Altered structural and effective connectivity in anorexia and bulimia nervosa in circuits that regulate energy and reward homeostasis.

Anorexia and bulimia nervosa are severe eating disorders that share many behaviors. Structural and functional brain circuits could provide biological links that those disorders have in common. We recruited 77 young adult women, 26 healthy controls, 26 women with anorexia and 25 women with bulimia nervosa. Probabilistic tractography was used to map white matter connectivity strength across taste and food intake regulating brain circuits. An independent multisample greedy equivalence search algorithm tested effective connectivity between those regions during sucrose tasting. Anorexia and bulimia nervosa had greater structural connectivity in pathways between insula, orbitofrontal cortex and ventral striatum, but lower connectivity from orbitofrontal cortex and amygdala to the hypothalamus (P<0.05, corrected for comorbidity, medication and multiple comparisons). Functionally, in controls the hypothalamus drove ventral striatal activity, but in anorexia and bulimia nervosa effective connectivity was directed from anterior cingulate via ventral striatum to the hypothalamus. Across all groups, sweetness perception was predicted by connectivity strength in pathways connecting to the middle orbitofrontal cortex. This study provides evidence that white matter structural as well as effective connectivity within the energy-homeostasis and food reward-regulating circuitry is fundamentally different in anorexia and bulimia nervosa compared with that in controls. In eating disorders, anterior cingulate cognitive-emotional top down control could affect food reward and eating drive, override hypothalamic inputs to the ventral striatum and enable prolonged food restriction

Eating Disorders: Anorexia and Bulimia as Developmental Crises

Eating disorders are classified as developmental crises and typically develop during the adolescent years when youths face the identity versus role confusion psychosocial stage of development. Individuals struggling with anorexia nervosa or bulimia nervosa share characteristics similar to those found in a drug addiction. Social comparison theory may be used to explain the way individuals look to culture and media to examine whether their body images are acceptable. This body image comparison may result in an eating disorder, as can an environment where family dynamics are dysfunctional and therefore cannot cultivate healthy life stage development. Both anorexia nervosa and bulimia nervosa are best treated with an intervention process that involves the family

The Link Between Dissociation, Eating Disorders, and Self-Harm

Many researchers and psychological professionals believe that there is a link between eating disorders and self-harm, though this has been less widely researched than other correlations such as that between eating disorders and substance abuse. Various studies have also indicated a relationship between these two variables and dissociation independently; however, there does not seem to be a comprehensive study covering the correlations between all three variables. The researcher for this study aimed to test the correlation between eating disorders and self-harm and collect new information on the link between all three to further the available data on this topic. Data were also collected and analyzed in order to determine if certain eating disorders are more highly associated with self-harm and dissociation. A correlation was found between all three variables, and anorexia and bulimia were more closely associated with self-harm than binge eating or healthy eating. The data also indicated that those with anorexia and bulimia were more likely to have dissociative experiences than those without eating disorders. It is hoped that the correlation found between dissociative experiences and eating disorders and self-injury will serve as an impetus for future experimental research to determine if this link is causal or merely correlational

Screening for Bulimia Nervosa in the Primary Care Setting: Educating Healthcare Providers on the use of the Most Valid and Reliable Screening Tools

Abstract There are currently no routine screening guidelines for eating disorders in the primary care setting, despite their high mortality rate. Bulimia Nervosa (BN) is one of the hardest eating disorders to diagnose due to the lack of physical features and its secretive nature. Primary care providers need to have knowledge of the most valid and reliable screening tools in order to better diagnose and treat BN. In order to assess the most valid and reliable screening tools for BN, current literature was appraised with the focus on tools specifically designed for detection of BN. The results of the literature were translated into an educational tool and presented to healthcare team members at a pediatric primary care office in Burlington, Vermont. Pre and post-presentation questionnaires were distributed to attendees to gauge current knowledge around BN screening tools and gauge the efficacy of the presentation

In Response: A Discussion of Bulimia as a Masturbatory Equivalent

My research and that of my colleagues in the psychodynamic cause, structure and treatment of patients with bulimic anorexia nervosa correlates with and confirms the hypotheses presented by Levin ( 1) that bulimic symptoms may represent a masturbatory equivalent. In our recently published book, Fear of Being Fat: The Treatment of Anorexia Nervosa and Bulimia (2) we confirmed Sperling\u27s findings (3) that unresolved preoedipal fixations to the mother contribute to difficulties in psychosexual development and that anorexic girls and boys displace sexual and masturbatory conflicts from the genitals to the mouth

The Neurobiology of Eating Disorders.

Eating disorders are severe psychiatric illnesses with a typical age of onset in adolescence. Brain research in youth and young adults may help us identify specific neurobiology that contributes to onset and maintenance of those disorders. This article provides a state-of-the-art review of our current understanding of the neurobiology of anorexia nervosa and bulimia nervosa. This includes brain structure and function studies to understand food restriction, binge-eating or purging behaviors, cognitive and emotional factors, as well as interoception. Binge-eating disorder and avoidant restrictive food intake disorder are also discussed, but the literature is still very small

Fat Mass and Obesity-Associated Gene (FTO) in Eating Disorders: Evidence for Association of the rs9939609 Obesity Risk Allele with Bulimia nervosa and Anorexia nervosa

Objective: The common single nucleotide polymorphism (SNP) rs9939609 in the fat mass and obesity-associated gene (FTO) is associated with obesity. As genetic variants associated with weight regulation might also be implicated in the etiology of eating disorders, we evaluated whether SNP rs9939609 is associated with bulimia nervosa (BN) and anorexia nervosa (AN). Methods: Association of rs9939609 with BN and AN was assessed in 689 patients with AN, 477 patients with BN, 984 healthy non-population-based controls, and 3,951 population-based controls (KORA-S4). Based on the familial and premorbid occurrence of obesity in patients with BN, we hypothesized an association of the obesity risk A-allele with BN. Results: In accordance with our hypothesis, we observed evidence for association of the rs9939609 A-allele with BN when compared to the non-population-based controls (unadjusted odds ratio (OR) = 1.142, one-sided 95% confidence interval (CI) 1.001-infinity; one-sided p = 0.049) and a trend in the population-based controls (OR = 1.124, one-sided 95% CI 0.932-infinity; one-sided p = 0.056). Interestingly, compared to both control groups, we further detected a nominal association of the rs9939609 A-allele to AN (OR = 1.181, 95% CI 1.027-1.359, two-sided p = 0.020 or OR = 1.673, 95% CI 1.101-2.541, two-sided p = 0.015,). Conclusion: Our data suggest that the obesity-predisposing FTO allele might be relevant in both AN and BN. Copyright (C) 2012 S. Karger GmbH, Freibur

Disordered eating behaviour is associated with blunted cortisol and cardiovascular reactions to acute psychological stress

Research suggests a potential dysregulation of the stress response in individuals with bulimia nervosa. This study measured both cardiovascular and cortisol reactions to a standardised laboratory stress task in individuals identified as showing disordered eating behaviour to determine whether dysregulation of the stress response is characteristic of the two branches of the stress response system. Female students (N = 455) were screened using two validated eating disorder questionnaires. Twelve women with disordered eating, including self-induced vomiting, and 12 healthy controls were selected for laboratory stress testing. Salivary cortisol and cardiovascular activity, via Doppler imaging and semi-automatic blood pressure monitoring, were measured at resting baseline and during and after exposure to a 10-min mental arithmetic stress task. Compared to controls the disordered eating group showed blunted cortisol, cardiac output, heart rate, and stroke volume reactions to the acute stress, as well as an attenuated vasodilatory reaction. These effects could not be accounted for in terms of group differences in stress task performance, subjective task impact/engagement, age, BMI, neuroticism, cardiorespiratory fitness, or co-morbid exercise dependence. Our findings suggest that disordered eating is characterised by a dysregulation of the autonomic stress-response system. As such, they add further weight to the general contention that blunted stress reactivity is characteristic of a number of maladaptive behaviours and states