Sex differences in addictive disorders

Gender-dependent differences in the rate of initiation and frequency of misuse of addicting drugs have been widely described. Yet, men and women also differ in their propensity to become addicted to other rewarding stimuli (e.g., sex, food) or activities (e.g., gambling, exercising). The goal of the present review is to summarize current evidence for gender differences not only in drug addiction, but also in other forms of addictive behaviours. Thus, we first reviewed studies showing gender-dependent differences in drug addiction, food addiction, compulsive sexual activity, pathological gambling, Internet addiction and physical exercise addiction. Potential risk factors and underlying brain mechanisms are also examined, with particular emphasis given to the role of sex hormones in modulating addictive behaviours. Investigations on factors allowing the pursuit of non-drug rewards to become pathological in men and women are crucial for designing gender-appropriate treatments of both substance and non-substance addictions.

Treatment effects on compulsive exercise and physical activity in eating disorders

BACKGROUND

Dysfunctional thoughts- and use of physical activity (PA) are core symptoms of the eating disorders (ED) bulimia nervosa (BN) and binge eating disorder (BED). The compulsive desire for PA complicates a favourable treatment outcome; hence, regular, adapted PA led by personnel with competence in exercise science is rarely part of treatment of BN and BED. The present study compared cognitive behaviour therapy (CBT) with a new treatment combining physical exercise and dietary therapy (PED-t) with respect to the short- and long-term changes in the level of compulsive exercise and actual level of PA in women with BN or BED.

METHODS

We enrolled 187 women with BN or BED, aged 18-40 years, with BMI 17.5-35, in an outpatient randomised controlled therapy trial. Participants were randomised to PED-t or CBT, while waitlist participants served as a control group during the treatment period. The treatment covered 16 weeks, with 6- and 12 months follow-up, and outcomes included self-reported compulsive exercise (CE) and objectively measured PA, analysed by linear mixed regression models.

RESULTS

Both CBT and PED-t reduced CE from baseline (P < 0.01, Hedges g ~ 0.4), but with no difference to control group. Compared to baseline, only PED-t significantly reduced the number of patients who scored above cut-off rating for CE, but with no between-group differences. The proportion of participants complying with the official recommendation for PA neither changed following treatment, nor emerged different between the treatment arms.

CONCLUSION

Both therapies resulted in significant improvements in compulsive exercise, a change not found in the control group, however there were no between-group differences. The findings are tempered by the low statistical power due to a small control group size. The number of participants complying with the recommendation for PA were stable throughout the study, and no change in total PA was found. Presence and intensity of CE decline with treatment, but a need to increase PA towards healthy levels remains unsolved.

TRIAL REGISTRATION

Approved by the Norwegian Regional Committee for Medical and Health Research Ethics (ID: 2013/1871, 16th of December 2013); registered in Clinical Trials (ID: NCT02079935, 17th of February 2014).

Semaglutide attenuates excessive exercise-induced myocardial injury through inhibiting oxidative stress and inflammation in rats

AIMS

To investigate the protective effects and mechanism of semaglutide on exercise-induced myocardial injury.

MAIN METHODS

Effects of semaglutide on lipopolysaccharide (LPS)-induced oxidative stress injuries and inflammatory response were assessed in H9c2 cell via MTT assay and Western blot. Quiet control group, over training group and three doses of semaglutide treated overtraining groups were subjected to the swimming training with increasing load for consecutive 10 weeks. Immediately after the last training, the body weight, myocardial morphological changes, injury markers and inflammatory response related proteins of the model rats were analyzed.

KEY FINDINGS

Semaglutide at three concentrations in LPS treated H9c2 cells significantly increased the survival rate and inhibited the apoptosis of cardiomyocytes. Moreover, semaglutide activated AMPK pathway, improve autophagy and inhibited reactive oxygen species production in LPS treated H9C2 cells. In vivo results further revealed that chronic treatment of semaglutide induced significant increase in myocardial injury markers. The pathological histology analysis results showed that semaglutide ameliorated myocardial morphological changes, reduced area of lipid accumulation and significantly decreased the expression levels of NF-κB, TNF-α and IL-1β.

SIGNIFICANCE

Semaglutide exert the protective effects on exercise-induced cardiomyopathy by activating AMPK pathway, increasing autophagy, reducing the production of ROS and inflammation-related proteins.

The expression of excessive exercise co-segregates with the risk of developing an eating disorder in women

Excessive exercise (EE) is an important symptom of eating disorders (ED) and is a likely risk factor for developing ED, however, no population-based studies have been performed on the relationship between EE and obtaining ED diagnosis. The aim of this study was to examine the co-occurrence of EE and ED diagnosis in a general population of women. Data for 778 females (age min=30, max=55) from the Saint Thomas Twin Registry, London were used. Phenotypes analyzed included self-reported time spent on physical activity per week, ED diagnosis, Eating Disorder Inventory results (EDI-III), age, BMI and kinship (twin pair). Generalized Estimating Equation analysis showed that only EE (>5 h of exercise per week) and Bulimia Subscale of EDI-III were significantly associated with obtaining ED diagnosis throughout the life. These data revealed that the odds of ever being diagnosed with an ED are more than 2.5 times higher for excessive exercisers compared to individuals with lower activity levels. These data support the notion that EE may be an important risk factor for developing an ED in women.

Body dissatisfaction, excessive exercise, and weight change strategies used by first-year undergraduate students: comparing health and physical education and other education students

BACKGROUND

Health and Physical Education (HPE) teachers are known to be under social-, personal-, and employment-related pressure to be and appear physically fit, and to use dangerous dieting and weight control practices. This is problematic due to the influence this may have on their own health and the potential to model these attitudes and behaviours to their future students.

METHODS

In this paper, we compare the body image, dieting, disordered eating, and exercise behaviours of first year, HPE, and non-HPE, teacher education students. Participants were 596 first-year university student pre-service teachers (n = 249 HPE and n = 347 non-HPE) from three universities in Australia who completed self-report questionnaires. Analysis of covariance and logistic regression analyses were used to determine differences in attitudes and behaviours between these two groups for males and females separately.

RESULTS

We found that male HPE participants had significantly higher levels of drive for muscularity and obligatory exercise, and were more likely to be classified as having an exercise disorder, dieting, and using steroids than non-HPE students were. Female HPE students were more likely to engage in self-reported excessive exercise, to have higher scores on the Obligatory Exercise Questionnaire, and be classified as having an exercise disorder.

CONCLUSION

These findings are important as they confirm the presence of dieting and disordered eating attitudes and behaviours among all teacher education students, and highlight male HPE teachers as a potentially vulnerable group. These results may inform the implementation of intervention programs for teacher education students to ensure their personal wellbeing and professional capacity in promoting positive body image, nutrition, and physical activity among young people.

Physical Exercise for Muscle Atrophy

The most direct characteristic of muscle atrophy is reduction in muscle mass, which is due to increased protein degradation or reduced protein synthesis in skeletal muscle. The loss of muscle mass can directly affect the quality of daily life, prolong the recovery period, and become the main risk factor for chronic diseases. However, there is currently no effective way to prevent and treat this disease, and therefore it is imperative to explore effective therapeutic approaches for muscle atrophy. It is well known that physical exercise is important for maintaining good health and long-term adherence to exercise can reduce the risk of cardiovascular diseases, obesity, and diabetes. It is also well established that exercise training can promote the synthesis of muscle protein and activate signaling pathways that regulate the metabolism and function of muscle fibers. Therefore, exercise can be used as a method to treat muscle atrophy in many of these conditions. Mitochondria play an important role in skeletal muscle homeostasis and bioenergy metabolism. Mitochondria are sensitive to contractile signals, and hence exercise can improve mitochondrial function and promote biosynthesis, which ultimately maintains the healthy state of cells and the whole body. On the other hand, frequent unaccustomed exercise will change the structure and function of skeletal muscle fibers, which is called exercise-induced muscle damage. When the exercise-induced muscle damage happens, it can cause temporary muscle damage and soreness, giving a negative effect on the muscle function.

Examining similarities in eating pathology, negative affect, and perfectionism among peers: A social network analysis

Friends tend to be more similar than non-friends (i.e., exhibit homophily) in body image concerns and disordered eating behaviors. These similarities may be accounted for by similarities in eating disorder risk factors and correlates. The current study sought to replicate findings of homophily for eating pathology using social network analysis and to test if similarity in eating pathology is present above and beyond homophily for eating disorder risk factors and correlates. College students (n = 89) majoring in nutrition completed a social network assessment and measures of eating pathology (i.e., body dissatisfaction, binge eating, restricting, excessive exercise), negative affect, and perfectionism. Homophily for eating pathology, negative affect, and perfectionism were tested as predictors of friendship ties using exponential random graph modeling, adjusting for gender, year in school, and body mass index. Results did not support homophily for eating pathology. However, restricting was associated with a lower likelihood of friendship ties. Homophily was present for perfectionism, but not for negative affect. Results suggest that eating pathology may influence the propensity to form friendships and account for previous findings of homophily in the literature. Homophily for perfectionism may have also driven previous findings for homophily. More longitudinal work using social network analysis is needed to understand the role that personality plays in peer influences on eating pathology.

Competitiveness as a moderator of the relation between appearance-related factors and disordered eating behaviors

The present study examined competitiveness as a moderator of the relationships between appearance-related factors (i.e., thin-ideal internalization, appearance contingent self-worth) and disordered eating behaviors (i.e., dieting, excessive exercise). Participants were 441 undergraduate females for cross-sectional analyses, with 237 also contributing data longitudinally, 1 year later. Results showed that, in a model including thin-ideal internalization and appearance contingent self-worth and their interactions with competitiveness, thin-ideal internalization (but not appearance contingent self-worth) interacted with competitiveness to identify concurrent levels of both dieting and excessive exercise. Individuals high in both thin-ideal internalization and competitiveness exhibited the highest levels of concurrent dieting and excessive exercise. After controlling for baseline levels of the dependent variables, neither appearance-related factor interacted with competitiveness to predict dieting or excessive exercise. These findings suggest that individuals who are both competitive and accept and strive to achieve the thin ideal may be at risk for disordered eating behaviors.

Treatment for female patients with eating disorders in the largest medical prison in Japan

The number of offenders with eating disorders in women’s prisons in Japan has grown annually over the last 15 years. Women’s prisons have experienced significant difficulties in the management of patients with eating disorders who have body-critical complications arising from low body weight, in addition to behavioral problems. Patients in Japan’s 185 correctional facilities who display high refractoriness or who present a physical risk are transferred to the Hachioji medical prison, a national specialty hospital operated by the Ministry of Justice. The medical prison must manage any psychosomatic problems necessary for the safety of inmates regardless of a patient’s wishes. The most common conviction resulting in imprisonment of women with eating disorders was shoplifting (n = 44; 63%), with the second most common being drug-offenses (n = 17; 24%). While shoplifting is of concern in relation to eating disorders, a causal relationship remains unclear. Most patients in the shoplifting group did not have histories of antisocial and/or impulsive behaviors such as drug abuse, sexual deviation, self-injury, or other criminal activity. Instead, shoplifting appears to be an obsessive-compulsive behavior deeply rooted in the psychopathology of severe eating disorder patients. Patients in this group tended to have histories of relatively high education and steady employment, although most also had histories of prolonged eating disorders and unstable treatment. Although adherence to treatment was poor among patients with eating disorders in the medical prison, body weight and behavioral problems improved following treatment in the special compulsory environment, without severe sequelae or patient death. The Ministry of Justice recently established another specialized ward for the care for female patients with eating disorders. If greater emphasis is placed on early-stage, protective, medical treatment, the number of patients with eating disorders in prisons may decrease. Further research is required to investigate the relationship between shoplifting and eating disorders.

Protection versus risk? The relative roles of compassionate and uncompassionate self-responding for eating disorder behaviors

Research demonstrates the protective role of self-compassion for eating disorder symptoms. However, studies investigating self-compassion most often use the Self-Compassion Scale, which aggregates the distinct but related constructs of compassionate and uncompassionate self-responding. This study examined differential associations of compassionate and uncompassionate self-responding with positive and negative affect and with a range of eating disorder behaviors (i.e., binge eating, purging, dietary restriction, and excessive exercise). Participants were 547 undergraduate students (59% women, M_age = 20.49, SD_age = 1.83) who completed measures of self-compassion, trait affect, and eating disorder behaviors. Compassionate and uncompassionate self-responding were moderately negatively correlated (rs = -0.41 and -0.33, among women and men, respectively). Compassionate self-responding was more strongly related to positive affect, and uncompassionate self-responding was more strongly related to negative affect. Among women, uncompassionate self-responding was related to all eating disorder behaviors controlling for compassionate self-responding, whereas compassionate self-responding was not uniquely related to any eating disorder behavior. Among men, a similar pattern emerged, except that only compassionate self-responding related uniquely to excessive exercise. Results are consistent with studies showing that the presence of uncompassionate self-responding might outweigh the absence of compassionate self-responding in explaining psychopathology. Findings highlight the potential importance of primarily targeting uncompassionate self-responding in eating disorder interventions.

An investigation of the process of change in psychopathology and exercise during inpatient treatment for adults with longstanding eating disorders

BACKGROUND

Excessive exercise is recognized as a predictor of poor outcome in eating disorders. However, little is known about how excessive exercise might affect the treatment process. The aim of this study was to describe process of weekly changes in eating disorder psychopathology, general psychopathology and exercise, and the possible interactive effects of excessive exercise on these changes during inpatient treatment of longstanding eating disorders.

METHODS

Eighty-four patients meeting the DSM-IV criteria for Anorexia Nervosa, Bulimia Nervosa, or Eating Disorders Not Otherwise Specified received inpatient cognitive-behavioural therapy including, physical activity and nutritional counselling treatment over 12 weeks. Excessive exercise was defined as having ≥6 episodes of driven exercise during week 1 of treatment. Excessive exercisers received one additional session of individual counseling with the clinical exercise physiologist. The study used repeated measurements during treatment and collected measures of eating disorders: psychopathology (EDE-Q), general psychopathology (SCL-5), and frequencies of exercise and body mass index (BMI). Statistical analysis was performed using repeated measures ANOVA.

RESULTS

Both eating disorders and general psychopathology were reduced from admission to discharge in excessive exercisers and non-exercisers. There was an overall interaction effect between time (week) and excessive exercise for the process of exercise and eating disorders psychopathology reduction. This interaction effect was also found in week 10 vs 11 regarding general psychopathology. The excessive exercisers showed steep reduction at first, followed by a smaller increase towards the end of treatment in both eating disorder and general psychopathology; this pattern was not found among the non-exercisers.

CONCLUSION

The process of change in exercise and psychopathology during inpatient treatment of longstanding eating disorders differs across excessive and non-excessive exercisers. Although excessive exercisers were given special attention for their exercise cognition and behavior during treatment, it is apparent that this part of treatment must be further developed.

Disordered eating symptoms in Austrian men of different ages in the context of fitness centers

PURPOSE

To assess eating behavior and associated factors in male fitness-center attendees.

METHODS

An anonymous questionnaire was administered to male fitness center members of Innsbruck (Austria), aged 18-80 years to assess socio-demographic features, weight history, sports activity, eating behavior including disordered eating based on the Eating Disorder Examination Questionnaire (EDE-Q) and DSM-5 key symptoms for eating disorders (anorexia nervosa, binge eating, bulimia nervosa, purging disorder) and body image. Three age groups (younger-middle-aged-older men) were compared regarding the variables described above.

RESULTS

A total of 307 men included displayed high rates of disordered eating as described by EDE-Q cutoff scores (5-11%) as well as by DSM-5 eating disorder symptoms (10%). While EDE-Q cutoff scores did not differentiate between the groups, the prevalences of DSM-5 eating disorder symptoms yielded significant differences indicating a clear decrease with increasing age. Binge eating and bulimic symptoms with excessive exercising as the purging method were the most often reported symptoms.

CONCLUSION

Although described as typically female, disordered eating does occur in male fitness-gym attendees across all ages. The older the men, the less prevalent are the symptoms. Awareness of disordered eating and possible negative effects need to be addressed for attendees and trainers of the gym.

LEVEL OF EVIDENCE

V-descriptive survey study.

Functional hypothalamic amenorrhea: case presentations and overview of literature

Functional hypothalamic amenorrhea is a form of chronic anovulation not due to identifiable organic causes with adverse health consequences. A thorough history is paramount in the identification of women with this disorder as it is usually associated with lifestyle factors such as stress, weight loss, and excessive exercise. In this paper, recently published clinical guidelines are reviewed and a series of cases is presented that highlights diagnostic and therapeutic challenges encountered.

Hippocampal MCT4 as a key regulator in excessive exercise-induced cognitive impairment: involvement of neuroinflammation

BACKGROUND

As human life expectancy increases, maintaining a healthy lifestyle has become crucial. However, excessive exercise (EE) can lead to negative consequences such as muscle damage and exercise addiction. Recently, numerous reports have indicated that EE negatively impacts cognitive performance, although the exact mechanism remains unclear.

OBJECTIVE

This study aimed to investigate the specific mechanisms underlying cognitive alterations induced by EE.

METHODS

We conducted the Y-maze, Barnes maze, and Novel Object Recognition Test to assess both short-term and long-term memory, as well as object recognition ability. We then validated our findings using qRT-PCR to elucidate the underlying mechanisms. Additionally, Diclofenac (Dic), an anti-inflammatory drug, was administered to evaluate its effects on cognitive function and the results of the molecular experiments.

RESULTS

EE-induced mice exhibited cognitive impairments, along with elevated expression of inflammatory cytokines such as tumor necrosis factor-α, interleukin (IL) -6, and IL-1β, and downregulated monocarboxylate transporters (MCTs) like MCT4. However, animals pre-treated with Dic regained cognitive function, alongside restored levels of IL-6, IL-1β, and MCT4.

CONCLUSION

MCT4 plays may play a crucial role in EE-induced cognitive impairments.

Weight status and weight-control exercise in adolescents: A longitudinal population-based study

OBJECTIVE

Exercise is a transdiagnostic clinical feature of eating disorders, but consensus is lacking as to what constitutes, and gives rise to, excessive exercise motivated by weight control. Using a longitudinal cohort study, we aimed to describe population-level prevalence rates of varying levels of weight-control exercise and examine gender and weight status (overweight or obesity; OVOB) as cross-sectional determinants of weight-control exercise in 14-15-year-old adolescents. We then evaluated the association of OVOB at 10-11 years with weight-control exercise at 14-15 years.

METHODS

The sample comprised 6329 adolescents from the Longitudinal Study of Australian Children (LSAC). Weight and height were measured in early adolescence (aged 10-11) and in mid-adolescence (aged 14-15). Participants reported weight-control exercise using the Branched Eating Disorders Test at 14-15 years.

RESULTS

In mid-adolescence, the estimated population prevalence for any weight-control exercise was 49 % (55 % in females). For girls, moderate levels of exercise were most prevalent, and low levels for boys. For all levels except for the very lowest, boys with (vs. without) OVOB history (10-11 years) had about twice the odds of endorsing every level of weight-control exercise. Patterns among girls were similar, though lower in magnitude (∼1.5 times).

CONCLUSIONS

For both girls and boys, across most exercise levels, rates of weight-control exercise were greatest for those with OVOB; for the highest exercise level, effects were strongest for boys with OVOB. To accurately identify at-risk adolescents, our results provide preliminary support for a fluid definition of excessive weight-control exercise, dependent on gender and weight status.

McArdle disease in a patient with anorexia nervosa: a case report

BACKGROUND

McArdle disease is an autosomal recessive genetic disorder caused by a deficiency of the glycogen phosphorylase (myophosphorylase) enzyme, which muscles need to break down glycogen into glucose for energy. Symptoms include exercise intolerance, with fatigue, muscle pain, and cramps being manifested during the first few minutes of exercise, which may be accompanied by rhabdomyolysis.

CASE PRESENTATION

This case report describes for the first time the clinical features, diagnosis and management of a 20 year-old patient with anorexia nervosa and McArdle disease, documented by means of muscle biopsy.

CONCLUSION

Anorexia nervosa and McArdle disease interact in a detrimental bidirectional way. In addition, some laboratory parameter alterations (e.g., elevated values of creatine kinase) commonly attributed to the specific features of eating disorders (e.g., excessive exercising) may delay the diagnosis of metabolic muscle diseases. On the other hand, the coexistence of a chronic disease, such as McArdle disease, whose management requires the adoption of a healthy lifestyle, can help to engage patients in actively addressing their eating disorder.

Severe nondiabetic plantar mal perforant in an adolescent girl with anorexia nervosa

PURPOSE

We describe the case of a severe skin ulcer of the heel in an adolescent girl hospitalised for anorexia nervosa (AN) associated with a severe excessive exercise.

METHODS

This case report includes retrospective anamnestic and clinical data from the patient's medical record. A literature review was conducted on the dermatological changes described in AN.

CONCLUSION

Severe starving syndrome in AN due to intake restriction and pathological associated behaviours can cause serious somatic complications, including psycho-dermatological lesions. We describe a rare case of a nondiabetic plantar "mal perforant" resulting from multiple risk factors including prolonged undernutrition, excessive exercise, and significant psychiatric comorbidity with self-injury. We suggest that, in this context, one should include a particular attention to the risk of non-visible skin complications reflecting both the AN symptoms severity and the severity of the patient's psychological distress requiring individualised and specialised multidisciplinary approach.

LEVEL OF EVIDENCE

Level V, case report.

Gallic acid alleviates exercise-induced muscle damage by inhibiting mitochondrial oxidative stress and ferroptosis

BACKGROUND

Skeletal muscle injury caused by excessive exercise is one of the most commonly seen clinical diseases. It is indispensable to explore drugs for treating and relieving skeletal muscle injury. Gallic acid (GA) is a polyphenolic extract that has anti-inflammatory and antioxidant biological activities. However, its function and mechanism in skeletal muscle injury remain unclear.

METHODS

We first established a skeletal muscle injury model caused by excessive exercise. Histopathological analysis was used to determine the severity of skeletal muscle injury in mice. Techniques such as ELISA, Western blot, and RT-qPCR were used to measure skeletal muscle injury markers including CK, LDH, IL-6, TNF-α, and ferroptosis-related indicators such as Fe2+, MDA, COX2, and GPX4. Transmission electron microscopy was used to observe the morphology of mitochondria. JC-1, DHE, and C11-BODIPY 581/591 probes were used to detect mitochondrial membrane potential, mitochondrial reactive oxygen species (mtROS), and lipid peroxidation levels.

RESULTS

The results of this study indicate that GA has a positive therapeutic effect on skeletal muscle inflammation and injury induced by excessive exercise. On the one hand, GA can alleviate skeletal muscle mitochondrial injury and redox imbalance by reducing mitochondrial membrane potential level and increasing ATP production. On the other hand, GA can inhibit ferroptosis in skeletal muscle cells induced by excessive exercise through its antioxidant and anti-iron accumulation ability.

CONCLUSIONS

In summary, GA protects against skeletal muscle injury induced by excessive exercise by inhibiting mitochondrial oxidative stress and ferroptosis pathways, providing new evidence for GA as a promising therapeutic agent for skeletal muscle injury.