Anorexia nervosa and bulimia nervosa: A meta-analysis of executive functioning

ObjectiveResearch investigating the link between eating disorder (ED) diagnosis and executive dysfunction has had conflicting results, yet no meta-analyses have examined the overall association of ED pathology with executive functioning (EF).MethodEffect sizes were extracted from 32 studies comparing ED groups (27 of anorexia nervosa, 9 of bulimia nervosa) with controls to determine the grand mean effect on EF. Analyses included effects for individual EF measures, as well as an age-based subgroup analysis.ResultsThere was a medium effect of ED diagnosis on executive functioning, with bulimia nervosa demonstrating a larger effect (Hedges’s g = −0.70) than anorexia nervosa (g = −0.41). Within anorexia nervosa studies, subgroup analyses were conducted for age and diagnostic subtype. The effect of anorexia nervosa on EF was largest in adults; however, subgroup differences for age were not significant.ConclusionsAnorexia and bulimia nervosa are associated with EF deficits, which are particularly notable for individuals with bulimia nervosa. The present analysis includes recommendations for future studies regarding study design and EF measurement.     

Epidemiology of anorexia nervosa and bulimia nervosa in Bornholm County,Denmark, 1970–1989

In a retrospective study of anorexia nervosa and bulimia nervosa, potential cases were traced, studied, and diagnosed according to ICD-10. Forty-two cases were found in Bornholm County, comprising the island of Bornholm in Denmark, in a population of 47,000 from 1970 to 1989. Less than half of these cases (n= 16) were registered in Danish psychiatric case registers, and 35% (n= 14) could be found only by search in primary care. The incidence rates were stable during most of the study period, but a significant increase occurred during the last 5 years. The prevalence rates, determined by counting the number of cases in the population year by year, also increased during the late part of the study period. In 1989 the incidence rate of the high-risk group of females 10 to 24 years of age was 136 per 100,000 for anorexia nervosa and 45 per 100,000 for bulimia nervosa, and the prevalence rate was 222 per 100,000 for anorexia nervosa and 89 per 100,000 for bulimia nervosa.     

Patient interpersonal factors and the therapeutic alliance in two treatments for bulimia nervosa

Abstract

Although the therapeutic alliance is robustly associated with psychotherapy outcomes, less is known about factors that influence its development. This study examined the association between baseline patient interpersonal factors and patient-rated alliance in a randomized trial comparing cognitive–behavioral therapy (CBT) and interpersonal therapy (IPT) for bulimia nervosa. Using hierarchical linear modeling, early and middle alliance were negatively associated with interpersonal distress and positively associated with interpersonal affiliation. Middle alliance was also related to treatment group interactions with rigidity, affiliation, and control. Overall, alliance growth was higher in IPT than CBT. Using group-based trajectory analysis, three divergent alliance trajectories emerged (high and improving, low and improving, and low and stable), with group mean differences between two of them in terms of interpersonal distress and hostile–submissiveness.     

Bulimia nervosa and abnormal cardiac repolarization

OBJECTIVE: Eating disorders (ED) are thought to be risk factors for sudden death, and arrhythmias are one of the major causes of sudden death in ED patients. Late potentials (LPs) are a predictor of arrhythmias and can be measured using signal-averaged electrocardiography (SAECG). We examined arryhthmogenicity by LPs in ED patients. METHODS: We performed SAECG on 48 female ED patients [21 with anorexia nervosa (AN) and 27 with bulimia nervosa (BN)] and on 20 healthy women. An LP was judged positive if two or more of the following criteria were fulfilled: QRS duration >120 ms, root-mean-square voltage <20 microV, and a high-frequency, low-amplitude duration >38 ms. We compared the occurrence of LPs among subgroups. RESULTS: Compared with the controls, BN patients with a history of AN had significantly more SAECG abnormalities. CONCLUSIONS: BN patients with a history of AN may be prone to ventricular arrhythmias.     

Social perception in people with eating disorders

ObjectiveSocial perception is a key aspect of social cognition which has so far not been investigated in eating disorders (ED). This study aimed to investigate social perception in individuals with anorexia nervosa (AN) and bulimia nervosa (BN).MethodsOutpatients with AN (restricting subtype [AN-R]: n = 51; binge-purge subtype [AN-BP]: n = 26) or BN (n = 57) and 50 healthy control (HC) participants completed the Interpersonal Perception Task (IPT-15). This is an ecologically valid task, which consists of 15 video clips, depicting complex social situations relating to intimacy, status, kinship, competition and deception. The participants have to assess relationships between protagonists’ based on non-verbal cues.ResultsOverall, there was no difference between groups on the IPT total score and subscale scores. Group differences on the Intimacy subscale approached significance so post hoc comparisons were carried out. HCs performed significantly better than AN-R participants in determining the degree of intimacy between others.ConclusionsSocial perception is largely preserved in ED patients. Individuals with AN-R show impairments in identifying intimacy in social situations, this may be due to the lack of relationship experience. Further research into different aspects of social cognition is required to establish the link between interpersonal difficulties and ED psychopathology.     

Fatigue mood as an indicator discriminating between anorexia nervosa and bulimia nervosa

In order to clarify the differences in mood states between anorexia and bulimia nervosa, the Profile of Mood States (POMS) with tension-anxiety, depression, anger-hostility, vigour, fatigue and confusion scales was administered to 32 female patients with anorexia nervosa (age range 14 to 32 years, mean age 20 years), 49 female patients with bulimia nervosa (age range 15 to 33 years, mean age 23 years) and 410‘normal’ female subjects (age range 14 to 35 years, mean age 23 years). The scores on the depression, fatigue and confusion scales for both anorexia and bulimia nervosa and those on the tension-anxiety and anger-hostility scales for bulimia nervosa were significantly higher than those for the control subjects. The score on the fatigue scale for bulimia nervosa was significantly higher than that for anorexia nervosa. Moreover, the result of the multiple logistic regression analysis including all of the POMS scales indicated that the fatigue scale significantly discriminated between the two disorders. Fatigue mood appears to be a principal indicator for differentiating between the two disorders.     

Cost-effectiveness of anorexia nervosa in QALYs

Background: The costs of treating eating disorders are often considered high.

Aims: The objective was to perform a cost-utility analysis to estimate the cost-effectiveness of treatment of anorexia nervosa (AN).

Methods: Thirty-nine patients entering treatment of AN completed the 15D health-related quality-of-life (HRQoL) questionnaire before and 2 years after the start of treatment. Direct hospital costs were obtained. Quality-adjusted life years (QALYs) gained were calculated and cost-utility assessed.

Results: Patients’ baseline HRQoL was severely impaired. During follow-up, mean HRQoL improved statistically significantly. The cost per QALY gained was €5296 (best-case scenario) or €64?440 (base-case scenario) (€11?559 or €71?600 discounted 3%) depending on the assumptions used in the analysis.

Conclusions: The cost per QALY was in the same range as that of many other interventions provided in specialized medical care and within the limits usually considered acceptable, indicating that the treatment of AN is cost-effective.     

Measuring state trait properties of detail processing and global integration ability in eating disorders

Abstract

Objectives. Women with eating disorders (EDs) are reported to have strengths in local or detailed information processing and difficulties with coherence or global processing/integration. Methods. This study aimed to replicate these findings and additionally explore a global integration task which has not previously been reported for an ED group, the Fragmented Pictures Task (FPT). Two hundred and twenty-two women (50 with anorexia nervosa (AN), 48 with bulimia nervosa (BN), 35 recovered from AN and 89 controls (HC)) completed the Rey–Osterrieth Complex Figure Task (RCFT) to measure global/local processing strategies, the Group Embedded Figures Task (GEFT) to measure local processing and the FPT to measure global integration. Results. Superior detail processing skills (GEFT) and a tendency to utilise detail processing strategies (RCFT) were associated with having AN, BN and being in recovery from AN. Global integration difficulties (FPT) were only observed in acute AN, whereas participants in the BN and recovered group performed similarly to HCs. Conclusions. People currently ill with, and recovered from EDs are skilled at detail processing. The acute phase of AN is associated with difficulties in global integration.     

Resting-state synchrony between anterior cingulate cortex and precuneus relates to body shape concern in anorexia nervosa and bulimia nervosa

Cortical areas supporting cognitive control and salience demonstrate different neural responses to visual food cues in patients with eating disorders. This top-down cognitive control, which interacts with bottom-up appetitive responses, is tightly integrated not only in task conditions but also in the resting-state. The dorsal anterior cingulate cortex (dACC) is a key node of a large-scale network that is involved in self-referential processing and cognitive control. We investigated resting-state functional connectivity of the dACC and hypothesized that altered connectivity would be demonstrated in cortical midline structures involved in self-referential processing and cognitive control. Seed-based resting-state functional connectivity was analyzed in women with anorexia nervosa (N=18), women with bulimia nervosa (N=20) and age matched healthy controls (N=20). Between group comparisons revealed that the anorexia nervosa group exhibited stronger synchronous activity between the dACC and retrosplenial cortex, whereas the bulimia nervosa group showed stronger synchronous activity between the dACC and medial orbitofrontal cortex. Both groups demonstrated stronger synchronous activity between the dACC and precuneus, which correlated with higher scores of the Body Shape Questionnaire. The dACC-precuneus resting-state synchrony might be associated with the disorder-specific rumination on eating, weight and body shape in patients with eating disorders.     

Validation of the French version of SCOFF questionnaire for screening of eating disorders among adults

Abstract

Objective. The aim of this study was to translate and validate a French version of the English SCOFF questionnaire for the screening of eating disorders (ED) in a student population. Methods. The translation and back-translation method were employed for adaptation of the French version of SCOFF (SCOFF-F). SCOFF-F paper questionnaire was given to female students attending yearly evaluation in the University Preventive Medicine Department. After completing the SCOFF-F, each student was evaluated by one ED specialist blinded to SCOFF-F results. The validated French version of Mini International Neuropsychiatric Interview (MINI) and DSM-IV criteria for ED were employed as diagnostic references. Results. A total of 400 women were evaluated. ED were diagnosed in 37 (9.3%) of students: eight (2%) cases of anorexia nervosa (AN) and 29 (7.3%) of bulimia nervosa (BN). Diagnostic threshold was fixed at two positive answers with a sensitivity of 94.6%, a specificity of 94.8% and an area under the curve of 96.2%. Positive and negative predictive values for ED were 65 and 99%. Similar figures were obtained separately for AN and BN. Conclusion. This study demonstrates that the French version of SCOFF questionnaire is accurate and reliable for the detection of women with EDs in this high-risk student population.     

Effectiveness of individualized,integrative outpatient treatment for females with anorexia nervosa and bulimia nervosa

ABSTRACT

The effectiveness of an individualized outpatient program was investigated in the treatment of bulimia nervosa (BN) and anorexia nervosa (AN). Participants included 151 females who received outpatient eating disorder treatment in the partial hospitalization program, the intensive outpatient program, or a combination of the two programs. Outcome measures included the Eating Disorder Inventory (EDI-2), Beck Depression Inventory (BDI-II), frequency of binge eating and purging, and mean body weight. Findings included significant increases in weight for the AN group, reductions in binge eating frequency for the BN group, and reductions in EDI-2 and BDI-II scores and purging frequency for both groups. This study provides preliminary support for the efficacy of a multimodal program for the treatment of both anorexia nervosa and bulimia nervosa.     

Psykoterapi med pasienter med anorexia nervosa og bulimia nervosa: Kontroll som dimensjon i psykologisk behandling av alvorlige spiseforstyrrelser

Buhl C. Psykoterapi med pasienter med anorexia nervosa og bulimia nervosa.

Anorexia nervosa and bulimia represent a deficit pathology; a faulty psychological intrasystemic development, which is expressed mainly by means of the control apparatus. The ninety patients treated at the outpatient clinic demonstrate the differences between the two separate diagnostic disorders. The consequences of differential diagnosis concern both the techniques and the therapeutic attitude. The patient's symptoms must be in focus throughout the entire psychotherapy, as they do not disappear automatically. The progress towards more flexible mature control of impulses and emotional reactions are different for the two disorders. The anorectic symptoms demonstrate a reserved, isolated loneliness which dries out the need and capacity for contact. In the psychotherapy the control problems must be met with sensitive constant support towards the gradual acknowledgement of impulses and emotions, without forcing the brittle control. The bulimic patient shows a more eruptive way of handling contact and control, both acting out and repressing. The therapist must continually focus on the alternation between the acting-out and flooding, and the repression and isolation of impulses, and must function as a stable, respecting model throughout the entire psychotherapy. The reconstruction of meaning and order in the patients' experiences of first the outer, then the inner, world is the most important technique in the psychodynamic psychotherapy of both anorectic and bulimic patients. while developing capacity for tolerating emotions.     

神经性贪食症11例临床分析

目的：了解神经性贪食症（ＢＮ）的临床情况。方法：对１１例神经性贪食症的临床资料进行分析。结果：发现发病前大多有厌食症状或神经性厌食症。结论：认为ＢＮ为持久性神经性厌食症的延续，社会文化因素在发病中起重要作用。应以心理治疗为主。     

High levels of free testosterone in women with bulimia nervosa

Women with normal-weight bulimia nervosa (n= 11) displayed significantly higher serum levels of free testosterone than age-matched controls (6.0 ± 0.7 vs 3.9 ± 0.8 pmol/l; P= 0.03). The possible importance of androgens, in women, for the pathophysiology of conditions characterized by an impairment in impulse control is being discussed.     

Regional cerebral blood flow patterns of change following the own body image exposure in eating disorders: A longitudinal study

ObjectiveThe aim of the present study is to see if the changes in the regional cerebral blood flow (rCBF) experienced by restrictive anorexia nervosa (AR) and bulimia nervosa (BN) patients, following the exposure to their own body image, persist at follow-up.MethodsThree single photon emission computed tomography (SPECT) were performed on nine patients with a DSM-IV diagnosis of AR, 13 with BP, and 12 controls: at rest, following a neutral stimulus, and after exposure to their previously filmed whole body image. Body dissatisfaction was measured by means of the Body Dissatisfaction Questionnaire (BSQ). One year later the same assessment was repeated.ResultsFollowing the exposure to their own body image, BN showed an increase in body dissatisfaction, which was associated with the increase in the rCBF of the Right Temporal Area. Those changes persisted at follow-up.DiscussionMore specific long term therapies are needed for the treatment of the averse response showed by ED patients to their own body image exposure that is associated with the hyperactivation of the right temporal area when they are confronted with their whole body image.     

Salivary opiorphin levels in anorexia nervosa: A case–control study

Abstract

Objectives: Opiorphin is a physiological inhibitor of peptidases inactivating endogenous opioids displaying strong analgesic properties without undesirable side effects, antidepressant properties or hormonal dependency. It might therefore play an important role in patients with painful diseases related to neuro-hormonal dysregulation of the nervous system, affecting saliva secretion and composition such as anorexia nervosa (AN). The main objective aim of this study was to compare the level of opiorphin in saliva of patients with AN to matched subjects free of eating disorders.

Methods: A case–control clinical trial was conducted in 68 AN patients and 43 healthy matched control subjects. Depression symptoms were assessed with the self-scored questionnaire Beck Depression Inventory (BDI) and salivary samples were taken during the acute stage of AN (BMI <15?kg/m²) for measuring opiorphin. Opiorphin levels were measured with a quantitative assay using a commercial immunoenzymatic Elisa kit (cat no. EH1927, Wuchan, Hubei, China).

Results: No statistically significant difference was found in salivary opiorphin levels between the AN and control groups, (P?=?0.499, Mann–Whitney U-test). Positive correlations to duration of the disease, BDI and bodyweight in AN patients were evidenced.

Conclusions: Measurement of salivary opiorphin levels cannot be used as a marker of AN but may allow new perspectives in monitoring AN in its early stages.     

Temperament, character and suicide attempts in anorexia nervosa, bulimia nervosa and major depression.

OBJECTIVE: We examined the relation between personality traits as measured by the Temperament and Character Inventory (TCI) and a reported history of suicide attempts in women with anorexia nervosa, bulimia nervosa and major depression. METHOD: We compared the prevalence and severity of suicide attempts in women with anorexia nervosa (n = 68), bulimia nervosa (n = 152) and major depression with no history of an eating disorder (n = 59), and we examined the relation between the TCI scales and suicide attempts. RESULTS: Comparable numbers of women across the three groups had attempted suicide. The temperament dimension of high persistence and the character dimensions of low self-directedness and high self-transcendence were associated with a reported history of suicide attempts. CONCLUSION: Suicide attempts are equally common in women with eating disorders and women with depression. Whether the observed association between temperament and suicide attempts reflects correlates, causal factors or sequelae of suicide attempts is unknown.     

The association between interpersonal problems and treatment outcome in the eating disorders: A systematic review

Abstract

Objective: To review systematically the eating disorder literature in order to examine the association between pre-treatment interpersonal problems and treatment outcome in people diagnosed with an eating disorder. Methods: Six relevant databases were searched for studies in which interpersonal problems prior to treatment were examined in relation to treatment outcome in patients diagnosed with anorexia nervosa (AN), bulimia nervosa (BN) or eating disorders not otherwise specified (EDNOS). Results: Thirteen studies were identified (containing 764 AN, 707 BN and 48 EDNOS). The majority of studies indicated that interpersonal problems at the start of therapy were associated with a detrimental treatment outcome. Conclusions: Individuals with a binge/purge-type of eating disorder may be particularly vulnerable to interpersonal issues and these issues may lead to poorer treatment recovery by reducing the individual's ability to engage in the treatment process on a functional level. The clinical and research implications are discussed.     

Cognitive flexibility in anorexia nervosa and bulimia nervosa.

The aim of this study was to determine if there are differences in cognitive flexibility in anorexia nervosa and bulimia nervosa. Fifty-three patients with an eating disorder (34 with anorexia nervosa and 19 with bulimia nervosa) and 35 healthy controls participated in the study. A battery of neuropsychological tests for cognitive flexibility was used, including Trail Making B, the Brixton Test, Verbal Fluency, the Haptic Illusion Test, a cognitive shifting task (CatBat) and a picture set test. Using exploratory factor analysis, four factors were obtained: 1: Simple Alternation; 2: Mental Flexibility; 3: Perseveration; and 4: Perceptual Shift. Patients with anorexia nervosa had abnormal scores on Factors 1 and 4. Patients with bulimia nervosa showed a different pattern, with significant impairments in Factors 2 and 4. These findings suggest that differential neuropsychological disturbance in the domain of mental flexibility/rigidity may underlie the spectrum of eating disorders.     

Metabolic and endocrine indices of starvation in bulimia: a comparison with anorexia nervosa

Fifteen patients with bulimia (DSM-III) and 22 patients with anorexia nervosa (10 "restricters" and 12 "vomiters") were compared with 24 age- and sex-matched healthy controls. Serial blood samples were collected between 8:30 and 9:30 a.m. with patients in supine and standing positions. Elevated blood values of beta-hydroxybutyric acid and free fatty acids were observed in the majority of patients with bulimia and anorexia nervosa. These data indicate that many patients with bulimia showed the metabolic signs of starvation at the time of the study, a finding supported by the symptoms of endocrine adaptation to starvation, namely low triiodothyronine and a decreased noradrenaline response to an orthostatic test in many of these patients.