The implications of the COVID-19 pandemic on eating disorder features and comorbid psychopathology among adolescents with anorexia nervosa and matched controls: a comparative cohort design study

PURPOSE

To examine implications of the COVID-19 pandemic on eating disorder (ED) features and psychopathology in female adolescents with anorexia nervosa (AN).

METHOD

In total 79 females with first-onset AN (aged 12-22 years) were included and were followed up across a period of 1 year. We assessed AN participants recruited pre-pandemic (n = 49) to those recruited peri-pandemic (n = 30). Pre- (n = 37) and peri-pandemic (n = 38) age-, and education-matched typically developing (TD) girls (n = 75) were used as a reference cohort. ED features and psychopathology were assessed at baseline. After 1 year of follow-up the association between pandemic timing and clinical course was assessed. Analyses of covariance were used to examine differences in ED features and psychopathology.

RESULTS

Peri-pandemic AN participants experienced less ED symptoms at baseline compared to pre-pandemic AN participants. In particular, they were less dissatisfied with their body shape, and experienced less interpersonal insecurity. In addition, the peri-pandemic AN group met fewer DSM-IV criteria for comorbid disorders, especially anxiety disorders. In contrast, peri-pandemic AN participants had a smaller BMI increase over time. In TD girls, there were no differences at baseline in ED features and psychopathology between the pre- and peri-pandemic group.

CONCLUSION

Overall, peri-pandemic AN participants were less severely ill, compared to pre-pandemic AN participants, which may be explained by less social pressure and peer contact, and a more protective parenting style during the pandemic. Conversely, peri-pandemic AN participants had a less favorable clinical course, which may be explained by reduced access to health care facilities during the pandemic.

LEVEL OF EVIDENCE

Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

Intranasal administration of olanzapine has beneficial outcome in a rat activity-based anorexia model

The atypical antipsychotic drug olanzapine is prescribed despite clinical studies on olanzapine treatment showing mixed results on treatment efficacy in anorexia nervosa. We investigated the effect of systemic and intranasal administration of olanzapine in the activity-based anorexia (ABA) model. Rats were habituated to a running wheel and exposed to the ABA model while treated with olanzapine. During ABA rats had 1.5 h of daily access to food and ad libitum access to a running wheel for seven consecutive days. Olanzapine was administered via an osmotic minipump (1, 2.75, and 7.5 mg/kg) or intranasally 2 h before dark onset (1 and 2.75 mg/kg). We monitored body weight, food intake, wheel revolutions, body temperature, and adipose tissue. We found 2.75 and 7.5 mg/kg systemic olanzapine decreased wheel revolutions during ABA. Relative adipose tissue mass was increased in the 7.5 mg/kg olanzapine-treated group while body weight, food intake, and body temperature were unaltered by the systemic olanzapine. 1 and 2.75 mg/kg intranasal olanzapine diminished wheel revolutions and body temperature during the first 2 h after administration. The intranasal olanzapine-treated rats had a higher body weight at the end of ABA. We find that olanzapine has beneficial outcomes in the ABA via two administration routes by acting mainly on running wheel activity. Intranasal olanzapine showed a rapid effect in the first hours after administration in reducing locomotor activity. We recommend further exploring intranasal administration of olanzapine in anorectic patients to assist them in coping with restlessness.

Psychopathological and Neurobiological Overlap Between Anorexia Nervosa and Self-Injurious Behavior: A Narrative Review and Conceptual Hypotheses

Empirical evidence and clinical observations suggest a strong -yet under acknowledged-link between anorexia nervosa (AN) and non-suicidal self-injurious behavior (NSSI). By reviewing the literature on the psychopathology and neurobiology of AN and NSSI, we shed light on their relationship. Both AN and NSSI are characterized by disturbances in affect regulation, dysregulation of the reward circuitry and the opioid system. By formulating a reward-centered hypothesis, we explain the overlap between AN and NSSI. We propose three approaches understanding the relationship between AN and NSSI, which integrate psychopathology and neurobiology from the perspective of self-destructiveness: (1) a nosographical approach, (2) a research domain (RDoC) approach and (3) a network analysis approach. These approaches will enhance our knowledge of the underlying neurobiological substrates and may provide groundwork for the development of new treatment options for disorders of self-destructiveness, like AN and NSSI. In conclusion, we hypothesize that self-destructiveness is a new, DSM-5-transcending concept or psychopathological entity that is reward-driven, and that both AN and NSSI could be conceptualized as disorders of self-destructiveness.

The effects of probiotics administration on the gut microbiome in adolescents with anorexia nervosa-A study protocol for a longitudinal, double-blind, randomized, placebo-controlled trial

Objective

Knowledge on gut–brain interaction might help to develop new therapies for patients with anorexia nervosa (AN), as severe starvation‐induced changes of the microbiome (MI) do not normalise with weight gain. We examine the effects of probiotics supplementation on the gut MI in patients with AN.

Method

This is a study protocol for a two‐centre double‐blind randomized‐controlled trial comparing the clinical efficacy of multistrain probiotic administration in addition to treatment‐as‐usual compared to placebo in 60 patients with AN (13–19 years). Moreover, 60 sex‐ and age‐matched healthy controls are included in order to record development‐related changes. Assessments are conducted at baseline, discharge, 6 and 12 months after baseline. Assessments include measures of body mass index, psychopathology (including eating‐disorder‐related psychopathology, depression and anxiety), neuropsychological measures, serum and stool analyses. We hypothesise that probiotic administration will have positive effects on the gut microbiota and the treatment of AN by improvement of weight gain, gastrointestinal complaints and psychopathology, and reduction of inflammatory processes compared to placebo.

Conclusions

If probiotics could help to normalise the MI composition, reduce inflammation and gastrointestinal discomfort and increase body weight, its administration would be a readily applicable additional component of multi‐modal AN treatment.

Patients with anorexia nervosa face profound alterations of the gut microbiome which does not normalise with weight gain.

Alterations in the gut microbiome in patients with anorexia nervosa are linked to psychopathological symptoms and neurophysiological deficits, for example, related to the reward system.

This is the first study examining the effects of probiotics administration in adolescents with anorexia nervosa using a randomized controlled trial design.

Mental Capacity, Decision-Making and Emotion Dysregulation in Severe Enduring Anorexia Nervosa

Severe and Enduring Anorexia Nervosa (SE-AN) is a chronic eating disorder characterized by long-term starvation and its physical and psychological sequelae, and severe loss of quality of life. Interactions between neurobiological changes caused by starvation, vulnerability (personality) traits, and eating behaviors play a role. Several other factors, such as increased fear and decreased social cognition, have also been found in relation to SE-AN. With this in mind, we aim to add to the understanding of SE-AN by introducing the concept of mental capacity (MC), which refers to the ability to understand and process information-both on a cognitive and an emotional level-and then make a well-informed choice. MC may be an important construct within the context of SE-AN. Furthermore, we will argue how impaired decision-making processes may underlie, fuel, or contribute to limited MC in SE-AN. We will speculate on the importance of dysfunctional emotion processing and anxiety-related processes (e.g., a high intolerance of uncertainty) and their potential interaction with decision-making. Lastly, we will propose how these aspects, which to our knowledge have previously received little attention, may advise research and treatment or help in dealing with the "want but cannot" situation of life-threatening AN.

Do anxiety, depression, and intolerance of uncertainty contribute to social problem solving in adult women with anorexia nervosa?

INTRODUCTION

Inefficient problem solving in the social domain may be one of the difficulties underlying the interpersonal challenges thought to maintain anorexia nervosa (AN). However, past studies have neglected to control for depression, anxiety, and intolerance of uncertainty (IU), which are known to contribute to social problem solving.

METHODS

This study aimed to investigate whether adults with AN would show differences in social problem solving on an experimental task (Means-End Problem Solving; MEPS) and report differences in their attitudes (positive, negative) toward social problem solving and their use of social problem-solving styles (rational, impulsive-careless, avoidant) on the Social Problem-Solving Inventory Revised (SPSRI) compared to a non-AN control group.

RESULTS

Seventy-four adult women took part (30 with AN and 44 non-AN controls), and data show that those with AN generated significantly less effective solutions on the MEPS (d = 1.96) reported overall poorer social problem solving on the SPSRI (d = 0.58), reporting more negative and less positive attitudes toward social problem solving, and less impulsive and more avoidant social problem-solving styles. However, those with AN did not differ from controls in being able to rationalize social problems. Once depression (Beck Depression Inventory: BDI), state anxiety (State-Trait Anxiety Inventory: STAI), and IU (Intolerance of Uncertainty Scale-12; IUS-12) were included as covariates, these differences were no longer significant, suggesting that comorbid depression, anxiety, and IU symptoms may contribute to social problem solving in AN.

CONCLUSIONS

There was no specific effect of depression. Treating anxiety and IU might help to improve social problem solving and enable people with AN to be able to better access social support to aid their recovery.

Significant Locus and Metabolic Genetic Correlations Revealed in Genome-Wide Association Study of Anorexia Nervosa

OBJECTIVE

The authors conducted a genome-wide association study of anorexia nervosa and calculated genetic correlations with a series of psychiatric, educational, and metabolic phenotypes.

METHOD

Following uniform quality control and imputation procedures using the 1000 Genomes Project (phase 3) in 12 case-control cohorts comprising 3,495 anorexia nervosa cases and 10,982 controls, the authors performed standard association analysis followed by a meta-analysis across cohorts. Linkage disequilibrium score regression was used to calculate genome-wide common variant heritability (single-nucleotide polymorphism [SNP]-based heritability [h²_SNP]), partitioned heritability, and genetic correlations (r_g) between anorexia nervosa and 159 other phenotypes.

RESULTS

Results were obtained for 10,641,224 SNPs and insertion-deletion variants with minor allele frequencies >1% and imputation quality scores >0.6. The h²_SNP of anorexia nervosa was 0.20 (SE=0.02), suggesting that a substantial fraction of the twin-based heritability arises from common genetic variation. The authors identified one genome-wide significant locus on chromosome 12 (rs4622308) in a region harboring a previously reported type 1 diabetes and autoimmune disorder locus. Significant positive genetic correlations were observed between anorexia nervosa and schizophrenia, neuroticism, educational attainment, and high-density lipoprotein cholesterol, and significant negative genetic correlations were observed between anorexia nervosa and body mass index, insulin, glucose, and lipid phenotypes.

CONCLUSIONS

Anorexia nervosa is a complex heritable phenotype for which this study has uncovered the first genome-wide significant locus. Anorexia nervosa also has large and significant genetic correlations with both psychiatric phenotypes and metabolic traits. The study results encourage a reconceptualization of this frequently lethal disorder as one with both psychiatric and metabolic etiology.

Cognitive remediation therapy (CRT) as a treatment enhancer of eating disorders and obsessive compulsive disorders: study protocol for a randomized controlled trial

BACKGROUND

Anorexia nervosa (AN) and Obsessive Compulsive Disorder (OCD) are among the most incapacitating and costly of mental disorders. Cognitive Behaviour Therapy (CBT), medication, and combination regimens, to which in AN personalised guidance on weight control is added, are moderately successful, leaving room for more effective treatment algorithms. An underlying deficit which the two disorders share is cognitive inflexibility, a trait that is likely to impede treatment engagement and reduce patients' ability to benefit from treatment. Cognitive remediation therapy (CRT) is an easy-to-use intervention aimed at reducing cognitive inflexibility and thereby enhancing treatment outcome, which we aim to test in a controled study.

METHODS

In a randomized-controlled multicenter clinical trial 64 adult patients with AN and 64 with OCD are randomized to 10 bi-weekly sessions with either CRT or a control condition, after which Treatment As Usual (TAU) is started. All patients are evaluated during single-blind assessments at baseline, post-CRT/control intervention, and after 6 months. Indices of treatment effect are disorder-specific symptom severity, quality of life, and cost-effectivity. Also, moderators and mediators of treatment effects will be studied.

DISCUSSION

To our knowledge, this is the first randomized controlled trial using an control condition evaluating the efficacy and effectiveness of CRT as a treatment enhancer preceding TAU for AN, and the first study to investigate CRT in OCD, moreover taking cost-effectiveness of CRT in AN and OCD into account.

TRIAL REGISTRATION

The Netherlands Trial Register NTR3865 . Registered 20 february 2013.

A Virtual Reality Full Body Illusion Improves Body Image Disturbance in Anorexia Nervosa

BACKGROUND

Patients with anorexia nervosa (AN) have a persistent distorted experience of the size of their body. Previously we found that the Rubber Hand Illusion improves hand size estimation in this group. Here we investigated whether a Full Body Illusion (FBI) affects body size estimation of body parts more emotionally salient than the hand. In the FBI, analogue to the RHI, participants experience ownership over an entire virtual body in VR after synchronous visuo-tactile stimulation of the actual and virtual body.

METHODS AND RESULTS

We asked participants to estimate their body size (shoulders, abdomen, hips) before the FBI was induced, directly after induction and at ~2 hour 45 minutes follow-up. The results showed that AN patients (N = 30) decrease the overestimation of their shoulders, abdomen and hips directly after the FBI was induced. This effect was strongest for estimates of circumference, and also observed in the asynchronous control condition of the illusion. Moreover, at follow-up, the improvements in body size estimation could still be observed in the AN group. Notably, the HC group (N = 29) also showed changes in body size estimation after the FBI, but the effect showed a different pattern than that of the AN group.

CONCLUSION

The results lead us to conclude that the disturbed experience of body size in AN is flexible and can be changed, even for highly emotional body parts. As such this study offers novel starting points from which new interventions for body image disturbance in AN can be developed.

ESCAP Expert Paper: New developments in the diagnosis and treatment of adolescent anorexia nervosa--a European perspective

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.

Patients with anorexia nervosa who self-injure: a phenomenological study

PURPOSE

This study investigates self-injury from the perspective of patients with anorexia nervosa.

DESIGN AND METHODS

A phenomenological design was used. Twelve patients participated. Data were collected using a semi-structured interview guide.

FINDINGS

Participants display self-injurious behavior predominantly in situations when they are forced to eat. They are terrified of gaining weight and use self-injurious behavior to cope with their anxiety. Self-injury is envisioned as a technique to regain control of their own eating pattern without bothering anyone. They feel shame for not controlling their emotions more constructively.

PRACTICE IMPLICATIONS

Healthcare professionals should systematically observe signals and explore less harmful strategies that help to regulate overwhelming feelings.

Drive for activity in patients with anorexia nervosa

OBJECTIVE

Hyperactivity and elevated physical activity are both considered symptom characteristics of anorexia nervosa (AN). It has been suggested that a drive for activity (DFA) may underlie these expressions, yet research into DFA in AN remains scant. This study investigated DFA levels in patients with AN and its relation to AN severity. Furthermore, as physical exercise may be a way to reduce negative affect, the influence of negative affect (anxiety) on the role of DFA in AN was tested.

METHOD

Two hundred and forty female patients with AN completed measures for DFA, eating disorder (ED) pathology, anxiety, and clinical parameters.

RESULTS

A strong relation between DFA levels and ED pathology was found, which remained significant even after controlling for negative affect (anxiety).

DISCUSSION

After much theorizing about DFA in AN this study provides empirical evidence for DFA as a hallmark feature of AN, independent of anxiety levels. Future research should shed light on the relationships between DFA, actual physical activity, and the course of AN.

Too fat to fit through the door: first evidence for disturbed body-scaled action in anorexia nervosa during locomotion

To date, research on the disturbed experience of body size in Anorexia Nervosa (AN) mainly focused on the conscious perceptual level (i.e. body image). Here we investigated whether these disturbances extend to body schema: an unconscious, action-related representation of the body. AN patients (n = 19) and healthy controls (HC; n = 20) were compared on body-scaled action. Participants walked through door-like openings varying in width while performing a diversion task. AN patients and HC differed in the largest opening width for which they started rotating their shoulders to fit through. AN patients started rotating for openings 40% wider than their own shoulders, while HC started rotating for apertures only 25% wider than their shoulders. The results imply abnormalities in AN even at the level of the unconscious, action oriented body schema. Body representation disturbances in AN are thus more pervasive than previously assumed: They do not only affect (conscious) cognition and perception, but (unconscious) actions as well.

Aberrant somatosensory perception in Anorexia Nervosa

Anorexia Nervosa (AN) patients have a disturbed experience of body size and shape. Previously it has been shown that these body representation disturbances extend to enlarged perception of tactile distances. Here we investigated whether misperception of tactile size could be related to inaccurate elementary somatosensory perception. Tactile size perception was measured with the Tactile Estimation Task (TET) (see Keizer et al., 2011). Elementary somatosensory perception was assessed with a pressure detection task and two point discrimination (TPD). Compared to controls (n=28), AN patients (n=25) overestimated tactile size, this effect was strongest for the abdomen. Elementary tactile perception deviated in AN as well: Patients had a lower threshold for detecting pressure on their abdomen, and a higher threshold for TPD on both the arm and abdomen. Regression results implied that group membership predicted tactile size estimation on the arm. Both group membership and TPD predicted tactile size estimation on the abdomen. Our results show that AN patients have a disturbance in the metric properties of the mental representation of their body as they overestimate the size of tactile stimuli compared to controls. Interestingly, AN patients and controls differ in elementary somatosensory perception as well. However, this could not solely explain misperception of tactile distances, suggesting that both bottom-up and top-down processes are involved.

The Anorexia Relapse Prevention Guidelines in practice: a case report

PURPOSE

The purpose of this case report is to illustrate the application of the Anorexia Relapse Prevention Guidelines in nursing practice.

DESIGN AND METHODS

In a single case report, the implementation of the intervention was described.

FINDINGS

A purposive use of the Anorexia Relapse Prevention Guidelines provides insight into the actual process of relapse, which contributes to an early recognition of relapse symptoms and permits early intervention aimed at recovery.

NURSING IMPLICATIONS

Use of the Guidelines will lead to the implementation of well-structured professional procedures which are likely to support the patient's recovery.

Recovery of normal body weight in adolescents with anorexia nervosa: the nurses' perspective on effective interventions

PROBLEM

  Little is known about effective nursing interventions for adolescents with anorexia nervosa. The purpose of this study was to discover which aspects of nursing care are most effective, according to nurses, in recovery of normal body weight in adolescents with anorexia nervosa.

METHODS

  A qualitative descriptive research design was applied with individual in-depth interviews and a focus group. Thematic analysis was used to analyze the data.

FINDINGS

  Nurses state that they are in a key position in guiding patients with anorexia nervosa toward a path of weight recovery. A good therapeutic relationship is essential to the implementation of targeted nursing interventions in the areas of eating and exercising, social support, and parent counseling.

CONCLUSIONS

  The results of this research can be used to define more detailed nursing interventions, the effectiveness of which can be tested in follow-up research.

Tactile body image disturbance in anorexia nervosa

Body image disturbances are central to anorexia nervosa (AN). Previous studies have focused mainly on attitudinal and visual aspects. Studies on somatosensory aspects thus far have been scarce. We therefore investigated whether AN patients and controls differed in tactile perception, and how this tactile body image related to visual body image and body dissatisfaction. The Tactile Estimation Task (TET) measured tactile body image: Two tactile stimuli were applied to forearm and abdomen, and, while blindfolded, participants estimated the distance between the two tactile stimuli between their thumb and index finger. The Distance Comparison Task (DCT) measured visual body image. Compared to controls (n=25), AN patients (n=20) not only visualized their body less accurately, but also overestimated distances between tactile stimuli on both the arm and abdomen, which might reflect a disturbance in both visual and tactile body image. High levels of body dissatisfaction were related to more severe inaccuracies in the visual mental image of the body, and overestimation of tactile distances. Our results imply that body image disturbances in AN are more widespread than previously assumed as they not only affect visual mental imagery, but also extend to disturbances in somatosensory aspects of body image.

Translating experimental neuroscience into treatment of eating disorders: two examples

Anorexia nervosa (AN) is a serious mental disorder with impaired functioning including not only the cognitive and socio-emotional but also physical domains. Improved treatments, especially for adults with AN, are urgently needed. The insights gained from basic research in experimental animal models and the advent of cognitive neuroscience have produced major advances in our understanding of the condition, but translating these into clinical research or practice remains a challenge. We describe here what the eating disorders field can gain from schizophrenia research in this area. We use the example of socio-emotional impairments in AN to describe the iterative process between basic research and intervention development for neurobiologically informed and based treatments for this condition and briefly touch on some other examples that stem from translational science.

Effective nursing care of adolescents diagnosed with anorexia nervosa: the patients' perspective

AIMS AND OBJECTIVES

The purpose of this study is to develop - from the patients' perspective - a tentative theoretical model explaining the effectiveness of inpatient nursing care of adolescents diagnosed with anorexia nervosa.

BACKGROUND

The continuous and direct involvement of nurses with patients is likely to play a significant role in the recovery process of patients with anorexia nervosa. However, only limited evidence is available on what patients with anorexia nervosa themselves consider important and effective in terms of nursing care.

DESIGN

The design of this study was qualitative.

METHODS

A grounded theory approach was applied where 13 adolescents with anorexia nervosa were interviewed to generate data for the model.

RESULTS

Participants stated that nurses contributed significantly to their recovery from anorexia nervosa. Three recurring themes emerged from the data: (1) normalisation, (2) structure and (3) responsibility. The focus of nursing care with respect to these themes shifted during the phases of recovery.

CONCLUSIONS

Based on patients' experiences a theoretical model is developed describing effective nursing care of adolescents diagnosed with anorexia nervosa. Patients identified the key components of this model as essential to their weight recovery.

RELEVANCE TO CLINICAL PRACTICE

The model may be used to improve the quality of nursing care of adolescents diagnosed with anorexia nervosa through analysis of current practice with respect to the key components of our model. Interventions that are based on these components closely follow the patients' needs.

Pneumomediastinum: a rare complication of anorexia nervosa in children and adolescents. A case study and review of the literature

Spontaneous pneumomediastinum is uncommon in paediatric practice. We describe two cases of spontaneous pneumomediastinum in a child and an adolescent with anorexia nervosa. Thorough investigation failed to reveal any underlying cause for secondary pneumomediastinum. Pneumomediastinum in anorexia nervosa can be caused by not only elevated intrathoracic pressures, but also by the poor quality of the alveolar walls due to malnutrition. The incidence of spontaneous pneumomediastinum in anorexia nervosa is probably higher than that recorded, since it resolves spontaneously and, therefore, it can remain undetected. We conclude that it is our considered opinion that malnutrition associated with anorexia nervosa predisposes for spontaneous pneumomediastinum due to weakness of the alveolar wall and the loss of connective tissue.

Adolescent anorexia nervosa patients have a discrepancy between neurophysiological responses and self-reported emotional arousal to psychosocial stress

In both clinical practice and research, eating disorder patients are reported to have difficulties in identifying and describing their feelings. They are often described as being unaware of the linkage between their feelings and their behavior. The present study experimentally induced emotions in adolescent anorexia nervosa (AN) patients to examine both self-reported emotional arousal and neurophysiological responses. A group of 10 AN patients and a group of 22 healthy controls (HC) were compared with respect to changes in self-reported emotional arousal and neurophysiological responses, heart rate (HR) and HPA-axis response (cortisol in saliva) during a public speaking test inducing anxious stress. The AN group reported higher levels of anxiety, as a result of stress, but this was not reflected in their HR or cortisol response. By contrast, in the HC group higher levels of self-reported anxiety coincided with clear increases in HR and cortisol. The data indicate that AN patients, in contrast to healthy individuals, show a discordance between self-reported emotional and neurophysiological arousal during psychosocial stress.

Emotional functioning in anorexia nervosa patients: adolescents compared to adults

Studies concerning eating disorder patients have revealed the presence of alexithymia, depressive, and anxiety disorders. We compared these aspects of emotional functioning in two groups of anorexia nervosa (AN) patients: adolescents vs. adults. Forty-eight adolescent anorexia nervosa patients (ADO) and 23 adult anorexia nervosa patients (ADU) completed a battery of tasks and questionnaires to measure these different aspects of emotional functioning and to control for differences of a more general cognitive nature. Both groups showed marked resemblance; both had high alexithymia scores and performed worse on emotional tasks measuring aspects of alexithymia. Furthermore, both groups showed high percentages of depressive and anxiety disorders, with the ADU group scoring only higher on specific and social phobia than the ADO group. Adult and adolescent AN patient groups do not differ substantially with respect to emotional functioning.