Anxiolytic effects of acute tryptophan depletion in anorexia nervosa

OBJECTIVE: Recent studies have raised the question as to whether a dysregulation of the neurotransmitter serotonin may contribute to the alterations in mood seen in anorexia nervosa (AN). People with AN tend to be anxious, obsessional, perfectionistic, and harm avoidant. These traits are premorbid and persist after recovery. It has been suggested that increased activity of brain serotonin systems could contribute to this pathologic condition. Dieting in AN, which serves to reduce plasma levels of tryptophan (TRP), may serve to reduce symptoms of dysphoric mood. METHOD: Fourteen women currently symptomatic with AN (ILL AN), 14 women recovered from AN (REC AN), and 15 healthy control women (CW) underwent acute tryptophan depletion (ATD). Measures of psychological state were self-assessed at baseline and hourly after ATD to determine whether ATD would reduce negative mood. RESULTS: ILL AN and REC AN had significantly higher mean baseline TRP/LNAA (tryptophan/large neutral amino acids) ratios compared with CW. In contrast to placebo, the ATD challenge demonstrated a significantly greater reduction in the TRP/LNAA ratio for ILL AN (-95%) and REC AN (-84%) compared with CW (-70 %). Both the ILL AN and REC AN had a significant reduction in anxiety on the ATD day compared with the placebo day. DISCUSSION: These data demonstrate that a dietary-induced reduction of TRP, the precursor of serotonin, is associated with decreased anxiety in people with AN. Restricting dietary intake may represent a mechanism through which individuals with AN modulate a dysphoric mood.     

Stigmatization of anorexia nervosa

OBJECTIVE: The current study examined the perceptions about an individual with anorexia nervosa (AN) relative to perceptions about a healthy person and a person with another mental or nonmental illness. METHOD: Ninety-one participants recruited from the community completed questionnaires targeting perceptions about 4 individuals: a healthy person, a person with asthma, a person with schizophrenia, and a person with AN. RESULTS: Evaluations of personal characteristics were most negative for persons with AN. Participants believed the person with AN was most to blame for his/her condition, was best able to pull him/herself together if he/she wanted to, and was most acting this way for attention and that biological factors were least relevant in developing the illness. CONCLUSION: Negative perceptions of a person with AN fell into stigma categories of self-attribution and responsibility. These attitudes may contribute to reluctance to seek treatment among individuals with AN.     

Melatonin disturbances in anorexia nervosa and bulimia nervosa

The pineal gland releases melatonin into the blood stream in response to sympathetic noradrenergic stimulation of pinealocytes. This process is inhibited by light via the retino-hypothalamic-pineal pathway. Hence melatonin is predominantly released in darkness. Because serotonin is a precursor of melatonin, the intake of dietary tryptophan may also influence melatonin levels. Although the exact physiological role of melatonin in humans is unclear, it appears to be implicated in reproductive physiology, especially in terms of the onset of menarche. Low levels of melatonin also occur in depression. In this review, studies of melatonin in patients with anorexia nervosa and bulimia nervosa are considered in relation to potential abnormalities of noradrenergic function and circadian rhythm. The influence of weight loss, binging and purging, and depression on melatonin is discussed. Other studies involving the assessment of melatonin in relation to menstrual function are required. © 1994 by John Wiley & Sons, Inc.     

Body images in anorexia nervosa and bulimia nervosa

This study extends earlier research on body image disturbance in anorexia nervosa to the reactions of patients with bulimia nervosa. “Natural” procedures were employed, and normal comparison groups as well as those with anorexia nervosa or bulimia nervosa used adjective scales to rate “the self,” mirror images of themselves that were veridical, exaggerated for fatness or for thinness and adjusted to their ideal, and a television image they had adjusted to show how they feel and then how they think their body is. The different adjustments and ratings that were made in each condition question the validity of any single estimates of body size. Nevertheless, this multimethod approach to the cognitive and affective components of body image shows that those with anorexia nervosa and bulimia nervosa consistently emphasize their feelings of fatness.     

Rib fractures and anorexia nervosa

A twenty-five year old patient with long standing anorexia nervosa and recent forced vomiting presented with a pulling sensation in her lower anterior thorax. Seven months later, callus formation over the left tenth rib was documented. Chest x-ray revealed healing fractures of the seventh, ninth, and tenth ribs. Since her oral intake of calcium was low, she was started on a regimen of milk and sun bathing. We postulate her rib fractures were the result of forced vomiting in an individual with fragile bones. The osteoporotic state may have been induced by her malnourished low-estrogen state.     

Religious belief and anorexia nervosa

This study examines aspects of the relationship between religious belief and anorexia ner-vosa. It uses data from postal questionnaires sent to members of a U.K. national self-help organization for people with “eating disorders” which elicited a profile of symptoms and other clinical data and information about personal and family religious beliefs. The data suggest that the majority of respondents were or had been afflicted with anorexia nervosa. Subjects with a religion, particularly those with strong beliefs, and particularly those who were Anglican, reported particularly lowest ever adult Body Mass Indices (BMIs). Part of the explanation for these findings would seem to be an increase in the importance of subjects' religious beliefs during their anorectic illnesses. Conversely, bulimic symptomatology seemed to be associated with a weakening of subjects' beliefs. Religious conversion seemed to serve as a protective function against severe weight loss. © 1992 John Wiley & Sons, Inc.     

Hospitalization for anorexia nervosa

In 1980 and 1987, 112 patients received a principal diagnosis of anorexia nervosa during their first admission to a psychiatric unit in New Zealand. Over the subsequent 5 years 48 (43%) were readmitted to hospital on one or more occasions, with those who were 16 years or less being more likely to be readmitted. These patients with anorexia nervosa spent longer in hospital for each admission than any other group of psychiatric patients with non-organic disorders, and over the 5-year follow-up the average cumulative length of stay was exceeded only by patients with schizophrenia and organic disorders. These findings suggest the need for further study into the best treatment setting for patients with anorexia nervosa, and to what extent chronicity in anorexia nervosa may be reduced.     

Obsessive-compulsive neurosis and anorexia nervosa

A large number of anorexia nervosa patients manifest anancastic personality traits or obsessive-compulsive symptoms. The clinical characteristics and psychological data from nine female anorexia nervosa patients, characterized by obsessive-compulsive symptoms during the course of their illness, were compared with the data from sixteen anorexia nervosa patients without obsessive-compulsive features. Patients with obsessive-compulsive symptoms showed higher scores in general psychiatric symptoms and in anorectic behavior. Deficiencies in social adjustment were pronounced. The combination of marked obsessive-compulsive and anorectic behaviors seems to coincide with more severe disturbances and chronicity of the disease. The data from this study, which are consistent with the hypothesis that there is a strong relationship between anorexia nervosa and obsessive- compulsive neurosis, are discussed.     

Sexual assault and anorexia nervosa

Two cases of sexual assault with subsequent onset or exacerbation of anorexia nervosa are described. Features common to anorexia nervosa and the sexual assault syndrome include feelings of guilt, inadequacy, loss of control, and distortion of body image.     

Perfectionism in anorexia nervosa

Although it is well accepted that most patients with anorexia nervosa are perfectionistic, little work has been done in characterizing this behavior. Anorexics were assessed by two new multidimensional instruments that were designed to measure multiple aspects of perfectionism. Both scales confirm that underweight, malnourished patients with anorexia nervosa are perfectionistic. Importantly, elevated perfectionism scores persisted after weight restoration. Anorexics experienced their perfectionism as selfimposed, and not as a response to other's expectations. Perfectionism is a dimension of the rigid, obsessive behaviors that may contribute to resistance to treatment and relapse in anorexia nervosa. Thus, these scales may be of value in assessing response to treatment. © 1995 by John Wiley & Sons, Inc.     

Osteoporosis in anorexia nervosa

Anorexia nervosa is a disorder characterized by low body weight and amenorrhoea (in females). These features lead to a risk of osteoporosis, a condition in which bone loss leads to weakening of bone structure and increased fracture risk.     

Pregnancy after anorexia nervosa

Pregnancies of two women with a history of anorexia nervosa are described. Anxieties and fears of obesity were greatest during the first trimester and the second postpartum month. Disturbed eating behaviors gradually diminished during pregnancy but were augmented approximately 6 weeks after delivery. One woman received regular emotional support and dietary counseling from obstetrical staff during her pregnancy. Neither woman received counseling during the postpartum crisis. Supplemental antenatal and postnatal counseling for women with eating disorders is recommended.