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PubMed1984

Adolescence, sexual conflict, and anorexia nervosa.

Anorexia nervosa is a life-threatening mental disorder. As many as one out of every 250 girls between the ages of 12 and 18 may develop anorexia nervosa. The high incidence of the disorder among adolescent girls suggests that developmental sexual pressure inherent in adolescence may be associated with the onset of the disease. The symptoms of anorexia nervosa appear with the onset of puberty and the development of the secondary sex characteristics. Symptom formation is related to the following developmental issues: physiological changes (menstruation and breast development) and psychological changes (body image and sexual identity).

Adolescent↗

PubMed1991

Cholecystokinin, vasoactive intestinal peptide and peptide histidine methionine responses to feeding in anorexia nervosa.

Anorexia nervosa (AN) is a syndrome of unknown cause characterized by voluntary starvation. Cholecystokinin has been implicated as a neuroendocrine regulatory factor in control of satiety. Relatively little information is known about gastrointestinal hormone responses to feeding in subjects with anorexia nervosa. In the present studies, we examine fasting and postprandial levels of cholecystokinin (CCK), vasoactive intestinal peptide (VIP) and peptide histidine methionine (PHM) in anorexia nervosa subjects and in control individuals. Results of these studies indicate that plasma CCK response to a liquid meal (Ensure Plus) in untreated AN subjects was distinctly different from that observed in healthy controls, both in terms of temporal pattern of peptide released and the amount of CCK secreted into the circulation. Peak levels of CCK release occurred at 30 min following meal ingestion in AN patients and at 60 min in control subjects. Integrated CCK release in untreated AN patients was approximately twice that measured in control individuals. Renutrition therapy was associated with reversion of the pattern of CCK release to that observed in control subjects. Plasma VIP levels were unchanged following meal ingestion in both control and anorexic subjects. In contrast, PHM levels in AN subjects were significantly greater than that observed in control individuals. The pattern of PHM release following liquid meal ingestion was similar to that observed with plasma CCK; namely, peak release of peptide was observed at 30 min which was significantly greater than corresponding control values (P less than 0.05). In conclusion, these results demonstrate distinctive differences in plasma CCK and PHM levels in response to feeding in AN subjects when compared to control individuals. These findings suggest that the earlier and greater rise in plasma CCK levels in AN subjects following meal ingestion may contribute to the abnormal sensation of satiety in this condition.

Anorexia Nervosa↗

PubMed1993

Dietary zinc intake of vegetarian and nonvegetarian patients with anorexia nervosa.

Anorexia nervosa (AN) and zinc deficiency, found most frequently in young females, have a number of symptoms in common. These include weight loss, alterations in taste and appetite, depression, and amenorrhea. Approximately half of anorexia nervosa patients (ANs) are vegetarian (VANs), a practice that may increase their risk for zinc deficiency. This study compared the dietary intake of zinc and related nutrients in 9 outpatient VANs with that of 11 outpatient nonvegetarian patients with anorexia nervosa (NVANs). VANs reported significantly lower (p < .05) dietary intakes of zinc, fat, and protein, and a significantly higher (p < .05) intake of calories from carbohydrates than NVANs. There were no significant differences between the groups in dietary intake of calories, calcium, copper, iron, or magnesium. These findings indicate that zinc intake should be routinely assessed in VANs and that zinc supplementation of their diets may be indicated.

Adolescent↗

PubMedDate not supplied

[Functional disturbances of the hypothalamus in patients with anorexia nervosa].

Anorexia nervosa is a complex disease characterized by abnormal feeding behaviour, food aversion and acute disturbances in perception of the body shape. Every eating disorder comes about as a consequence of disturbances in synaptic transmission in particular brain regions (hypothalamus, limbic system, cortical centres). The human and animal feeding physiology is precisely regulated by autonomic nuclei of hypothalamus. The perikarya of arcuate nucleus, lateral hypothalamic nuclei and other areas produce and release both the orexigenic (e.g. NPY) and anorexigenic (e.g. a-MSH) signalling substances. The novel hypothalamic and peripheral neurohormones: orexins and ghrelin as well as serotonin and dopamine seem to play a significant role in pathogenesis of eating disorders. In anorexia nervosa simultaneous excess of orexigenic and anorexigenic factors may evoke a "mixed signal" leading to failure of hypothalamic regulatory pathways. Experimental results also suggest that women with anorexia nervosa have disturbances of regional cerebral blood flow.

Anorexia Nervosa↗

PubMed1980

Evaluation of cardiac conduction in anorexia nervosa.

Anorexia nervosa is a disorder characterized by excessive dieting, a morbid fear of becoming obese, a distorted body image and amenorrhea in women. The condition is seen chiefly in girls and young women but also occurs in men. Death in anorexia nervosa may be sudden, and the mortality rate is the highest of any psychiatric disease. Despite investigations of its endocrine and psychiatric manifestations, little has been written about cardiac conduction in this entity. We report a patient with anorexia nervosa who presented with syncope due to a sinus bradycardia. His bundle electrograms were performed during the course of her hospitalization, and revealed that the abnormalities were reversible with food intake.

Adult↗

PubMedDate not supplied

Differential diagnosis and pathogenesis of anorexia nervosa.

Anorexia nervosa is a disease of increasing frequency with serious medical and psychological consequences. The presentation is one of significant weight loss. The initial assessment of such a patient must differentiate between an underlying systemic medical illness and an eating disorder. This paper will review the more common medical conditions causing weight loss and their distinguishing characteristics, including malignancy, inflammatory bowel disease, infections and metabolic disorders. Once an organic disease is ruled out, anorexia nervosa must then be differentiated from other eating disorders such as bulimia or other psychological diseases such as depression, schizophrenia, drug abuse, conduct disorders, and anxiety reactions. The pathogenesis of anorexia nervosa includes complex societal, family, and individual factors which require evaluation in the treatment process.

Adolescent↗

PubMed1994

Reversal of megaduodenum and duodenal dysmotility associated with improvement in nutritional status in primary anorexia nervosa.

Anorexia nervosa is considered one type of eating disorder that may result in severe malnutrition. Patients with this disorder commonly complain of postprandial nausea, abdominal pain, and distension. We describe the radiologic and motility abnormalities associated with anorexia nervosa in a 21-year-old female. Barium gastrointestinal series demonstrated marked dilation of the duodenum, with prolongation of intestinal transit. A 4-hr fasting gastroduodenal motility study showed no propagating migrating motor complexes (MMC). Prolonged, but nonpropagating, bursts of high-amplitude phasic and tonic contractions were seen in the duodenum. In contrast, antral contractions were of low amplitude and esophageal motor function was normal. Metoclopramide and edrophonium caused an increase in gastroduodenal motor activity, but increased contractions were not associated with symptoms. Following a renutrition program that raised the patient's weight from 64 to 80% of her ideal body weight, the radiographic abnormalities and gastrointestinal dysmotility resolved completely. These observations suggest that anorexia-associated gastrointestinal motor dysfunctions are a consequence, not the cause of the generalized protein-calorie malnutrition associated with anorexia nervosa. The facts that motility in different parts of the gut is affected to different degrees and that gastric and duodenal muscle responds normally to exogenous stimulation argue against a generalized myogenic dysfunction and, rather, point to a reversible dysfunction of neural regulation.

Adult↗

PubMed1999

Association between a marker in the UCP-2/UCP-3 gene cluster and genetic susceptibility to anorexia nervosa.

Anorexia nervosa (AN) is an enigmatic syndrome affecting approximately 0.1% of the at risk population in the UK which equates to approximately 70000 sufferers. Data from a number of studies have demonstrated the heritability of this disorder, however it is only in the last few years that studies have begun to determine the involvement of particular candidate genes in this genetic predisposition. In the current study we have used classical case-control association analysis to determine whether two highly polymorphic microsatellite markers, located within a 3-cM region of the UCP-2/UCP-3 locus, show involvement of this region of the human genome in the predisposition to AN. Analysis of a cohort of 170 female Caucasian anorexia nervosa sufferers and 150 normal female controls shows evidence of association with the marker D11S911 but not D11S916. Allele 13 of the marker D11S911 is significantly over represented in the anorexia nervosa population suggesting that a mutation in linkage disequilibrium with this locus may form part of the genetic component of AN. Further work is now required to try to reproduce these data in a second independent cohort and to further characterise this region of the human genome.

Adolescent↗

PubMed1992

'Culture' in culture-bound syndromes: the case of anorexia nervosa.

Anorexia nervosa is presently considered a Western culture-bound syndrome. A cultural focus on dieting and ideals of thinness for women are assumed to be implicated in the disorder. While research indicates that the majority of non-anorectic women in the United States are preoccupied with body weight and dieting, it is not clear what 'thinness' means to anorectics themselves or that norms about dieting are always involved in subjective experiences of anorexia. Meaning-centered studies of anorectics--especially those in non-clinical settings--are needed to clarify the cultural contexts of the disorder. Case studies of two anorectic women from Minneapolis-Saint Paul, Minnesota, show that for some anorectics self-starvation is encoded in religious idioms and symbols about the body, food, and self. A review of the literature illustrates a long-standing relation between self-starvation and religious ideals in Western culture and points to an association between contemporary anorexia nervosa and asceticism. The case studies presented here demonstrate that this asceticism may be subjectively expressed through religious concepts about the body and food and suggest that future research formally investigate the religious practices and beliefs of anorectics seen clinically. The author explores the implications of these findings for definitions of 'normality' and 'abnormality,' key issues in ethnopsychiatry. These findings also suggest that future cross-cultural research might examine asceticism about the body and food in religions other than Judeo-Christian, cultural groups with rituals of fasting and vomiting, and the presence of fundamentalist churches and missionaries in those non-Western cultures for which there are recent reports of eating disorders. Anorexia nervosa's designation as a syndrome limited to Western cultures or to those cultures influenced by them may reflect unexamined assumptions on the part of researchers that dieting and secular ideals of slimness are primarily involved in the disorder.

Adolescent↗

PubMed2006

[Anorexia nervosa].

Anorexia nervosa differs distinctly from other psychogenic eating disorders. Well known for the past 300 years, anorexia occurs consistently and is one of the most serious illnesses to be found for a certain age group. Three-quarters of the patients are healed or improve their condition long-term; one-quarter has a chronic course frequently including somatic complications and death. Because of the long healing process as well as the extensive chronification and complication rate, an individual treatment plan should be set up at the beginning of therapy to allow for a long-term structure of the course of therapy. Depending on the severity, phase and co-morbidity, inpatient and ambulant therapies are indicated. Depending on the duration of therapy, adequate weight (BMI > 15 kg/m2), good motivation, and lack of complications, an ambulant therapy is justified. Inpatient treatment is multimodal corresponding to the multifactorial etiology of anorexia nervosa. Weight gain is an important primary goal of therapy and a prerequisite for a conflict oriented, ambulant psychotherapy to be carried on after inpatient treatment. Ambivalent psychotherapy motivation and the necessity of symptom orientation demand technical modification both for inpatient as well as ambulant psychotherapy.

Anorexia↗

PubMed1993

Fluoxetine induces vasopressin and oxytocin abnormalities in food-restricted rats given voluntary exercise: relationship to anorexia nervosa.

Anorexia nervosa is associated with vasopressin, oxytocin and serotonin abnormalities. Because of the relationship between exercise and anorexia nervosa, we explored the weight-loss syndrome produced by wheel running in food-deprived rats. Its effects on regional vasopressin and oxytocin concentrations were determined under basal conditions and following systemic fluoxetine. Weight-matched, exercised and unexercised rats served as controls. Fluoxetine caused abnormalities in suprachiasmatic vasopressin and dynorphin A content and in thymus oxytocin content that did not occur in weight-matched or exercised controls. No syndrome-specific anomalies occurred in the hypothalamo-neurohypophysial system or dorsal vagal complex (DVC). However, weight reduction and fluoxetine increased circulating vasopressin; moderate exercise caused fluoxetine-induced elevations in posterior pituitary vasopressin and oxytocin; and, unlike the other groups, fluoxetine increased DVC oxytocin in freely fed unexercised rats. It was concluded that syndrome-specific vasopressin and oxytocin abnormalities occur that are not secondary to weight loss or moderate exercise; that weight loss or fluoxetine increases circulating vasopressin; that moderate exercise alters neurohypophysial vasopressin and oxytocin content; and that weight loss or exercise inhibits a fluoxetine-stimulated increase in DVC oxytocin. Finally, it was argued that the fluoxetine abnormalities indicate possible serotonin dysfunction in the syndrome.

Animals↗

PubMed2003

[Endocrine abnormalities in anorexia nervosa].

Anorexia nervosa is a syndrome with multifactorial etiology in which several genetic, biologic, psychological and social factors are involved. Patients affected by anorexia nervosa (AN) may develop multiple endocrine abnormalities, e.g. amenorrhea, hypothalamus-pituitary-adrenal axis hyperactivity, low T3 syndrome and peculiar changes of somatotroph axis function. These endocrine abnormalities are also found after prolonged starvation and may represent an adaptive response developed in order to save energy and proteins. It is still a matter of debate whether these endocrine changes are etiologic or secondary. In fact, several evidences suggest the existence in AN of hypothalamus functional alterations, which may be involved in the development and maintenance of the food intake disorder; on the other hand, the increased CRH secretion seems to be secondary to malnutrition as well as GH hypersecretion coupled to low IGF-I levels; the latter is a common finding in AN, as well as in other undernutrition and malabsorption conditions, type 1 diabetes mellitus, liver cirrhosis and catabolic states. Hypothalamic amenorrhea, which is one of the diagnostic criteria for AN, is not linked only to the reduction of body weight but reflects also deep alterations of gonadotropin secretory pattern. Low T3 syndrome is frequently found in AN; on the other hand, an iodide-induced hypothyroidism is quite uncommon. T3 reduction in AN seems to be an adaptive response to prolonged starvation; however the presence of a simultaneous central dysregulation cannot be excluded. Finally, AN patients frequently show defects in urinary concentration or dilution with inappropriate secretion of antidiuretic hormone, which may be due to intrinsic defects in the neurohypophysis or to abnormalities of its regulatory afferent neurons.

Animals↗

PubMed2005

Developing interpersonal relationships with adolescents with anorexia nervosa.

Anorexia nervosa is a complex eating disorder that usually develops during adolescence. This paper reports how paediatric nurses develop professional interpersonal relationships with adolescent patients with anorexia nervosa. The study used a grounded theory approach to data collection and analysis. Data were collected using in-depth interviews from ten registered nurses who worked on a paediatric ward. The findings revealed two foci of care: 'interacting with nurses', and 'interacting with patients', with interrelated categories and strategies. A core category highlighted the importance of instigating an individual focus when developing professional interpersonal relationships with patients with anorexia. Contextual factors emphasise the broader influences that modified the way nurses developed relationships with these patients. The findings have implications for clinical practice, education, unit administration, and further research, and these are examined. Nurses who use this approach are better positioned to gain understanding of individuals experiencing the disorder and to develop professional interpersonal relationships.

Adaptation, Psychological↗

PubMed1999

A psychodynamically informed, integrated psychotherapy for anorexia nervosa.

Anorexia nervosa is a multiply determined syndrome, thought to require integrated, multimodal treatment. In this article, we discuss the place of psychodynamically inspired psychotherapy techniques in the treatment of Anorexia Nervosa, and attempt to provide a practical heuristic for the application of such techniques with anorexic clients. Our recommendations for therapy emphasize confrontation of interpersonal patterns arising within the therapeutic dyad and linkage of these patterns to parallel adaptations that structure the client's generalized patterns of coping and eating symptoms. Case vignettes, drawn from different clinical contexts, are used to illustrate dynamic themes that frequently emerge in psychotherapeutic work with anorexic clients, and techniques that use interactions that occur in the therapeutic relationship to (i) expose implicit metaphors between interpersonal adaptations and eating symptoms, and (ii) balance against the intensity of anorexic preoccupations.

Adaptation, Psychological↗

PubMed1997

Medical complications of anorexia nervosa.

Anorexia nervosa is often characterized by progressive deterioration in many different organ systems. Most medical complications are the result of starvation and can be reversed with a well-planned refeeding program. While some of the complications of anorexia nervosa are predictable physiologic adaptations to the self-imposed starvation, many others are potentially life threatening. It is therefore incumbent upon all primary care physicians to become familiar with this disorder, because it is increasing in incidence and is commonly burdened by substantial chronicity and recidivism.

Adolescent↗

PubMed1999

Lower urinary tract symptoms and their impact on women with anorexia nervosa.

Anorexia nervosa is a condition which is associated with extremely low body weight and endocrine problems including persistent anovulation and a hypo-oestrogenic state. As the lower urinary tract is oestrogen sensitive, it is possible that women suffering from anorexia nervosa may experience similar distressing urinary problems. Of 29 anorexic women assessed, the majority had significant irritative urinary symptoms of which frequency, urgency and nocturia were the most common. These symptoms also had an unfavorable impact on their quality of life.

Adolescent↗

PubMed1994

Adolescent boys and anorexia nervosa.

Anorexia nervosa is an eating disorder that primarily affects adolescent girls and young adult females, and is considered to be rare among males. It is estimated that one in 200 adolescents between the ages of 12 and 18 years, the high risk group, develop anorexia nervosa with 90% of those affected being females. However, there has been a steady increase in the reported incidence of male anorectics, from approximately 5% (DSM III) in 1985, to as much as 10% in 1987 (NIMH, 1987). Since educators and counselors can serve a vital role in the early identification of this disorder, the young anorectic male has a better prognosis for recovery if they receive treatment during the early stages.

Adolescent↗

PubMed1990

Cutaneous abnormalities in anorexia nervosa.

Anorexia Nervosa (A.N.) is a relatively common eating disorder with well recognised psychological and physiological features. A study of 14 female patients with A.N. revealed a number of dermatological disorders, including lanugo hair, xeroderma and hyperpigmentation. Laboratory investigations revealed various abnormalities including elevated Beta-carotene levels, abnormal sex hormone and thyroid function. An unusual finding was the development of acne in a small subset of patients at the time of weight gain, during recovery from A.N. Anorexia Nervosa represents a useful model for the interaction between eating disorders, endocrine function and the skin.

Adolescent↗