Comorbidity Between Anorexia Nervosa and Depressive Disorder: A Narrative Review

Objective Anorexia nervosa (AN) is a disorder with a significantly high prevalence. Affective disorders, including depressive disorder (DD), often coexist with this eating disorder (ED). In this review we will focus on its prevalence, associated vulnerability factors, clinical manifestations, possible etiological factors and its prognosis. Methods A bibliographic search was carried out in the PubMed database selecting those articles that approached the subject of comorbidity between AN and DD. The search was limited to articles published from January 1990 to December 2021. Results Of the 1891 abstracts reviewed, 33 studies met inclusion criteria. The prevalence of this comorbidity was extremely variable between studies, which exposed their heterogeneity. As to symptomatology this comorbidity presents itself with more severity, greater expression of psychological traits and greater cognitive impairment. Certain personality traits are postulated as vulnerability factors. Genetic factors such as neurochemicals seem to be involved in its pathogenesis. Conclusion The comorbidity between DD and ED have important influence in its symptomatic expression, severity and prognosis. Some of the analyzed studies provide consistent data, but there are others that are contradictory. It would be necessary to increase the number of studies and use a unified methodology.     

The use of the Pros and Cons of Anorexia Nervosa (P-CAN) Scale with children and adolescents

Objective: The Pros and Cons of Anorexia Nervosa (P-CAN) Scale was developed out of a previous qualitative study [Int J Eat Disord 25 (1999) 177] in which the positive and negative aspects of anorexia nervosa (AN) were elicited from individuals with AN. Principal components analysis was then used in an adult sample to reduce the number of items and to derive empirically and theoretically based subscales [Serpell et al., submitted]. The aim of the current study was to validate the P-CAN in children and adolescents with AN and compare the pros and cons of young people with AN with those of adults. Methods: Forty-eight young people with AN completed the P-CAN and the Eating Disorders Examination, a semistructured interview used to aid in the diagnosis of eating disorders. Results: Validity in younger patients appeared to be good. Children and adolescents showed both similarities and differences from adults tested in a previous study. Conclusions: The measure is the first to measure attitudes of children and adolescents with AN towards their illness and may prove a useful tool for the measurement of attitudes towards AN in both clinical and research settings.     

Fathers,Daughters, and Anorexia Nervosa

PURPOSE. The study described the nature and meaning of the father–daughter relationship throughout the daughter's (N = 11) life from the perspective of the daughter, who has been in a 2-year recovery from anorexia nervosa (AN). Particular consideration was given to the changes over time. DESIGN AND METHODS. A narrative analysis method was used to examine the daughter's stories. FINDINGS. Several patterns emerged. This study is an exploration of the paths and processes that lead to, through, and into recovery from AN with regard to the father–daughter relationship. PRACTICE IMPLICATIONS. The results have implications for nursing practice, research, and health policy.     

Recent Developments in Anorexia Nervosa

Background:  This review summarises recent clinical developments, topics of debate, and research findings in relation to anorexia nervosa in children and adolescents. Following an update of diagnostic and prevalence issues, recent developments in treatment approaches are discussed. These cover recommendations for the medical management of anorexia nervosa in young people, as well as psychological interventions for children, adolescents and their families. The question of which type of service setting is most appropriate for the treatment of young people with anorexia nervosa remains a subject of discussion, and recent guidance and work in this area is presented. Finally, the ongoing relatively poor prognosis in terms of general mental health associated with anorexia nervosa is highlighted and the implications for CAMHS practitioners discussed.     

Non-eating disorders psychopathology in children and adolescents with eating disorders: implications for malnutrition and symptom severity

OBJECTIVES: To compare the general psychopathology in an eating disorders (ED) and a child mental health outpatient sample and investigate the implications of comorbidity on psychological and physical measures of ED severity. METHODS: One hundred thirty-six children and adolescents with a DSM-IV ED diagnosis were compared with age- and gender-matched controls. Measures included the Eating Disorders Examination and the Child Behavior Checklist. RESULTS: The ED group had lower general and externalizing psychopathology scores and no difference in internalizing (anxiety-depression) symptoms. Of the anorexia nervosa group, 49% experienced comorbid psychopathology. This group had significantly higher ED psychopathology, longer duration of illness, and more gastrointestinal symptoms, but no difference in malnutrition status. Eating disorders not otherwise specified (EDNos) group measures were less influenced by comorbidity status. CONCLUSIONS: Anxiety-depressive symptoms are very common in children and adolescents with EDs. Comorbidity status influences illness severity, especially in the anorexia nervosa group. The management implications of these findings are discussed.     

Different Patterns of Emotional Eating and Visuospatial Deficits Whereas Shared Risk Factors Related with Social Support between Anorexia Nervosa and Bulimia Nervosa

Objective

Although it is thought that eating disorders result from the interplay of personal and sociocultural factors, a comprehensive model of eating disorders remains to be established. The aim of this study was to determine the extent to which the childhood factors and deficit in visuoperceptual ability contribute to eating disorders.

Methods

A total of 76 participants - 22 women with anorexia nervosa (AN), 28 women with bulimia nervosa (BN), and 26 healthy women of comparable age, IQ, and years of education - were examined. Neuropsychological tasks were applied to measure the visuoperceptual deficits, viz. the Rey-Osterrieth complex figure test and the group embedded figures test (GEFT). A questionnaire designed to obtain retrospective assessments of the childhood risk factors was administered to the participants.

Results

The women with both AN and BN were less likely to report having supportive figures in their childhood and poor copy accuracy in the Rey-Osterrieth test. The women with AN were more likely to report premorbid anxiety, childhood emotional undereating and showed poor performances in the GEFT. In the final model, the factors independently contributing to the case status were less social support in childhood as a common factor for both AN and BN, and childhood emotional undereating and poor ability in the low-level visuospatial processing for AN.

Conclusion

Our results suggest the disturbance in the food-emotion relationship and the deficit in low-level visuospatial processing in people with AN. Lower social support appears to contribute to an increase in vulnerability to both AN and BN.     

Medical Findings in Women with Anorexia Nervosa in a Korean Population

Objective

Eating disorders are a common clinical problem among young women in Asian countries. The aim of this study is to determine the medical effects of anorexia nervosa (AN) in the Korean population.

Methods

We comprehensively investigated medical complications including haemodynamic, haematologic, endocrine, and bone density abnormalities in 67 Korean women with AN, together with 194 healthy Korean women of comparable age with a cross-sectional design.

Results

In AN, 36.9% were anaemic, 50.8% were leukopenic, 35.5% were hypoproteinemic, 7.9% were hypokalemic, 9.5% had increased alanine aminotransferase, 6.3% were hyperbilirubinemia, 14.5% were hypercholesterolemia, 14.8% had decreased triiodothyronine. Osteopenia at any one site was identified in 43.3% and an additional 13.4% had osteoporosis. The lowest-ever body mass index was the main determinant of bone mineral density.

Conclusion

Our data in Korean patients with AN show high frequencies of laboratory abnormalities for medical complications. This study emphasizes the importance of recognizing AN as a medical risk in young Korean women.     

Adolescent Anorexia Nervosa: Cognitive performance after weight recovery

Objective

Although there is no definitive consensus on the impairment of neuropsychological functions, most studies of adults with Anorexia Nervosa (AN) find impaired functioning in cognitive domains such as visual–spatial abilities. The objective of this study is to assess the cognitive functions in adolescents with AN before and after weight recovery and to explore the relationship between cognitive performance and menstruation.

Methods

Twenty-five female adolescents with AN were assessed by a neuropsychological battery while underweight and then following six months of treatment and weight recovery. Twenty-six healthy female subjects of a similar age were also evaluated at both time points.

Results

Underweight patients with AN showed worse cognitive performance than control subjects in immediate recall, organization and time taken to copy the Rey's Complex Figure Test (RCFT). After weight recovery, AN patients presented significant improvements in all tests, and differences between patients and controls disappeared. Patients with AN and persistence of amenorrhea at follow-up (n = 8) performed worse on Block Design, delayed recall of Visual Reproduction and Stroop Test than patients with resumed menstruation (n = 14) and the control group, though the two AN groups were similar in body mass index, age and psychopathological scale scores.

Conclusion

Weight recovery improves cognitive functioning in adolescents with AN. The normalization of neuropsychological performance is better in patients who have recovered at least one menstrual cycle. The normalization of hormonal function seems to be essential for the normalization of cognitive performance, even in adolescents with a very short recovery time.     

Rorschach-Test-Untersuchungen bei Anorexia nervosa-Kranken

Zusammenfassung Psychodiagnostische Untersuchungen mit dem Rorschach-Test wurden an einer Gruppe anorektischer Patienten durchgeführt.Während sich die Anorexie-Patienten von normalgesunden Kontrollpersonen unterscheiden, finden sich im Vergleich mit einer eigenen parallelisierten Kontrollgruppe von nichtanorektischen neurotischen Patienten keine kennzeichnenden Unterschiede.Dies führt zur Annahme, daß das klinische Bild in seiner Endstrecke nicht durch spezifische psychodynamische Faktoren, als vielmehr durch die im Test nicht erfaßbaren Faktoren wie somatische Disposition, Entgegenkommen der Organe bzw. Regressionstiefe mitbestimmt ist.     

Anorexia nervosa in Greek and Turkish adolescents

Summary Five samples of adolescents were assessed in three countries: (1) 867 Greek pupils in Munich (Germany), (2) 2,700 Greek pupils in Veria (Greece), (3) 567 girls in Ioannina (Greece), (4) 2,783 adolescents in Istanbul (Turkey), and (5) 157 adolescents in Upper Bavaria (Germany). A two-stage procedure was used for samples one, two and four using the Anorexia Nervosa Inventory for Self-rating (ANIS) for screening and a standardized interview (Structured Interview for Anorexia Nervosa and Bulimia) for personal exploration of possible cases and final case identification. Results of all samples were compared. Greek girls in Germany scored higher than Greek boys in Germany and Greek boys and girls in Germany scored lower than Greek girls in Veria in the ANIS factors figure consciousness, insufficiency, anancasm, negative effect of meals and bulimia in practically all age groups. The frequency distribution of the ANIS main factor figure consciousness was the same for both Greek samples in Greece, while the Turkish sample and the Greek sample in Munich had significantly lower scores. In the second stage the prevalence rates for anorexia nervosa according to Feighner criteria (modified for the purpose of a field study) were: 1.10% for Greek girls in Munich, 0.41% for Greek girls in Veria and 0.35% for Greeks in Ioannina. Thus, while Greek girls in Germany had lower scores in ANIS factors and other self-ratings (General Health Questionnaire) the actual rate of anorexic syndromes was highest among Greek girls in Munich. Socio-cultural influences and selection factors are discussed.     

Late-Onset Anorexia Nervosa in Schizophrenia: A Case Report

The authors report a case of a woman with chronic schizophrenia who developed anorexia nervosa in middle age. The reported rarity of this diagnostic combination and the need to be aware of treatment issues in all patients with coexisting psychoses and eating disorder symptoms are discussed.     

Anorexia nervosa and generalized anxiety disorder: further explorations of the relation between anxiety and body mass index

We explore comorbidity of anorexia nervosa (AN) and generalized anxiety disorder (GAD) and their relation with body mass index (BMI) and evaluate the presence of fasting and excessive exercise which both have anxiolytic and weight loss effects. All participants were female: 32 with AN only, 607 with GAD only, 22 with AN and GAD (AN + GAD), and 5424 with no history of AN or GAD (referent) from the Swedish Twin study of Adults: Genes and Environment (STAGE). Lowest adult BMI differed significantly (p < .001) and was lower in those with AN + GAD than those with AN only (p < .029). Those with AN + GAD were most likely to endorse fasting and excessive exercise, followed by women with AN only, women with GAD only, and the referent. Comorbid AN and GAD may be a particularly pernicious presentation influencing both BMI and proclivity to engage in behaviors such as fasting and exercise that serve both weight loss and anxiolytic goals.