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result(s) for
"Anorexia nervosa"
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Treating severe and enduring anorexia nervosa: a randomized controlled trial
There are no evidence-based treatments for severe and enduring anorexia nervosa (SE-AN). This study evaluated the relative efficacy of cognitive behavioral therapy (CBT-AN) and specialist supportive clinical management (SSCM) for adults with SE-AN.
Sixty-three participants with a diagnosis of AN, who had at least a 7-year illness history, were treated in a multi-site randomized controlled trial (RCT). During 30 out-patient visits spread over 8 months, they received either CBT-AN or SSCM, both modified for SE-AN. Participants were assessed at baseline, end of treatment (EOT), and at 6- and 12-month post-treatment follow-ups. The main outcome measures were quality of life, mood disorder symptoms and social adjustment. Weight, eating disorder (ED) psychopathology, motivation for change and health-care burden were secondary outcomes.
Thirty-one participants were randomized to CBT-AN and 32 to SSCM with a retention rate of 85% achieved at the end of the study. At EOT and follow-up, both groups showed significant improvement. There were no differences between treatment groups at EOT. At the 6-month follow-up, CBT-AN participants had higher scores on the Weissman Social Adjustment Scale (WSAS; p = 0.038) and at 12 months they had lower Eating Disorder Examination (EDE) global scores (p = 0.004) and higher readiness for recovery (p = 0.013) compared to SSCM.
Patients with SE-AN can make meaningful improvements with both therapies. Both treatments were acceptable and high retention rates at follow-up were achieved. Between-group differences at follow-up were consistent with the nature of the treatments given.
Journal Article
A genome-wide association study of anorexia nervosa
Anorexia nervosa (AN) is a complex and heritable eating disorder characterized by dangerously low body weight. Neither candidate gene studies nor an initial genome-wide association study (GWAS) have yielded significant and replicated results. We performed a GWAS in 2907 cases with AN from 14 countries (15 sites) and 14 860 ancestrally matched controls as part of the Genetic Consortium for AN (GCAN) and the Wellcome Trust Case Control Consortium 3 (WTCCC3). Individual association analyses were conducted in each stratum and meta-analyzed across all 15 discovery data sets. Seventy-six (72 independent) single nucleotide polymorphisms were taken forward for
in silico
(two data sets) or
de novo
(13 data sets) replication genotyping in 2677 independent AN cases and 8629 European ancestry controls along with 458 AN cases and 421 controls from Japan. The final global meta-analysis across discovery and replication data sets comprised 5551 AN cases and 21 080 controls. AN subtype analyses (1606 AN restricting; 1445 AN binge–purge) were performed. No findings reached genome-wide significance. Two intronic variants were suggestively associated: rs9839776 (
P
=3.01 × 10
−7
) in
SOX2OT
and rs17030795 (
P
=5.84 × 10
−6
) in
PPP3CA
. Two additional signals were specific to Europeans: rs1523921 (
P
=5.76 × 10
−
6
) between
CUL3
and
FAM124B
and rs1886797 (
P
=8.05 × 10
−
6
) near
SPATA13
. Comparing discovery with replication results, 76% of the effects were in the same direction, an observation highly unlikely to be due to chance (
P
=4 × 10
−6
), strongly suggesting that true findings exist but our sample, the largest yet reported, was underpowered for their detection. The accrual of large genotyped AN case-control samples should be an immediate priority for the field.
Journal Article
Dedication to Hunger
Writing as a competitive athlete, an academic, and a woman, Leslie Heywood merges personal history and scholarship to expose the \"anorexic logic\" that underlies Western high culture. She maneuvers deftly across the terrain of modern literature, illustrating how this logic-the privileging of mind over body, of hard over soft, of masculine over feminine-is at the heart of the modernist style. Her argument ranges from Plato to women's bodybuilding, from Franz Kafka to Nike ads. In penetrating examinations of Kafka, Pound, Eliot, William Carlos Williams, and Conrad, Heywood demonstrates how the anorexic aesthetic is embodied in high modernism. In a compelling chapter on Jean Rhys, Heywood portrays an author who struggles to develop a clean, spare, \"anorexic\" style in the midst of a shatteringly messy emotional life. As Heywood points out, students are trained in the aesthetic of high modernism, and academics are pressured into its straitjacket. The resulting complications are reflected in structures as diverse as gender identity formation, sexual harassment, and eating disorders. Direct, engaging, and intensely informed by the author's personal involvement with her subject, Dedication to Hunger offers a powerful challenge to cultural assumptions about language, gender, subjectivity, and identity. This title is part of UC Press's Voices Revived program, which commemorates University of California Press's mission to seek out and cultivate the brightest minds and give them voice, reach, and impact. Drawing on a backlist dating to 1893, Voices Revived makes high-quality, peer-reviewed scholarship accessible once again using print-on-demand technology. This title was originally published in 1996.
eBook
The Impact of Oxytocin on Food Intake and Emotion Recognition in Patients with Eating Disorders: A Double Blind Single Dose Within-Subject Cross-Over Design
Social difficulties and problems related to eating behaviour are common features of both anorexia nervosa (AN) and bulimia nervosa (BN). The aim of this study was to examine the impact of intranasal oxytocin on consummatory behaviour and emotional recognition in patients with AN and BN in comparison to healthy controls.
A total of 102 women, including 35 patients with anorexia nervosa (AN), 34 patients with bulimia nervosa (BN), and 33 healthy university students of comparable age and intelligence, participated in a double-blind, single dose placebo-controlled cross-over study. A single dose of intranasal administration of oxytocin (40 IU) (or a placebo) was followed by an emotional recognition task and an apple juice drink. Food intake was then recorded for 24 hours post-test.
Oxytocin produced no significant change in appetite in the acute or 24 hours free living settings in healthy controls, whereas there was a decrease in calorie consumption over 24 hours in patients with BN. Oxytocin produced a small increase in emotion recognition sensitivity in healthy controls and in patients with BN, In patients with AN, oxytocin had no effect on emotion recognition sensitivity or on consummatory behaviour.
The impact of oxytocin on appetite and social cognition varied between people with AN and BN. A single dose of intranasal oxytocin decreased caloric intake over 24 hours in people with BN. People with BN showed enhanced emotional sensitivity under oxytocin condition similar to healthy controls. Those effects of oxytocin were not found in patients with AN.
ClinicalTrials.gov KCT00000716.
Journal Article
Genome-wide association study identifies eight risk loci and implicates metabo-psychiatric origins for anorexia nervosa
Characterized primarily by a low body-mass index, anorexia nervosa is a complex and serious illness
1
, affecting 0.9–4% of women and 0.3% of men
2
–
4
, with twin-based heritability estimates of 50–60%
5
. Mortality rates are higher than those in other psychiatric disorders
6
, and outcomes are unacceptably poor
7
. Here we combine data from the Anorexia Nervosa Genetics Initiative (ANGI)
8
,
9
and the Eating Disorders Working Group of the Psychiatric Genomics Consortium (PGC-ED) and conduct a genome-wide association study of 16,992 cases of anorexia nervosa and 55,525 controls, identifying eight significant loci. The genetic architecture of anorexia nervosa mirrors its clinical presentation, showing significant genetic correlations with psychiatric disorders, physical activity, and metabolic (including glycemic), lipid and anthropometric traits, independent of the effects of common variants associated with body-mass index. These results further encourage a reconceptualization of anorexia nervosa as a metabo-psychiatric disorder. Elucidating the metabolic component is a critical direction for future research, and paying attention to both psychiatric and metabolic components may be key to improving outcomes.
Genome-wide analyses identify eight independent loci associated with anorexia nervosa. Genetic correlations implicate both psychiatric and metabolic components in the etiology of this disorder, even after adjusting for the effects of common variants associated with body mass index.
Journal Article