Psychological characteristics of mothers of patients with anorexia nervosa: implications for treatment and prognosis

The impact of COMT, BDNF and 5-HTT brain-genes on the development of anorexia nervosa: a systematic review

PURPOSE

The genetic aspect of anorexia nervosa (AN) involving specific genes of the central-nervous-system has not yet been clearly understood. The aim of this systematic review is to assess the impact of three candidate genes of the brain: catechol-O-methyltransferase, brain-derived neurotrophic factor (BDNF) and serotonin transporter protein, on the susceptibility to AN and identify whether a clear connection persists between each of the gene-polymorphisms and AN.

METHODS

A total of 21 articles were selected for this review conforming to the PRISMA guidelines. Detailed keyword combinations were implemented within specific databases such as MEDLINE, SCIENCEDIRECT and PUBMED.

RESULTS

The catechol-O-methyltransferase gene-polymorphism did not show any change in phenotypic variation between AN and control subjects; but the familial association was rather strong with an over-transmission of the H allele. The latter also correlated with several dimensions of the Temperament and Character Inventory (TCI) scale. A notable relation was indicated between BDNF gene-polymorphism and anorexia-restrictive in terms of phenotypic distribution; the Met66-allele also depicted high association with anorexic behavioral traits. The 5-HTTLPR gene-polymorphism was found to be significantly associated with AN susceptibility with an over-transmission of the S-allele from parents to offspring.

CONCLUSION

The systematic review distinctively emphasized the genetic contribution of the brain-genes on the development of AN. Despite significant study findings, no clear and standardized genetic route was determined to be the cause of AN development. Future research is needed on these specific genes to closely monitor the genetic polymorphisms and their mechanism on AN susceptibility.

LEVEL OF EVIDENCE

I, systematic review.

SYMBIOTIC ILLUSION AND FEMALE IDENTITY CONSTRUCTION IN EATING DISORDERS: A PSYCHOANALYTICAL PSYCHOSOMATICS’ PERSPECTIVE

Abstract: This study aims primarily to reflect on the role of symbiotic illusion in the construction of female identity in women with eating disorders (ED), using premises from psychoanalytic psychosomatics. Considering ED as psychopathologies related to the affective economy, Oedipal relations play crucial role in the process of identity constitution. Mother-daughter relationships in ED are shaped in the molds of symbiotic illusion, with weak father figures. We presented a case study to briefly illustrate the theoretical framework. The omissive posture of a father to interdict the symbiotic relation leads daughters to find themselves unable to libidinally invest in other objects.

Brain and Cognitive Development in Adolescents with Anorexia Nervosa: A Systematic Review of fMRI Studies

Anorexia nervosa (AN) is an eating disorder often occurring in adolescence. AN has one of the highest mortality rates amongst psychiatric illnesses and is associated with medical complications and high risk for psychiatric comorbidities, persisting after treatment. Remission rates range from 23% to 33%. Moreover, weight recovery does not necessarily reflect cognitive recovery. This issue is of particular interest in adolescence, characterized by progressive changes in brain structure and functional circuitries, and fast cognitive development. We reviewed existing literature on fMRI studies in adolescents diagnosed with AN, following PRISMA guidelines. Eligible studies had to: (1) be written in English; (2) include only adolescent participants; and (3) use block-design fMRI. We propose a pathogenic model based on normal and AN-related neural and cognitive maturation during adolescence. We propose that underweight and delayed puberty-caused by genetic, environmental, and neurobehavioral factors-can affect brain and cognitive development and lead to impaired cognitive flexibility, which in turn sustains the perpetuation of aberrant behaviors in a vicious cycle. Moreover, greater punishment sensitivity causes a shift toward punishment-based learning, leading to greater anxiety and ultimately to excessive reappraisal over emotions. Treatments combining physiological and neurobehavioral rationales must be adopted to improve outcomes and prevent relapses.

Social support networks and eating disorders: an integrative review of the literature

AIMS

This study aimed to analyze the scientific literature about social networks and social support in eating disorders (ED).

METHODS

By combining keywords, an integrative review was performed. It included publications from 2006-2013, retrieved from the MEDLINE, LILACS, PsycINFO, and CINAHL databases. The selection of articles was based on preestablished inclusion and exclusion criteria.

RESULTS

A total of 24 articles were selected for data extraction. There was a predominance of studies that used nonexperimental and descriptive designs, and which were published in international journals. This review provided evidence of the fact that fully consolidated literature regarding social support and social networks in patients with ED is not available, given the small number of studies dedicated to the subject. We identified evidence that the family social network of patients with ED has been widely explored by the literature, although there is a lack of studies about other networks and sources of social support outside the family.

CONCLUSION

The evidence presented in this study shows the need to include other social networks in health care. This expansion beyond family networks would include significant others - such as friends, colleagues, neighbors, people from religious groups, among others - who could help the individual coping with the disorder. The study also highlights the need for future research on this topic, as well as a need for greater investment in publications on the various dimensions of social support and social networks.