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The International Journal of Eating... Nov 2023Food-cue-reactivity entails neural and experiential responses to the sight and smell of attractive foods. Negative emotions can modulate such cue-reactivity and this...
OBJECTIVE
Food-cue-reactivity entails neural and experiential responses to the sight and smell of attractive foods. Negative emotions can modulate such cue-reactivity and this might be central to the balance between restrictive versus bulimic symptomatology in Anorexia Nervosa (AN) and Bulimia Nervosa (BN).
METHOD
Pleasantness ratings and electrocortical responses to food images were measured in patients with AN (n = 35), BN (n = 32) and matched healthy controls (HC, n = 35) in a neutral state and after idiosyncratic negative emotion induction while electroencephalography (EEG) was recorded. The EEG data were analyzed using a mass testing approach.
RESULTS
Individuals with AN showed reduced pleasantness for foods compared to objects alongside elevated widespread occipito-central food-object discrimination between 170 and 535 ms, indicative of strong neural cue-reactivity. Food-object discrimination was further increased in the negative emotional condition between 690 and 1200 ms over centroparietal regions. Neither of these effects was seen in individuals with BN.
DISCUSSION
Emotion modulated food-cue-reactivity in AN might reflect a decreased appetitive response in negative mood. Such specific (emotion-)regulatory strategies require more theoretical work and clinical attention. The absence of any marked effects in BN suggests that emotional cue-reactivity might be less prominent in this group or quite specific to certain emotional contexts or food types.
PUBLIC SIGNIFICANCE
Negative affectivity is a risk factor for the development of eating disorders and individuals with eating disorders experience problems with emotion regulation. To better understand the effects of negative emotions, the present study investigated how they affected neural correlates of food perception in anorexia nervosa and bulimia nervosa.
Topics: Humans; Anorexia Nervosa; Bulimia Nervosa; Cues; Emotions; Electroencephalography
PubMed: 37565581
DOI: 10.1002/eat.24028 -
The Primary Care Companion For CNS... Aug 2023While eating disorders (EDs) affect people of all ages, reproductive stages, and genders, they are most prevalent in women of reproductive age and can have a profound... (Review)
Review
While eating disorders (EDs) affect people of all ages, reproductive stages, and genders, they are most prevalent in women of reproductive age and can have a profound impact on fertility and obstetric outcomes. Due to the high prevalence and health consequences, EDs in this group of women require specific attention. To discuss the implications of EDs in infertility, pregnancy, and the postpartum period and to introduce tools to aid in identifying disordered eating and appropriate treatment recommendations for women with suspected EDs. A comprehensive literature search was conducted of articles available on PubMed, last updated retrieval date March 27, 2023. Chain searching was used to identify other relevant articles. The following search terms were included: (pregnancy OR postpartum) AND (bulimia nervosa OR eating disorder OR anorexia nervosa OR binge eating disorder) AND (obstetric outcome OR infant outcome OR infant development OR depression OR anxiety); (fertility OR infertility) AND (bulimia nervosa OR eating disorder OR anorexia nervosa OR binge eating disorder OR weight suppression OR eating disorder not otherwise specified OR other specified feeding and eating disorder OR atypical anorexia nervosa OR binge eating OR low weight); and eating disorders AND PCOS. Articles pertinent to the impact of eating disorders on fertility and the impact of perinatal eating disorders on infant and mother were selected. Perinatal EDs impact maternal mental health and obstetric and infant outcomes. They can have a long-lasting effect on the offspring via epigenetic changes. EDs are also a common and treatable cause of infertility. : Recognition and treatment of EDs in women prior to conception can minimize obstetric risks to the woman and potential long-term adverse effects on the offspring. For women with infertility, recognition and treatment of EDs can increase the probability of conception. .
Topics: Female; Humans; Infant; Male; Pregnancy; Anorexia Nervosa; Binge-Eating Disorder; Feeding and Eating Disorders; Infertility; Reproductive Health
PubMed: 37671825
DOI: 10.4088/PCC.22nr03475 -
Acta Psychiatrica Scandinavica May 2024Anorexia nervosa (AN) is associated with increased risk of mortality, but little is known about the risk of inpatient admissions and mortality outcomes in individuals...
OBJECTIVE
Anorexia nervosa (AN) is associated with increased risk of mortality, but little is known about the risk of inpatient admissions and mortality outcomes in individuals with diagnoses of both AN and other psychiatric and somatic conditions. We aimed to investigate the inpatient admissions and mortality among people with AN and other diagnosed conditions using Danish national registers.
METHOD
This retrospective cohort study included individuals diagnosed with AN in Denmark, born 1977-2010. We identified other mental and somatic conditions in this population. We used Cox proportional hazards regression to estimate the risk of inpatient admission and mortality, focusing on (i) the number of other diagnosed conditions, and (ii) specific combinations of conditions diagnosed prior to the AN diagnosis. Categories of inpatient admissions considered were due to: (i) AN, (ii) any psychiatric disorder, and (iii) any somatic disorder. Additionally, competing risks survival analysis was used to calculate the cumulative incidence of inpatient admission and all-cause mortality over the follow-up period.
RESULTS
The study population included 11,489 individuals. The most common conditions individuals had prior to their AN diagnosis were other eating disorders (34.5%) and anxiety disorders (32.7%). During the follow-up, 3184 (27.7%), 4604 (40.1%), and 6636 (57.8%) individuals were admitted for AN, any psychiatric disorder, and any somatic disorder, respectively; and in total 106 (0.9%) died. The risk of all outcomes was highest among those who had received a higher number of other diagnoses. For most combinations, the risks of admission and mortality were increased.
DISCUSSION
Our study presents the prevalence of other conditions in patients with AN in Denmark and elucidates their association with higher rates of inpatient admission and mortality. Our findings highlight the need for comprehensive, multidisciplinary care of patients with AN considering the spectrum of other diagnosed conditions to improve health outcomes.
Topics: Humans; Anorexia Nervosa; Inpatients; Retrospective Studies; Hospitalization; Feeding and Eating Disorders
PubMed: 38408593
DOI: 10.1111/acps.13676 -
Health Care For Women International Sep 2023Childhood trauma has long been implicated in the development of anorexia nervosa and is known to impact more women than men. Still, less is known about the meaning women...
Childhood trauma has long been implicated in the development of anorexia nervosa and is known to impact more women than men. Still, less is known about the meaning women attribute to food and bodily practices and how they contribute to feminine subjectivity. In this article, we examine the subjective experiences of women with histories of childhood abuse and anorexia and women who did not develop an eating disorder. Through a visual narrative analysis of eight body maps and narratives, we identified five themes: "time and the body have a way of showing what matters," "femininity and family," "sexual subjectivities and food meanings," "voices, dissociation, and sexual subjectivities," and "religion and healthism." In women with anorexia, specific eating and bodily practices reconstructed the traumatic events to align with the available cultural discourses related to health, religion, and family and had implications for their feminine and sexual subjectivities and self-worth. This research showcased how arts-based methodologies add value and advance knowledge about the role of culturally available representations in the development of anorexia and has implications for therapy and prevention of anorexia.
Topics: Male; Female; Humans; Child; Anorexia Nervosa; Anorexia; Sexual Behavior
PubMed: 35727112
DOI: 10.1080/07399332.2022.2087074 -
Psychoneuroendocrinology Aug 2023Eating disorders continue to be a major public health issue and important cause of morbidity and premature mortality, particularly for young people. Yet in a concerning... (Review)
Review
Eating disorders continue to be a major public health issue and important cause of morbidity and premature mortality, particularly for young people. Yet in a concerning dialectic, this occurs in the context of an epidemic of obesity which, with its medical complications, constitutes another vexing public health challenge. While it is not an eating disorder per se obesity is often comorbid with eating disorders. Effective treatment for both eating disorders and obesity has proven to be elusive and in the search for novel therapeutic interventions, the prosocial, anxiolytic, brain plasticity and metabolic effects of oxytocin (OT) have been examined from this perspective. The availability of intranasal oxytocin (IN-OT) has led to a number of interventional treatment studies in anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), their atypical and subclinical forms and in medical and psychiatric conditions co-occurring or comorbid with these, obesity with BED would be included here. The aim of this mini review is to collate recent findings on OT as a novel therapeutic intervention in eating disorders and obesity and to identify and address some of the knowledge gaps in the use of IN-OT. The wider clinical perspective utilised here might better address some of the gaps and identify future directions of research. Clearly much remains to be done for OT to fulfil its therapeutic promise in eating disorders. OT might yet be of therapeutic promise and will be appreciated where treatment advances have been hard to come by and prevention challenging for these disorders.
Topics: Humans; Anorexia Nervosa; Binge-Eating Disorder; Bulimia Nervosa; Feeding and Eating Disorders; Obesity; Oxytocin
PubMed: 37178641
DOI: 10.1016/j.psyneuen.2023.106290 -
Soins; La Revue de Reference Infirmiere Dec 2023Anorexia nervosa affects people of all ages, and has the highest mortality rate of all psychiatric disorders, following medical complications inherent in the disease or...
Anorexia nervosa affects people of all ages, and has the highest mortality rate of all psychiatric disorders, following medical complications inherent in the disease or suicide. Early and appropriate treatment is crucial to prevent the risk of chronic disease, which may affect one in two anorexics. Severe undernutrition linked to a complex psychopathology calls for the necessary theoretical and clinical knowledge on the part of the caregiver, applied to the dynamics of care, ideally conceived in a transdisciplinary way and involving nursing teams.
Topics: Humans; Anorexia Nervosa
PubMed: 38070976
DOI: 10.1016/j.soin.2023.10.005 -
Neuroscience and Biobehavioral Reviews Sep 2023The dysregulation of excitatory and inhibitory neurotransmission is considered a pathological marker of Anorexia Nervosa (AN), however, no systematic evaluation of the... (Review)
Review
The dysregulation of excitatory and inhibitory neurotransmission is considered a pathological marker of Anorexia Nervosa (AN), however, no systematic evaluation of the proton Magnetic Resonance Spectroscopy (H-MRS) literature has been conducted to date. Accordingly, we conducted a systematic review of neurometabolite differences between individuals with AN and healthy controls (HC). A comprehensive database search (until June 2023) identified seven studies meeting inclusion criteria. Samples included adolescents and adults with similar mean age (AN: 22.20 HC: 22.60), and female percentages (AN: 98%; HC: 94%). The review found a considerable need for improving study design and the reporting of MRS sequence parameters and analysis. Reduced glutamate concentrations in the ACC and OCC, and reduced Glx concentrations in the ACC were reported by one and two studies, respectively. Lastly, only one study to date has quantified GABA concentrations, with no significant differences found. In conclusion, there is currently insufficient evidence of excitatory and inhibitory neurometabolites changes in AN. As the H-MRS literature in AN increases, the key questions herein proposed must be revisited.
Topics: Anorexia Nervosa; Proton Magnetic Resonance Spectroscopy; Gyrus Cinguli; Occipital Lobe; Humans; Glutamic Acid
PubMed: 37307945
DOI: 10.1016/j.neubiorev.2023.105279 -
Journal of Eating Disorders Jun 2024The label severe and enduring anorexia nervosa (SE-AN) is widely used in the literature on longstanding anorexia nervosa (AN). However, the process of constructing the...
The label severe and enduring anorexia nervosa (SE-AN) is widely used in the literature on longstanding anorexia nervosa (AN). However, the process of constructing the criteria and the use of the label SE-AN has ethical implications that have not been taken into account. Through combining existing literature and lived experience perspective, this paper addresses to what extent the current criteria do and do not reflect the lived experience. Arguments are presented on why the process of constructing the criteria for SE-AN and the application of the label can be both identified as, and give rise to, epistemic injustice. Epistemic injustice is an injustice that is done to a person as an individual with the capacity of acquiring and sharing knowledge. This type of injustice can occur at any stage of an interaction between people in which knowledge is shared with one another. The paper concludes by giving suggestions on how to pursue epistemic justice in the process of defining longstanding AN.
PubMed: 38863013
DOI: 10.1186/s40337-024-01040-w -
The International Journal of Eating... May 2024Anorexia nervosa (AN) is a serious psychiatric illness associated with significant medical and psychiatric comorbidity and impairment. Theoretical models of AN and...
OBJECTIVE
Anorexia nervosa (AN) is a serious psychiatric illness associated with significant medical and psychiatric comorbidity and impairment. Theoretical models of AN and self-report studies suggest that negative self-evaluation (i.e., low self-esteem) is related to the development and maintenance of AN. The goal of this study was to extend findings from self-report methodology using a neurocognitive task that probes self-evaluation implicitly and explicitly.
METHOD
We compared female adolescent and adult patients with AN (n = 35) and healthy controls (HC, n = 38) on explicit (i.e., endorsement of words as self-relevant), implicit (recall, recognition, reaction time), and composite (i.e., valence index, bias score, drift rates) indices of self-evaluation. We applied a drift-diffusion model to compute the drift rates, reflecting participants' decision-making process as to whether words were self-relevant. The association between self-evaluation indices and eating disorder severity was examined.
RESULTS
There were significant Group × Condition interaction effects for all explicit and implicit measures (all p's ≤ .01), where the AN group endorsed, recalled, and recognized more negative relative to positive words than HC. The AN group had more negative valence index and bias scores, and slower drift rate away from negative words, reflecting more negative self-evaluation. The finding for recall was attenuated when individuals with depression were excluded. Measures of self-evaluation bias were not related to eating disorder severity.
DISCUSSION
Using a neurocognitive approach that includes explicit and implicit indices of bias, results suggest that patients with AN have more negative self-evaluation. Due to the cross-sectional design, additional studies are needed to further evaluate directionality.
PUBLIC SIGNIFICANCE
Negative self-evaluation/low self-esteem is thought to contribute to eating disorder symptoms. Findings of this study using a neurocognitive task to probe self-evaluation suggested that individuals with anorexia nervosa have more negative self-evaluation, reflected by endorsing and remembering more negative (than positive) words compared to healthy controls, and doing so faster. Targeting the construct of negative self-evaluation in treatment of AN may be warranted.
Topics: Humans; Anorexia Nervosa; Female; Adolescent; Adult; Self Concept; Young Adult; Reaction Time; Mental Recall; Neuropsychological Tests; Case-Control Studies; Self Report
PubMed: 38436447
DOI: 10.1002/eat.24176 -
Journal of Eating Disorders Oct 2023Studies have established the central role of the family in the recognition, treatment, and recovery of anorexia nervosa. The objective of this study was to review,... (Review)
Review
BACKGROUND
Studies have established the central role of the family in the recognition, treatment, and recovery of anorexia nervosa. The objective of this study was to review, synthesize, and critically appraise the literature on parents' views on the treatment and recovery process of anorexia nervosa in their adolescent child.
METHOD
A systematic search of Medline, PsychINFO, CINHAL, EMBASE, Cochrane library, and SSCI was conducted for qualitative studies published regarding parents' views about the treatment of anorexia nervosa. The quality of articles was assessed using the critical appraisal skills program (CASP) and findings were analysed using thematic synthesis.
RESULTS
A total of 25 studies from nine countries reporting the views of 357 parents met the inclusion criteria. Four major themes were developed from the analysis: understanding the child and the disease, experience of services and treatment modalities, the role of professionals, and the experience of recovery.
CONCLUSION
Parents report struggles with delays in finding help, judgmental attitudes of professionals, and uncertainty about the future. Recognition of the challenges faced by parents and families empowers clinicians to build stronger therapeutic relationships essential for long-term recovery from anorexia nervosa.
PubMed: 37904246
DOI: 10.1186/s40337-023-00910-z