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Eating disorders are complex chronic medical conditions that have both psychological and medical consequences. They are characterized by abnormal eating behaviors that can lead to significant morbidity and even mortality. The pathophysiology of binge eating disorder involves both biological and psychological factors. Just as in substance use disorders, dysregulation in neurocircuitry related to reward and emotional processing might contribute to the development and maintenance of binge eating behavior. Pharmacologic treatment options for binge eating disorder have provided disappointing results. Comorbid mood and anxiety disorders are more common in this population and treatment of these conditions may produce related improvements in comorbid eating disorders. Ethical challenges can present themselves when dealing with those with eating disorders in long-term care settings. Patients in long-term care settings have as much right to engage in legal, albeit self-destructive, behaviors as those outside of long-term care.
It is well established that there is a substantial genetic component to eating disorders (EDs). Polygenic risk scores (PRSs) can be used to quantify cumulative genetic risk for a trait at an individual level. Recent studies suggest PRSs for anorexia nervosa (AN) may also predict risk for other disordered eating behaviors, but no study has examined if PRS for AN can predict disordered eating as a global continuous measure. This study aimed to investigate whether PRS for AN predicted overall levels of disordered eating, or specific lifetime disordered eating behaviors, in an Australian adolescent female population.
Methods
PRSs were calculated based on summary statistics from the largest Psychiatric Genomics Consortium AN genome-wide association study to date. Analyses were performed using genome-wide complex trait analysis to test the associations between AN PRS and disordered eating global scores, avoidance of eating, objective bulimic episodes, self-induced vomiting, and driven exercise in a sample of Australian adolescent female twins recruited from the Australian Twin Registry (N = 383).
Results
After applying the false-discovery rate correction, the AN PRS was significantly associated with all disordered eating outcomes.
Conclusions
Findings suggest shared genetic etiology across disordered eating presentations and provide insight into the utility of AN PRS for predicting disordered eating behaviors in the general population. In the future, PRSs for EDs may have clinical utility in early disordered eating risk identification, prevention, and intervention.
Disordered eating (DE) is associated with elevated cardiometabolic risk (CMR) factors, yet little is known about this association in non-Western countries. We examined the association between DE characteristics and CMR and tested the potential mediating role of BMI. This cross-sectional study included 2005 Chinese women (aged 18–50 years) from the 2015 China Health and Nutrition Survey. Loss of control, restraint, shape concern and weight concern were assessed using selected questions from the SCOFF questionnaire and the Eating Disorder Examination-Questionnaire. Eight CMR were measured by trained staff. Generalised linear models examined associations between DE characteristics with CMR accounting for dependencies between individuals in the same household. We tested whether BMI potentially mediated significant associations using structural equation modelling. Shape concern was associated with systolic blood pressure (β (95 % CI) 0·06 (0·01, 0·10)), diastolic blood pressure (DBP) (0·07 (95 % CI 0·03, 0·11)) and high-density lipoprotein (HDL)-cholesterol (–0·08 (95 % CI –0·12, −0·04)). Weight concern was associated with DBP (0·06 (95 % CI 0·02, 0·10)), triglyceride (0·06 (95 % CI 0·02, 0·10)) and HDL-cholesterol (–0·10 (95 % CI –0·14, −0·07)). Higher scores on DE characteristics were associated with higher BMI, and higher BMI was further associated with lower HDL-cholesterol and higher other CMR. In summary, we observed significant associations between shape and weight concerns with some CMR in Chinese women, and these associations were potentially partially mediated by BMI. Our findings suggest that prevention and intervention strategies focusing on addressing DE could potentially help reduce the burden of CMR in China, possibly through controlling BMI.
Previous research on the changes in resting-state functional connectivity (rsFC) in anorexia nervosa (AN) has been limited by an insufficient sample size, which reduced the reliability of the results and made it difficult to set the whole brain as regions of interest (ROIs).
Methods
We analyzed functional magnetic resonance imaging data from 114 female AN patients and 135 healthy controls (HC) and obtained self-reported psychological scales, including eating disorder examination questionnaire 6.0. One hundred sixty-four cortical, subcortical, cerebellar, and network parcellation regions were considered as ROIs. We calculated the ROI-to-ROI rsFCs and performed group comparisons.
Results
Compared to HC, AN patients showed 12 stronger rsFCs mainly in regions containing dorsolateral prefrontal cortex (DLPFC), and 33 weaker rsFCs primarily in regions containing cerebellum, within temporal lobe, between posterior fusiform cortex and lateral part of visual network, and between anterior cingulate cortex (ACC) and thalamus (p < 0.01, false discovery rate [FDR] correction). Comparisons between AN subtypes showed that there were stronger rsFCs between right lingual gyrus and right supracalcarine cortex and between left temporal occipital fusiform cortex and medial part of visual network in the restricting type compared to the binge/purging type (p < 0.01, FDR correction).
Conclusion
Stronger rsFCs in regions containing mainly DLPFC, and weaker rsFCs in regions containing primarily cerebellum, within temporal lobe, between posterior fusiform cortex and lateral part of visual network, and between ACC and thalamus, may represent categorical diagnostic markers discriminating AN patients from HC.
This study tested whether the dissonance-based Body Project eating disorder prevention program reduced onset of subthreshold/threshold anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD) over long-term follow-up.
Methods
Data were combined from three prevention trials that targeted young women at high-risk for eating disorders (N = 1092; M age = 19.3). Participants were randomized to Body Project groups led by peer educators or expressive writing/educational controls and completed masked diagnostic interviews over 2- to 4-year follow-ups. Logistic regressions tested whether onset of each eating disorder over follow-up differed between Body Project and control participants.
Results
Peer-led Body Project groups produced a 46% reduction in onset of subthreshold/threshold BN and a 62% reduction in onset of PD relative to controls over follow-up. Rates of onset of subthreshold/threshold AN and BED did not significantly differ between peer-led Body Project participants and control participants.
Conclusions
Results support the dissemination of the peer-led Body Project for reducing future onset of BN and PD. This study and recent research suggest that thin-ideal internalization, the risk factor for eating disorders targeted in the Body Project, may be more relevant for predicting onset of BN and PD compared to AN and BED. Findings support the development of a version of the Body Project aimed to reduce risk factors that have predicted future onset of all four types of eating disorders (e.g. overvaluation of weight/shape, fear of weight gain), which may more effectively prevent all eating disorder types.
Edited by
Ornella Corazza, University of Hertfordshire and University of Trento, Italy,Artemisa Rocha Dores, Polytechnic Institute of Porto and University of Porto, Portugal
Dysfunctional exercise is one of the most challenging behaviours in individuals with eating disorders, among whom it makes a significant contribution to morbidity and impaired quality of life. This chapter examines the prevalence of dysfunctional exercise symptoms in the context of an eating disorder, the neurobiological basis of dysfunctional exercise symptoms, and the various predisposing and maintaining factors that are involved. It then highlights the need for management and treatment of excessive exercise to address the neurobiological and psychological factors involved, and describes the evidence base for such treatments, especially physiotherapy-based psychological interventions. A multidisciplinary approach to management is recommended, so that treatment can be formulated within the wider context of the individual’s psychosocial difficulties, enabling them to challenge their exercise-related beliefs and behaviour. Finally, two semi-fictional case studies are presented that illustrate common presentations of dysfunctional exercise in eating disorder clinics.
Describes the symptoms and physical consequences of eating disorders. Identifies the symptoms of binge-eating disorder, bulimia nervosa, and anorexia nervosa. Describes the epidemiology of eating disorders. Describes some of the social and cultural factors associated with eating disorders. Compares the various treatments for eating disorders.
The quantification of suicidal risk in specific populations is important for the adoption of prevention and risk reduction measures. This risk remains very high in patients with eating disorders compared to the general population.
Objectives
The present study evaluates the prevalence of suicide among patients with eating disorders all seeking different suicidal risk factors in these patients.
Methods
A retrospective study of medical records of all patients with eating disorders, diagnosed according to DSM 5 criteria, at Arrazi hospital of Salé for the past 14 years, by assessing the prevalence of suicide attempts and care.
Results
In our work, all patients are female, 17 years old on average, 18 patients out of 20 have anorexia nervosa, 4 of them have had bouts of bulimia, and only one patient was admitted for management of bulimia nervosa alone. The mean age of onset was 15 years with addictive comorbidity in 5 patients.
Thirteen patients had comorbid depressive disorder, one patient was schizophrenic and six patients had borderline personality disorder.
12 patients have made suicide attempts, planned especially in a depressive environment.
Conclusions
Preventive management of suicidal risk must be taken in order to improve the prognosis in this category of patients.
Alexithymia is a construct which has been described in persons under the autistic spectrum. Besides Autistic Spectrum Disorders, alexithymia nowadays is highly correlated with several psychiatric disorders, among them being Eating Disorders. Several studies suggested a “cognitive-affective” division in the inner experience of patients with Anorexia Nervosa, because of their difficulty in describing, identifying and recognising their own emotions as well as others
Objectives
This study aims to identify how many adolescents diagnosed with Anorexia Nervosa meet the characteristics of alexithymic personality traits and in which domain of these traits they had the most struggles with.
Methods
The study lot includes 34 adolescents diagnosed with Anorexia Nervosa evaluated by a self report survey: Online Alexithymia Questionnaire-G2 (OAQ-G2). The cut-off scores are: 113 and above - correlated with alexithymia, 95-112 - correlated with possible alexithymia and under 94 - insignificant clinical score. We analyzed the result of every subcategory of the questionnaire in order to determine whether there is an area affected more than others.
Results
The sample included 34 patients, female to male ratio 31:3, evaluated in the Department of Child and Adolescent Psychiatry, “Prof. Dr. Alexandru Obregia” Psychiatry Hospital. 29,41% had clinically semnificative scores for alexithymic traits, while 52,94% scored for possibile alexithymia according to the OAQ-G2.
Conclusions
In 82,35% of patients from the lot we identified alexithymic personality traits. The F1 subcategory (difficulty identifying feelings) and F5a (problematic interpersonal process) were the ones that distinguished the alexithymic group from the possible alexithymic one.
During the last 30 years, many studies have shown a high prevalence of substance use among patients diagnosed with an Eating Disorder (ED). Almost 50% of the patients with ED have a history of substance use, and 35% of the patients that seek help for an addiction disorder also meet criteria for ED. Nevertheless, both substance abuse specialists and pratictioners with expertise in ED have difficulties in treating these dually diagnosed patients.
Objectives
The aim of this study is to emphasize the importance of assessing substance use in patients with ED and disturbed eating behaviors in patients with Substance Use Disorders (SUD), as well as the need for evidence-based treatment guidelines for this comorbid condition.
Methods
A literature search of published articles on substance use patterns in ED and on the therapeutic approach for this comorbid condition was performed on PubMed database.
Results
A diagnosis of Bulimia Nervosa and the presence of binging/ purging behaviors are strongly associated with substance use. Most frequently used substances are represented by nicotine, caffeine and alcohol, followed by cannabis and amphetamines. Reasons why patients with ED use substances are emotional regulation and appetite suppression. Detailed and systematic evaluation of the substances used and for other psychiatric comorbidities is mandatory. Management plan involves simultaneously treating ED and SUD.
Conclusions
The comorbidity of Substance Use Disorders and Eating Disorders is a complex entity, but nonetheless treatable. Further studies are needed to specify the patterns of substance use in Eating Disorders and their implications for treatment.
Current studies indicate a strong relationship between Eating Disorders and obesity, while studies on Bipolar Disorder (BPD) show that patients with BPD form an important risk group in terms of obesity.
Objectives
The aim of this study is to investigate the frequency of Binge Eating Disorder (BED) in patients diagnosed with euthymic Bipolar Disorder 1 (BPD 1), and the relationship between their clinical features
Methods
This study included 150 patients between 18-65 years of age, diagnosed with euthymic BPD 1 according to DSM 5 criteria. Structured Clinical Interview for DSM-5 Disorders, Structured Sociodemographic Form, Young Mania Scale, Beck Depression Scale, Eating Disorders Assessment Scale (EDAS) , Eating Attitude Test (EAT) were applied to participants.
Results
A diagnosis of BED was detected in 19.3% of the patients. Body weight, highest weight and BMI values were significantly higher in those who were diagnosed with BED compared to those who were not diagnosed with BED. Most of the diagnosed with BED are women; gender was found to be determinant for BED. The total and subscale scores of EAT and EDAS of those with a diagnosis of BED were statistically significantly higher than those who did not. The rate of attacks with psychotic symptoms, rapid cycling and presence of suicide attempt were significantly higher in those with a diagnosis of BED compared to those who did not.
Conclusions
BED may be frequent in BPD 1 patients. Noticing BED in BPD1 patients might help both the more effective treatment of BPD and the prevention of obesity.
Binge-eating disorder (BED), is one of the most common eating disorder. Treatment aims to reduce binge-eating frequency and disordered eating–related cognitions, improve metabolic health and weight, and regulate mood (in patients with coexisting depression or anxiety)
Objectives
The aim of this study was to examine the efficacy of lisdexamfetamine dimesylate in a simple of 50 women with a binge eating disorder diagnosis compare with selective serotonin reuptake inhibitor
Methods
Two groups were made, one with lisdexamfetamine and the other with selective serotonin reuptake inhibitor (fluoxetine). 20 women were in each group (total n=40). The doses depend of the binge symptoms and rates were from 30 to 70md/day for lisdexamfetamine and for fluoxetine the doses were from 20 to 60mg/day.
Results
Binge behaviors decreased with a 50mg/day dose of lisdexamfetamine. The 70mg/day doses present also less binge behaviors but also more adverse events. The 30mg/day doses did not decrease binge-eating behaviors.
Conclusions
Lisdexamfetamine is the first pharmacological agent to receive FDA approval for use in adults with moderate to severe binge eating disorder. This study supports further assessment of lisdexamfetamine as a treatment option for decreasing binge eating behavior and also symptoms associated such as anxiety and obsessive and compulsive features in adults.Increased efficacy with increasing dosages of lisdexamfetamine suggests a dose-response relationship until 50mg/day. Women with a dose of 50mg/day of lisdexamfetamine report less adverse event, more adherence to treatment and improve their eating behaviors.
15-year-old female referred to outpatient unit after COVID lockdown for binge eating and purging with depressive symptoms and anxiety.
Objectives
To show the importance of a correct diagnosis in an impulsive patient with eating disorder
Methods
case report and literature review
Results
The patient presents emotional instability with interpersonal difficulties with high fear of rejection. She suffered from fear of gaining weight and desires to lose weight with rejection of her body image. Fluoxetine and lorazepam are started together with low doses of olanzapine. During the follow up she presented a worsening of mood, onset of self-injuries and an episode of suicidal attempt. A biographical examination was performed, expressing a feeling of academic failure with difficulty concentrating and performing simple tasks. As a child she is described as impulsive, with frequent arguments with classmates. CPT III was performed with a high probability of ADHD. Treatment was started with lisdexamfetamine up to 50 mg with good tolerance. From the beginning of the treatment the patient expressed a feeling of improvement in the control of emotions as well as in the management of her impulsivity. There was an improvement in her academic performance with a decrease in self-injury episodes. The patient was able to express improvement in the sense of incapacity she felt.
Conclusions
This case shows how marked emotional dysregulation and impulsive symptoms improves after diagnosis and subsequent treatment of ADHD, also improving eating symptoms. ADHD is present in eating disorders, especially in those with impulse dyscontrol such as binge eating disorder or bulimia nervosa.
Adolescence, when physical body image changes occur, is highly vulnerable to the development of eating disorders. At this age, there is an acute task of accepting oneself as another - an adult who has changed.
Objectives
To study the features of the image of an adult in young people with eating disorders.
Methods
The study involved 58 girls (from 17 to 22 years old). The main group included 31 people with a high risk of eating disorders, the control group - 27 people with an average and low risk. Respondents filled in: Taylor Manifest Anxiety Scale, Eating behavior rating scale, projective drawing of an adult and child, association test about words «adult» and «child»
Results
1. A high level of personal anxiety was revealed in the main group; 2. The visualized image of an adult in the main group has more distortions and fewer signs of gender identification than in the normal group; 3. Semantic ideas about adulthood in the main group are negatively emotionally colored and include categories related to eating behavior; 4. Semantic ideas about childhood in the main group are more negatively emotionally colored, and ideas about the present are more connected with appearance than in the control group. Semantic ideas about the future in this group are often negatively colored.
Conclusions
Figurative and semantic ideas about childhood, adulthood and about oneself in the present and in the future in girls with eating disorders have qualitative characteristics in comparison with the control group.
Hepatic ones are some of the most described somatic complications in anorexia nervosa (AN) affected patients. They can be due to malnutrition, which is the more usual thing, or due to re-feeding. The first one can lead to more marked elevations of the hepatic enzymes, especially alanine-aminotransferase (ALT). It’s been also described the relation between a sharply decreased body mass index (BMI) and this kind of complications, but there are still to determine more predictors.
Objectives
Identifying clinical predictors of hepatic complications in AN.
Methods
We analysed data from 71 AN affected patients hospitalized at Bellvitge Hospital from January 2016 to October 2021. We used IBM SPSS Statistics 22 to do all the statistics in this work.
Results
The medium age of the sample was 27.66 years with 10.8 years of evolution of AN. The medium BMI was 13.88. 33.80% of them had some sort of hepatic enzymes elevation, two of them a several one. AST, ALT and ALP were significantly more elevated in those patients with lower BMI. GGT was significantly more elevated in patients with more years of disorder development. We didn’t identify correlation between any purgative method and hepatic alterations.
Conclusions
The elevation of ALT, AST and ALP seems to be related with the BMI of the patients, while the elevation of the GGT turns out to be related to the time of evolution of the eating disorder. Purgative methods don’t seem to be related to the development of hepatic alterations in AN.
Eating disorders (ED) and gender dysphoria (GD) are associated with a change in body perception. Therefore, body dissatisfaction plays a common and central role in these disorders. In GD, body image concerns are related to the features of the biological sex. In ED, body dissatisfaction comes from a distorted perception of weight and body shape and plays an important role in the development and maintenance of the psychopathology.
Objectives
To present and discuss the clinical case of a patient with a previous diagnosis of GD who presented with a clinical condition suggesting a restrictive anorexia nervosa (AN).
Methods
Patient´s clinical files consultation and literature review using Pubmed and the keywords: eating disorders and gender dysphoria.
Results
We present the case of a 25-year-old patient who was living in a shelter for victims of domestic violence and was admitted for severe restrictive AN. The patient was discharged after 40 days and medicated with sertraline, diazepam and olanzapine, as well as her previous medication (hormonal therapy): cyproterone, finasteride, estradiol, oxybutynin.
Conclusions
Although studies on this subject are still scarce, there has been some progress and the literature recognizes the coexistence of these conditions. However ED symptoms in patients with GD could have a different meaning: they may represent a dysfunctional coping strategy adopted to block features of the biological sex. Therefore health professionals may take a more holistic approach to body image. Additional studies will be necessary, allowing the establishment of cause-consequence interactions between weight loss and psychopathology related to GD.
Eating disorders (EDs) constitute serious mental illnesses with high morbidity, lifetime mortality and associated stigma due to the label of mental illness. The sparse research assessing adolescents’ knowledge of and attitudes towards EDs highlights their low understanding of these conditions.
Objectives
The proposed study aims to bridge this gap by investigating adolescents’ knowledge of and attitudes towards EDs as this will inform young people’s engagement with ED services.
Methods
Participants aged 12-18 will be randomly assigned a vignette depicting either a male or female 15-year-old displaying symptoms of anorexia nervosa (AN) or binge eating disorder (BED). They will be asked to select what they believe the condition described in the vignette is from a pre-determined list. They will then be informed of the correct diagnosis before completing a series of scales designed to assess their attitudes towards EDs. Participants’ own potentially disordered eating behaviours will be assessed using the ED risk composite (EDRC) subscale from the EDI-3.
Results
It is expected that BED will be less likely to be correctly identified compared to AN, eliciting more stigma and male vignette subjects will be seen more negatively than female vignette subjects. Also, it is expected that participants with higher EDRC scores will have more knowledge of and less negative attitudes towards EDs than those with lower EDRC scores.
Conclusions
This study will highlight the need for education around EDs targeted at adolescents to increase their knowledge and awareness, providing them with factual information ought to reduce stigma and negative attitudes and beliefs about EDs.
Despite the huge effect eating disorders (Eds) have on the lives of sufferers and their families there has been little research on the effect an ED has on siblings even though their lives are repeatedly significantly affected by the situation. It is important to gain more insight into the experiences and needs of siblings as the nature and magnitude of the effect of patients EDs on non-affected siblings is mixed in the current research.
Objectives
To conduct a systematic review allowing an extensive search of the current literature to identify where the current research is lacking. Also, to highlight the need for a greater focus on the effect of EDs on siblings both in research and clinical practice.
Methods
A systematic review is being conducted to gain an understanding of the gaps in the literature.
Results
It is expected that the systematic review will reveal a lack of literature regarding siblings’ experiences of having a brother or sister with an ED. As well as showing the conflicting emotions felt by the siblings, both positive due to the love they feel for their sibling and negative due to the burden they feel.
Conclusions
By raising awareness of the needs of non-affected siblings this research should have a notable impact on their experiences by highlighting the need for specific interventions and support services as well as education about their siblings’ ED.
Anorexia nervosa (AN) is characterised by the restriction of energy intake in relation to energy needs and a significantly lowered body weight than normally expected, coupled with an intense fear of gaining weight. Treatment of AN is currently based on psychological and refeeding approaches, but their efficacy remains limited since 40% of patients after 10 years of medical care still present symptoms of AN. The intestine hosts a large community of microorganisms, called the “microbiota”, which live in symbiosis with the human host. The gut microbiota of a healthy human is dominated by bacteria from two phyla: Firmicutes and, majorly, Bacteroidetes. However, the proportion in their representation differs on an individual basis and depends on many external factors including medical treatment, geographical location and hereditary, immunological and lifestyle factors. Drastic changes in dietary intake may profoundly impact the composition of the gut microbiota, and the resulting dysbiosis may play a part in the onset and/or maintenance of comorbidities associated with AN, such as gastrointestinal disorders, anxiety and depression, as well as appetite dysregulation. Furthermore, studies have reported the presence of atypical intestinal microbial composition in patients with AN compared with healthy normal-weight controls. This review addresses the current knowledge about the role of the gut microbiota in the pathogenesis and treatment of AN. The review also focuses on the bidirectional interaction between the gastrointestinal tract and the central nervous system (microbiota–gut–brain axis), considering the potential use of the gut microbiota manipulation in the prevention and treatment of AN.
This chapter provides an overview of orthorexia, a relatively new disease included within the broader category of eating disorders. The term orthorexia derives from the combination of two Greek words: orthos, meaning "healthy/correct" and oreksis, meaning "appetite." It is used to describe an unhealthy obsession with eating only healthy and natural food. A series of worries are related to this phenomenon: some preoccupations are expressly rooted in cultural and social contexts that reinforce the importance of healthy eating. For example, certain food items may be invested with alleged curative power and almost miraculous properties in some environments. Such views can discourage individuals from having a spontaneous and direct relationship with food because foods may be chosen only for their supposed healing properties rather than their taste. Theories, clinical cases, and scientific studies about this topic are presented.