Habit learning and anorexia nervosa: a cognitive neuroscience hypothesis

OBJECTIVE: Anorexia nervosa (AN) is characterized by abnormal behaviors involving eating and weight that are impressively resistant to change. The persistence of these behaviors likely plays an important role in the high relapse rate after initial treatment. Persistent, stereotyped behaviors are also characteristic of obsessive-compulsive disorder (OCD). This article presents a neurocognitive model of AN, based on comparisons with OCD. METHOD: This article reviews clinical, neuropsychological, and neuroimaging findings in both OCD and AN relevant to a neurobiological understanding of a potential mechanism of the perpetuation of AN. RESULTS: The identification of specific neurocognitive disturbances in individuals with OCD has led to a compelling hypothesis of the neural mechanisms mediating this disorder. Evidence suggests that similar disturbances, involving neural circuits between the cortex and the basal ganglia, may be present in individuals with AN. CONCLUSION: Research on such neurocognitive disturbances has the potential both to inform understanding of neural mechanisms underlying AN and to lead to advances in treatment.     

Denial and minimization in adolescents with anorexia nervosa

OBJECTIVES: This study examines symptoms of denial in 86 adolescents with anorexia nervosa (AN) using a dataset from a family therapy trial. METHOD: Using the Restraint subscale of the Eating Disorders Examination (EDE) at baseline, participants were divided into deniers (n = 15), minimizers (n = 21), and admitters (n = 50). These subgroups were compared with analysis of variance (ANOVA; Tukey post-hoc analysis) on a variety of assessment and treatment variables at baseline and at 12 months. RESULTS: Although body mass index (BMI) was not significantly different, all subscale scores of the EDE were lower in the deniers compared with the admitters (p = .0001 for all subscales) at baseline. Minimizers also scored lower than admitters on 3 of 4 subscales (p = .0001 for the Restraint, Weight Concern, and Shape Concern subscales of the EDE). At baseline and at 12 months, there were no significant differences on the Youth Self-Report or the Child Behavior Checklist. At 12 months, the only significant difference was in the Restraint subscale, with deniers still scoring lower than admitters (p = .015). CONCLUSION: Denial and minimization appear to be common processes occurring in adolescents with AN and present difficulties in assessment.     

Salinophagia in anorexia nervosa: Case reports

We report two cases of pathological ingestion of salt as a feature of anorexia nervosa, which we have previously termed “salinophagia.” Both cases were young women with anorexia nervosa of the purging subtype and of sufficient severity to necessitate inpatient treatment. In both instances, excessive quantities of salt were ingested in the context of treatment programs requiring nutritional rehabilitation, and motivated by a wish to despoil the food and render it distasteful, to rob its ingestion of any hedonic qualities. In one instance, this behavior pattern was imitated by other patients on the unit. Having first briefly described salinophagia in 1999, the first author has received considerable correspondence from other specialists suggesting that this is not an isolated phenomenon. The issues of phenomenology and treatment are further discussed. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord, 2010     

Micrographia and hypophonia in anorexia nervosa

Micrographia is a condition, in which the sufferers write with small handwriting. Hypophonia is described as low volume speech. Both conditions have been described in neurological conditions, such as lesions in the deep white matter of the brain, Parkinson's disease etc., In this case report, we are presenting a 22‐years‐old female patient with anorexia nervosa who suffered from both these conditions. The patient also suffered from epilepsy. The onset of these symptoms, progress, and current status provides scope for discussing both the possible biological and psychodynamic etiology for these symptoms in this young woman. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010; 43:762–765     

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.