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Page MJ, Hill AP, Kavanagh O, Jones S. Multidimensional perfectionism and cortisol stress response in non-clinical populations: A systematic review and evaluation. PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2017.11.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sestan-Pesa M, Horvath TL. Metabolism and Mental Illness. Trends Mol Med 2016; 22:174-183. [PMID: 26776095 DOI: 10.1016/j.molmed.2015.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 01/23/2023]
Abstract
Over the past century, overwhelming evidence has emerged pointing to the hypothalamus of the central nervous system (CNS) as a crucial regulator of systemic control of metabolism, including appetite and feeding behavior. Appetite (or hunger) is a fundamental driver of survival, involving complex behaviors governed by various parts of the brain, including the cerebral cortex. Here, we provide an overview of basic metabolic principles affecting the CNS and discuss their relevance to physiological and pathological conditions of higher brain functions. These novel perspectives may well provide new insights into future research strategies to facilitate the development of novel therapies for treating mental illness.
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Affiliation(s)
- Matija Sestan-Pesa
- Program in Integrative Cell Signaling and Neurobiology of Metabolism, Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Tamas L Horvath
- Program in Integrative Cell Signaling and Neurobiology of Metabolism, Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT 06520, USA.
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Bailer UF, Frank GK, Price JC, Meltzer CC, Becker C, Mathis CA, Wagner A, Barbarich-Marsteller NC, Bloss CS, Putnam K, Schork NJ, Gamst A, Kaye WH. Interaction between serotonin transporter and dopamine D2/D3 receptor radioligand measures is associated with harm avoidant symptoms in anorexia and bulimia nervosa. Psychiatry Res 2013; 211:160-8. [PMID: 23154100 PMCID: PMC3880148 DOI: 10.1016/j.pscychresns.2012.06.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 06/25/2012] [Accepted: 06/29/2012] [Indexed: 10/27/2022]
Abstract
Individuals with anorexia nervosa (AN) and bulimia nervosa (BN) have alterations of measures of serotonin (5-HT) and dopamine (DA) function, which persist after long-term recovery and are associated with elevated harm avoidance (HA), a measure of anxiety and behavioral inhibition. Based on theories that 5-HT is an aversive motivational system that may oppose a DA-related appetitive system, we explored interactions of positron emission tomography (PET) radioligand measures that reflect portions of these systems. Twenty-seven individuals recovered (REC) from eating disorders (EDs) (7 AN-BN, 11 AN, 9 BN) and nine control women (CW) were analyzed for correlations between [(11)C]McN5652 and [(11)C]raclopride binding. There was a significant positive correlation between [(11)C]McN5652 binding potential (BP(non displaceable(ND))) and [(11)C]Raclopride BP(ND) for the dorsal caudate, antero-ventral striatum (AVS), middle caudate, and ventral and dorsal putamen. No significant correlations were found in CW. [(11)C]Raclopride BP(ND), but not [(11)C]McN5652 BP(ND), was significantly related to HA in REC EDs. A linear regression analysis showed that the interaction between [(11)C]McN5652 BP(ND) and [(11)C]raclopride BP(ND) in the dorsal putamen significantly predicted HA. This is the first study using PET and the radioligands [(11)C]McN5652 and [(11)C]raclopride to show a direct relationship between 5-HT transporter and striatal DA D2/D3 receptor binding in humans, supporting the possibility that 5-HT and DA interactions contribute to HA behaviors in EDs.
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Affiliation(s)
- Ursula F. Bailer
- University of California San Diego, Department of Psychiatry, La Jolla, CA,Medical University of Vienna, Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Vienna, Austria
| | - Guido K. Frank
- Department of Psychiatry, University of Colorado Denver, Children’s Hospital Colorado, Aurora, CO, USA,Department of Neuroscience, University of Colorado Denver; Anschutz Medical Campus, Aurora, CO, USA
| | - Julie C. Price
- University of Pittsburgh, School of Medicine, Department of Radiology, Presbyterian University Hospital, Pittsburgh, PA
| | - Carolyn C. Meltzer
- University of Pittsburgh, School of Medicine, Department of Radiology, Presbyterian University Hospital, Pittsburgh, PA,University of Pittsburgh, School of Medicine, Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA,Emory School of Medicine, Departments of Radiology, Neurology, and Psychiatry and Behavioral Sciences, Atlanta, Georgia, and Adjunct Professor of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Carl Becker
- University of Pittsburgh, School of Medicine, Department of Radiology, Presbyterian University Hospital, Pittsburgh, PA
| | - Chester A. Mathis
- University of Pittsburgh, School of Medicine, Department of Radiology, Presbyterian University Hospital, Pittsburgh, PA
| | - Angela Wagner
- University of California San Diego, Department of Psychiatry, La Jolla, CA
| | | | - Cinnamon S. Bloss
- Scripps Genomic Medicine, Scripps Translational Science Institute (STSI), and Scripps Health, La Jolla, CA
| | - Karen Putnam
- Department of Environmental Health, Division of Epidemiology and Biostatistics, University of Cincinnati, School of Medicine, Cincinnati, Ohio
| | - Nicholas J. Schork
- Department of Environmental Health, Division of Epidemiology and Biostatistics, University of Cincinnati, School of Medicine, Cincinnati, Ohio
| | - Anthony Gamst
- University of California San Diego, Department of Biostatistics and Bioinformatics, La Jolla, CA
| | - Walter H. Kaye
- University of California San Diego, Department of Psychiatry, La Jolla, CA,Corresponding author: Walter H. Kaye, M.D., University of California, San Diego, UCSD Department of Psychiatry, 8950 Villa La Jolla Drive, Suite C – 207, La Jolla, California 92037, Tel. (858) 534 3951, FAX: (858) 534 6727,
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Abstract
Anorexia nervosa (AN) and bulimia nervosa (BN) are disorders characterized by aberrant patterns of feeding behavior, weight regulation, and disturbances in attitudes and perceptions toward body weight and shape. Several lines of evidence nominate disturbances of serotonin (5-HT) pathways as playing a role in the pathogenesis and pathophysiology of AN and BN. For example, 5-HT pathways are known to contribute to the modulation of a range of behaviors commonly seen in individuals with AN and BN. New technology using brain imaging with radioligands offers the potential for understanding previously inaccessible brain 5-HT neurotransmitter function and its dynamic relationship with human behaviors. Recent studies using positron emission tomography and single photon emission computed tomography with 5-HT-specific radioligands have consistently shown 5-HT(1A) and 5-HT(2A) receptor and 5-HT transporter alterations in AN and BN in cortical and limbic structures, which may be related to anxiety, behavioral inhibition, and body image distortions. These disturbances are present when subjects are ill and persist after recovery, suggesting that these may be traits that are independent of the state of the illness. Effective treatments for AN and BN have been elusive. A better understanding of neurobiology is likely to be important for developing specific and more powerful therapies for these often chronic and deadly disorders.
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Affiliation(s)
- Ursula F Bailer
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University of Vienna, Austria
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Harrison A, O'Brien N, Lopez C, Treasure J. Sensitivity to reward and punishment in eating disorders. Psychiatry Res 2010; 177:1-11. [PMID: 20381877 DOI: 10.1016/j.psychres.2009.06.010] [Citation(s) in RCA: 172] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 06/08/2009] [Accepted: 06/11/2009] [Indexed: 11/28/2022]
Abstract
The aim of this review was to collate and summarise the self-report data regarding anomalies in sensitivity to reward and punishment in eating disorders (ED) with use of a meta-analysis where possible. Electronic databases were searched to December 2008. Studies were required to have a non-eating disorder healthy control group and include at least one self-report measure of sensitivity to reward or punishment in an eating disorder population. Findings were very heterogeneous and inconsistencies between studies and measures were highlighted. In general, patients with anorexia nervosa (restricting type) were less sensitive to reward than healthy controls, whereas patients with bulimia nervosa and anorexia nervosa (binge/purge) type were more sensitive. All ED groups report higher sensitivity to punishment than healthy controls. Individuals with eating disorders differ from healthy controls in measures of reward and punishment sensitivity as measured using the Temperament and Character Inventory, Tridimensional Personality Questionnaire and BIS/BAS scales, but further work is required as there is some heterogeneity in the data. Generating more research using behavioural measures may increase understanding of the findings.
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Affiliation(s)
- Amy Harrison
- Institute of Psychiatry, Kings College London, UK.
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Bardone-Cone AM, Sturm K, Lawson MA, Robinson DP, Smith R. Perfectionism across stages of recovery from eating disorders. Int J Eat Disord 2010; 43:139-48. [PMID: 19308994 PMCID: PMC2820585 DOI: 10.1002/eat.20674] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study examined perfectionism in relation to recovery from eating disorders by comparing different conceptualizations of perfectionism across healthy controls and fully recovered, partially recovered, and active eating disorder cases, where full recovery was defined using physical, behavioral, and psychological indices. METHOD Participants were primarily young adult females; 53 active eating disorder cases, 15 partially recovered cases, 20 fully recovered cases, and 67 healthy controls. Participants completed questionnaires assessing trait perfectionism, perfectionistic self-presentation style, and frequency of perfectionism cognitions, as well as a diagnostic interview to determine lifetime and current eating disorder diagnoses. RESULTS A robust pattern emerged whereby the fully recovered individuals and healthy controls had similar levels of perfectionism that were significantly lower than the perfectionism levels of the partially recovered and active individuals with eating disorder, who were comparable to each other. DISCUSSION These findings have implications for more clearly defining eating disorder recovery and for the role perfectionism may play in achieving full recovery.
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Affiliation(s)
- Anna M. Bardone-Cone
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri,Correspondence to: Anna M. Bardone-Cone, PhD, Department of Psychological Sciences, 210 McAlester Hall, University of Missouri, Columbia, MO 65211.
| | - Katrina Sturm
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | | | | | - Roma Smith
- University of Missouri School of Medicine, Columbia, Missouri
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Dellava JE, Policastro P, Hoffman DJ. Energy metabolism and body composition in long-term recovery from anorexia nervosa. Int J Eat Disord 2009; 42:415-21. [PMID: 19107831 DOI: 10.1002/eat.20619] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The aim of this study was to determine if energy metabolism and body composition differ between women recovered from anorexia nervosa for 2 or more years (RAN) and control (C) women. METHOD Using a cross-sectional design, 16 RAN and 18 C women were studied. Respiratory quotient (RQ) and resting energy expenditure (REE) were measured using indirect calorimetry and body composition using dual energy X-ray absorptiometry. RESULTS The REE between RAN and C women was not significantly different, even when adjusted for body composition. However, RAN women had a higher rate of fat oxidation (p = .015), controlling for diet and body composition. There were no significant differences between the groups for body composition, percent body fat, or percent truncal fat mass. DISCUSSION Although RAN women have a higher rate of fat oxidation, there were no significant differences in REE or body composition when compared with C women.
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Affiliation(s)
- Jocilyn E Dellava
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Bachner-Melman R, Zohar AH, Elizur Y, Kremer I, Golan M, Ebstein R. Protective self-presentation style: association with disordered eating and anorexia nervosa mediated by sociocultural attitudes towards appearance. Eat Weight Disord 2009; 14:1-12. [PMID: 19367135 DOI: 10.1007/bf03327789] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We tested the hypothesis that a protective self-presentation style (Lennox and Wolfe, 1984) is associated with eating pathology and anorexia nervosa (AN) and that this association is mediated by sociocultural attitudes towards appearance emphasizing the thin ideal. METHOD We compared the protective-presentation style of women with AN (N=17), partially recovered women (N=110), fully recovered women (N=73), and female controls (N=374). RESULTS Ill women had a more protective self-presentation style than partially or fully recovered women, who in turn had a more protective self-presentation style than controls. Sociocultural attitudes towards appearance fully mediated the association between protective self-presentation and disordered eating. CONCLUSIONS Protective self-presentation may therefore be a risk factor for AN and/or a prognostic factor. Implications for therapy and prevention are discussed.
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Affiliation(s)
- R Bachner-Melman
- Psychology, Hebrew University of Jerusalem, Mount Scopus, Jerusalem 91905, Israel.
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Abstract
Anorexia nervosa (AN) and bulimia nervosa (BN) are related disorders of unknown etiology that most commonly begin during adolescence in women. AN and BN have unique and puzzling symptoms, such as restricted eating or binge-purge behaviors, body image distortions, denial of emaciation, and resistance to treatment. These are often chronic and relapsing disorders, and AN has the highest death rate of any psychiatric disorder. The lack of understanding of the pathogenesis of this illness has hindered the development of effective interventions, particularly for AN. Individuals with AN and BN are consistently characterized by perfectionism, obsessive-compulsiveness, and dysphoric mood. Individuals with AN tend to have high constraint, constriction of affect and emotional expressiveness, ahendonia and asceticism, whereas individuals with BN tend to be more impulsive and sensation seeking. Such symptoms often begin in childhood, before the onset of an eating disorder, and persist after recovery, suggesting they are traits that create a vulnerability for developing an ED. There is growing acknowledgement that neurobiological vulnerabilities make a substantial contribution to the pathogenesis of AN and BN. Considerable evidence suggests that altered brain serotonin (5-HT) function contributes to dysregulation of appetite, mood, and impulse control in AN and BN. Brain imaging studies, using 5-HT specific ligands, show that disturbances of 5-HT function occur when people are ill, and persist after recovery from AN and BN. It is possible that a trait-related disturbance of 5-HT neuronal modulation predates the onset of AN and contributes to premorbid symptoms of anxiety, obsessionality, and inhibition. This dysphoric temperament may involve an inherent dysregulation of emotional and reward pathways which also mediate the hedonic aspects of feeding, thus making these individuals vulnerable to disturbed appetitive behaviors. Restricting food intake may become powerfully reinforcing because it provides a temporary respite from dysphoric mood. Several factors may act on these vulnerabilities to cause AN to start in adolescence. First, puberty-related female gonadal steroids or age-related changes may exacerbate 5-HT dysregulation. Second, stress and/or cultural and societal pressures may contribute by increasing anxious and obsessional temperament. Individuals with AN may discover that reduced dietary intake, by reducing plasma tryptophan availability, is a means by which they can modulate brain 5-HT functional activity and anxious mood. People with AN enter a vicious cycle which accounts for the chronicity of this disorder because caloric restriction results in a brief respite from dysphoric mood. However, malnutrition and weight loss, in turn, produce alterations in many neuropeptides and monoamine function, perhaps in the service of conserving energy, but which also exaggerates dysphoric mood. In summary, this article reviews findings in brain chemistry and neuroimaging that shed new light on understanding the psychopathology of these difficult and frustrating disorders.
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Affiliation(s)
- Walter Kaye
- University of California, San Diego, 8950 Villa La Jolla Drive, Suite C207, La Jolla, CA 92037, United States.
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10
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The relationship between obstetric complications and temperament in eating disorders: a mediation hypothesis. Psychosom Med 2008; 70:372-7. [PMID: 18256341 DOI: 10.1097/psy.0b013e318164604e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Recent studies have hypothesized that perinatal complications might increase the risk of developing eating disorders. However, it is unclear which pathways might link obstetric complications and eating disorders. The present study aimed at exploring the relationship between obstetric complications and temperament in eating disordered subjects. METHODS The sample was selected among subjects who took part in a prevalence study carried out on a representative sample of the general population and from among people with anorexia and bulimia nervosa referred to an outpatient specialist unit. Subjects who were born in the two obstetric wards of Padua Hospital between 1971 and 1979 and who completed the Tridimensional Personality Questionnaire were included. A blind analysis of the obstetric records of the whole sample was performed. The final sample was composed of 66 anorexia nervosa, 44 bulimia nervosa, and 257 control subjects. RESULTS Among the different groups of obstetric complications, only the group that included preterm birth and other signs of neonatal immaturity or dysmaturity displayed a significant relationship with harm avoidance. The use of a mediation path analytic model revealed a significant, but incomplete, mediation effect of harm avoidance in explaining the link between neonatal dysmaturity and the development of eating disorders. Maternal weight gain during pregnancy seemed to have a protective effect on harm avoidance. CONCLUSIONS The presence of signs of neonatal dysmaturity at birth seems to influence the development of high levels of harm avoidance in eating disorders.
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Bailer UF, Frank GK, Henry SE, Price JC, Meltzer CC, Becker C, Ziolko SK, Mathis CA, Wagner A, Barbarich-Marsteller NC, Putnam K, Kaye WH. Serotonin transporter binding after recovery from eating disorders. Psychopharmacology (Berl) 2007; 195:315-24. [PMID: 17690869 DOI: 10.1007/s00213-007-0896-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Accepted: 07/05/2007] [Indexed: 10/23/2022]
Abstract
RATIONALE Several lines of evidence suggest that altered serotonin (5-HT) function persists after recovery from anorexia nervosa (AN) and bulimia nervosa (BN). OBJECTIVES We compared 11 subjects who recovered (>1 year normal weight, regular menstrual cycles, no binging or purging) from restricting-type AN (REC RAN), 7 who recovered from bulimia-type AN (REC BAN), 9 who recovered from BN (REC BN), and 10 healthy control women (CW). MATERIALS AND METHODS Positron emission tomography (PET) imaging with [11C]McN5652 was used to assess the 5-HT transporter (5-HTT). For [11C]McN5652, distribution volume (DV) values were determined using a two-compartment, three-parameter tracer kinetic model, and specific binding was assessed using the binding potential (BP, BP=DVregion of interest/DVcerebellum-1). RESULTS After correction for multiple comparisons, the four groups showed significant (p<0.05) differences for [11C]McN5652 BP values for the dorsal raphe and antero-ventral striatum (AVS). Post-hoc analysis revealed that REC RAN had significantly increased [11C]McN5652 BP compared to REC BAN in these regions. CONCLUSIONS Divergent 5-HTT activity in subtypes of eating disorder subjects may provide important insights as to why these groups have differences in affective regulation and impulse control.
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Affiliation(s)
- Ursula F Bailer
- Western Psychiatric Institute and Clinic, University of Pittsburgh, Iroquois Building, Suite 600, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
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12
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Bailer UF, Frank GK, Henry SE, Price JC, Meltzer CC, Mathis CA, Wagner A, Thornton L, Hoge J, Ziolko SK, Becker CR, McConaha CW, Kaye WH. Exaggerated 5-HT1A but normal 5-HT2A receptor activity in individuals ill with anorexia nervosa. Biol Psychiatry 2007; 61:1090-9. [PMID: 17241616 DOI: 10.1016/j.biopsych.2006.07.018] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 06/23/2006] [Accepted: 07/06/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Many studies have found disturbances of serotonin (5-HT) activity in anorexia nervosa (AN). Because little is known about 5-HT receptor function in AN, positron emission tomography (PET) imaging with 5-HT receptor-specific radioligands was used to characterize 5-HT1A and 5-HT2A receptors. METHODS Fifteen women ill with AN (ILL AN) were compared with 29 healthy control women (CW); PET and [11C]WAY100635 were used to assess binding potential (BP) of the 5-HT1A receptor, and [18F]altanserin was used to assess postsynaptic 5-HT2A receptor BP. [15O] water and PET were used to assess cerebral blood flow. RESULTS The ILL AN women had a highly significant (30%-70%) increase in [11C]WAY100635 BP in prefrontal and lateral orbital frontal regions, mesial and lateral temporal lobes, parietal cortex, and dorsal raphe nuclei compared with CW. The [18F]altanserin BP was normal in ILL AN but was positively and significantly related to harm avoidance in suprapragenual cingulate, frontal, and parietal regions. Cerebral blood flow was normal in ILL AN women. CONCLUSIONS Increased activity of 5-HT1A receptor activity may help explain poor response to 5-HT medication in ILL AN. This study extends data suggesting that 5-HT function, and, specifically, the 5-HT2A receptor, is related to anxiety in AN.
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Affiliation(s)
- Ursula F Bailer
- Department of Psychiatry, Western Psychiatric Institute and Clinic, School of Medicine, Pittsburgh, University of Pittsburgh, Pennsylvania 15213, USA
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13
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Bardone-Cone AM, Wonderlich SA, Frost RO, Bulik CM, Mitchell JE, Uppala S, Simonich H. Perfectionism and eating disorders: Current status and future directions. Clin Psychol Rev 2007; 27:384-405. [PMID: 17267086 DOI: 10.1016/j.cpr.2006.12.005] [Citation(s) in RCA: 308] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Revised: 12/19/2006] [Accepted: 12/21/2006] [Indexed: 11/15/2022]
Abstract
The literature examining the relation between perfectionism and eating disorders was reviewed and content and methodological comparisons were made with the perfectionism literature in anxiety disorders and depressive disorders. A PsychInfo search using the key words "perfectionism/perfect/perfectionistic," "anorexia," "bulimia," and "eating disorders" was performed and the generated list of papers was supplemented based on a review of reference lists in the papers. A total of 55 papers published between 1990 and 2005 were identified that assessed perfectionism among individuals with diagnosed eating disorders. The key research questions were distilled from these publications and empirical findings were summarized for each question, followed by a comparison with perfectionism papers in the anxiety and depressive disorder literatures. Also, key research design methodological parameters were identified and comparisons made across the three literatures: eating disorders, anxiety disorders, depressive disorders. The current review concludes with conceptual and methodological recommendations for researchers interested in perfectionism and eating disorders.
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Affiliation(s)
- Anna M Bardone-Cone
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO, USA.
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Mondelli V, Gianotti L, Picu A, Abbate Daga G, Giordano R, Berardelli R, Pariante CM, Fassino S, Ghigo E, Arvat E. Neuroendocrine effects of citalopram infusion in anorexia nervosa. Psychoneuroendocrinology 2006; 31:1139-48. [PMID: 17045409 DOI: 10.1016/j.psyneuen.2006.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Revised: 08/18/2006] [Accepted: 08/28/2006] [Indexed: 11/27/2022]
Abstract
Because of the role of serotonin (5HT) in regulating food intake and mood, several studies have focused their attention on the assessment of serotonergic activity in eating disorders, and in particular in anorexia nervosa, but the results have been inconsistent. Citalopram, a highly selective 5HT reuptake inhibitor, has been recently reported as a neuroendocrine probe to assess the serotonergic function in physiological and pathological conditions. We evaluated the adrenocorticotropic hormone (ACTH), cortisol, prolactin (PRL) and growth hormone (GH) secretion during placebo or citalopram IV infusion (20 mg over 120 min), in six women with anorexia nervosa restricter type, and in six healthy women, in order to test the hypothesis that this neurotransmitter system is abnormal in this group of patients. ACTH and PRL secretion was higher during citalopram infusion compared to placebo (p<0.05) in both groups, while cortisol secretion was higher during citalopram infusion only in healthy controls (p<0.05), but not in anorexic patients. GH levels were unaffected by citalopram in both groups. These results demonstrate that serotonergic activation by citalopram affects corticotroph and lactotroph but not somatotroph secretion in anorexic as well as in normal subjects. Our preliminary findings do not support the existence of remarkable alterations in the serotonergic control of anterior pituitary function in anorexia nervosa, while there seems to be an impairment of the adrenal function in this group of patients.
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Affiliation(s)
- Valeria Mondelli
- Section of Psychiatry, Department of Neuroscience, University of Turin, Italy.
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15
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Bachner-Melman R, Zohar AH, Ebstein RP. An examination of cognitive versus behavioral components of recovery from anorexia nervosa. J Nerv Ment Dis 2006; 194:697-703. [PMID: 16971822 DOI: 10.1097/01.nmd.0000235795.51683.99] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Definitions of "full recovery" from anorexia nervosa (AN) vary, and rarely include the cognitive criteria of lack of body image distortion and fear of weight gain. We investigated the implications of including or excluding cognitive criteria of AN in the definition of "full recovery". Current symptomatology and personality characteristics associated with AN were assessed and compared in 42 behaviorally but not cognitively recovered women, 32 both behaviorally and cognitively recovered women, and 253 controls. On all measures included, the scores of the behaviorally recovered women were significantly more anorexic-like than those of the women recovered cognitively as well, who were indistinguishable from controls. Criteria for recovery from AN need to be refined and standardized, and cognitive criteria incorporated, to characterize a minority who recover to the extent that their eating attitudes and personality profiles are indistinguishable from those of women with no history of an eating disorder.
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Affiliation(s)
- Rachel Bachner-Melman
- Department of Psychiatry, Hadassah University Medical Center, Ein Kerem, Jerusalem, Israel.
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16
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Bruce KR, Steiger H, Ng Ying Kin NMK, Israel M. Reduced platelet [3H]paroxetine binding in anorexia nervosa: relationship to eating symptoms and personality pathology. Psychiatry Res 2006; 142:225-32. [PMID: 16697471 DOI: 10.1016/j.psychres.2005.08.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2005] [Revised: 07/19/2005] [Accepted: 08/03/2005] [Indexed: 10/24/2022]
Abstract
Alterations in serotonin function have been implicated in both anorexia and bulimia nervosa, and previous studies suggest associations between serotonin function and variations in pathological personality traits. Women meeting DSM-IV criteria for anorexia nervosa (AN, 16 with the restricting subtype and 14 with the binge-purge subtype) and 49 healthy control women (CW) provided blood samples for analyses of platelet [(3)H]paroxetine binding. Participants also filled out questionnaires tapping eating disorder symptoms, depression, and personality pathology. Compared with CW, women with restricting and binge-purge AN had significantly lower levels of paroxetine binding (respectively: 1012 + 487 vs. 560 + 253 vs. 618 + 217 fmol/mg protein). Simple correlation analyses showed that, within AN but not within controls, paroxetine binding was inversely related to dieting preoccupations, affective instability, anxiousness, compulsivity, restricted expression and social avoidance but independent of age, body mass index, depression, and other eating symptoms. Findings suggest that reduced peripheral serotonin transporter density in AN relates to increased dieting preoccupations, affective instability and anxiousness-fearfulness.
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Affiliation(s)
- Kenneth R Bruce
- Eating Disorders Program, Douglas Hospital, Montreal, Quebec, Canada.
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Wagner A, Barbarich-Marsteller NC, Frank GK, Bailer UF, Wonderlich SA, Crosby RD, Henry SE, Vogel V, Plotnicov K, McConaha C, Kaye WH. Personality traits after recovery from eating disorders: do subtypes differ? Int J Eat Disord 2006; 39:276-84. [PMID: 16528697 DOI: 10.1002/eat.20251] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We compared individuals recovered from anorexia (AN) and bulimia nervosa (BN) to determine characteristics that are shared by or distinguish eating disorder (ED) subtypes. METHOD Sixty women recovered for > or = 1 year from AN or BN were compared with 47 control women (CW). Assessments included the Yale-Brown-Cornell Eating Disorder Scale, the Spielberger State-Trait Anxiety Inventory, the Beck Depression Inventory, the Yale-Brown Obsessive Compulsive Scale, the Temperament and Character Inventory, and Structured Clinical Interviews for DSM-IV. RESULTS Individuals recovered from an ED had similar scores for mood and personality variables that were significantly higher than the scores for CW. Few recovered subjects had Cluster B personality disorder. Most individuals recovered within 6 years of their ED onset. A latent profile analysis identified an "inhibited" and "disinhibited" cluster based on personality traits. CONCLUSION A wide range of symptoms persist after recovery and do not differ between subtypes of ED. These findings may aid in identifying traits that create vulnerabilities for developing an ED.
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Affiliation(s)
- Angela Wagner
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania 15213, USA
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18
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Crisp A. 1.7. Vulnerability to anorexia nervosa; constitutional markers. EUROPEAN EATING DISORDERS REVIEW 2006. [DOI: 10.1002/erv.705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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19
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Bosanac P, Norman T, Burrows G, Beumont P. Serotonergic and dopaminergic systems in anorexia nervosa: a role for atypical antipsychotics? Aust N Z J Psychiatry 2005; 39:146-53. [PMID: 15701063 DOI: 10.1080/j.1440-1614.2005.01536.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To review serotonergic and dopaminergic system function in anorexia nervosa in terms of potential modulation by atypical antipsychotic medications. METHOD A systematic review of clinical, neurobiological and functional neuroimaging findings of serotonergic and dopaminergic system activity in anorexia nervosa was conducted via MEDLINE, PsycINFO and EMBASE psychiatry databases, with a critical review of dysregulation of these systems as therapeutic targets for atypical antipsychotics, in context of evidence regarding the utility and efficacy of these medications in this syndrome. RESULTS There is evidence of persistently altered serotonergic and dopaminergic function in anorexia nervosa independent to weight-recovery. Case reports, open-label and single-blinded studies, albeit sparse, suggest that atypical antipsychotics may be beneficial in the management of anorexia nervosa psychopathology beyond weight gain. CONCLUSIONS Double-blind placebo controlled studies of atypical antipsychotics in anorexia nervosa with well defined outcome measures are required.
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Affiliation(s)
- Peter Bosanac
- Austin Health and Department of Psychiatry, The University of Melbourne, Austin Hospital, Austin Health, Victoria, Australia.
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20
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Ramacciotti CE, Paoli RA, Ciapparelli A, Marcacci G, Placidi GE, Dell'Osso L, Garfinkel PE. Affective temperament in the eating disorders. Eat Weight Disord 2004; 9:114-9. [PMID: 15330078 DOI: 10.1007/bf03325054] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In this study, we investigate the affective temperamental characteristics in a sample of ED (eating disorder) patients. METHODS 49 ED patients diagnosed by the SCID (Structured Clinical Interview for DSM-IV), were divided into two groups on the basis of the presence or absence of Binge Eating (restricting-anorexia nervosa [R-AN]= 16; Binge Eaters= 33). All patients were administered the TEMPS-I (Temperament Evaluation Memphis Pisa Semistructured - Interview), to assess affective temperament. A third group of controls (N= 1010), derived from a study with the TEMPS-I on normal subjects, was included for comparison. RESULTS A full affective temperament was not found in patients of the restricting group. By contrast 24% of the binge eating group had a full affective temperament of one of three types. Comparing the three temperaments for the three groups, only cyclothymic temperament proved to be significant, with higher levels in the binge eating group (p<0.01). CONCLUSIONS In this study, people with R-AN do not show a full affective temperament. However, people with binge eating, had depressive and hyperthymic temperament, and displayed higher level of cyclothymic temperament than the normal population. The findings of this study add to a growing literature on temperament in people with ED; particularly, they add to the view that may be various paths leading to R-AN, and these may differ from those of binge eating.
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21
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Bailer UF, Price JC, Meltzer CC, Mathis CA, Frank GK, Weissfeld L, McConaha CW, Henry SE, Brooks-Achenbach S, Barbarich NC, Kaye WH. Altered 5-HT(2A) receptor binding after recovery from bulimia-type anorexia nervosa: relationships to harm avoidance and drive for thinness. Neuropsychopharmacology 2004; 29:1143-55. [PMID: 15054474 PMCID: PMC4301578 DOI: 10.1038/sj.npp.1300430] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Several lines of evidence suggest that a disturbance of serotonin neuronal pathways may contribute to the pathogenesis of anorexia nervosa (AN) and bulimia nervosa (BN). This study applied positron emission tomography (PET) to investigate the brain serotonin 2A (5-HT(2A)) receptor, which could contribute to disturbances of appetite and behavior in AN and BN. To avoid the confounding effects of malnutrition, we studied 10 women recovered from bulimia-type AN (REC AN-BN, > 1 year normal weight, regular menstrual cycles, no binging, or purging) compared with 16 healthy control women (CW) using PET imaging and a specific 5-HT(2A) receptor antagonist, [18F]altanserin. REC AN-BN women had significantly reduced [18F]altanserin binding potential relative to CW in the left subgenual cingulate, the left parietal cortex, and the right occipital cortex. [18F]altanserin binding potential was positively related to harm avoidance and negatively related to novelty seeking in cingulate and temporal regions only in REC AN-BN subjects. In addition, REC AN-BN had negative relationships between [18F]altanserin binding potential and drive for thinness in several cortical regions. In conclusion, this study extends research suggesting that altered 5-HT neuronal system activity persists after recovery from bulimia-type AN, particularly in subgenual cingulate regions. Altered 5-HT neurotransmission after recovery also supports the possibility that this may be a trait-related disturbance that contributes to the pathophysiology of eating disorders. It is possible that subgenual cingulate findings are not specific for AN-BN, but may be related to the high incidence of lifetime major depressive disorder diagnosis in these subjects.
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Affiliation(s)
- Ursula F Bailer
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
- Department of General Psychiatry, University Hospital of Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Julie C Price
- Department of Radiology, School of Medicine, Presbyterian University Hospital, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carolyn C Meltzer
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
- Department of Radiology, School of Medicine, Presbyterian University Hospital, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chester A Mathis
- Department of Radiology, School of Medicine, Presbyterian University Hospital, University of Pittsburgh, Pittsburgh, PA, USA
| | - Guido K Frank
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - Lisa Weissfeld
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Claire W McConaha
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - Shannan E Henry
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - Sarah Brooks-Achenbach
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - Nicole C Barbarich
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - Walter H Kaye
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
- Correspondence: WH Kaye, Western Psychiatric Institute and Clinic, University of Pittsburgh, Iroquois Building, Suite 600, 3811 O’Hara Street, Pittsburgh, PA 15213, USA, Tel: + 1-412-647-9845, Fax: + 1-412-647-9740,
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22
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Kaye WH, Devlin B, Barbarich N, Bulik CM, Thornton L, Bacanu SA, Fichter MM, Halmi KA, Kaplan AS, Strober M, Woodside DB, Bergen AW, Crow S, Mitchell J, Rotondo A, Mauri M, Cassano G, Keel P, Plotnicov K, Pollice C, Klump KL, Lilenfeld LR, Ganjei JK, Quadflieg N, Berrettini WH. Genetic analysis of bulimia nervosa: methods and sample description. Int J Eat Disord 2004; 35:556-70. [PMID: 15101071 DOI: 10.1002/eat.10271] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Twin and family studies suggest that genetic variants contribute to the pathogenesis of bulimia nervosa (BN) and anorexia nervosa (AN). The Price Foundation has supported an international, multisite study of families with these disorders to identify these genetic variations. The current study presents the clinical characteristics of this sample as well as a description of the study methodology. METHOD All probands met modified criteria for BN or bulimia nervosa with a history of AN (BAN) as defined in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994). All affected relatives met DSM-IV criteria for BN, AN, BAN, or eating disorders not otherwise specified (EDNOS). Probands and affected relatives were assessed diagnostically using both trained-rater and self-report assessments. DNA samples were collected from probands, affected relatives, and available biologic parents. RESULTS Assessments were obtained from 163 BN probands and 165 BAN probands. Overall, there were 365 relative pairs available for linkage analysis. Of the affected relatives of BN probands, 62 were diagnosed as BN (34.8%), 49 as BAN (27.5%), 35 as AN (19.7%), and 32 as EDNOS (18.0%). For the relatives of BAN probands, 42 were diagnosed as BN (22.5%), 67 as BAN (35.8%), 48 as AN (25.7%), and 30 as EDNOS (16.0%). DISCUSSION This study represents the largest genetic study of eating disorders to date. Clinical data indicate that although there are a large number of individuals with BN disorders, a range of eating pathology is represented in the sample, allowing for the examination of several different phenotypes in molecular genetic analyses.
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Affiliation(s)
- Walter H Kaye
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Bloks H, Hoek HW, Callewaert I, van Furth E. Stability of personality traits in patients who received intensive treatment for a severe eating disorder. J Nerv Ment Dis 2004; 192:129-38. [PMID: 14770057 DOI: 10.1097/01.nmd.0000110284.12816.fe] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A longitudinal prospective design with four assessments was used to examine the stability of personality traits and their relation to recovery in patients with restrictive anorexia nervosa (N=35), bingeing/purging anorexia nervosa (N=37), bulimia nervosa (N=47), and eating disorder not otherwise specified (N=27). Recovery is associated with changes in personality traits in the direction of healthy control women. Recovered patients still show higher harm avoidance and higher persistence than healthy control women. These temperament factors seem to be a vulnerability factor for developing an eating disorder. Novelty seeking seems to define the type of eating disorder one is prone to develop. The character dimensions contribute the most to recovery. High self-directedness contributes to a favorable prognosis of bulimic symptomatology, whereas high cooperativeness contributes to an unfavorable prognosis in patients with anorexia nervosa.
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Affiliation(s)
- Hans Bloks
- National Centre for Eating Disorders, Robert Fleury Stichting, Leidschendam, The Netherlands
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24
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Jacobi C, Hayward C, de Zwaan M, Kraemer HC, Agras WS. Coming to Terms With Risk Factors for Eating Disorders: Application of Risk Terminology and Suggestions for a General Taxonomy. Psychol Bull 2004; 130:19-65. [PMID: 14717649 DOI: 10.1037/0033-2909.130.1.19] [Citation(s) in RCA: 819] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aims of the present review are to apply a recent risk factor approach (H. C. Kraemer et al., 1997) to putative risk factors for eating disorders, to order these along a timeline, and to deduce general taxonomic questions. Putative risk factors were classified according to risk factor type, outcome (anorexia nervosa, bulimia nervosa, binge-eating disorder, full vs. partial syndromes), and additional factor characteristics (specificity, potency, need for replication). Few of the putative risk factors were reported to precede the onset of the disorder. Many factors were general risk factors; only few differentiated between the 3 eating disorder syndromes. Common risk factors from longitudinal and cross-sectional studies were gender, ethnicity, early childhood eating and gastrointestinal problems, elevated weight and shape concerns, negative self-evaluation, sexual abuse and other adverse experiences, and general psychiatric morbidity. Suggestions are made for the conceptualization of future risk factor studies.
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Affiliation(s)
- Corinna Jacobi
- Department of Psychology, University of Trier, Trier, Germany.
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25
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Nakazato M, Hashimoto K, Shimizu E, Kumakiri C, Koizumi H, Okamura N, Mitsumori M, Komatsu N, Iyo M. Decreased levels of serum brain-derived neurotrophic factor in female patients with eating disorders. Biol Psychiatry 2003; 54:485-90. [PMID: 12915293 DOI: 10.1016/s0006-3223(02)01746-8] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Several lines of evidence suggest that brain-derived neurotrophic factor (BDNF) plays a role in the regulation of eating behavior. Because of its role in eating behavior, which is especially relevant to eating disorders, BDNF is an attractive candidate for investigation of potential biological markers of eating disorders such as bulimia nervosa (BN) and anorexia nervosa (AN). METHODS We enrolled 18 female patients with BN, 12 female patients with AN, and 21 age-matched female normal control subjects in this study. Eating-related psychopathology and depressive symptoms were evaluated using the Bulimic Investigatory Test, Edinburgh (BITE) and the Hamilton Depression Rating Scale (HDRS). Serum BDNF levels were measured by a sandwich enzyme-linked immunosorbent assay. RESULTS Serum levels of BDNF in the patients with AN or BN were significantly (p<.0001) decreased compared with those of normal control subjects, and serum BDNF levels in the patients with AN were significantly (p=.027) lower than those in patients with BN. A significant positive correlation (r=.378, p=.006) between serum BDNF levels and body mass index in all of the subjects was detected. Furthermore, there was a significant positive correlation (r=.435, p=.015) between the BITE symptom scale score and HDRS in these patients. CONCLUSIONS The present study suggests that BDNF may play a role in the pathophysiology of eating disorders.
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Affiliation(s)
- Michiko Nakazato
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
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26
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Connan F, Campbell IC, Katzman M, Lightman SL, Treasure J. A neurodevelopmental model for anorexia nervosa. Physiol Behav 2003; 79:13-24. [PMID: 12818706 DOI: 10.1016/s0031-9384(03)00101-x] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This paper integrates genetic and biological data on aetiological risk for anorexia nervosa (AN) with cognitive and psychosocial explanatory models. We have reviewed clinical and basic science data from each of these domains and then used a developmental perspective to formulate a multifactorial threshold model. By positioning interpersonal stress as a central component of this model, psychological, social and biological conceptualisations of AN can be used to generate a data driven, neurodevelopmental hypothesis for the aetiology of this complex disorder.
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Affiliation(s)
- Frances Connan
- Institute of Psychiatry, Kings College London, London SE5 8PF, UK.
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27
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Bonne O, Avraham Y, Bachar E, Katz M, Berry EM. Does short-term diet restriction in mice precipitate the development of anorexia? Nutr Neurosci 2003; 6:197-9. [PMID: 12793525 DOI: 10.1080/1028415031000094282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Anorexia nervosa (AN) inevitably begins with dieting. Yet, it is unknown whether anyone who will ultimately suffer from anorexia is already ill upon "going on a diet", or whether disease begins during, and is perhaps triggered by, dieting. The objective of the following study was to precipitate anorexia by imposing diet restriction on animals, as a model for generating AN in humans. Three hundred young female Sabra mice were diet restricted to 40% of daily nutrient requirements for 12 days, lost 17% of body weight and were then re-fed ad-lib. All mice regained appetite and weight. Our conclusions are that diet restriction does not precipitate anorexia in mice. Our findings do not support a role for diet restriction per se in triggering AN.
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Affiliation(s)
- Omer Bonne
- Department of Psychiatry, Hebrew University-Hadassah Medical School, PO Box 12000, Jerusalem 91120, Israel.
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28
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Kaye WH, Barbarich NC, Putnam K, Gendall KA, Fernstrom J, Fernstrom M, McConaha CW, Kishore A. Anxiolytic effects of acute tryptophan depletion in anorexia nervosa. Int J Eat Disord 2003; 33:257-67; discussion 268-70. [PMID: 12655621 DOI: 10.1002/eat.10135] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Recent studies have raised the question as to whether a dysregulation of the neurotransmitter serotonin may contribute to the alterations in mood seen in anorexia nervosa (AN). People with AN tend to be anxious, obsessional, perfectionistic, and harm avoidant. These traits are premorbid and persist after recovery. It has been suggested that increased activity of brain serotonin systems could contribute to this pathologic condition. Dieting in AN, which serves to reduce plasma levels of tryptophan (TRP), may serve to reduce symptoms of dysphoric mood. METHOD Fourteen women currently symptomatic with AN (ILL AN), 14 women recovered from AN (REC AN), and 15 healthy control women (CW) underwent acute tryptophan depletion (ATD). Measures of psychological state were self-assessed at baseline and hourly after ATD to determine whether ATD would reduce negative mood. RESULTS ILL AN and REC AN had significantly higher mean baseline TRP/LNAA (tryptophan/large neutral amino acids) ratios compared with CW. In contrast to placebo, the ATD challenge demonstrated a significantly greater reduction in the TRP/LNAA ratio for ILL AN (-95%) and REC AN (-84%) compared with CW (-70 %). Both the ILL AN and REC AN had a significant reduction in anxiety on the ATD day compared with the placebo day. DISCUSSION These data demonstrate that a dietary-induced reduction of TRP, the precursor of serotonin, is associated with decreased anxiety in people with AN. Restricting dietary intake may represent a mechanism through which individuals with AN modulate a dysphoric mood.
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Affiliation(s)
- Walter H Kaye
- Department of Psychiatry, Anorexia and Bulimia Nervosa Research Module, University of Pittsburgh Medical School, 600 Iroquois Building, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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29
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Bergen AW, van den Bree MBM, Yeager M, Welch R, Ganjei JK, Haque K, Bacanu S, Berrettini WH, Grice DE, Goldman D, Bulik CM, Klump K, Fichter M, Halmi K, Kaplan A, Strober M, Treasure J, Woodside B, Kaye WH. Candidate genes for anorexia nervosa in the 1p33-36 linkage region: serotonin 1D and delta opioid receptor loci exhibit significant association to anorexia nervosa. Mol Psychiatry 2003; 8:397-406. [PMID: 12740597 DOI: 10.1038/sj.mp.4001318] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Serotonergic and opioidergic neurotransmitter system alterations have been observed in people with eating disorders; the genes for the serotonin 1D receptor (HTR1D) and the opioid delta receptor (OPRD1) are found on chr1p36.3-34.3, a region identified by our group in a linkage analysis of anorexia nervosa (AN). These candidate genes were evaluated for sequence variation and for linkage and association of this sequence variation to AN in family and case : control data sets. Resequencing of the HTR1D locus and a portion of the OPRD1 locus identified novel SNPs and confirmed existing SNPs. Genotype assay development and genotyping of nine SNPs (four at HTR1D and five at OPRD1) was performed on 191 unrelated individuals fulfilling DSM-IV criteria (w/o amenorrhea criterion) for AN, 442 relatives of AN probands and 98 psychiatrically screened controls. Linkage analysis of these candidate gene SNPs with 33 microsatellite markers in families including relative pairs concordantly affected with restricting AN (N=37) substantially increased the evidence for linkage of this region to restricting AN to an NPL score of 3.91. Statistically significant genotypic, allelic, and haplotypic association to AN in the case : control design was observed at HTR1D and OPRD1 with effect sizes for individual SNPs of 2.63 (95% CI=1.21-5.75) for HTR1D and 1.61 (95% CI=1.11-2.44) for OPRD1. Using genotype data on parents and AN probands, three SNPs at HTR1D were found to exhibit significant transmission disequilibrium (P&<0.05). The combined statistical genetic evidence suggests that HTR1D and OPRD1 or linked genes may be involved in the etiology of AN.
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Affiliation(s)
- A W Bergen
- Biognosis US, Inc. (Dissolved). From the Price Foundation Collaborative Group, Pittsburgh, PA, USA
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30
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Affiliation(s)
- Anne Ward
- Psychotherapy Unit, Maudsley Hospital, London, SE5 8AZ, United Kingdom
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31
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Brown NW, Ward A, Surwit R, Tiller J, Lightman S, Treasure JL, Campbell IC. Evidence for metabolic and endocrine abnormalities in subjects recovered from anorexia nervosa. Metabolism 2003; 52:296-302. [PMID: 12647266 DOI: 10.1053/meta.2003.50067] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Subjects with anorexia nervosa (AN) at low weight display metabolic, endocrine, and behavioral abnormalities. Whether these various differences are a consequence of the condition and persist after recovery is unclear. We tested the hypothesis that abnormalities in the insulin and leptin axes and in the desire to eat persisted in subjects who had recovered from AN in terms of body mass index (BMI) and menstrual function. Endocrine, metabolic, and psychological parameters were assessed by sampling under fasting conditions and serially in response to a standard meal. Subjects included 18 females recovered from AN and 18 female controls and measures included plasma insulin, leptin, glucose and beta-hydroxybutyrate (beta-HBA) concentrations together with desire to eat. Fasting glucose concentrations were normal in both groups, but fasting insulin concentrations were significantly lower and the fasting glucose/insulin ratio significantly higher in the recovered subjects. The glucose concentration was significantly higher at the end of the meal period in the recovered group. The peak increase of insulin during the meal was significantly less in the recovered group and in response to the meal, glucose/insulin ratios were significantly higher for the first 45 minutes indicating a delayed insulin response. Fasting beta-HBA concentrations were not significantly different between groups, but postmeal decreases were significant and larger in the recovered AN group. Fasting and meal-related leptin concentrations were not significantly different between the groups and in both groups were correlated with BMI. In controls, but not in recovered subjects, the reported desire to eat was correlated with plasma glucose and leptin concentrations. The insulin, glucose and beta-HBA data indicated the presence of insulin hypersensitivity in the recovered subjects. As the insulin response to the meal was blunted and apparently delayed, there may be a persistent alteration in pancreatic function as a long-term pathological consequence of the anorexia. Alternatively, these data indicate a possible trait marker for AN.
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Frank GK, Kaye WH, Meltzer CC, Price JC, Greer P, McConaha C, Skovira K. Reduced 5-HT2A receptor binding after recovery from anorexia nervosa. Biol Psychiatry 2002; 52:896-906. [PMID: 12399143 DOI: 10.1016/s0006-3223(02)01378-1] [Citation(s) in RCA: 152] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Several lines of evidence suggest that a disturbance of serotonin neuronal pathways may contribute to the pathogenesis of anorexia nervosa (AN). This study applied positron emission tomography (PET) to investigate the brain serotonin 2A (5HT2A) receptor, which could contribute to disturbances of appetite and behavior in AN. METHODS To avoid the confounding effects of malnutrition, we studied 16 women recovered from AN (REC AN, >1 year normal weight, regular menstrual cycles, no bingeing or purging) compared with 23 healthy control women (CW) using [18F]altanserin, a specific 5-HT2A receptor antagonist on PET imaging. RESULTS REC AN women had significantly reduced [18F]altanserin binding relative to CW in mesial temporal (amygdala and hippocampus), as well as cingulate cortical regions. In a subset of subjects (11 CW and 16 REC AN), statistical parametric mapping (SPM) confirmed reduced mesial temporal cortex 5HT2A receptor binding and, in addition, showed reduced occipital and parietal cortex binding. CONCLUSIONS This study extends research suggesting that altered 5-HT neuronal system activity persists after recovery from AN and may be related to disturbances of mesial temporal lobe function. Altered 5-HT neurotransmission after recovery also supports the possibility that this may be a trait-related disturbance that contributes to the pathophysiology of AN.
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Affiliation(s)
- Guido K Frank
- Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania 15213, USA
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33
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Kordy H, Krämer B, Palmer RL, Papezova H, Pellet J, Richard M, Treasure J. Remission, recovery, relapse, and recurrence in eating disorders: conceptualization and illustration of a validation strategy. J Clin Psychol 2002; 58:833-46. [PMID: 12205723 DOI: 10.1002/jclp.2013] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In a consensus-building process a group of experts from 19 European countries (COST Action B6) adapted the terms partial and full remission, relapse, recovery, and recurrence according to principles described by Frank et al. for depression. The empirical validity of the operationalizations was illustrated by longitudinal data on the post treatment course of 233 anorectic and 422 bulimic patients (diagnosed according to DSM-IIIR) from the German Project TR-EAT. These data were collected 2.5 years after admission using the Longitudinal Interval Follow-up Evaluation (LIFE) and statistically explored by survival-analysis. It was demonstrated that these consensus definitions measure what they intend to measure. They open a longitudinal perspective in that one can learn not only whether, but also when and with what probability patients change for the better or worse. Data suggest that persistence of symptom improvement has different implications for anorexia and bulimia nervosa. For example, relapse prevention would be most beneficial for bulimic patients for about 4 months after key symptoms remit, while this would be of less importance for anorexic patients. It is discussed whether and how this longitudinal approach can contribute to an empirically based rationale for targeted and individualized treatment.
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Affiliation(s)
- Hans Kordy
- Center for Psychotherapy Research, Stuttgart, Germany.
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Klump KL, McGue M, Iacono WG. Genetic relationships between personality and eating attitudes and behaviors. JOURNAL OF ABNORMAL PSYCHOLOGY 2002; 111:380-9. [PMID: 12003459 DOI: 10.1037/0021-843x.111.2.380] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Genetic and environmental factors underlying relationships between personality traits and disordered eating were examined in 256 female adolescent twin pairs (166 monozygotic, 90 dizygotic). Eating behaviors were assessed with the Total Score, Body Dissatisfaction, Weight Preoccupation, Binge Eating, and Compensatory Behavior subscales from the Minnesota Eating Disorders Inventory (M-EDI; K. L. Klump, M. McGue, & W. G. Iacono, 2000). Personality characteristics were assessed with the Negative Emotionality, Positive Emotionality, and Constraint scales from the Multidimensional Personality Questionnaire (MPQ; A. Tellegen, 1982). Model-fitting analyses indicated that although genetic factors were more likely to contribute to MPQ and M-EDI phenotypic associations than environmental factors, shared genetic variance between the 2 phenotypes was limited. MPQ personality characteristics may represent only some of several genetic risk factors for eating pathology.
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Affiliation(s)
- Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing 48824, USA.
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Klump KL, Wonderlich S, Lehoux P, Lilenfeld LRR, Bulik CM. Does environment matter? A review of nonshared environment and eating disorders. Int J Eat Disord 2002; 31:118-35. [PMID: 11920974 DOI: 10.1002/eat.10024] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Nonshared environmental influences are experiences that are unique to siblings reared in the same family. We review studies highlighting the importance of nonshared factors for the development of eating disorders and suggest areas for future research. METHODS Findings from behavioral genetic studies of eating disorders as well as methodological issues are reviewed. RESULTS Twin studies suggest that approximately 17%-46% of the variance in both anorexia nervosa (AN) and bulimia nervosa (BN) can be accounted for by nonshared environmental factors. Studies directly examining these influences are scarce, although initial data indicate that differential paternal relationships, body weight teasing, peer group experiences, and life events may account for the development of eating pathology in one sibling versus another. DISCUSSION Additional research is needed to identify specific nonshared environmental influences on eating disorders such as differential parental and sibling treatment, disparate peer group characteristics, and differential experience of life events such as physical and sexual abuse.
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Affiliation(s)
- Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing, Michigan 48824, USA.
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Frank GK, Kaye WH, Weltzin TE, Perel J, Moss H, McConaha C, Pollice C. Altered response to meta-chlorophenylpiperazine in anorexia nervosa: support for a persistent alteration of serotonin activity after short-term weight restoration. Int J Eat Disord 2001; 30:57-68. [PMID: 11439409 DOI: 10.1002/eat.1054] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Patients with anorexia nervosa (AN) have disturbances of appetite and behaviors, such as dysphoria, inhibition, and obsessions, that could be related to altered serotonin activity. To investigate such relationships, we administered meta-chlorophenylpiperazine (m-CPP), a relatively serotonin-specific drug. METHODS To avoid the confounding effects of malnutrition or weight loss, we studied 12 patients with restricting-type AN between 5 and 17 days after a return to a normal weight and while on a stable dietary intake. We compared them to 12 healthy control women (CW). m-CPP was administered double blind and placebo controlled. RESULTS Although weight restored, AN women had lower body weight and increased ratings for depression and obsessionality compared with CW. After m-CPP, AN women had an elevation in mood and a reduction in body image distortion when compared with placebo. After m-CPP, groups had similar cortisol, adrenocorticotropin (ACTH), and growth hormone responses whereas AN women had an uncertain reduction in prolactin response. DISCUSSION These data support other studies that suggest that altered serotonin activity persists after weight restoration in AN patients. The finding that m-CPP temporarily improved mood and reduced body image distortions supports the hypothesis that altered serotonin activity may contribute to the pathophysiology of AN.
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Affiliation(s)
- G K Frank
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Abstract
Data described earlier are clear in establishing a role for genes in the development of eating abnormalities. Estimates from the most rigorous studies suggest that more than 50% of the variance in eating disorders and disordered eating behaviors can be accounted for by genetic effects. These high estimates indicate a need for studies identifying the specific genes contributing to this large proportion of variance. Twin and family studies suggest that several heritable characteristics that are commonly comorbid with AN and BN may share genetic transmission with these disorders, including anxiety disorders or traits, body weight, and possibly major depression. Moreover, some developmental research suggests that the genes involved in ovarian hormones or the genes that these steroids affect also may be genetically linked to eating abnormalities. Molecular genetic research of these disorders is in its infant stages. However, promising areas for future research have already been identified (e.g., 5-HT2A receptor gene, UCP-2/UCP-3 gene, and estrogen receptor beta gene), and several large-scale linkage and association studies are underway. These studies likely will provide invaluable information regarding the appropriate phenotypes to be included in genetic studies and the genes with the most influence on the development of these disorders.
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Affiliation(s)
- K L Klump
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA.
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Klump KL, Bulik CM, Pollice C, Halmi KA, Fichter MM, Berrettini WH, Devlin B, Strober M, Kaplan A, Woodside DB, Treasure J, Shabbout M, Lilenfeld LR, Plotnicov KH, Kaye WH. Temperament and character in women with anorexia nervosa. J Nerv Ment Dis 2000; 188:559-67. [PMID: 11009328 DOI: 10.1097/00005053-200009000-00001] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present study examined temperament differences among anorexia nervosa (AN) subtypes and community controls, as well as the effect of body weight on personality traits in women with AN. Temperament and Character Inventory (TCI) scores were compared between 146 women with restrictor-type AN (RAN), 117 women with purging-type AN (PAN), 60 women with binge/purge-type AN (BAN), and 827 community control women (CW) obtained from an archival normative database. Women with AN scored significantly higher on harm avoidance and significantly lower on cooperativeness than CW. Subtype analyses revealed that women with RAN and PAN reported the lowest novelty seeking, RAN women the highest persistence and self-directedness, and PAN women the highest harm avoidance. Body mass index had a nominal effect on subgroup differences, suggesting that personality disturbances are independent of body weight. Findings suggest that certain facets of temperament differ markedly between women with AN, regardless of diagnostic subtype, and controls. More subtle temperament and character differences that were independent of body weight emerged that distinguish among subtypes of AN.
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Affiliation(s)
- K L Klump
- Department of Psychology, Michigan State University, East Lansing, USA
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Affiliation(s)
- M G Katz
- Monash Institute of Reproduction and Development, Monash University, Monash Medical Centre, Victoria, Australia
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Abstract
Speculation about the etiology of eating disorders has gone through different phases, variously favoring familial, organic, and psychosocial factors. Recent evidence has particularly contributed to our understanding of the organic view. We review the evidence for an organic contribution to the illness and present a series of cases in which organic factors were present. The cases illustrate the complex interaction between biological and psychological factors. In particular, a growth hormone-producing pituitary adenoma was discovered in a patient following successful treatment of her bulimia by psychological means alone. Etiological theories of eating disorders need to encompass both organic and psychosocial factors, allowed to interact in complex ways. Focusing exclusively on either aspect is a disservice to our patients.
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Affiliation(s)
- A Ward
- Eating Disorders Unit, Maudsley Hospital, Denmark Hill, London, England
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