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.     

Olfactory dysfunction in anorexia and bulimia nervosa

Fifty-five eating-disordered women and 16 normal controls participated in this study to determine whether olfactory function is altered in patients with food-restricting anorexia, anorexia with bulimic features, and bulimia nervosa. Olfactory function was assessed using the University of Pennsylvania Smell Identification Test and by determining phenyl ethyl alcohol odor detection thresholds. Only the very low-weight anorexics showed impairments in their identification and detection of odors. This group's olfactory function did not improve from admission to discharge despite significant weight gain. Although, overall, smoking had only a minor influence on olfactory function, the very low-weight anorexic smokers had the lowest scores of all subjects. Since higher-weight anorexics did not show such impairments, the results suggest that the severe and prolonged starvation experienced by the very low-weight anorexics caused or contributed to intractable deficits in the olfactory system and that these deficits are compounded by smoking. © 1995 by John Wiley & Sons, Inc.     

Suicide and attempted suicide in anorexia nervosa and bulimia nervosa

Suicide in anorexia nervosa and bulimia nervosa is a major cause of death. Risk factors for suicide and attempted suicide (which in many cases results in successful suicide) in anorexia nervosa include: purging type, chronic disease, and during treatment, obsessive symptoms and drug abuse, major depression, and for anorexia nervosa low body mass index (BMI) at presentation. In anorexia nervosa suicide has been considered the first cause of death and attempted suicide is a serious threat to these individuals. Data concerning suicide in bulimia nervosa has still scarce whereas attempted suicides are easily found in clinical histories of patients. No doubt suicidal behavior is underestimated amongst patients with anorexia nervosa and bulimia nervosa. An effort to reconcile with subject of suicide and a better evaluation of these patients' psychopathology should improve suicide prevention strategies amongst these individuals.     

Depressive and anxiety disorders in anorexia nervosa and bulimia nervosa

Several investigators have documented that depressive and anxiety disorders are frequently present in individuals with eating disorders. This study reports on three aspects of the relationship between depressive and anxiety disorders in eating disorder patients. Eating-disordered subjects, as a group, were not significantly different in their lifetime or concurrent rates of depressive or anxiety disorders, although anorectics were characterized by significantly more frequent lifetime rates of depressive than anxiety disorders. Bulimic-anorectics were significantly more likely than bulimics to co-present with a major depressive disorder. There were no significant group differences in the concurrent rates of anxiety disorders between bulimic, anorectic, and bulimic-anorectic subjects. Bulimic-anorectics, however, were significantly more likely than anorectic subjects to qualify for obsessive-compulsive disorder at some point in their lifetime. Thus, with regard to Axis I co-morbidity, bulimic-anorectics would appear to be the most pathological of the eating disorder subgroups.     

Parenting by patients with anorexia nervosa and bulimia nervosa

The authors present the experiences of the parents of 12 patients with anorexia nervosa and/or bulimia nervosa. Most patients experience serious parenting difficulties, with two out of 12 parents abandoning their children. As expected, the severity of marital dysfunction appears to mirror the severity of parenting dysfunction. Assessment of parenting skills should be a routine part of the assessment of any patient with Anorexia nervosa or Bulimia nervosa who is also a parent.     

Taste function in patients with anorexia nervosa and bulimia nervosa

The sensitivity to sucrose, sodium hydrochloride, tartrate, and quinine was examined by a filter paper disc method in patients with anorexia nervosa and with bulimia nervosa. There were 20 of the 23 anorexia patients and 11 of the 13 bulimic patients who showed hypogeusia. There were 12 of the 23 anorexia patients and 8 of the 13 bulimia patients who showed dysgeusia. Seven anorexia patients were restudied when the treatments produced a weight gain to more than 85% of normal body weight. Taste function had improved substantially in all but still was subnormal. Serum zinc, iron, and triiodothyronine levels in these patients were depressed; however, none of these levels correlated with the taste recognition scores or dysgeusia scores. In conclusion, patients with anorexia nervosa and bulimia nervosa showed hypogeusia and/or dysgeusia, although the etiology of the taste dysfunction in these patients remains to be determined. These findings should be considered in the implications for treating these patients.     

Vitamin status in patients with anorexia nervosa and bulimia nervosa

Vitamin status of 24 bulimic and 8 anorectic patients was determined. Intake of vitamins A, E, C, B₁, B₂, B₆, B₁₂, and folic acid is clearly reduced. Save vitamin C contrentration, which is reduced in several patients, all vitamin plasma values lie in the reference range. Great variability in the vitamin plasma concentrations was observed. Four patients had very high, almost toxic, retinol concentrations. The activation of erythrocytic transketolase, glutathione reductase, and aspartate transketolase is enhanced in a few patients. A plausible cause is a lack of vitamin B₁, B₂, and B₆. Five patients have a prolonged prothrombin time, perhaps resulting from a vitamin K deficiency. All these results show that the vitamin status of bulimic and anorectic patients should be controlled regularly in order to prevent severe vitamin deficiencies or intoxications.     

Invalidating childhood environments in anorexia and bulimia nervosa

OBJECTIVE: This study examined the relationship between an invalidating childhood environment and eating pathology, including diagnoses, eating attitudes and eating behaviours. METHOD: Fifty-eight eating-disordered patients completed a measure of invalidating childhood environments, and a standardised measure of eating pathology. RESULTS: Patients with bulimia nervosa scored higher on levels of paternal invalidation than those with anorexia nervosa. There were no associations at the attitudinal level, but some behaviours were related to perceived parental style. Self-induced vomiting was associated with paternal invalidation, while those who experienced an invalidating mother were less likely to report binge-eating. Those who exercised excessively were more likely to have experienced a family style in which the focus is on remaining in control of one's emotions, success and achievement. DISCUSSION: Invalidating childhood environment was related to eating psychopathology in a clinical population - particularly the presence or absence of some behaviours. Implications for treatment are considered.     

Body shape perception in bulimia and anorexia nervosa

Nineteen female patients with bulimia and thirty-one with anorexia nervosa were studied using a distorting lens technique. Both groups overestimated their actual body shapes and the bulimia patients desired to be much thinner than they were. These findings are discussed in relation to the literature on the treatment of these disorders.     

Establishing guidelines for pharmacotherapy trials in bulimia nervosa and anorexia nervosa

OBJECTIVE: This paper addresses the lack of a standard protocol for pharmacotherapy trials for patients with bulimia nervosa (BN) and anorexia nervosa (AN). METHOD: Twenty-two surveys were sent to established researchers in the field of eating disorders to elicit their opinions regarding medication trials, including baseline laboratory tests, the optimal length/frequency of medication management sessions, and the information that should or should not be included in these sessions. RESULTS: Sixteen of 22 researchers completed and returned the survey. Their answers are the basis of the data presented. DISCUSSION: We propose a battery of screening laboratory tests for both conditions. We suggest 30-45-min initial medication management sessions in both AN and BN trials with 15-min follow-ups to be held weekly for AN subjects, and weekly for 2 weeks, then biweekly for 2 weeks, then monthly, for BN subjects. We also recommend that published trials should include explicit details of medication management.     

Cognitive style of patients with anorexia nervosa and bulimia nervosa

Nine female patients with anorexia nervosa and 7 female patients with bulimia nervosa were assessed on the Matching Familiar Figures Test (MFFT). This study found that subjects with bulimia nervosa responded more quickly than did the anorexic subjects. Results such as these suggest that not only are bulimic patients more behaviorally impulsive than anorexic patients, they are also more cognitively impulsive. Patients with anorexia nervosa in contrast seemed to display a reflective cognitive style. Extreme cognitive styles may contribute to resistance in treatment and/or relapse in anorexia or bulimia nervosa. © 1995 by John Wiley & Sons, Inc.     

Attitudes and knowledge regarding bulimia and anorexia nervosa

The current study investigated general knowledge of the symptoms, causes, and treatment of bulimia and anorexia nervosa, as well as attitudes toward anorexics and bulimics. High school and college students, 15 to 25 years of age, were administered an anonymous questionnaire. Adequate definitions of bulimia and anorexia were provided by 44% and 71% of the subjects, respectively. Females demonstrated more knowledge than did males. Emotional problems were seen as the most likely cause of both disorders, and psychotherapy was considered the most effective treatment. The subjects were more rejecting of an anorexic female, an obese female, and an average weight vomiter than an average weight binger. Over 4 7 % of the males were rejecting of an anorexic, obese, or purger female as a dating partner.     

The role of pharmacotherapy in anorexia nervosa and bulimia

The purpose of this article is to review the basic pharmacology and the role of drugs that are used to treat anorexia nervosa and bulimia. The pharmacological treatment of eating disorders is based upon theoretical principles. The theoretical models include: (a) an illness secondary to other psychiatric disorders, (b) a disorder in the hypothalamic control of food intake, (c) a disorder of hypothalamic endocrine regulation, (d) a syndrome secondary to depressive illness, and (e) a disorder in the hypothalamic regulation of food intake. Theoretical models a, b, and c govern the choice of drug therapy for anorexia nervosa, and models d and e govern the choice of drug therapy for bulimia. Drugs used to treat anorexia nervosa and bulimia include tricyclic antidepressants and lithium carbonate. Chlorpromazine, metoclopramide, cyproheptadine, and clomiphene citrate have also been prescribed for the treatment of anorexia nervosa. Monoamine oxidase inhibitors are commonly prescribed to treat bulimia. Fenfluramine has the potential to be of therapeutic value in patients with bulimia. Although drug therapy plays a limited role in the treatment of eating disorders, drugs are commonly prescribed. Therefore, the nutritionist should be familiar with the basic pharmacology and the side effects related to drug therapy.