Biomedical subjects
J Treasure
Publications and source records attributed to J Treasure.
Sexual abuse, disordered personality and eating disorders.
Standardised personality assessments were administered to 50 consecutive referrals to an Eating Disorders Clinic. A history of childhood sexual abuse was identified in 30% of patients using a modified version of the SLEI. This rate is comparable with those from other studies. Overall, 52% of the patients were rated as having a personality disorder but a significantly higher proportion of women with a personality disorder had a history of childhood sexual abuse compared with those without a personality disorder (13/26 v. 2/24, Fisher P less than 0.001). Although in patients with eating disorders no clear causal link between CSA and personality disorder was demonstrated, our findings emphasise the need to inquire sensitively into the sexual history of such patients.
Comments on some theoretical considerations: dietary restraint to binge eating.
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Bulimia nervosa and anorexia nervosa.
Anorexia and bulimia nervosa are aetiologically distinct diseases with different treatments. Though it was described more recently, bulimia nervosa occurs more commonly. Accurate diagnosis and early treatment should reduce the mortality of both conditions.
Children of mothers with bulimia nervosa.
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The effect of anorexia nervosa on skin thickness, skin collagen and bone density.
The effects of anorexia nervosa on skin thickness, skin collagen content and bone density were investigated in a cross-sectional study of 36 women with anorexia nervosa with a 4-year median duration of amenorrhoea and compared with a group of 33 women of comparable age without anorexia and with normal periods. The median skin thickness, assessed radiologically, was significantly reduced (P less than 0.01) from 0.88 mm in the comparison group to 0.70 mm in the anorectic group and the median collagen content was significantly reduced from 209 micrograms/mm2 in the comparison group to 164 micrograms/mm2 in the anorectic group (P less than 0.05). The median bone density in the comparison group was 0.93 gHA/cm2 at the lumbar spine and 0.84 gHA/cm2 at the proximal femur. These values were greatly reduced in the women with anorexia nervosa to 0.77 gHA/cm2 and 0.65 gHA/cm2 respectively (P less than 0.01). Our findings confirm the loss of bone mass with anorexia and demonstrate the coexistent loss of skin thickness and skin collagen content. This association supports the hypothesis that a generalized loss of collagen is a major factor in the causation of osteoporosis following oestrogen deficiency.
Bulimia nervosa and Crohn's disease: two case reports.
Two patients are described for whom Crohn's disease and its treatment were significant factors in the development and course of bulimia nervosa.
The modern history of anorexia nervosa. An interpretation of why the illness has changed.
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Crohn's disease presenting as anorexia nervosa.
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Anorexia nervosa: evidence for a genetic basis.
This paper reports the preliminary results of a combined twin and family study of anorexia nervosa. Fifty-six per cent of the 25 female monozygotic (MZ) twin pairs and 5% of the 20 female dizygotic (DZ) twin pairs were concordant for anorexia nervosa. Nearly 5% of other female first degree relatives also had a history of anorexia nervosa. Analysis of data from the Eating Disorders Questionnaire (EDI) given to the twins and data as to weight loss, length of amenorrhoea and other characteristics of anorexia nervosa, together with the twin and family data, supports the hypothesis that genetic factors are very significant in the aetiology of anorexia nervosa. Analysis of this data using established techniques of psychiatric genetics suggested that up to 80% of the variance in liability to anorexia nervosa may be accounted for by genetic factors. The problems of this type of analysis are discussed as is the background to the genetics of weight and appetite control. A genetic/environmental model accounting for the features of anorexia nervosa is proposed.
A study of sulphatoxymelatonin excretion and gonadotrophin status during weight gain in anorexia nervosa.
To clarify a controversy as to whether melatonin secretion is related to body weight, urinary sulphatoxymelatonin (aMT6s) excretion was estimated in 10 patients with anorexia nervosa before and after weight gain, and compared with 10 age-matched controls. There was no change in aMT6s excretion after weight gain, and no significant difference between the patients and control groups at either point. Significant increases in plasma LH, FSH, and estradiol were detected after weight gain in anorexic patients, independent of aMT6s excretion.
Anorexia nervosa in childhood.
Anorexia nervosa in childhood can be difficult to diagnose and without adequate treatment can lead to a severe developmental disturbance. These problems and the aetiology and treatment are discussed in this article.
Depression and outcome in acute myocardial infarction.
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The biochemical and hormonal sequelae of the eating disorders.
In this article the current nomenclature of the eating disorders is discussed, as this is an area of great confusion. The basic metabolic disturbances in anorexia nervosa and bulimia nervosa are then outlined.
Eating disorders: a review of recent research.
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Osteopaenia of the lumbar spine and femoral neck in anorexia nervosa.
The bone density in the spine, femoral neck and radius in 31 outpatients with anorexia nervosa (AN) was measured by photon absorptiometry and compared with 31 age matched controls. In all bone sites measured the patients with anorexia nervosa had reduced bone mineral density (spine- control 0.91 + .10 gHA/cm2, AN 0.75 + .09 gHA/cm2; femur- control 0.87 + .09 gHA/cm2, AN 0.67 + .07 gHA/cm2; radius-control 0.41 + .04 gHA/cm2, AN 0.38 + 0.9 gHA/cm2). The mean difference between the groups was greatest in the femoral neck at 0.21 gHA/cm2 (95% CI 0.18-.024 p less than 0.001) and least at the radius 0.04 gHA/cm2 (95% CI 0.02-0.06, p less than 0.05), the lumbar spine was intermediate with a mean difference of 0.16 gHA/cm2 (95% CI 0.12-0.2 p less than 0.001). Femoral and spinal bone mineral density was positively correlated with body mass and negatively correlated with duration of amenorrhoea. Three of these patients had vertebral crush fractures which suggests that this diminution in bone density is of clinical significance.
Anorexia nervosa and the adrenal: the effect of weight gain.
Cortisol (F) and dehydroepiandrosterone (DHA) were measured following each 5 kg gain in weight in a group of 16 patients with anorexia nervosa admitted to hospital for refeeding. The mean percentage of standard weight on admission was 65% and that on discharge was 92%. Basal plasma cortisol fell gradually throughout the inpatient period, the correlation coefficient of the regression line relating percentage of standard weight to plasma cortisol in all patients was -0.559 (p less than 0.001). Adrenal androgen production, however, increased with weight gain and the correlation coefficient of the regression line of androgen production against percentage of standard weight was +0.303 (p less than 0.01). The DHA/F ratio increased with weight gain. This suggests that weight gain in the patient with anorexia nervosa could be associated with increased activity in the adrenal 17,20-lyase enzymes and a decrease in the activity of the 3-beta hydroxysteroid dehydrogenase. The possibility that these adrenal enzyme changes are controlled by pituitary proopiocortin peptides [the putative cortical androgen stimulating hormone (CASH)] is discussed as is the relationship between normal adrenarche and the weight related changes in adrenal function in anorexia nervosa.
A controlled study of alexithymia in eating disorders.
The aims of the study were (1) to establish whether alexithymia is present in patients with bulimia nervosa (BN), (2) to compare bulimic patients with restricting anorexics (AN/R), bulimic anorexics (AN/BN), and normal controls with regard to alexithymia, (3) to determine whether in BN patients alexithymia is a state or a trait, and (4) to see whether alexithymia predicts short-term treatment outcome in BN. Study 1 included 173 eating disorder patients (BN: n = 93, AN/R: n = 55, AN/BN: n = 25) who were compared with 95 controls on the Toronto Alexithymia Scale (TAS). Study 2 included 41 BN patients who were assessed prospectively with the TAS before and after a 10-week drug treatment. AN/R patients in study 1 had significantly higher alexithymia scores than BN patients. All three eating disorder groups had significantly higher alexithymia scores than controls. For BN patients in study 2, TAS scores before and after drug treatment were stable, despite significant symptomatic improvement. We conclude the following: (1) eating disorder patients are considerably more alexithymic than normal controls; and (2) in BN, alexithymia may be a trait, unaffected by clinical improvement unless psychological treatment, encouraging the expression of emotions is offered.