related phenotypes. Finally, we review the nascent field of epigenetics of EDs and a look forward to future directions for ED genetic research.
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Affiliation(s)
- Zeynep Yilmaz
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - J Andrew Hardaway
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Purcell Lalonde M, O'Connor K, Aardema F, Coelho JS. Food for thought: ego-dystonicity and fear of self in eating disorders. EUROPEAN EATING DISORDERS REVIEW 2015; 23:179-84. [PMID: 25728327 DOI: 10.1002/erv.2349] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 01/23/2015] [Accepted: 01/27/2015] [Indexed: 11/11/2022]
Abstract
Degree of ego-dystonicity in obsessions is clinically relevant to the conceptualization and treatment of eating disorders (EDs). Obsessive-compulsive disorder research has suggested that the transformation of intrusive thoughts into obsessions is linked to the degree to which intrusive thoughts threaten core perceptions of the self. This study aims to explore the relationship between the ego-dystonic nature of obsessions in ED patients and a fear of self, the link between ED symptom severity and ego-dystonicity in obsessions, and differences between non-clinical and individuals with EDs in the presence of ego-dystonic thoughts and a fear of self. Ego-dystonicity (Ego-dystonicity Questionnaire (EDQ)) and feared self (Fear of Self Questionnaire (FSQ)) degrees were measured in a clinical sample (n = 57 with EDs) and a non-clinical sample (n = 45). EDQ and FSQ scores were highly correlated in both samples. EDQ scores were not significantly correlated to ED symptom severity with the exception of the EDQ Irrationality subscale, which was strongly related to compulsion severity. Participants with an ED had significantly higher EDQ and FSQ scores compared with controls.
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Affiliation(s)
- Magali Purcell Lalonde
- Research Center, OCD Spectrum Study Center, Montreal Mental Health University Institute, Canada; University of Montreal, Canada
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Billeci L, Tartarisco G, Brunori E, Crifaci G, Scardigli S, Balocchi R, Pioggia G, Maestro S, Morales MA. The role of wearable sensors and wireless technologies for the assessment of heart rate variability in anorexia nervosa. Eat Weight Disord 2015; 20:23-31. [PMID: 24923563 DOI: 10.1007/s40519-014-0135-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/26/2014] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Bradycardia and abnormal cardiac autonomic function are related to increased mortality in anorexia nervosa (AN). The aim of this study was to assess heart rate (HR) and HR variability of young adolescents with AN as compared to controls by means of wearable sensors and wireless technologies. METHOD The ECG signal was recorded in 27 AN girls and 15 healthy girls at rest using a wearable chest strap. The tachogram, the mean intervals between R peaks (meanRR), the root mean square of successive differences (RMSSD), the power of low-frequency (LF) and high-frequency (HF) bands and the LF/HF ratio were assessed. RESULTS All AN girls showed a reduced HR and an increased meanRR and RMSSD. An HF increase, a LF decrease, and a LF/HF reduction indicated a prevalence of the parasympathetic on sympathetic activity. CONCLUSIONS The instruments used in this pilot study were feasible, unobtrusive and extremely suitable in AN subjects who are burdened by high incidence of cardiovascular mortality; their application could open to new approaches of vital signs monitoring in hospitals as well as in home settings.
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Affiliation(s)
- Lucia Billeci
- Institute of Clinical Physiology, National Research Council of Italy (CNR), via Moruzzi 1, 56124, Pisa, Italy,
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Accept, distract, or reframe? An exploratory experimental comparison of strategies for coping with intrusive body image thoughts in anorexia nervosa and body dysmorphic disorder. Psychiatry Res 2015; 225:643-50. [PMID: 25530419 DOI: 10.1016/j.psychres.2014.11.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/08/2014] [Accepted: 11/09/2014] [Indexed: 11/20/2022]
Abstract
Negative body image is the hallmark of anorexia nervosa (AN) and body dysmorphic disorder (BDD). One aspect of body image, appearance-related thoughts, have shown to be a major contributor to relapse, thus further investigation of successful treatment strategies targeting these maladaptive thoughts are warranted. The present study tested an acceptance/mindfulness (AC), a cognitive restructuring (CR), and a distraction strategy with regard to their short-term effectiveness of reducing the frequency of thought occurrence and associated outcomes in participants with AN (n=20), BDD (n=21), and healthy controls (HC; n=22). Although all strategies led to a significant reduction of thought frequency, there was no group × strategy interaction effect in their reduction. Positive affect increased in the BDD group through the AC strategy, but decreased in healthy controls. Acceptance of the thought increased in the CR strategy in AN, whereas that strategy seemed to work least for BDD. Healthy controls showed most acceptance when using distraction. Taken together, the study suggests that all strategies might have their benefits and that it might be worthwhile further investigating differential indication of the strategies with regard to diagnosis and individual factors.
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Abstract
The eating disorders literature has focussed on females and little is known of the male experience. The overall image this has generated suggests a young woman in conflict with socio-cultural pressures which associate thinness with beauty. Historical studies have examined anorexia nervosa from an entirely female focus while ignoring how diagnostic categories have shaped approaches to the male body. This paper will track the case of the male with anorexia nervosa through changing theories of causation and treatment approaches, from when the condition first emerged in 1873 to the present. In doing so, we gain a valuable new insight into how anorexia nervosa has been historically gendered and the far-reaching implications this has had for diagnosis and treatment of the male sufferer. Similarities between the sexes helped to establish male anorexia as a distinct category. However, this shifted focus away from important differences, which have yet unexplored implications in the assessment, diagnosis and management of disordered eating. Throughout history, there has been constant pressure to give a precise definition to anorexia nervosa, despite being fraught with medical uncertainties. This has resulted in inevitably harmful generalisations rooted in the dominant epidemiology. This paper reveals that anorexia nervosa is a truly global phenomenon which cannot be adequately constructed through exclusive studies of the female. There is consequently a pressing need to address the dearth of research examining eating disorders in males.
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Affiliation(s)
- Chengyuan Zhang
- Imperial College London; South Kensington Campus, SW7 2AZ Exhibition Road, London, UK
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42
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Smink FRE, van Hoeken D, Oldehinkel AJ, Hoek HW. Prevalence and severity of DSM-5 eating disorders in a community cohort of adolescents. Int J Eat Disord 2014; 47:610-9. [PMID: 24903034 DOI: 10.1002/eat.22316] [Citation(s) in RCA: 222] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 04/30/2014] [Accepted: 05/27/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes a considerably revised eating disorder section. The aim of this study was to establish the prevalence and severity of eating disorders based on the new DSM-5 criteria in a community cohort of adolescents. METHOD This study is part of TRAILS (TRacking Adolescents' Individual Lives Survey), a Dutch cohort study on mental health and social development from preadolescence into young adulthood. At baseline, the participants (n = 2,230) were about 11 years old. Body mass index was measured at all four assessment waves. At age 19, the Composite International Diagnostic Interview was administered to 1,584 of the participants. A two-stage screening approach was used to estimate the prevalence of DSM-5 eating disorders. Adolescents at high risk for eating disorders (n = 312) were selected for an additional interview administered by eating disorder experts. RESULTS Of the high-risk group n = 296 (95%) could be interviewed. Among the women, the lifetime prevalence of DSM-5 anorexia nervosa was 1.7%, of bulimia nervosa 0.8% and of binge eating disorder 2.3%. Eating disorders were relatively rare among the men. The severity of most cases was mild to moderate and detection and treatment rates depended on the level of severity. DISCUSSION The most common DSM-5 eating disorder diagnoses in adolescents in the community are anorexia nervosa and binge eating disorder. Severity ratings for eating disorders seem valid in terms of both the distribution in the community and the correlation with detection and treatment by health care services.
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Berner LA, Shaw JA, Witt AA, Lowe MR. The relation of weight suppression and body mass index to symptomatology and treatment response in anorexia nervosa. JOURNAL OF ABNORMAL PSYCHOLOGY 2014; 122:694-708. [PMID: 24016010 DOI: 10.1037/a0033930] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Weight suppression, the difference between highest past weight and current weight, is a robust predictor of clinical characteristics of bulimia nervosa; however, the influence of weight suppression in anorexia nervosa (AN) has been little studied, and to our knowledge, no study to date has investigated the ways in which the relevance of weight suppression in AN may depend upon an individual's current body mass index (BMI). The present study investigated weight suppression, BMI, and their interaction as cross-sectional and prospective predictors of psychological symptoms and weight in AN. Women with AN completed depression (Beck Depression Inventory-II) and eating disorder symptomatology measures (Eating Disorder Examination Questionnaire and Eating Disorders Inventory-3) at residential treatment admission (N = 350) and discharge (N = 238). Weight suppression and BMI were weakly correlated (r = -.22). At admission, BMI was positively correlated with all symptom measures except Restraint and Depression scores. Weight suppression was also independently positively correlated with all measures except Weight Concern and Body Dissatisfaction subscale scores. In analyses examining discharge scores (including admission values as covariates), the admission weight suppression × BMI interaction consistently predicted posttreatment psychopathology. Controlling for weight gain in treatment and age, higher admission weight suppression predicted lower discharge scores (less symptom endorsement) among those with lower BMIs; among those with higher BMIs, higher weight suppression predicted higher discharge scores. These results are the first to our knowledge to demonstrate that absolute and relative weight status are joint indicators of AN severity and prognosis. These findings may have major implications for conceptualization and treatment of AN.
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Jappe LM, Cao L, Crosby RD, Crow SJ, Peterson CB, Le Grange D, Engel SG, Wonderlich SA. Stress and eating disorder behavior in anorexia nervosa as a function of menstrual cycle status. Int J Eat Disord 2014; 47:181-8. [PMID: 24222529 PMCID: PMC3946633 DOI: 10.1002/eat.22211] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 08/12/2013] [Accepted: 09/06/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Fluctuations in ovarian hormones during the menstrual cycle and psychosocial stress contribute to eating disorder (ED) behavior. METHOD Using ecological momentary assessment techniques, this study examined relationships between stress and binge eating, self-induced vomiting, and dietary restriction based on menstrual cycle status in anorexia nervosa (AN). One hundred nine females with full and subthreshold AN (17-45 years old) recorded ED behavior and stress ratings over 2 weeks. Using hierarchical linear modeling, individuals with eumenorrhea and those with amenorrhea or oligomenorrhea were compared. RESULTS Following episodes of meal skipping, momentary stress decreased in individuals with normal menstrual cycles and increased in those with irregular menstrual cycles. DISCUSSION Results suggest that changes in stress severity in response to food restriction may differ based on ovarian hormonal status and may be a mechanism by which AN is maintained in individuals without menstrual disturbance.
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Affiliation(s)
| | - Li Cao
- Neuropsychiatric Research Institute, Department of Psychiatry, University of North Dakota
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, Department of Psychiatry, University of North Dakota
| | | | | | - Daniel Le Grange
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago
| | - Scott G. Engel
- Neuropsychiatric Research Institute Department of Psychiatry, University of North Dakota
| | - Stephen A. Wonderlich
- Neuropsychiatric Research Institute Department of Psychiatry, University of North Dakota
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Steinglass JE, Albano AM, Simpson HB, Wang Y, Zou J, Attia E, Walsh BT. Confronting fear using exposure and response prevention for anorexia nervosa: A randomized controlled pilot study. Int J Eat Disord 2014; 47:174-80. [PMID: 24488838 PMCID: PMC3927538 DOI: 10.1002/eat.22214] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 09/27/2013] [Accepted: 09/27/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) is a severe illness with high rates of relapse. Exposure and Response Prevention for AN (AN-EXRP) is a new approach that specifically addresses maladaptive eating behavior by targeting eating-related fear and anxiety. The aim of this study was to evaluate AN-EXRP as an adjunctive strategy to improve eating behavior during weight restoration, at a pivotal moment when treatment goals shift toward relapse prevention. METHOD A randomized controlled trial was conducted to compare AN-EXRP with a comparison condition, Cognitive Remediation Therapy (CRT). Hospitalized patients with AN (n = 32) who had achieved weight restoration to a BMI > 18.5 kg/m(2) received 12 sessions of either AN-EXRP or CRT. Outcome was assessed by change in caloric intake in an objective assessment of eating behavior. RESULTS The average test meal caloric intake of participants who received AN-EXRP increased from 352 ± 263 kcal at baseline to 401 ± 215 kcal post-treatment, while that of participants who received CRT decreased from 501 ± 232 kcal at baseline to 424 ± 221 kcal post-treatment [t(28) = 2.5, p = .02]. Improvement in intake was significantly associated with improvement in eating-related anxiety (Spearman's ρ = 0.40, p = .03). DISCUSSION These data demonstrate that AN-EXRP, compared to a credible comparison intervention, is associated with better caloric intake in a laboratory meal over time in AN. Additional studies are required to determine whether incorporation of these techniques into a longer treatment program leads to enduring and clinically significant change.
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Affiliation(s)
- Joanna E Steinglass
- Columbia University 622 West 168 Street New York, NY 10032,New York State Psychiatric Institute 1051 Riverside Drive New York, NY 10032
| | - Anne Marie Albano
- Columbia University 622 West 168 Street New York, NY 10032,New York State Psychiatric Institute 1051 Riverside Drive New York, NY 10032
| | - H Blair Simpson
- Columbia University 622 West 168 Street New York, NY 10032,New York State Psychiatric Institute 1051 Riverside Drive New York, NY 10032
| | - Yuanjia Wang
- Columbia University 622 West 168 Street New York, NY 10032
| | - Jingjing Zou
- Columbia University 622 West 168 Street New York, NY 10032
| | - Evelyn Attia
- Columbia University 622 West 168 Street New York, NY 10032,New York State Psychiatric Institute 1051 Riverside Drive New York, NY 10032
| | - B. Timothy Walsh
- Columbia University 622 West 168 Street New York, NY 10032,New York State Psychiatric Institute 1051 Riverside Drive New York, NY 10032
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46
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Scanelli G, Gualandi M, Simoni M, Manzato E. Somatic involvement assessed through a cumulative score of clinical severity in patients with eating disorders. Eat Weight Disord 2014; 19:49-59. [PMID: 24078389 DOI: 10.1007/s40519-013-0065-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 08/31/2013] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate the overall somatic involvement in patients with eating disorders (EDs). METHODS The medical records of 206 patients (age 15-56 years, 96.1% females) with diagnosis of anorexia nervosa (AN, n = 63, 30.6%), bulimia nervosa (BN, n = 78, 37.9%), or eating disorder not otherwise specified (EDNOS, n = 65, 31.6 %) were analyzed. A cumulative score of clinical severity (SCS) was computed according to the presence of physical, instrumental, and laboratory abnormalities, as well as to their prognostic impact. Based on the tertile distribution of SCS, three levels of severity were defined: low, medium, and high. RESULTS A medium/high level of severity was found in 63% of the whole sample, 89% of AN, 49% of BN, and 55% of EDNOS. In the whole sample, the risk of medium/high SCS was significantly and inversely related to the body mass index (BMI) and to the lifetime minimum BMI. The severity level was significantly and positively associated with diagnosis of AN, duration of amenorrhea C1 year, and presence of ED-related symptoms. EDNOS patients showed a higher risk for increased SCS than BN patients, although not significantly. CONCLUSION The non-negligible frequency of a relevant somatic involvement in patients with EDNOS suggests that a transdiagnostic scoring system might be helpful to identify ED cases at risk of medical complications.
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Bomba M, Corbetta F, Gambera A, Nicosia F, Bonini L, Neri F, Tremolizzo L, Nacinovich R. Heart rate variability in adolescents with functional hypothalamic amenorrhea and anorexia nervosa. Psychiatry Res 2014; 215:406-9. [PMID: 24359810 DOI: 10.1016/j.psychres.2013.11.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 10/16/2013] [Accepted: 11/12/2013] [Indexed: 11/15/2022]
Abstract
Aim of this study consisted in assessing the 24-h heart rate variability (HRV), a measure of autonomic nervous system (ANS) imbalance, in 21 adolescents with functional hypothalamic amenorrhea (FHA, 11 normogonadotropic, N-FHA, and 10 hypogonadotropic, Hy-FHA) compared to 21 patients with anorexia nervosa (AN) and 21 controls. As expected, subjects with AN showed a significant dysregulation in multiple HRV parameters, while Hy-FHA patients presented with a dysregulation in a few domains (SDNN, HFr), which was not present in girls with N-FHA, who showed values largely similar to controls. FHA might represent part of the AN biological spectrum, and a link between these two conditions might exist, possibly related to the degree of psychological and/or hormonal dysfunction.
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Affiliation(s)
- Monica Bomba
- Clinic of Child and Adolescent Mental Health, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy.
| | - Fabiola Corbetta
- Clinic of Child and Adolescent Mental Health, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Alessandro Gambera
- Department of Gynecological Endocrinology, Spedali Civili, Brescia, Italy
| | - Franco Nicosia
- Geriatric Unit, Spedali Civili, Department of Medical and Surgery Sciences, University of Brescia, Brescia, Italy
| | - Luisa Bonini
- Department of Childhood and Adolescent Neuropsychiatry, Spedali Civili, Brescia, Italy
| | - Francesca Neri
- Clinic of Child and Adolescent Mental Health, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Lucio Tremolizzo
- Department of Neurology - University of Milano-Bicocca, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Renata Nacinovich
- Clinic of Child and Adolescent Mental Health, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
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48
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Brown TA, Holland LA, Keel PK. Comparing operational definitions of DSM-5 anorexia nervosa for research contexts. Int J Eat Disord 2014; 47:76-84. [PMID: 24013875 DOI: 10.1002/eat.22184] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 08/01/2013] [Accepted: 08/06/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE DSM-5 anorexia nervosa (AN) criteria include several changes that increase reliance on clinical judgment. However, research contexts require operational definitions that can be applied reliably and that demonstrate validity. The present study evaluated different operational definitions for DSM-5 AN. METHOD DSM-5 AN criteria were applied to diagnostic interview data from 364 women varying two features: threshold for determining low weight for Criterion A (body mass index [BMI] <17.0 kg/m(2) vs. <18.5 kg/m(2)) and explicit endorsement of weight phobia (Criterion B explicit vs. inferred). Resulting groups of individuals with DSM-5 AN were compared on estimated frequency. In addition, AN groups were compared to non-eating disorder controls and individuals with an other specified feeding or eating disorder (OSFED) on external validators. RESULTS All operational DSM-5 definitions produced higher lifetime frequency estimates than reported for DSM-IV AN, with a particularly large increase associated with the broadest definition. All definitions produced significant differences in comparison to controls on external validators that were associated with medium to large effect sizes. Only definitions that required a lower weight threshold or explicit endorsement of weight phobia demonstrated significant differences compared to OSFED on external validators, and these were of small effect size. The specific combination of BMI <18.5 kg/m(2) with inferred weight phobia exhibited few meaningful distinctions from the OSFED group. DISCUSSION To balance inclusivity, syndromal reliability, and validity, an operational definition for DSM-5 AN in research contexts should define low weight as BMI <18.5 kg/m(2) and require measurable rather than inferred weight phobia.
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Affiliation(s)
- Tiffany A Brown
- Department of Psychology, Florida State University, Tallahassee, Florida
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49
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Hartmann AS, Thomas JJ, Wilson AC, Wilhelm S. Insight impairment in body image disorders: delusionality and overvalued ideas in anorexia nervosa versus body dysmorphic disorder. Psychiatry Res 2013; 210:1129-35. [PMID: 23992792 DOI: 10.1016/j.psychres.2013.08.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 07/01/2013] [Accepted: 08/08/2013] [Indexed: 01/12/2023]
Abstract
The two body image disorders anorexia nervosa (AN) and body dysmorphic disorder (BDD) share many similarities. Delusionality in BDD has recently gained increased attention, as the new DSM-5 criteria for BDD include an insight specifier. However, delusionalilty in AN has rarely been examined. We evaluated the delusionality of appearance-related beliefs in AN (n=19) vs. BDD (n=22) via structured interview. Participants also completed measures of disorder-specific psychopathology and body image. Compared to those with AN, individuals with BDD exhibited significantly greater delusionality on a dimensional scale (p=0.0014, d=1.07), and were more likely to meet dichotomous criteria for delusional beliefs (p=0.021, V=0.36). In AN, delusionality was associated specifically with shape concerns and drive for thinness; in BDD, delusionality was related to the severity of BDD symptoms (all p<0.05). Delusionality of appearance beliefs is present in individuals with AN, but is less pronounced than in BDD. Nevertheless, as high delusionality might predict poor treatment outcome in AN, treatment strategies that were originally developed to address delusionality in BDD might be modified for AN.
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Affiliation(s)
- Andrea S Hartmann
- Institute of Psychology, Department of Human Sciences, University of Osnabrück, Knollstrasse 15, 49069 Osnabrück, Germany; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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50
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Urgesi C, Fornasari L, Canalaz F, Perini L, Cremaschi S, Faleschini L, Thyrion EZ, Zuliani M, Balestrieri M, Fabbro F, Brambilla P. Impaired configural body processing in anorexia nervosa: evidence from the body inversion effect. Br J Psychol 2013; 105:486-508. [PMID: 24206365 DOI: 10.1111/bjop.12057] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 09/13/2013] [Indexed: 11/29/2022]
Abstract
Patients with anorexia nervosa (AN) suffer from severe disturbances of body perception. It is unclear, however, whether such disturbances are linked to specific alterations in the processing of body configurations with respect to the local processing of body part details. Here, we compared a consecutive sample of 12 AN patients with a group of 12 age-, gender- and education-matched controls using an inversion effect paradigm requiring the visual discrimination of upright and inverted pictures of whole bodies, faces and objects. The AN patients presented selective deficits in the discrimination of upright body stimuli, which requires configural processing. Conversely, patients and controls showed comparable abilities in the discrimination of inverted bodies, which involves only detail-based processing, and in the discrimination of both upright and inverted faces and objects. Importantly, the body inversion effect negatively correlated with the persistence scores at the Temperament and Character Inventory, which evaluates increased tendency to convert a signal of punishment into a signal of reinforcement. These results suggest that the deficits of configural processing in AN patients may be associated with their obsessive worries about body appearance and to the excessive attention to details that characterizes their general perceptual style.
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Affiliation(s)
- Cosimo Urgesi
- Department of Human Sciences, University of Udine, Italy; IRCCS Scientific Institute "E. Medea", Pordenone, Italy
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