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PubMedDate not supplied

Appetizing loss: anorexia as an experiment in living.

This paper turns upside-down the commonly held assumption that anorexia nervosa is inherently destructive or counter-productive. The author delves beneath the façade of anorexia's main symptom, self-starvation, to explore what refusing to eat accomplishes, psychically, for the sufferer. Featured in this paper are the clinical reflections of contemporary child analyst Adam Phillips who argues that symptoms, such as those in anorexia, are "experiments in living." In his view, anorexia is a particular way of testing the environment for its capacity to withstand and satisfy one's desires. Working also with the notion that anorexia is an attempt at compensation for traumatic loss or affective rupture, attention is drawn to both the inter-personal and intra-personal contexts within which self-starvation is pursued. Importantly, this approach recognizes that responses by those around the anorexic individual affect the conditions within which possibilities for recovery are made.

Anorexia Nervosa↗
PubMed2001

Death from anorexia nervosa: age span and sex differences.

The purpose of this study was to assess characteristics of individuals who died from anorexia nervosa by assessing the frequency with which anorexia nervosa is listed as a causal factor related to the death of individuals in the USA. Data from over 10 million death records (all National Center for Health Statistic registered deaths in the USA for 1986-90) were examined for mention of anorexia nervosa as a primary or contributing cause of death. Only 724 were found, which equals an average of 145 annual deaths, and a rate of 6.73 per 100,000 deaths. The age and sex distribution suggests two fatal forms of anorexia nervosa, an early-onset form comprising 89% women and a later form comprising 24% men. The findings suggest that the mortality risk from current anorexia nervosa may be lower than formerly supposed and that it is not confined to young adults and adolescents.

Adolescent↗
PubMed2005

Serotonergic and dopaminergic systems in anorexia nervosa: a role for atypical antipsychotics?

OBJECTIVE: To review serotonergic and dopaminergic system function in anorexia nervosa in terms of potential modulation by atypical antipsychotic medications. METHOD: A systematic review of clinical, neurobiological and functional neuroimaging findings of serotonergic and dopaminergic system activity in anorexia nervosa was conducted via MEDLINE, PsycINFO and EMBASE psychiatry databases, with a critical review of dysregulation of these systems as therapeutic targets for atypical antipsychotics, in context of evidence regarding the utility and efficacy of these medications in this syndrome. RESULTS: There is evidence of persistently altered serotonergic and dopaminergic function in anorexia nervosa independent to weight-recovery. Case reports, open-label and single-blinded studies, albeit sparse, suggest that atypical antipsychotics may be beneficial in the management of anorexia nervosa psychopathology beyond weight gain. CONCLUSIONS: Double-blind placebo controlled studies of atypical antipsychotics in anorexia nervosa with well defined outcome measures are required.

Anorexia Nervosa↗
PubMed1984

Total body water and total body potassium in anorexia nervosa.

In the ill hospitalized patient with clinically relevant malnutrition, there is a measurable decrease in the ratio of the total body potassium to total body water (TBK/TBW) and a detectable increase in the ratio of total exchangeable sodium to total exchangeable potassium (Nae/Ke). To evaluate body composition analyses in anorexia nervosa patients with chronic uncomplicated semistarvation, TBK and TBW were measured by whole body K40 counting and deuterium oxide dilution in 10 females with stable anorexia nervosa and 10 age-matched female controls. The ratio of TBK/TBW was significantly (p less than 0.05) higher in anorexia nervosa patients than controls. The close inverse correlation found in published studies between TBK/TBW and Nae/Ke together with our results suggest that in anorexia nervosa, Nae/Ke may be low or normal. A decreased TBK/TBW is not a good indicator of malnutrition in the anorexia nervosa patient. The use of a decreased TBK/TBW ratio or an elevated Nae/Ke ratio as a definition of malnutrition may result in inappropriate nutritional management in the patient with severe nonstressed chronic semistarvation.

Adult↗
PubMed2001

Changes in regional fat redistribution and the effects of estrogen during spontaneous weight gain in women with anorexia nervosa.

BACKGROUND: Anorexia nervosa is a disease of severe acquired undernutrition with a high and increasing prevalence among young women in the United States. OBJECTIVE: The objective was to investigate the effects of spontaneous outpatient weight recovery and estrogen administration on fat distribution in patients with anorexia nervosa. DESIGN: Twenty-seven amenorrheic women aged 26.6 +/- 1.2 y with anorexia nervosa were identified through an outpatient study of bone loss and were randomly assigned to receive or not receive estrogen without any dietary intervention other than calcium and multivitamin supplements. Body composition was measured at baseline and at 6 and 9 mo and was compared with cross-sectional values obtained in 20 healthy, eumenorrheic, age-matched (25.4 +/- 0.5 y) control subjects. RESULTS: Twenty of the 27 patients with anorexia aged 27.0 +/- 1.3 y spontaneously gained weight (4.1 +/- 0.9 kg); body mass index (in kg/m(2)) increased from 16.1 +/- 0.3 to 17.5 +/- 0.4. Fat mass and lean mass accounted for 68% and 32% of the gain in total body mass, respectively. With spontaneous weight gain, there was a significant increase in the percentage of trunk fat from 32.4 +/- 1.3% at baseline to 36.5 +/- 1.0% at 9 mo (P = 0.03), which correlated with urinary free cortisol (r = 0.66, P = 0.003). Estrogen treatment was not protective against the gain in trunk fat with spontaneous weight gain. CONCLUSIONS: In women with anorexia nervosa, spontaneous weight gain is associated with a significant increase in trunk adiposity, and estrogen administration may not protect against the accumulation of central fat with weight gain.

Adipose Tissue↗
PubMed1993

Activity of the hypothalamic-pituitary-adrenal axis is elevated in rats with activity-based anorexia.

Activity-based anorexia is characterized by suppressed food intake and excessive physical activity. These behaviors are typical of persons with anorexia nervosa. Activity of the hypothalamic-pituitary-adrenal axis is known to be elevated in anorexia nervosa. We investigated the status of this axis in activity-based anorexia. Meal fed-control (MFC) and meal fed-wheel running (MFWR) rats were given access to food for 90 min daily; MFWR animals were allowed access to an activity wheel the remainder of the day. The experiment terminated when MFWR animals reached 75% of preexperimental body weight (males 3.9 +/- 0.3 d; females 4.2 +/- 0.2 d). Male and female MFWR rats consumed less food than MFC animals, while maintaining a high level of wheel running. Corticosterone concentrations were significantly elevated in MFWR animals. Corticotropin-releasing hormone mRNA concentrations in the paraventricular nucleus were not different. Relative adrenal gland weights were greater and thymus gland weights were lower in MFWR animals. Changes in food intake could not be explained by differences in insulin, glucose, beta-hydroxybutyrate or norepinephrine concentrations. Our results suggest increased activity of the hypothalamic-pituitary-adrenal axis in activity-based anorexia.

Animals↗
PubMed1995

Patients with anorexia nervosa demonstrate deficiencies of selected essential fatty acids, compensatory changes in nonessential fatty acids and decreased fluidity of plasma lipids.

The objective of this study was to assess the essential fatty acid status of patients with anorexia nervosa. Blood was collected from eight fasting female anorexia nervosa patients with a mean of 81% ideal body weight. Fatty acid composition of phospholipids, nonesterified fatty acids, triglycerides and cholesteryl esters of plasma were determined by capillary gas chromatography to indicate polyunsaturated fatty acids status compared with 19 healthy female adults < 25 y old. Subjects with anorexia nervosa showed polyunsaturated fatty acid deficiencies in plasma phospholipids different from simple nutritional essential fatty acid deficiency or chronic malnutrition. The phospholipid profile showed significantly lower (n-6) and (n-3) elongation and desaturation products, and elevated short-chain saturated, short-chain monounsaturated, branched-chain and odd-chain fatty acids. These elevations indicate enhancement of biosynthesis of alternative fatty acids that only partially compensated for the loss of polyunsaturated fatty acids in providing membrane "fluidity." Calculated mean melting point of the fatty acids of phospholipids in patients with anorexia nervosa was elevated 7.7 degrees C above normal values. These results demonstrate that patients with anorexia nervosa have deficiencies of selected essential fatty acids, compensatory changes in nonessential fatty acids and decreased fluidity of plasma lipids.

Adolescent↗
PubMed1995

Neuropeptide Y and the development of cancer anorexia.

OBJECTIVE: The authors determined whether radioligand binding of neuropeptide Y (NPY) to hypothalamus taken from nonanorectic and anorectic tumor-bearing rats was altered as compared with similar tissue taken from freely-feeding and food-restricted control rats. SUMMARY BACKGROUND DATA: Previous results indicate that tumor-bearing rats exhibit a refractory feeding response to NPY, the most potent feeding stimulus known. Additional studies indicate that the concentration of NPY in the hypothalamus of anorectic tumor-bearing rats is decreased as compared with freely-feeding or food-restricted control rats. METHODS: Because these observations of decreased response to exogenous peptide in the presence of decreased endogenous levels suggest an alteration in hypothalamic NPY receptors, this study investigated binding of 125I-NPY to hypothalamic membranes of tumor-bearing and control rats. RESULTS: Determinations of receptor affinity for NPY (half maximal concentration for displacement) indicated a 20-fold decrease in affinity with the development of anorexia, which changed to an 80-fold decrease during severe anorexia. Receptor density, as indicated by specific binding, exhibited only a 30% decrease, even during severe anorexia. CONCLUSIONS: These results suggest major alterations in NPY receptor mechanisms in experimental cancer anorexia, with receptor affinity being decreased progressively as the rats become more anorectic. The absence of a compensatory up-regulation in receptor density in the presence of decreased endogenous NPY concentrations indicate dysfunction in receptor regulatory mechanisms. This receptor aberration may be the central nervous system basis for the etiology of cancer anorexia.

Animals↗
PubMed1994

Anorexia nervosa outcome: six-year controlled longitudinal study of 51 cases including a population cohort.

OBJECTIVE: Controlled study of intermediate term outcome of representative cases with adolescent-onset anorexia nervosa. METHOD: A group of 51 cases with anorexia nervosa with a mean age of reported onset of 14.3 years (including a total population of cases from one birth cohort) were compared with a sex-, age-, and school-matched group of 51 comparison subjects on various measures of outcome at a mean age of 21.0 years (6.7 years after reported onset and 4.9 years after the original diagnostic study). There was no attrition. This paper reports on results obtained using the Morgan-Russell scales. RESULTS: Forty-seven percent of the anorexia nervosa cases reported that they were recovered. In the unrecovered group all aspects of outcome were worse in the anorexia nervosa than in the comparison group. Differences between the two groups were particularly pronounced with regard to aspects of social relationships. CONCLUSIONS: Outcome was fairly similar to that reported in recent clinic-based samples. Poor outcome was associated with the presence of empathy deficits (problems understanding about other people's perspectives and difficulties interacting reciprocally). There is a need to find ways of subgrouping anorexia nervosa cases at onset. The subgroup with empathy deficits warrants more intensive study in future research and clinical practice.

Adolescent↗
PubMed1995

Anorexia nervosa and bulimia nervosa in adolescence: effects of age and menstrual status on psychological variables.

OBJECTIVE: To compare, in adolescents and adults with anorexia nervosa and bulimia nervosa, eating disorder symptomatology and comorbid affective and anxiety states. METHOD: Two hundred fifty consecutive, female inpatients on an eating disorders unit were studied. They were given the Beck Depression Inventory; the Depression, Obsessive-Compulsive, Anxiety, and Phobic Anxiety scales from the Symptom Checklist 90; and the Eating Disorder Inventory. Patients were divided into categories based on age, diagnosis, and menstrual status. RESULTS: Onset of anorexia nervosa before age 14 and primary amenorrhea were associated with the greatest maturity fears during acute illness. For patients with restricting anorexia, adolescents aged 17 through 19 years had the highest drive for thinness compared to adolescents aged 13 through 16 years and adults. The lowest levels of depression and anxiety were seen in patients younger than age 14 with restricting anorexia. CONCLUSION: Overall, few psychological differences between adults and adolescents with eating disorders were found, with the exceptions of the youngest restricting anorectic patients at the time of treatment and both restricting and bulimic-anorectic patients who had a very early onset of their illness. Younger patients with acute anorexia nervosa may not require pharmacotherapy for anxiety and depression and may benefit from a focus on maturity fears in psychotherapy.

Adolescent↗
PubMed1998

Diagnosing infantile anorexia: the observation of mother-infant interactions.

OBJECTIVE: This study has three objectives: (1) to delineate the diagnostic criteria for infantile anorexia, including the onset of persistent food refusal during the infant's transition to spoon- and self-feeding, acute and/or chronic malnutrition, parental concern about the infant's poor food intake, and mother-infant conflict, talk, and distraction during feeding; (2) to determine the interrater agreement of child psychiatrists when diagnosing infantile anorexia based on these criteria; and (3) to describe the use of the Feeding Scale as a diagnostic tool. METHOD: One hundred two toddlers, ranging in age from 12 to 37 months, were assessed by two child psychiatrists and assigned the diagnosis of infantile anorexia, picky eater, or good eater. In addition, observers who were masked to the toddler's diagnosis rated mother-infant interactions with the Feeding Scale to permit objective evaluation of those interactions. RESULTS: Two child psychiatrists were able to assign toddlers to infantile anorexia, picky eating, and healthy, good eating groups with a high level of agreement. The objective scale for rating mother-infant interactions showed a high level of agreement between two masked raters and a good level of agreement between masked raters and the child psychiatrists' diagnostic assessment. CONCLUSIONS: Infantile anorexia can be diagnosed with high reliability by child psychiatrists. Evaluation of mother-infant interactions is a useful diagnostic tool.

Adult↗
PubMedDate not supplied

Cytokines and anorexia nervosa.

OBJECTIVE: Recent studies have indicated that the inflammatory cytokines could be implicated in anorexia nervosa and in its complications. To determinate the potential role of interleukins (IL-1, IL-2, IL-4, IL-6, IL-10), interferon (IFN gamma), tumor necrosis factor (TNF-alpha), and transforming growth factor (TGF-beta2) in anorexia nervosa, serum concentrations of these cytokines were measured in patients suffering from anorexia nervosa in comparison to healthy subjects. METHOD: Twenty-nine anorexic women according to DSM-IV criteria participated in the study. The control group consisted of 20 healthy women without eating disorders, mood disorders, and immunological disorders. RESULTS: We find that serum IL-2 and TGF-beta2 concentrations were both significantly decreased in anorexic patients, although the other cytokines did not differ significantly between the two groups. CONCLUSION: Our results show that in patients with anorexia nervosa, there are lower levels of specific cytokines (especially IL-2 and TGF-beta2). These levels may reflect the combination of impaired nutrition and weight loss, therefore, the dysregulation of these cytokines may contribute in anorexia's complications. Follow-up studies should examine the effects of parameters such as starvation, psychopathologic factors, and psychoneuroendocrinological perturbation which could affect interplay between cytokines, neuropeptides, and neurotransmitters.

Adolescent↗
PubMedDate not supplied

Cancer anorexia-cachexia syndrome: psychological effect on the patient and family.

The majority of patients with advanced cancer experience weight loss, reduced appetite, fatigue, and weakness. Chronic nausea and early satiety may also occur. This constellation of symptoms is known as the cancer anorexia-cachexia syndrome. Together with cancer pain, cancer anorexia-cachexia syndrome has been identified as 1 of the 2 most frequent and devastating problems affecting individuals with advanced malignancies. Research examining the issue of cancer anorexia-cachexia syndrome has been conducted; however, such work is largely biomedical in orientation. In contrast, the psychologic dimensions of the cancer anorexia-cachexia syndrome experience from the perspective of terminally ill patients and their family members is less well explored or described. The ability to provide psychosocial support to patients and families requires that caregivers appreciate the psychologic effect of cancer anorexia and cachexia on these individuals. This article examines that effect in light of existing knowledge and discusses the clinical implications arising from this work.

Anorexia↗
PubMed2004

Cancer anorexia-cachexia syndrome: cytokines and neuropeptides.

PURPOSE OF REVIEW: Cancer anorexia-cachexia syndrome is observed in 80% of patients in the advanced stages of cancer and is a strong independent risk factor for mortality. Numerous cytokines produced by tumor and immune cells, interacting with the neuropeptidergic system, mediate the cachectic effect of cancer. Since there is currently no effective pharmacological treatment and the anorexia-cachexia syndrome continues to be defined biochemically, we review the role of cytokines and neuropeptides in this process. RECENT FINDINGS: Currently data suggest that cancer anorexia-cachexia syndrome results from a multifactorial process involving many mediators, including hormones (e.g. leptin), neuropeptides (e.g. neuropeptide Y, melanocortin, melanin-concentrating hormone and orexin) and cytokines (e.g. interleukin 1, interleukin 6, tumor necrosis factor alpha and interferon gamma). It is likely that close interrelation among these mediators exists in the hypothalamus, decreasing food intake and leading to cachexia. SUMMARY: In the pathogenesis of cancer anorexia, cytokines play a pivotal role influencing the imbalance of orexigenic and anorexigenic circuits that regulate the homeostatic loop of body-weight regulation, leading to cachexia. Interfering pharmacologically with cytokine expression or neural transduction of cytokine signals can be an effective therapeutic strategy in anorectic patients before they develop cancer anorexia-cachexia syndrome.

Animals↗
PubMed2005

Forebrain patterns of c-Fos and FosB induction during cancer-associated anorexia-cachexia in rat.

Forebrain structures are necessary for the initiation of food intake and its coupling to energy expenditure. The cancer-related anorexia-cachexia syndrome is typified by a prolonged increase in metabolic rate resulting in body weight loss which, paradoxically, is accompanied by reduced food intake. The aim of the present work was to study the forebrain expression of Fos proteins as activation markers and thus to identify potential neurobiological mechanisms favouring catabolic processes or modulating food intake in rats suffering from cancer-related anorexia-cachexia. Neurons in forebrain structures showing most pronounced induction of Fos proteins were further identified neurochemically. To provoke anorexia-cachexia, cultured Morris hepatoma 7777 cells were injected subcutaneously in Buffalo rats. This resulted in a slowly growing tumour inducing approximately 7% body weight loss and a 20% reduction in food intake when the tumour represented 1-2% of body mass. Anorexia-cachexia in these animals was found to be accompanied by Fos induction in several hypothalamic nuclei including the paraventricular and ventromedial hypothalamus, in the parastrial nucleus, the amygdala, the bed nucleus of the stria terminalis, ventral striatal structures and the piriform and somatosensory cortices. Neurochemical identification revealed that the vast majority of FosB-positive neurons in the nucleus accumbens, ventral caudate-putamen and other ventral striatal structures contained prodynorphin or proenkephalin mRNA. These findings indicate that forebrain structures that are part of neuronal networks modulating catabolic pathways and food ingestion are activated during tumour-associated anorexia-cachexia and may contribute to the lack of compensatory eating in response to weight loss characterizing this syndrome.

Animals↗
PubMed1989

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.

Adolescent↗
PubMed1998

Cytokine-induced anorexia. Behavioral, cellular, and molecular mechanisms.

Cytokines induce anorexia. Recent issues concerning mechanistic aspects are: (1) Cytokines induce anorexia through different modes of behavioral action, that is, by affecting meal size, meal duration, and meal frequency differentially. Profiles also depend on the concentration or dosage. (2) The interface between the periphery and brain. Specific cytokines may be transported from the periphery to the brain. Cytokines generate mediators that can act on peripheral and/or brain target sites. Cerebrovasculature endothelium can also generate signals to modulate neural activities. Evidence indicates that the proposed vagal afferent signaling requires reassessment. Because of paracrine and autocrine actions, local cytokine production within the brain can induce anorexia. (3) Cytokines act directly on hypothalamic neurons proposed to participate in feeding. (4) Cytokine<-->cytokine and cytokine<-->peptide/neurotransmitter interactions are critical; for example, cytokines interact to induce anorexia synergistically, neuropeptide Y<-->cytokine interactions are antagonist, and cytokine<-->neurotransmitter and cytokine<-->leptin<-->neuropeptide Y<-->CRH-glucocorticoid and other endocrine interactions are important. A leptin receptor is related to gp 130, a signal transducer among interleukin (IL)-6 subfamily receptors; gp 130 and related molecules may be an interface for feeding control in health and disease. Various cytokines upregulate leptin and gp 130. An integrative approach combining computerized meal pattern analyses with cellular and molecular approaches is being used to characterize mechanisms (ligands, receptors, transducing molecules, and intracellular mediators) involved in cytokine-induced anorexia.

Animals↗
PubMed1982

Towards a functional analysis of anorexia nervosa and bulimia nervosa.

This paper is concerned with the description of an aetiological model of anorexia nervosa and one form of bulimia nervosa. The model has been generated within the conceptual framework of 'functional analysis' and is based on a combination of research evidence and clinical observation. The model attempts to explain the development of anorexia nervosa in terms of a set of hypothesized antecedent events/variables and its maintenance/exacerbation in terms of both positive and negative reinforcers. Specifically it is suggested that initial dieting behaviour is triggered by apparently innocuous psychosocial stimuli, in the context of major setting conditions which predispose the individual towards self- and bodily control: an that successful dieting is then powerfully reinforced by its consequences, which rapidly lead to a downward spiralling into full-blown anorexia nervosa. In this formulation anorexia nervosa is viewed as an attempted adaptive strategy (which has functional value to the individual), given the major setting conditions of the individual's current life situation. Similarly, bulimia nervosa following on from anorexia nervosa is viewed as an attempted adaptive strategy given prevailing environmental and biological pressures towards increasing food intake. The model is presented in the form of diagrammatic formulations and its theoretical and therapeutic implications discussed in relation to the relevant literature..

Adolescent↗