Profiling disordered eating patterns and body mass index (BMI) in the English general population

Purpose

Little national evidence exists on disordered eating patterns in the UK. This study examined the prevalence and nature of disordered eating patterns in the National Adult Psychiatric Morbidity Survey 2007.

Method

Responses to the screening tool for eating disorders (SCOFF) and body mass index (BMI) were analysed using latent class analysis (n = 7,001). Multinomial logistic regression explored the associations between latent classes and mental health comorbidities.

Results

The prevalence of possible eating disorders in England using the SCOFF was 6.3 %; this decreased to 1.6 % when accounting for the negative impact feelings about food had on the respondent’s life. Five latent classes were identified: classes 1 and 2 resembled known eating disorders (‘marginal anorexia’ relating to anorexia nervosa and ‘binge eaters’ relating to bulimia nervosa/binge eating disorder); class 3 consisted of people who were obese, but did not experience eating problems; class 4 was morbidly obese, with an elevated risk of anxiety disorders; class 5 was labelled as ‘normal eaters’, with a low probability of eating problems and a normal BMI.

Conclusions

Adults assigned to eating disorder type classes are at increased risk for mental health comorbidities and poorer social functioning. Information presented herein on clustering of disordered eating patterns may help clinicians identify those men and women risk for an eating disorder.     

Elevated levels of exhaled nitric oxide in patients with anorexia nervosa

Background

Nitric oxide (NO) is involved in eating behavior and inflammatory response. Moreover, there is evidence that NO production is altered in patients with anorexia nervosa (AN).

Aim

To assess whether the overproduction of NO in AN can affect NO level in exhaled air.

Materials and methods

Exhaled NO level was studied in 23 girls with AN and compared with that of healthy age- and gender-matched nonatopic controls.

Results

Exhaled NO levels were significantly higher in girls with AN compared with healthy age-matched controls.

Conclusions

It appears that anorexia nervosa was accompanied by a higher level of exhaled NO, likely resulting from a systemic increase in NO production because of the severe catabolic state.     

A two-stage epidemiologic study on prevalence of eating disorders in female university students in Wuhan,China

Background

The community prevalence of eating disorders among Chinese young women may now be similar to their western counterparts.

Aim

To investigate the prevalence of eating disorders (ED) in female university students in Wuhan, China, using a two-stage design.

Method

In stage one, 99.1 % (N = 8,444) of eligible students (N = 8,521) completed the eating disorder inventory-1 (EDI-1) and a survey of relevant anthropomorphic data. A total of 421 women scored above the cut-off for EDE-1, as defined by a set of criteria similar to those of Keski-Rahkonen (Int J Eat Disord 39:754–762, 2006). 257 (61 %) of these case-positive women and a random sample of case-negative women (312 out of 8,023, 4 %) whose scores did not exceed the defined cut-off were interviewed using the eating disorder examination (EDE) and the structured clinical interview for DSM-IV axis I disorders (SCID-I).

Results

On interview with the SCID-I, 79 women were diagnosed with an ED. Among them, 10 had anorexia nervosa (AN), 21 bulimia nervosa (BN), and 48 binge eating disorder (BED) The results showed a prevalence rate of 1.05 % (95 % CI = 0.02–2.08) for AN, 2.98 % (95 % CI = 1.21–4.74) for BN, and 3.53 % (95 % CI = 1.75–5.30) for BED.

Conclusion

The prevalence of ED among female university students in China is now similar to that of their western counterparts, and BED is the most common ED followed by BN and AN similarly.     

Biogenetic explanations and public acceptance of people with eating disorders

Purpose

It has been assumed that biogenetic causal models may improve public attitudes toward people with mental illnesses. The present study examines whether biogenetic attributions are positively associated with acceptance of people suffering from these disorders.

Methods

Population surveys were conducted in two large German cities. Respondents were presented with a vignette depicting a young female suffering from either anorexia nervosa (N = 680) or bulimia nervosa (N = 667), followed by a fully structured interview including questions on causal attributions, emotional reactions and desire for social distance.

Results

Attribution to hereditary factors showed hardly any relationship with attitudes toward people with symptoms of eating disorders. Respondents who endorsed brain disease as a cause tended more to hold those afflicted responsible for their condition, they also expressed more negative emotions and a stronger preference for social distance.

Conclusions

Our results do not support the notion that promulgating biogenetic causal models of eating disorders helps decrease the stigma surrounding these illnesses; it may even entail the risk of increasing it.     

Conventional intramuscular sedatives versus ziprasidone for severe agitation in adolescents: case-control study

Background

Child and adolescent psychiatry (CAP), a subspecialty of psychiatry in Japan, is facing a serious workforce shortage. To resolve this situation, the Japanese government has organized a task force and has been working to increase psychiatrists' clinical skills to improve care for children and adolescents with mental health problems. Using an online questionnaire system, the authors have conducted a survey to investigate the perceptions, experiences, and interests of early-career psychiatrists in CAP.

Methods

The subjects of this study were 182 psychiatrists in Japan whose individual clinical experiences did not exceed 15 years. The authors of this study created an online questionnaire system and e-mailed the URL and login password to all subjects. Respondents anonymously answered the questions. Most questions required an answer indicating a level of agreement scored on a nine-point scale. Responding to the questionnaire was considered to constitute consent, and all respondents' privacy was carefully protected.

Results

The mean age and clinical psychiatric experience of the subjects were found to be 33.1 ± 4.5 years and 5.43 ± 3.5 years, respectively. On a nine-point scale (with nine being the highest), experience and interest in CAP measured 3.05 ± 1.9 and 5.34 ± 2.5, respectively; further, these two factors showed significant correlation (r = 0.437, p < 0.0001). The mean score for the early-career psychiatrists' confidence in their ability to diagnose and appropriately treat was notably low, at 3.13 ± 1.9.

Conclusion

Our results demonstrated that early-career psychiatrists self-evaluated their CAP clinical experience as insufficient, and these clinicians' CAP experiences and interests correlated significantly. Therefore, in order to improve child and adolescent medical care, we need to expose young psychiatrists to sufficient CAP cases and explore the factors that could attract them to this field.     

Psychiatric symptoms causing delay in diagnosing childhood cancer: two case reports and literature review

Introduction

A somatic disorder may initially be overlooked when a child presents with psychiatric symptoms. We report two children with anorexia nervosa as initial diagnosis and in whom there was a delay in the final diagnosis of the underlying malignancy. A literature survey was performed including patients under 18 years of age with psychiatric symptoms in whom later on an oncological diagnosis became evident as an explanation.

Results

We have found 30 additional cases, with a median delay of 12 months until the diagnosis of the tumour. Overall, 16 boys and 16 girls had a solid tumour: 26 central nervous system tumours, 3 tumours of the gastrointestinal tract and 3 others. In 25 out of 32 patients anorexia nervosa was assumed, although it always appeared to be atypical. Patients younger than 7 years had a significantly longer delay until final diagnosis, while no other patient characteristics correlated with such delay.

Discussion

In addition to careful physical (including full neurological) examination, we advise additional neuroimaging especially in each case of atypical presentation of anorexia nervosa, in order to avoid a delay in diagnosis of a possible malignancy. Furthermore, it is desirable to perform a re-examination when a psychiatric disorder does not respond to therapy, in order not to overlook an underlying oncological disease.     

The adolescent onset anorexia nervosa study (ANABEL): Design and baseline results

The anorexia nervosa adolescent longitudinal biomarker assessment study (ANABEL) is a 2‐year longitudinal study.

Objective

Evaluate several clinical, biochemical, immunological, psychological, and family variables and their interactions in adolescent onset eating disorders (EDs) patients and their 2‐year clinical and biological outcome. This article illustrates the framework and the methodology behind the research questions, as well as describing general features of the sample.

Methods

A longitudinal study of 114 adolescents with EDs seeking treatment was performed. Only adolescents were selected during 4 years (2009–2013). The variables were collected at different times: baseline, 6, 12, 18, and 24 months of the start of treatment. Diagnoses were completed through the semi‐structured Kiddie‐Schedule for Affective Disorders and Schizophrenia interview.

Results

At baseline, the mean age was 15.11 (SD = 1.36). The mean ED duration was 10 months (SD = 5.75). The mean body mass index was 16.1 (SD = 1.8). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis at baseline for restrictive anorexia nervosa was 69.6%, 17.4% for purgative anorexia nervosa, and 24.3% for other specified feeding disorder. At 12 months, 19.4% were in partial remission, whereas at 24 months, 13.8% had fully recovered and 29.2% had partially recovered.

Conclusions

There was an acceptable physical and psychopathological improvement during the first year of treatment, with recovery being more evident during the first 6 months.

     

Aggressiveness, anger, and hostility in eating disorders

Objective

Despite evidence of a link between the behavioral and cognitive dimensions of aggressiveness and eating disorders, only few studies have tested this relation empirically.

Methods

A total of 112 female patients with anorexia nervosa (n = 61) or bulimia nervosa (n = 51) and 631 young girls attending 7 high schools in the same health district as the patients (northeast Italy) were invited to fill in a set of self-report instruments including the Eating Attitudes Test, the Bulimic Investigatory Test of Edinburgh, the Body Attitudes Test, and the Buss-Perry Aggression Questionnaire (AQ).

Results

In both healthy controls and patients, scores on the measures of eating disorder symptoms were positively related to the scores on the AQ: the strength of the association did not differ between healthy controls and patients. However, patients diagnosed with eating disorders were not more likely to disclose a propensity to aggression than the healthy controls drawn from the community: patients with anorexia nervosa scored lower than controls on the physical aggression and on the verbal aggression subscales of the AQ (P < .05). On the other hand, patients with bulimia nervosa scored higher than controls on the anger subscale of the AQ (P < .05) but did not differ from them on the other subscales of the questionnaire.

Conclusions

The results confirm the higher propensity to anger in patients with bulimia nervosa; in patients with anorexia nervosa, difficulties in expressing anger and outward-directed aggressiveness can be a prevailing feature. The younger age of controls and exclusive reliance on self-report measures might have concealed some differences between patients and community subjects.     

Health-related quality of life among adolescents with eating disorders

Objective

Health-related quality of life (HRQoL) is an emerging area of research in eating disorders (EDs) that has not been examined in adolescents in detail. The aim of the current study is to investigate HRQoL in an adolescent ED sample, examining the impact of ED symptoms on HRQoL.

Methods

Sixty-seven treatment-seeking adolescents (57 females) with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder not otherwise specified (EDNOS) completed self-report measures of HRQoL and ED symptoms.

Results

Participants reported poorer HRQoL in mental health domains than in physical health domains. Disordered attitudes, binge eating, and compensatory behaviors were associated with poorer mental health HRQoL, and body dissatisfaction was associated with poorer physical health HRQoL.

Conclusion

The current study assessed HRQoL among adolescents with EDs, finding several consistencies with the literature on adults with EDs. Future research should compare adolescents and adults with EDs on HRQoL.     

Anxiety and depression among caregivers of patients with eating disorders and their change over 1 year

Purpose

Limited data are available on the difficulties experienced over time by caregivers of patients with eating disorders (CPED). The aim of this study was to describe changes in anxiety and depression among such caregivers over 1 year and to identify factors predicting any change in both.

Methods

At recruitment, 145 ED patients and their 246 caregivers completed sociodemographic and clinical instruments, including the Hospital Anxiety and Depression Scale (HADS), and the Short-Form 12 (SF-12). Patients also completed the Eating Attitudes Test-26 (EAT-26), and their psychiatrists assessed clinical variables. Patients and caregivers completed the same instruments 1 year later.

Results

At baseline, prevalence of anxiety and depression among caregivers was 56 and 32 %, respectively. Scores were essentially the same 1 year later. Factors associated with the changes in anxiety were higher anxiety level at baseline and caring for a patient with a restrictive ED. Factors associated with changes in depression included higher depression at baseline and caring for a patient with a restrictive ED. Neither health-related quality of life among patients and caregivers nor patients’ eating attitudes was related to caregiver anxiety or depression.

Conclusions

These findings confirm the presence of substantial and continuing emotional distress among caregivers of patients with ED, highlighting the importance of offering them more extended follow-up and treatment.     

Are attitudes towards medication adherence associated with medication adherence behaviours among patients with psychosis? A systematic review and meta analysis

Background

Studies have shown patient attitudes to be an important predictor for health related behaviours including medication adherence. It is less clear whether patient attitudes are also associated with medication adherence among patients with psychoses.

Method

We conducted a systematic review and meta analysis of the data of studies that tested the association of attitude measures with medication adherence among patients with psychoses. 14 studies conducted between 1980 and 2010 were included.

Results

Results show a small to moderate mean weighted effect size (r ⁺ = 0.25 and 0.26 for Pearson and Spearman correlations, respectively).

Conclusions

Theory based interventions that target potentially modifiable attitude components are needed to assess the relationship between positive patient attitudes and adherence behaviours among patients with psychoses.     

Autonomic dysfunction responses to head-up tilt in anorexia nervosa

Purpose

Autonomic dysfunction of the cardiovascular system in anorexia nervosa (AN) was reported not only in the rest position, but also in the standing position in some previous studies, which might contribute to cardiac complications such as lethal arrhythmia. However, there has not been sufficient literature in this issue. Therefore, we performed a head-up tilt test, and compared the changes after tilting in indices of autonomic function between AN patients and healthy subjects by heart rate variability (HRV) and blood pressure variability (BPV).

Methods

The subjects were 21 females with AN and 30 age-matched healthy women. A head-up tilt test was performed following the protocol recommended by the American Heart Association. Blood pressure and heart rate data were collected for 10 min before and after tilting. In the frequency analysis, the powers of low-frequency (LF) and high-frequency (HF) components were calculated by a fast Fourier transformation.

Results

Regarding interactions between groups and head-up tilting, the head-up tilting-induced reduction of the HF component of HRV was significantly greater in the AN group. In addition, increases in the LF/HF of HRV and the LF component of BPV after head-up tilting were significantly smaller in the AN group.

Conclusions

Regardless of the posture, changes in HF and LF/HF of HRV and LF of BPV in AN patients suggested the presence of autonomic insufficiency.     

The needs of carers: a comparison between eating disorders and schizophrenia

Objective

This pilot study compares the level of distress and the need for support between carers of patients with anorexia (AN) and bulimia nervosa (BN) and carers of patients with schizophrenia.

Methods

Thirty-two carers of patients suffering from AN and BN and 30 carers of patients with schizophrenia filled out the general health questionnaire (GHQ-12) and the burden inventory (BI). In addition, they were interviewed with a semi-structured research interview, the carers’ needs assessment (CNA), to assess relevant problem areas as well as the need for helpful interventions. Patients with an eating disorder were interviewed with the eating disorder examination (EDE) and patients with schizophrenia with the positive and negative syndrome scale (PANSS) to assess the severity of the disorder.

Results

The mean duration of illness was 5.3 years in the patients with eating disorders and 7.3 years in the patients with schizophrenia. Most of the carers were mothers or partners. In the CNA we found high numbers of problems as well as high numbers of unmet needs for interventions. The most frequently mentioned problem areas in all groups of carers were “disappointment caused by the chronic course of the illness, concerns about the patient’s future” and “problems in communication with the patient”. The most frequently reported need for support in all groups was “counseling and support by a professional”. Carers of patients with BN reported a significantly lower number of problems and of needs for interventions compared to the carers of patients with AN and schizophrenia. Also in the BI and the GHQ-12 we found significantly lower total scores in carers of patients with BN. Carers of patients with AN and schizophrenia did not differ significantly in any of the assessments. The severity or duration of illness of the patients did not correlate with the carers’ burden or needs.

Conclusions

Carers of patients with an eating disorder and carers of patients with schizophrenia are burdened with similar problems and have high levels of unmet needs which are usually not addressed in clinical practice. Carers of anorectic patients have higher levels of difficulties in various areas compared to carers of bulimic patients and did not differ from carers of patients with schizophrenia.     

Capacités d’adaptation et fonctionnement défensif dans les troubles du comportement alimentaire. Étude structurale comparée basée sur le codage optimal

Objectives

Considering classic and current theories relevant to stress and coping, we reflect on the interaction between dysfunctional coping strategies influenced by defensive functioning and the launching, respectively maintaining of eating disorders (ED). Our objectives are to verify: (a) if the coping strategies of patients with anorexia and bulimia nervosa are different from those of young women without a current eating disorder, (b) what are the latent dimensions underlying the privileged way of coping associated with both anorexia nervosa and bulimia nervosa. The latent dimensions can create meaning in a disparate distribution of variables and objects by analyzing their configuration in a two or three dimensional space.

Patients and methods

We present a comparative study between patients suffering from anorexia or bulimia nervosa (Total n = 41) and a control group of female students non affected by eating disorders. The mean age was 19.95 years (SD = 3.73) in women diagnosed with anorexia nervosa, 19.81 years (SD = 2.33) in women diagnosed with bulimia nervosa and 20.88 (SD 1.40) in women without a current eating disorder. The study is based on the SVF 120 (Stressverarbeitungsfragebogen, Stress Coping Questionnaire, by Janke, Erdmann and Kallus, 1997) and the MDBF (Multidimensionales Befindlichkeitsfragebogen, Multidimensional State Questionnaire, by Steyer et al., in 1997).

Results

The means of the three subgroups are compared with the help of Univariate Anovas, preferential coping strategies associated to anorexia and bulimia nervosa are studied through Logistic Regressions, whereas the comparative structural exploration is based on the Non Linear Principal Components Analysis (PRINCALS). We observe that our two clinical subgroups (patients with anorexia and patients with bulimia) do not try to cope with stress by implementing active strategies (problem-oriented coping strategies), that is to say, seeking a solution or planning stages of the solution. Instead, they tend to get overwhelmed by the unpleasant situation. Coping strategies based on satisfaction seeking (β = 0.87) and positive reframing (β = −0.33) make a significant contribution to prevalent coping strategies in women with anorexia nervosa, whereas change into triviality (β = 0.87), isolation (β = 0.50), use of psychotropic medications (β = 0.43), denial of responsibility (β = −0.33) as well as diversion (β = −0.46) are predictors of coping manners in women with bulimia nervosa. Whereas the general features of latent dimensions were similar in all three groups, these dimensions were nuanced differently according to the psychopathological profile. One dimension was focused on an active handling of the situation as opposed to passivity, another was focused on restoring narcissism as opposed to a sense of humiliation and self-degradation and a third one was focused on the reinterpretation of reality (cognitive restructuring) as opposed to other types of strategies. This interpretation of the meaning of the latent dimensions seems plausible at the light of recent theories of eating disorders, as well as at the light of the current state-of-the-art.

Conclusions

Our multidimensional comparative study allowed us to identify some specific profiles, concerning the use of coping strategies, while also showing some similarities between clinical subgroups and control group. The analysis of the results shows that the general assumption saying that patients suffering from eating disorders use above all emotion-oriented coping strategies is too categorical. The data of the study point rather to a dimensional approach of psychopathology. The interaction between the fact of changing coping strategies and maintaining, respectively abandoning pathological conducts should be studied through a prospective longitudinal study accompanying psychotherapeutic interventions.     

Étude pilote – un nouvel éclairage attachementiste de l’anorexie mentale : les adolescentes anorexiques ont-elles un attachement insécure ?

ObjectivesAnorexia nervosa is a severe pathology with prevalence among women and the quality of family functioning is involved in the development and the persistence of this disorder and as such is a therapeutic tool of major importance. Among the numerous conceptualisations and models of these familial interactions, attachment theory, originating from John Bowlby's work, provides a useful tool for understanding the interaction of individual and family characteristics, much needed in our clinical work with anorexia nervosa. Attachment theory also integrates solid measures with clinically meaningful constructs. Previous research on attachment and eating disorders has hypothesized direct links between insecure attachment and diagnoses of eating disorders. The aim of the current study is to explore styles of attachment in adolescent girls with anorexia nervosa and in a “healthy” control group with a new self-report attachment questionnaire, the Inventory of Parental Representation.Patients and methodsThis quantitative study is based on the Inventory of Parental Representation completed by six in- and outpatient adolescent girls diagnosed with restrictive anorexia nervosa and six adolescent girls from the general population with no psychiatric disorder.ResultsOur results showed no difference between the clinical and the control groups. All 12 adolescents girls (from both groups) had secure parental representations and attachment styles, although there was a higher proportion of insecure-preoccupied attachment styles in the clinical group for paternal representations, compared to the control group.ConclusionOur results are not in agreement with the current literature and previous findings, which generally tend to find more insecure attachments in eating disorder populations. Firstly most of the studies on attachment in eating disorders are based on adults’ samples but recent research focusing on adolescents obtained findings in line with ours. Indeed, in spite of the fact that some continuity can be observed in attachment strategies from childhood to adulthood, it is possible that the observed pattern of attachment and its relative influence change over the course of development. Although these contradictory findings may not invalidate the link between insecure attachment and psychopathology, they tend to favour more developmental conceptualisations of the role of attachment in anorexia nervosa. Secondly, we recruited patients with no distinction of therapeutic modalities at the time of the study (in- or outpatients). The experience of hospitalisation, which may trigger traumatic separation, the foundation of Bowlby's theory, may contribute to the deactivation and reorganisation of the subject's internal representation models; in contrast, outpatient care may not generate this type of reorganisation. Thirdly, patients from our study all benefited from a multidisciplinary approach including family therapy. The influence of family interventions on attachment strategies must be taken into account since such treatment may contribute to the improvement of the quality of attachment, as suggested by Bowlby. Finally it is possible that the association might exist at the level of eating disorder pathology and of psychiatric symptoms, rather than at a diagnostic level.     

Stories I Tell My Patients

In this article, we review the clinical research on the implications of comorbid personality disorders (PDs), pathological personality traits, and the expression and response to treatment of those with eating disorders (EDs) (i.e., anorexia and bulimia nervosa, and binge eating disorder). Obsessive-compulsive PDs and related traits, such as perfectionism and rigidity, appear to be clear-cut risk and maintenance factors for anorexia nervosa. In bulimia nervosa, trait impulsivity seems to be related to early termination from therapy and, according to at least some indices, poorer responses to treatment. Dramatic-Erratic PD features, generally more characteristic of binge-purge ED variants, clearly predict a protracted course for general psychiatric symptoms, but may have less prognostic value for eating symptoms. Recent guidelines from two influential bodies—the American Psychiatric Association (APA, 2000 American Psychiatric Association. 2000. Practice guideline for the treatment of patients with eating disorders, Washington, DC: Author.  [Google Scholar]) and the United Kingdom’s National Institute for Clinical Excellence (NICE, 2004 National Institute for Clinical Excellence. 2004. Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders, London, UK: British Psychological Society.  [Google Scholar])—both include the concept that “trait-oriented” interventions, targeting personality-linked components like perfectionism, affective instability, impulsivity, and interpersonal disturbances, may optimize treatment effects. In general, the literature supports the recommendation that clinicians should apply well-validated, symptom-focused therapies for the EDs; in addition, clinicians may wish to incorporate trait-focused interventions in patients in whom personality pathology contributes to suboptimal response.     

Home Telehealth Uptake and Continued Use Among Heart Failure and Chronic Obstructive Pulmonary Disease Patients: a Systematic Review

Background

Home telehealth has the potential to benefit heart failure (HF) and chronic obstructive pulmonary disease (COPD) patients, however large-scale deployment is yet to be achieved.

Purpose

The aim of this review was to assess levels of uptake of home telehealth by patients with HF and COPD and the factors that determine whether patients do or do not accept and continue to use telehealth.

Methods

This research performs a narrative synthesis of the results from included studies.

Results

Thirty-seven studies met the inclusion criteria. Studies that reported rates of refusal and/or withdrawal found that almost one third of patients who were offered telehealth refused and one fifth of participants who did accept later abandoned telehealth. Seven barriers to, and nine facilitators of, home telehealth use were identified.

Conclusions

Research reports need to provide more details regarding telehealth refusal and abandonment, in order to understand the reasons why patients decide not to use telehealth.     

A Pilot Study of a Family-Based Treatment for Adolescent Anorexia Nervosa: 18- and 36-Month Follow-ups

The current study evaluated the outcome of family-based treatment for female adolescents with anorexia nervosa (N?=?32), at the Anorexia-Bulimia Outpatient Unit in Göteborg, Sweden. Patients/parents were assessed pre-treatment, at 18- and 36-month follow-ups concerning eating disorder symptoms, general psychopathology, family climate and BMI. At the 36-month follow-up, 75% of the patients were in full remission with reduction in eating disorder symptoms and internalizing problems and they experienced a less distant and chaotic atmosphere in their families. These results show that family-based treatment appears to be effective in adolescent anorexia nervosa patients regarding areas examined in this study.     

Disruption of brain white matter microstructure in women with anorexia nervosa

Background

The etiology of anorexia nervosa is still unknown. Multiple and distributed brain regions have been implicated in its pathophysiology, implying a dysfunction of connected neural circuits. Despite these findings, the role of white matter in anorexia nervosa has been rarely assessed. In this study, we used diffusion tensor imaging (DTI) to characterize alterations of white matter microstructure in a clinically homogeneous sample of patients with anorexia nervosa.

Methods

Women with anorexia nervosa (restricting subtype) and healthy controls underwent brain DTI. We used tract-based spatial statistics to compare fractional anisotropy (FA) and mean diffusivity (MD) maps between the groups. Furthermore, axial (AD) and radial diffusivity (RD) measures were extracted from regions showing group differences in either FA or MD.

Results

We enrolled 19 women with anorexia nervosa and 19 healthy controls in our study. Patients with anorexia nervosa showed significant FA decreases in the parietal part of the left superior longitudinal fasciculus (SLF; p_FWE < 0.05), with increased MD and RD but no differences in AD. Patients with anorexia nervosa also showed significantly increased MD in the fornix (p_FWE < 0.05), accompanied by decreased FA and increased RD and AD.

Limitations

Limitations include our modest sample size and cross-sectional design.

Conclusion

Our findings support the presence of white matter pathology in patients with anorexia nervosa. Alterations in the SLF and fornix might be relevant to key symptoms of anorexia nervosa, such as body image distortion or impairments in body–energy–balance and reward processes. The differences found in both areas replicate those found in previous DTI studies and support a role for white matter pathology of specific neural circuits in individuals with anorexia nervosa.