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Eating and Weight Disorders : EWD Jun 2024Although insecure attachment and interpersonal problems have been acknowledged as risk and maintaining factors of eating disorders (EDs), the mediating role of...
PURPOSE
Although insecure attachment and interpersonal problems have been acknowledged as risk and maintaining factors of eating disorders (EDs), the mediating role of interpersonal problems between attachment style and ED psychopathology has been poorly explored. The purpose of this study was to investigate the mediating role of interpersonal problems between insecure attachment and ED psychopathology.
METHODS
One-hundred-nine women with anorexia nervosa and 157 women with bulimia nervosa filled in the Eating Disorder Inventory-2 (EDI-2) and the Experiences in Close Relationships (ECR) revised scale to assess ED core symptoms and attachment styles, respectively. Interpersonal difficulties were evaluated by the Inventory of Interpersonal Problems (IIP-32). A mediator's path model was conducted with anxious and avoidant attachment subscores as independent variables, ED core symptoms as dependent variables and interpersonal difficulties as mediators. The diagnosis was entered in the model as a confounding factor.
RESULTS
The socially inhibited/avoidant interpersonal dimension was a mediator between avoidant attachment and the drive to thinness as well as between avoidant attachment and body dissatisfaction. An indirect connection was found between attachment-related anxiety and bulimic symptoms through the mediation of intrusive/needy score.
CONCLUSIONS
Social avoidance and intrusiveness mediate the relationships between avoidant and anxious attachment styles and ED psychopathology. These interpersonal problems may represent specific targets for psychotherapeutic treatments in individuals with EDs and insecure attachment.
LEVEL OF EVIDENCE
Level III: Evidence obtained from well-designed cohort or case-control analytic studies.
Topics: Humans; Female; Adult; Object Attachment; Interpersonal Relations; Young Adult; Feeding and Eating Disorders; Adolescent; Anorexia Nervosa; Bulimia Nervosa; Anxiety
PubMed: 38904743
DOI: 10.1007/s40519-024-01673-5 -
Acta Medica Okayama Jun 2024A 24-year-old Japanese female with anorexia nervosa presented to our hospital for bilateral pneumothorax, and 12-Fr thoracostomy catheters were inserted into the...
A 24-year-old Japanese female with anorexia nervosa presented to our hospital for bilateral pneumothorax, and 12-Fr thoracostomy catheters were inserted into the bilateral pleural cavities. On hospital day 9, a thoracoscopic bullectomy was performed. However, air leakage relapsed on both sides on postoperative day 1. The air leakage on the right side was particularly persistent, and we switched the drainage to a Heimlich valve. Both lungs expanded gradually and the chest tube was removed on postoperative day 19. Passive pleural drainage might be an option for prolonged air leakage after a bullectomy in patients with anorexia nervosa.
Topics: Humans; Pneumothorax; Female; Anorexia Nervosa; Young Adult; Postoperative Complications; Drainage
PubMed: 38902216
DOI: 10.18926/AMO/67203 -
Progress in Neuro-psychopharmacology &... Jun 2024Anorexia nervosa (AN) is characterized by hyperactivation of the hypothalamic-pituitary-adrenal axis and cognitive deficits. However, little is known about the rapid...
OBJECTIVE
Anorexia nervosa (AN) is characterized by hyperactivation of the hypothalamic-pituitary-adrenal axis and cognitive deficits. However, little is known about the rapid non-genomic stress response involvement. This study investigates the molecular, structural and behavioral signatures of the anorexic phenotype induction in female rats on stress-related mechanisms in the hippocampus.
METHOD
Female adolescent rats, exposed to the combination of food restriction and wheel access, i.e., the activity-based anorexia (ABA) protocol, were sacrificed in the acute phase of the pathology (postnatal day [P]42) or following a 7-day recovery period (P49).
RESULTS
ABA rats, in addition to body weight loss and increased wheel activity, alter their pattern of activity over days, showing increased food anticipatory activity, a readout of their motivation to engage in intense physical activity. Corticosterone plasma levels were enhanced at P42 while reduced at P49 in ABA rats. In the membrane fraction of the hippocampus, we found reduced glucocorticoid receptor levels together with reduced expression of caldesmon, n-cadherin and neuroligin-1, molecular markers of cytoskeletal stability and glutamatergic homeostasis. Accordingly, structural analyses revealed reduced dendritic spine density, a reduced number of mushroom-shaped spines, together with an increased number of thin-shaped spines. These events are paralleled by impairment in spatial memory measured in the spatial order object recognition test. These effects persisted even when body weight of ABA rats was restored.
DISCUSSION
Our findings indicate that ABA induction orchestrates hippocampal maladaptive structural and functional plasticity, contributing to cognitive deficits, providing a putative mechanism that could be targeted in AN patients.
PubMed: 38901757
DOI: 10.1016/j.pnpbp.2024.111065 -
Brain and Behavior Jun 2024Anorexia nervosa (AN) is a debilitating and potentially chronic eating disorder, characterized by low hedonic drive toward food, which has been linked with perturbations...
INTRODUCTION
Anorexia nervosa (AN) is a debilitating and potentially chronic eating disorder, characterized by low hedonic drive toward food, which has been linked with perturbations in both reward processing and dopaminergic activity. Neuromelanin-sensitive magnetic resonance imaging (MRI) is an emerging method to index midbrain neuromelanin-a by-product of dopaminergic synthesis. The assessment of midbrain neuromelanin, and its association with AN psychopathology and reward-related processes, may provide critical insights into reward circuit function in AN.
METHODS
This study will incorporate neuromelanin-sensitive MRI into an existing study of appetitive conditioning in those with AN. Specifically, those with acute and underweight AN (N = 30), those with weight-restored AN (N = 30), and age-matched healthy controls (N = 30) will undergo clinical assessment of current and previous psychopathology, in addition to structural neuromelanin-sensitive MRI, diffusion MRI, and functional MRI (fMRI) during appetitive conditioning.
CONCLUSION
This study will be among the first to interrogate midbrain neuromelanin in AN-a disorder characterized by altered dopaminergic activity. Results will help establish whether abnormalities in the midbrain synthesis of dopamine are evident in those with AN and are associated with symptomatic behavior and reduced ability to experience pleasure and reward.
Topics: Humans; Reward; Melanins; Anorexia Nervosa; Mesencephalon; Magnetic Resonance Imaging; Female; Adult; Young Adult; Adolescent; Male; Pre-Registration Publication
PubMed: 38898625
DOI: 10.1002/brb3.3573 -
Journal of Clinical Medicine May 2024Adolescents' early responses and overall outcomes during anorexia nervosa (AN) treatment may differ by patient gender, raising the question of whether evaluating...
Adolescents' early responses and overall outcomes during anorexia nervosa (AN) treatment may differ by patient gender, raising the question of whether evaluating clinical data during AN treatment may require different criteria. We investigated, using patient records, whether young men and young women with AN differed in terms of early treatment response (defined as weight change and variability within the first 14 days) and whether early treatment responses predicted treatment outcomes similarly across genders. : Weight changes predicted patient discharge weight across all gender groups. Weight variability predicted higher disordered eating psychopathology and higher body image insecurities at discharge. Gender differences emerged only for weight gain, which was more pronounced for young men, and gender modulated the effects of weight gain and variability on general psychopathology outcomes. The present findings suggest that early weight changes and weight variability are similarly important predictors of AN treatment outcomes in adolescents but also hint at possible gender differences in terms of the link between weight change and, respectively, variability on general psychopathology.
PubMed: 38892966
DOI: 10.3390/jcm13113255 -
Nutrients Jun 2024Recent data suggest a close association between positive body image (PBI) and eating disorder recovery. Nevertheless, the specific mechanisms through which PBI may...
Recent data suggest a close association between positive body image (PBI) and eating disorder recovery. Nevertheless, the specific mechanisms through which PBI may facilitate recovery from anorexia nervosa (AN) remain unknown. To advance understanding of these mechanisms, this study examined core indices of PBI within AN, exploring its association with emotion regulation and well-being outcomes. Data were collected from 159 female participants, 64 with AN diagnosis and 95 healthy controls (HCs), who completed measures of PBI (body appreciation, functionality appreciation, and body responsiveness), emotion regulation, and psychological well-being (depression, anxiety, stress, and psychological quality of life). The AN group reported lower levels of PBI and psychological well-being, along with greater difficulties in regulating emotions, relative to HCs. PBI variables significantly predicted emotion regulation and psychological well-being in AN, accounting for 36% to 72% of the variance, with body appreciation emerging as the strongest predictor. These findings lend credence to the view that PBI can serve as a catalyst for psychological health. We hypothesize that enhancing PBI can improve interoceptive awareness, which is crucial for emotion regulation and reducing maladaptive food-related coping. Emphasizing a mind-body connection in lifestyle could be a relevant element to consider for both treating and preventing AN.
Topics: Humans; Anorexia Nervosa; Female; Body Image; Adult; Young Adult; Quality of Life; Adolescent; Emotional Regulation; Mental Health; Anxiety; Depression; Adaptation, Psychological; Emotions; Case-Control Studies; Psychological Well-Being
PubMed: 38892718
DOI: 10.3390/nu16111787 -
Nutrients May 2024The variation in body mass index (BMI) of inpatients with anorexia nervosa has not been analyzed across the age span. A positive correlation between BMI and age has been...
BACKGROUND
The variation in body mass index (BMI) of inpatients with anorexia nervosa has not been analyzed across the age span. A positive correlation between BMI and age has been reported in adolescent inpatients aged 15 years and younger that levels off at 15 to 18 years. BMIs standardized for age and sex (standard deviation scores, SDSs) were negatively correlated with age in these inpatients aged 8 to 18 years.
METHODS
The aims of the current retrospective study were threefold: first, to confirm the relationships of BMI, BMI-SDS and age in adolescent inpatients in a larger sample; second, to systematically assess the relationship of BMI, BMI-SDS, body height-SDS and age in adult inpatients at the time of referral; and third, to assess body height-SDSs and age to evaluate stunting.
RESULTS
We included 1001 girls (aged 12-17.9 years) and 1371 women (aged 18-73 years) admitted to inpatient treatment between 2014 and 2021. Mean BMI at admission was 14.95 kg/m (SD = 1.43; range 10.67-18.47) in adolescents and 14.63 kg/m (SD = 2.02; range 8.28-18.47) in adults. None of the adolescent patients but 20 adults had very low BMI values below 10 kg/m. Adolescents showed a small but significant positive correlation between age and BMI (r = 0.12; = 2.4 × 10). In adults, BMI was not correlated with age (r = -0.03; = 0.3). BMI-SDSs was negatively correlated with age in adolescents and less so in adults (r = -0.35; < 0.001 and r = -0.09; = 0.001). Curve fit analyses for all patients indicated that there was a quadratic (age × age) relationship between age and BMI-SDS. Height correlated positively with BMI in adult (r = 0.1; < 0.001) and adolescent (r = 0.09 = 0.005) patients and we detected no evidence for stunting.
CONCLUSIONS
In conclusion, the BMI of inpatients seems to be relatively stable across the age span with mean values between 14 and 15 kg/m. BMI values initially increase with age in younger patients, drop between ages 18 and 23 and then slowly decline with age.
Topics: Humans; Adolescent; Body Mass Index; Female; Retrospective Studies; Anorexia Nervosa; Child; Adult; Young Adult; Inpatients; Middle Aged; Aged; Age Factors; Body Height
PubMed: 38892665
DOI: 10.3390/nu16111732 -
Nutrients May 2024The choice of a refeeding strategy is essential in the inpatient treatment of Anorexia Nervosa (AN). Oral nutrition is usually the first choice, but enteral nutrition...
The choice of a refeeding strategy is essential in the inpatient treatment of Anorexia Nervosa (AN). Oral nutrition is usually the first choice, but enteral nutrition through the use of a Nasogastric Tube (NGT) often becomes necessary in hospitalized patients. The literature provides mixed results on the efficacy of this method in weight gain, and there is a scarcity of studies researching its psychological correlates. This study aims to analyze the effectiveness of oral versus enteral refeeding strategies in inpatients with AN, focusing on Body Mass Index (BMI) increase and treatment satisfaction, alongside assessing personality traits. We analyzed data from 241 inpatients, comparing a group of treated vs. non-treated individuals, balancing confounding factors using propensity score matching, and applied regression analysis to matched groups. The findings indicate that enteral therapy significantly enhances BMI without impacting treatment satisfaction, accounting for the therapeutic alliance. Personality traits showed no significant differences between patients undergoing oral or enteral refeeding. The study highlights the clinical efficacy of enteral feeding in weight gain, supporting its use in severe AN cases when oral refeeding is inadequate without adversely affecting patient satisfaction or being influenced by personality traits.
Topics: Humans; Anorexia Nervosa; Intubation, Gastrointestinal; Female; Enteral Nutrition; Propensity Score; Patient Satisfaction; Adult; Body Mass Index; Treatment Outcome; Young Adult; Weight Gain; Male; Adolescent
PubMed: 38892597
DOI: 10.3390/nu16111664 -
Nutrients May 2024Anorexia nervosa (AN) is a severe eating disorder that predominantly affects females and typically manifests during adolescence. There is increasing evidence that serum...
Anorexia nervosa (AN) is a severe eating disorder that predominantly affects females and typically manifests during adolescence. There is increasing evidence that serum cytokine levels are altered in individuals with AN. Previous research has largely focused on adult patients, assuming a low-grade pro-inflammatory state. The serum levels of the cytokine tumour necrosis factor-alpha (TNF-α), interleukin (IL)-1β, IL-6 and IL-15, which are pro-inflammatory, were examined in 63 female adolescents with AN and 41 age-matched healthy controls (HC). We included three time points (admission, discharge, and 1-year follow-up) and investigated the clinical data to assess whether the gut microbiota was associated with cytokine alterations. Relative to the HC group, serum levels of IL-1β and IL-6 were significantly lower during the acute phase (admission) of AN. IL-1β expression was normalised to control levels after weight recovery. TNF-α levels were not significantly different between the AN and HC groups. IL-15 levels were significantly elevated in patients with AN at all time points. We found associations between cytokines and bodyweight, illness duration, depressive symptoms, and the microbiome. In contrast to most findings for adults, we observed lower levels of the pro-inflammatory cytokines IL-1β and IL-6 in adolescent patients, whereas the level of IL-15 was consistently increased. Thus, the presence of inflammatory dysregulation suggests a varied rather than uniform pro-inflammatory state.
Topics: Humans; Anorexia Nervosa; Female; Adolescent; Cytokines; Gastrointestinal Microbiome; Follow-Up Studies; Patient Discharge; Case-Control Studies; Interleukin-1beta; Tumor Necrosis Factor-alpha; Patient Admission; Interleukin-6
PubMed: 38892530
DOI: 10.3390/nu16111596 -
BMC Psychiatry Jun 2024Difficulties with inhibitory control have been identified in eating disorders (EDs) and neurodevelopmental disorders (NDs; including attention deficit hyperactivity... (Review)
Review
BACKGROUND
Difficulties with inhibitory control have been identified in eating disorders (EDs) and neurodevelopmental disorders (NDs; including attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder), and there appear to be parallels between the expression of these impairments. It is theorised that impairments in inhibitory control within NDs may represent a unique vulnerability for eating disorders (EDs), and this same mechanism may contribute to poorer treatment outcomes. This review seeks to determine the state of the literature concerning the role of inhibitory control in the overlap of EDs and neurodivergence.
METHOD
A scoping review was conducted to summarise extant research, and to identify gaps in the existing knowledge base. Scopus, Medline, PsycInfo, Embase, and ProQuest were systematically searched. Studies were included if the study measured traits of ADHD or autism, and symptoms of ED, and required participants to complete a performance task measure of inhibitory control. Where studies included a cohort with both an ND and ED, these results had to be reported separately from cohorts with a singular diagnosis. Studies were required to be published in English, within the last 10 years.
RESULTS
No studies explored the relationship between autism and EDs using behavioural measures of inhibitory control. Four studies exploring the relationship between ADHD and EDs using behavioural measures of inhibitory control met selection criteria. These studies showed a multifaceted relationship between these conditions, with differences emerging between domains of inhibitory control. ADHD symptoms predicted poorer performance on measures of response inhibition in a non-clinical sample; this was not replicated in clinical samples, nor was there a significant association with EDs. Both ADHD and ED symptoms are associated with poor performance on attentional control measures; where these diagnoses were combined, performance was worse than for those with a singular diagnosis of ADHD. This was not replicated when compared to those with only ED diagnoses.
CONCLUSION
Impairments in attentional control may represent a unique vulnerability for the development of an ED and contribute to poor treatment outcomes. Further research is needed to explore the role of inhibitory control in EDs, ADHD and autism, including the use of both self-report and behavioural measures to capture the domains of inhibitory control.
Topics: Humans; Inhibition, Psychological; Feeding and Eating Disorders; Attention Deficit Disorder with Hyperactivity; Autism Spectrum Disorder; Neurodevelopmental Disorders
PubMed: 38890597
DOI: 10.1186/s12888-024-05837-6