Self-illness ambiguity and anorexia nervosa

Anorexia Nervosa

BackgroundLong-term consequences of comorbid autism spectrum disorder (ASD) in individuals with anorexia nervosa (AN) are inadequately investigated.MethodsIn the 1980s, 51 adolescent-onset AN cases (AN group) and 51 matched controls (COMP group) were recruited from the community. They have been examined on five occasions. The four last assessments included the Morgan-Russell Outcome Assessment Schedule (MROAS) to assess eating disorder outcomes (weight, dieting, menstruation), and related problems including psychiatric, psychosexual and socioeconomic state. In the present study, at age 44, when 30 years had elapsed, MROAS data were compared with previous results. At age 16, 21, 24 and 32 years, all individuals had been assessed regarding ASD. At the 30-year follow-up, the impact of the ASD on the MROAS data was analysed.ResultsIn the AN group, all core anorectic symptoms (weight, dieting, menstruation) were on a par with the COMP group at the 30-year follow-up, but the positive outcomes were limited to those who had never had an ASD diagnosis. Psychiatric state was significantly worse in the AN group, particularly in the subgroup who had an ASD diagnosis assigned. The AN group—again particularly those with ASD—had a more negative attitude to sexual matters than the COMP group. The AN group had worse outcomes than the COMP group for ‘personal contacts’, ‘social contacts,’ and ‘employment record’ at the 30-year follow-up and the outcomes were worse the more often an ASD diagnosis had been assigned.LimitationsRare data collection points throughout 30 years (only 5 assessments). ASD was assessed in the first four studies but was not assessed again at the 30-year follow-up.ConclusionsMental health, psychosexual, and socioeconomic status were compromised up to 30 years after AN onset. Coexisting ASD contributed to the poor outcome. Core anorectic symptoms had “normalised” three decades after AN onset.Plain English summarySome individuals with anorexia nervosa (AN) also suffer from autism. In this study we have investigated outcome of AN 30 years after the onset of AN and whether the presence of autism affects the outcome. Since the 1980s we have followed 51 individuals with teenage-onset AN and 51 healthy controls. They have been examined on five occasions, and an instrument that measures symptoms of AN (weight, dieting, body image), psychiatric symptoms, ability to work, and relationships with partner, family, and friends has been used to assess outcome. Autism was assessed in the first four studies. Symptoms of AN had normalised at 30-year follow-up, but only among those without autism. Psychiatric symptoms, ability to work, and relationships were issues that persisted after 30 years in the AN group, and those who had both autism and a history of AN had even more pronounced problems in these areas. The AN group had a more negative attitude to sexual matters than the control group, the outcome was worse the more often an autism diagnosis had been assigned.ConclusionsMental health, psychosexual, and socioeconomic status are affected up to 30 years after AN onset, particularly among those with autism.

Anorexia Nervosa (AN), Bulimia Nervosa (BN) and their variants are characterized by persistent alteration of eating behaviour, such as restricted intake or bingeing and purging, as well as excessive concerns about body shape and body weight. Purging behaviour may include self induced vomiting and/or abuse of laxatives, diuretics and physical hyperactivity. Unlike other psychiatric disorders, patients suffering from AN and BN have a high prevalence of many different medical complications, through the sequelae of undernutrition and purging, often with a serious impairment of health status and quality of life. This article describes the main diagnostic and clinical aspects of medical complications in AN and BN. The medical complications of ED are extremely variable and can occur with only modest biological and physical damage up to extremely serious and life-threatening conditions; the mortality rate of young subjects with AN is 4 - 11% with a risk of death about 12 times higher than that of subjects of the same age of the general population. The management of the medical-internship aspects of AN and BN is rightly placed within complex and articulated programs of interdisciplinary treatment with different levels of intensity of care (outpatient, semi-residential/residential, hospital in cases of emergency/medical and/or psychiatric emergency). the results of the investigations carried out, describe the functions of the various organs and apparatuses and the alterations detected, the possible complications and physiological adaptations to malnutrition.

The core features of eating disorders include preoccupations with food, weight and body shape causing distress, functional impairment, and, often, physical as well as mental illness. Eating disorders can, therefore, present in a range of settings and can be challenging to recognize and manage. The best-described eating disorders are anorexia nervosa and bulimia nervosa. More recently, binge-eating disorder has been described, as has an ‘other’ category where features are not specific to any other diagnosis. This chapter focuses on the prominent disorders, anorexia and bulimia nervosa, and presents the key features of eating disorders with a focus on anorexia nervosa and bulimia nervosa. This chapter provides knowledge about: • How to diagnose anorexia nervosa and bulimia nervosa. • Physical and psychological complications of eating disorders. • Specific features, course and treatment of these disorders. Practical tips include: • A table highlighting key physical and psychological complications in these disorders. • Indicators for urgent medical admission. • A table highlighting key differences between anorexia nervosa and bulimia nervosa.

Genome-wide association studies of common disorders reveal polygenic architectures. While these variants may converge into biologically relevant pathways, how polygenicity aggregates across pathways remains unknown. We studied polygenicity at the pathway level in anorexia nervosa (AN)—a psychiatric disorder with multi-systemic clinical manifestations. We constructed pathway-based polygenic risk scores (pathway PRS) to model genetic risk at the pathway level for 3,687 individuals with AN and 11,257 controls. We identified 497 AN-associated pathways after Bonferroni correction, including pathways involved in the brain, metabolism, immunity/stress, and reproduction/development. A strong positive correlation was observed between number of pathways ranking at top 10% and AN case proportion (r = 0.74, P = 7.98×10−21). The positive correlation between pathway count and AN risk was also observed when restricted to individuals with low overall genetic risk of AN. Pathways ranking at top 10% among cases were more diverse than those in controls. Higher AN risk was observed for pathway aggregation within function (e.g., brain or metabolism) and across functions (e.g., brain + metabolism). Individuals at top 10% risk of brain-brain and brain-metabolism pathway pairs had the highest average AN risk compared to other pathway pairs (e.g., brain-immune, metabolism-metabolism). Further, pathway PRS provided higher prediction power of AN than overall genome-wide PRS and contributed to the genetic liability of AN among AN cases with low overall genetic risk. Together, our results demonstrate that polygenicity exists at the pathway level, opening new avenues for disease prediction and identification of actionable targets.

Background: Anorexia nervosa is an eating disorder that is characterized by strict restrictions of food intake leading to abnormally low body weight and an intense fear of gaining weight. Anorexia nervosa is a highly distinctive serious mental disorder. Method: A descriptive (cross-sectional) study was carried out from 15th October 2023 to the end of May 2024. The study was conducted in secondary schools of females aged (11-20) years old in the centre of Tikrit city. The data was collected using a well-designed questionnaire. Result: The current was included (700) female students. The frequency of anorexia nervosa was 132(18.9). Anorexia nervosa was more frequent among the older adolescent (17-20 years) age group [77 (58.3%)]. Normal BMI range was the most common weight category among females with anorexia nervosa. A high percentage of patients with anorexia nervosa (13% and 27% respectively) were in the O+ and A+ blood groups. Anorexia nervosa presented more frequently among medium socioeconomic levels, 83 (62.9%). Conclusion: This study revealed that anorexia nervosa was more frequent among older adolescents and more common among individuals with normal BMI, the study demonstrated significant associations between certain psychosocial factors, such as stress, perfectionism, and anorexia nervosa. There is a relationship between socioeconomic status (SES) and Anorexia Nervosa.

Exome & precision medicine in eating disorders

Many believe that the current application of modern logistics solutions in general and centralisation of distribution systems in particular is damaging from an environmental perspective. The reason for this claim is that when a distribution system is centralised, products need to be shipped over greater distances. This causes an increase in transport work, which in turn is believed to cause an increase in emissions. Further, the decision to centralise distribution can be characterised as a structural decision and earlier research has helped illustrate how such decisions have greater impact on the overall performance of a distribution system than decisions taken at subsequent levels (tactical and operative). The reason for this is that structural decisions help create new opportunities to make other logistical decisions that are beneficial for the performance of a distribution system, as measured in terms of costs and service. It is also acknowledged that there is a lack of research illustrating the actual environmental effects of centralisation. This area is the theme of this thesis and the overall purpose is to describe and analyse how centralisation of a distribution system can affect the environment. This purpose has been divided into two research questions, where the first one reads: - How does physical centralisation of a distribution system influence the environment? This question aims at investigating what effect centralisation has on the amount of emissions that are caused by transport in a distribution system. One of the main advantages with a centralised distribution system is that emergency deliveries are expected to decrease. This type of transport is often performed by airfreight, which is a mode of transport that is regarded to cause the largest amount of environmental stress among the four most commonly used transport modes. The argument that is made is that even though centralisation causes an increase in transport work, this must not necessarily mean that emissions increase. As indicated above, earlier studies on structural changes in distribution systems have shown that this type of decision creates new opportunities to make other decisions that are beneficial for the performance of a distribution system, albeit in terms of costs and service. The aim of the second research question is consequently to study this issue, but from an environmental perspective. This question therefore reads: - How do structural decisions in logistics create new opportunities to improve on the environmental performance of a distribution system? The results of the study show that it is not sufficient to only consider transport work and emergency deliveries when the environmental effect of a centralisation is to be evaluated. It has also been concluded that centralisation creates an opportunity to make improvements within the distribution system that can prove beneficial from an environmental perspective. In summary, three characteristics besides transport work and emergency deliveries were identified as being of importance when considering the environmental effects of a centralisation. These included centralised flow, modal change, and bargaining power. This model (see full pdf) does not aim to include all characteristics that can be relevant in an environmental evaluation of a centralisation, but rather those that have been found significant in this study. However, the model helps illustrate that there are many aspects that need to be considered in such an evaluation and that depending on the characteristics of the distribution system at hand the results can vary quite extensively.

Personnalité, tempérament et anorexie mentale

The first important descriptions of anorexia nervosa came in the late 19th century by William Gull and Charles Lasegue, although case histories for people with probable anorexia nervosa had been reported long before. However, it was through authors such as Hilde Bruch, Arthur Crisp and Gerald Russell, that we have the modern concept of the disorder. The binge-purge subtype for anorexia nervosa was subsequently described and became a common presentation for the disorder. Bulimia nervosa was then described and named in 1979 by Gerald Russell and was incorporated into the ICD-10 Classification of Mental and Behavioural Disorders (ICD-10)1 and the Diagnostic and Statistical Manual of Mental Disorders, third revised and fourth edition (DSM-III-R and IV). Multiimpulsive eating disorders and disorders classified under ‘eating disorders not otherwise specified’ (EDNOS) in DSM-IV, including disorders such as ‘binge-eating disorder’, ‘purging disorder’ and ‘partial syndrome anorexia or bulimia nervosa’ are being increasingly described.KeywordsAnorexia NervosaEating DisorderBulimia NervosaSuperior Mesenteric Artery SyndromeWeight RestorationThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

The aim of this study was to assess prospectively the long-term outcome in a representative sample of teenage-onset anorexia nervosa (AN) in respect of psychiatric disorders and overall outcome. Fifty-one AN cases, recruited by community screening, with a mean age of onset of 14 years, was contrasted with 51 matched comparison cases at a mean age of 24 years (10 years after AN onset). All 102 cases had been examined at ages 16 and 21 years. At 24 years all probands were interviewed regarding psychiatric disorders (SCID-I) and overall outcome (Morgan-Russell assessment schedule, the GAF). There were no deaths at 10-year follow-up. One in four in the AN group had a persisting eating disorder (ED), including three who still had anorexia nervosa. Lifetime diagnoses of affective disorders and obsessive-compulsive disorder were over-represented in the AN group. Outcome according to Morgan-Russell was poor in 27%, intermediate in 29%, and good in 43%. According to the GAF, half the AN group had a poor psychosocial functioning. These were subjects with either a persisting ED or lifelong problems with social interaction or obsessive-compulsive behaviour. Ten-year outcome of teenage-onset AN is favourable in the majority of cases; most individuals have recovered from their ED and have no other axis I disorder. However, half the AN group reported poor psychosocial outcome, in most cases explained by a persisting ED or chronic obsessive-compulsive behaviour/social interaction problems.

Based on the presence of early satiety in anorexia nervosa (AN), which may delay recovery, and given the dramatic impact of GLP-1 and GIP analog treatment on satiety and weight reduction in obesity by diminishing the sensation of hunger, we initiated this cross-sectional pilot study to explore fasting incretin levels in AN and to identify possible correlations between these hormones and psychiatric symptoms. 17 female subjects aged 18-35 were enrolled; 10 previously diagnosed with AN (5 weight restored, 5 non-weight restored) and 7 healthy controls (HC). Fasting blood samples were analyzed for incretin levels using ELISA. Psychiatric symptoms were evaluated using self-assessment scales for eating disorders (EDI-3, EDE-Q), anxiety (STAI-S + T), depression (MADRS-S), and obsessive-compulsive disorder (OCI-R). Subjects with AN scored overall higher on psychiatric scales, indicating poorer psychological well-being than HC. In non-weight restored AN (non-WRAN) subjects both serum GLP-1 levels (29 (15-85) vs 16 (15-21) pg/mL; p = 0.048) as well as serum GIP levels (37 (14-163) vs 5 (2-58) pmol/L; p = 0.048) were elevated compared to HC. No differences were found in glucagon or PYY levels between groups. A strong correlation between serum GLP-1 levels and EDI-perfectionism independent of BMI (r = 0.768, p = 0.001) was found in the entire group. Independent of BMI, GLP-1 levels were associated with perfectionism, a typical characteristic of AN. Fasting GLP-1 levels were elevated in subjects with non-WRAN. Elevated GLP-1 levels may perpetuate AN symptoms, emphasizing the need for further research into their role in the metabolic and psychiatric dimensions of AN. Level III: Evidence obtained from well-designed case-control analytic studies.

Anorexia Nervosa (AN) is a psychiatric eating disorder that causes serious health consequences due to nutrient deprivation. Because of this, it has been associated with changes to brain morphology. Rat models can be useful to understand the physiological consequences of AN during both the disease and after weight recovery. PURPOSE: Use MRI analysis to determine the effect of simulated AN on brain matter volume during low weight status and following weight recovery. HYPOTHESIS: If food intake is restricted to simulate AN, brain matter volume will decrease and not fully recover following weight gain. METHODS: Female Sprague Dawley rats, 8 weeks of age, underwent simulated AN for 30 days with 50-60% food restriction. One cohort with simulated AN was euthanized, and their brains were imaged immediately after (AN, n=8). Another cohort was allowed ad libitum food consumption for an additional 30 days following AN, to allow for weight recovery (AN-R, n=6). AN and AN-R rats were compared to age matched control rats (CON and CON-R respectively, n=6-8/group). After the images were processed, ImageJ was used to quantify total brain volume and gray matter volume. The data were compared by a T-test with the significance denoted at p<0.05. RESULTS: The AN rats had lower total brain volume compared to the CON rats (79354 + 873 v. 84674 + 942 mm3, p=0.002). Gray matter volume was also lower in AN rats compared to the CON (68088 + 591 v. 74201 + 700 mm3, p<0.001). The total brain volume and gray matter volume was lower in AN-R compared to CON-R but did not reach statistical significance (81158 +1867 v. 86065 + 2017 mm3, p=0.10) and (70894 + 1675 v. 74184 + 1810 mm3, p=0.21). CONCLUSION: Brain volume and corresponding gray matter volume were altered following simulated AN, suggesting our rat model sufficiently recapitulates the brain matter alterations associated with AN. It is possible these alterations do not resolve with weight restoration; however larger sample sizes may be needed to support this hypothesis. This study was supported by NIH grant K12HD051959 and the Beth Israel Translational Spark Hubs Grant. This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

The aetiology of anorexia nervosa (AN) is considered to be multifactorial. This study aims to identify potential risk factors for AN and whether these factors are specific to AN or precede the development of psychiatric disorders in general and to identify specific life events in the 12 months immediately preceding the onset of eating disorder (ED) symptoms. A case-control design was used to compare a group of women who meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for AN (N = 86) with healthy controls (N = 86) and with a group of controls with other psychiatric disorders (N = 68), each group matched to the AN patients by age and parental socioeconomic status bands. Risk factors were assessed by interviewing each person with the Oxford Risk Factor Interview. Women with AN reported significantly higher rates of perfectionism, negative attitudes toward parents' shape and weight, significant concern about feeling fat and a family history of AN or bulimia nervosa. Critical comments about weight, shape or eating was the most notable event in the year preceding AN onset. Perfectionism and a family history of ED emerged as the most convergent findings in the development of AN, along with being critical toward parents' shape and weight, and feeling fat. Critical comments about appearance and eating seem to be an important precipitating factor in AN onset.

25. Global Salivary Microbiome Activity In Female Adolescents With Anorexia Nervosa