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Advances in Eating Disorders
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Advances in Eating Disorders

A special issue of Journal of Clinical Medicine (ISSN 2077-0383).

Deadline for manuscript submissions: closed (31 August 2020) | Viewed by 109334

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Dr. Zaida Aguera

E-Mail Website
Guest Editor
Department of Psychiatry, Bellvitge University Hospital-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), L’Hospitalet de Llobregat, Barcelona, Spain
Interests: eating disorders; emotion regulation; cognitive behavioral therapy; personality; new technologies; neuropsychology; obesity
Dr. Susana Jiménez-Murcia

E-Mail Website
Guest Editor
Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 Barcelona, Spain
Interests: behavioral addictions; gambling disorder; gaming disorder; buying-shopping disorder; sex addiction; food addiction; interventions based on new technologies
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Eating disorders are a group of mental disorders characterized by an altered food intake and the presence of inappropriate behaviors for the control of body weight, framed as an excessive concern regarding one’s weight and figure. These disorders lead to physical and psychosocial functioning problems in the patients. Although cognitive behavioral therapy (CBT) is the first-line evidence-based treatment for eating disorders, a growing body of research has provided strong empirical support for new potential therapeutic tools in the treatment of eating disorders. While we are far from having definitive solutions, scientific understanding of the treatment of eating disorders has developed significantly in recent years. Some of these advances in the management of eating disorders have included the complementary use of new technologies, as well as the use of virtual reality exposure therapy, or the use of ecological momentary assessment approaches. Moreover, cognitive rehabilitation, implicit–explicit emotion regulation strategies, neuromodulation techniques such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), and even neurosurgery, among others, appear as potential effective therapeutic tools for the treatment of eating disorders. Likewise, identifying both possible trajectories of treatment outcome and clinical phenotypes would allow for the most appropriate treatment to be applied to each patient. This Special Issue will address the most recent and relevant scientific findings regarding advances in the treatment of eating disorders.

Dr. Zaida Aguera
Dr. Susana Jiménez-Murcia
Guest Editors

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Keywords

  • eating disorders
  • clinical phenotypes
  • treatment trajectories
  • new technologies
  • virtual reality
  • cognitive rehabilitation
  • neuromodulation

Published Papers (22 papers)

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Editorial

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5 pages, 197 KiB  
Editorial
Advances in Eating Disorders
by Zaida Agüera and Susana Jiménez-Murcia
J. Clin. Med. 2020, 9(12), 4047; https://doi.org/10.3390/jcm9124047 - 15 Dec 2020
Cited by 1 | Viewed by 1735
Abstract
Eating disorders (EDs) are a group of mental disorders characterized by an altered food intake and the presence of inappropriate behaviors for the control of body weight, framed as an excessive concern regarding one’s weight and figure [...] Full article
(This article belongs to the Special Issue Advances in Eating Disorders)

Research

Jump to: Editorial, Review

19 pages, 1556 KiB  
Article
Validity of Virtual Reality Body Exposure to Elicit Fear of Gaining Weight, Body Anxiety and Body-Related Attentional Bias in Patients with Anorexia Nervosa
by Bruno Porras-Garcia, Marta Ferrer-Garcia, Eduardo Serrano-Troncoso, Marta Carulla-Roig, Pau Soto-Usera, Helena Miquel-Nabau, Nazilla Shojaeian, Isabel de la Montaña Santos-Carrasco, Bianca Borszewski, Marina Díaz-Marsá, Isabel Sánchez-Díaz, Fernando Fernández-Aranda and José Gutiérrez-Maldonado
J. Clin. Med. 2020, 9(10), 3210; https://doi.org/10.3390/jcm9103210 - 5 Oct 2020
Cited by 15 | Viewed by 3844
Abstract
Fear of gaining weight (FGW), body image disturbances, associated anxiety and body-related attentional bias are the core symptoms of anorexia nervosa (AN) and play critical roles in its development and maintenance. The aim of the current study is to evaluate the usefulness of [...] Read more.
Fear of gaining weight (FGW), body image disturbances, associated anxiety and body-related attentional bias are the core symptoms of anorexia nervosa (AN) and play critical roles in its development and maintenance. The aim of the current study is to evaluate the usefulness of virtual reality-based body exposure software for the assessment of important body-related cognitive and emotional responses in AN. Thirty female patients with AN, one of them subclinical, and 43 healthy college women, 25 with low body dissatisfaction (BD) and 18 with high BD, owned a virtual body that had their silhouette and body mass index. Full-body illusion (FBI) over the virtual body was induced using both visuo-motor and visuo-tactile stimulation. Once the FBI was induced, the FBI itself, FGW, body anxiety and body-related attentional bias toward weight-related and non-weight-related body areas were assessed. One-way analyses of covariance (ANCOVA), controlling for age, showed that AN patients reported higher FGW, body anxiety and body-related attentional bias than healthy controls. Unexpectedly, patients with AN reported significantly lower FBI levels than healthy participants. Finally, Pearson correlations showed significant relationships between visual analog scales and body-related attentional bias measures, compared to other eating disorder measures. These results provide evidence about the usefulness of virtual reality-based body exposure to elicit FGW and other body-related disturbances in AN patients. Thus, it may be a suitable intervention for reducing these emotional responses and for easing weight recovery. Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
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19 pages, 988 KiB  
Article
Unexpected Association of Desacyl-Ghrelin with Physical Activity and Chronic Food Restriction: A Translational Study on Anorexia Nervosa
by Philibert Duriez, Lauralee Robichon, Roland Dardennes, Guillaume Lavoisy, Dominique Grouselle, Jacques Epelbaum, Nicolas Ramoz, Philip Gorwood, Virginie Tolle and Odile Viltart
J. Clin. Med. 2020, 9(9), 2782; https://doi.org/10.3390/jcm9092782 - 28 Aug 2020
Cited by 8 | Viewed by 2466
Abstract
Anorexia nervosa (AN) is a severe metabopsychiatric disorder characterised by caloric intake restriction and often excessive physical exercise. Our aim is to assess in female AN patients and in a rodent model, the co-evolution of physical activity and potential dysregulation of acyl—(AG) and [...] Read more.
Anorexia nervosa (AN) is a severe metabopsychiatric disorder characterised by caloric intake restriction and often excessive physical exercise. Our aim is to assess in female AN patients and in a rodent model, the co-evolution of physical activity and potential dysregulation of acyl—(AG) and desacyl—(DAG) ghrelin plasma concentrations during denutrition and weight recovery. AN inpatients were evaluated at inclusion (T0, n = 29), half—(T1) and total (T2) weight recovery, and one month after discharge (T3, n = 13). C57/Bl6 mice with access to a running wheel, were fed ad libitum or submitted to short—(15 days) or long—(50 days) term quantitative food restriction, followed by refeeding (20 days). In AN patients, AG and DAG rapidly decreased during weight recovery (T0 to T2), AG increased significantly one-month post discharge (T3), but only DAG plasma concentrations at T3 correlated negatively with BMI and positively with physical activity. In mice, AG and DAG both increased during short- and long-term food restriction. After 20 days of ad libitum feeding, DAG was associated to persistence of exercise alteration. The positive association of DAG with physical activity during caloric restriction and after weight recovery questions its role in the adaptation mechanisms to energy deprivation that need to be considered in recovery process in AN. Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
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11 pages, 917 KiB  
Article
Does ADHD Symptomatology Influence Treatment Outcome and Dropout Risk in Eating Disorders? A longitudinal Study
by Giulia Testa, Isabel Baenas, Cristina Vintró-Alcaraz, Roser Granero, Zaida Agüera, Isabel Sánchez, Nadine Riesco, Susana Jiménez-Murcia and Fernando Fernández-Aranda
J. Clin. Med. 2020, 9(7), 2305; https://doi.org/10.3390/jcm9072305 - 20 Jul 2020
Cited by 10 | Viewed by 4372
Abstract
Attention-deficit/hyperactivity disorder (ADHD) and its symptoms have been shown to be present in patients with eating disorders (EDs) and are associated with increased psychopathology and more dysfunctional personality traits. This study aimed to assess if the presence of ADHD symptoms in patients with [...] Read more.
Attention-deficit/hyperactivity disorder (ADHD) and its symptoms have been shown to be present in patients with eating disorders (EDs) and are associated with increased psychopathology and more dysfunctional personality traits. This study aimed to assess if the presence of ADHD symptoms in patients with EDs affects their short and long-term therapy outcome. A total of 136 consecutively treated ED patients were considered in this study. Baseline pre-treatment evaluation included the Adult ADHD Self-Report Scale (ASRS v1.1) for ADHD symptoms and the assessment of eating symptomatology using the Eating Disorders Inventory (EDI-2). Treatment outcome was evaluated in terms of ED symptoms after cognitive behavioral therapy (CBT) and dropout rate during treatment. Furthermore, we evaluated ED symptoms in treatment completers after a follow-up of 8 years on average. Path analyses assessed the potential mediational role of the EDI-2 total score in the relationship between ADHD and treatment outcome. Results showed that baseline symptoms of ADHD indirectly affected treatment outcome after CBT; the ASRS positive screening was related to higher eating symptomatology (standardized coefficient B = 0.41, p = 0.001, 95% CI: 0.26 to 0.55), and the presence of high ED levels contributed to the increase of dropout (B = 0.15, p = 0.041, 95% CI: 0.03 to 0.33) and a worse treatment outcome (B = 0.18, p = 0.041, 95% CI: 0.01 to 0.35). No direct effect was found between the ASRS positive screening with the risk of dropout (B = −0.08, p = 0.375) and worse treatment outcome (B = −0.07, p = 0.414). These results suggest the relevance of identifying specific treatment approaches for patients with ADHD symptoms and severe eating symptomatology. Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
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12 pages, 624 KiB  
Article
Somatotype Components as Useful Predictors of Disordered Eating Attitudes in Young Female Ballet Dance Students
by José Ramón Alvero-Cruz, Verónica Parent Mathias and Jerónimo C. García-Romero
J. Clin. Med. 2020, 9(7), 2024; https://doi.org/10.3390/jcm9072024 - 27 Jun 2020
Cited by 10 | Viewed by 2901
Abstract
The current study used receiver operating characteristic (ROC) curve analysis to examine the accuracy of somatotype components in correctly classifying disordered eating attitudes (DEA) in female dance students. Participants were a sample of 81 female dancers distributed in two groups: beginner training (BT; [...] Read more.
The current study used receiver operating characteristic (ROC) curve analysis to examine the accuracy of somatotype components in correctly classifying disordered eating attitudes (DEA) in female dance students. Participants were a sample of 81 female dancers distributed in two groups: beginner training (BT; age (mean ± SD) = 10.09 ± 1.2 years, n = 32) and advanced training (AT; age = 15.37 ± 2.1 years, n = 49). For evaluation of DEA, the Eating Attitudes Test- 26 (EAT-26) questionnaire was used. We defined an EAT-26 score ≥20 as positive for DEA. Somatotype components were calculated using the Heath-Carter anthropometric method. The risk of presenting DEA was 28.1% (n = 9) in the BT group and 6.1% (n = 3) in the AT group. In the BT group, mesomorphy demonstrated moderate–high accuracy in predicting DEA (area under the curve (AUC) = 0.82, 95% confidence interval (CI): 0.64–0.93). The optimal cut-off of 6.34 yielded a sensitivity of 0.77 and a specificity of 0.95. Ectomorphy showed moderate accuracy in predicting DEA (AUC = 0.768, 95% CI: 0.58–0.89). The optimal cut-off of 2.41 yielded a sensitivity of 0.78 and a specificity of 0.78. In the AT group, none of the components demonstrated accuracy in predicting DEA. Somatotype components were good predictors of disordered eating attitudes in the younger dance student group (beginner training). Further research is needed to identify the determinants of these differences between the two groups. Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
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16 pages, 1095 KiB  
Article
Reduction of High Expressed Emotion and Treatment Outcomes in Anorexia Nervosa—Caregivers’ and Adolescents’ Perspective
by Julia Philipp, Stefanie Truttmann, Michael Zeiler, Claudia Franta, Tanja Wittek, Gabriele Schöfbeck, Michaela Mitterer, Dunja Mairhofer, Annika Zanko, Hartmut Imgart, Ellen Auer-Welsbach, Janet Treasure, Gudrun Wagner and Andreas F. K. Karwautz
J. Clin. Med. 2020, 9(7), 2021; https://doi.org/10.3390/jcm9072021 - 27 Jun 2020
Cited by 13 | Viewed by 3259
Abstract
High expressed emotion (EE) is common in caregivers of patients with anorexia nervosa (AN) and associated with poorer outcome for patients. In this study, we examined the prevalence of high EE in caregivers of adolescents with AN and analyzed predictors for EE using [...] Read more.
High expressed emotion (EE) is common in caregivers of patients with anorexia nervosa (AN) and associated with poorer outcome for patients. In this study, we examined the prevalence of high EE in caregivers of adolescents with AN and analyzed predictors for EE using multivariate linear regression models. We further analyzed whether EE is reduced by the “Supporting Carers of Children and Adolescents with Eating Disorders in Austria” (SUCCEAT) intervention using general linear mixed models and whether a reduction of EE predicts patients’ outcomes. Caregivers were randomly allocated to the SUCCEAT workshop (N = 50) or online intervention (N = 50) and compared to a comparison group (N = 49). EE and patients’ outcomes were assessed at the baseline, post-intervention, and at the 12-month follow-up. Up to 47% of caregivers showed high EE. Lower caregiver skills, higher AN symptom impact, higher levels of depression and motivation to change in caregivers were significant predictors for high EE. EE significantly decreased in the SUCCEAT groups and the comparison group according to the caregivers’, but not the patients’ perspective. The level of reduction could partially predict subjective improvement and improvement in clinically assessed AN symptoms and body mass index of patients. Implementing interventions for caregivers addressing EE in the treatment of adolescents with AN is strongly recommended. Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
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16 pages, 1484 KiB  
Article
A Randomized Trial of Deep Brain Stimulation to the Subcallosal Cingulate and Nucleus Accumbens in Patients with Treatment-Refractory, Chronic, and Severe Anorexia Nervosa: Initial Results at 6 Months of Follow Up
by Gloria Villalba Martínez, Azucena Justicia, Purificación Salgado, José María Ginés, Rocío Guardiola, Carlos Cedrón, María Polo, Ignacio Delgado-Martínez, Santiago Medrano, Rosa María Manero, Gerardo Conesa, Gustavo Faus, Antoni Grau, Matilde Elices and Víctor Pérez
J. Clin. Med. 2020, 9(6), 1946; https://doi.org/10.3390/jcm9061946 - 22 Jun 2020
Cited by 25 | Viewed by 3363
Abstract
Background: The main objective of this study was to assess the safety and efficacy of deep brain stimulation (DBS) in patients with severe anorexia nervosa (AN). Methods: Eight participants received active DBS to the subcallosal cingulate (SCC) or nucleus accumbens (NAcc) depending on [...] Read more.
Background: The main objective of this study was to assess the safety and efficacy of deep brain stimulation (DBS) in patients with severe anorexia nervosa (AN). Methods: Eight participants received active DBS to the subcallosal cingulate (SCC) or nucleus accumbens (NAcc) depending on comorbidities (affective or anxiety disorders, respectively) and type of AN. The primary outcome measure was body mass index (BMI). Results: Overall, we found no significant difference (p = 0.84) between mean preoperative and postoperative (month 6) BMI. A BMI reference value (BMI-RV) was calculated. In patients that received preoperative inpatient care to raise the BMI, the BMI-RV was defined as the mean BMI value in the 12 months prior to surgery. In patients that did not require inpatient care, the BMI-RV was defined as the mean BMI in the 3-month period before surgery. This value was compared to the postoperative BMI (month 6), revealing a significant increase (p = 0.02). After 6 months of DBS, five participants showed an increase of ≥10% in the BMI-RV. Quality of life was improved (p = 0.03). Three cases presented cutaneous complications. Conclusion: DBS may be effective for some patients with severe AN. Cutaneous complications were observed. Longer term data are needed. Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
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13 pages, 468 KiB  
Article
Impulsivity, Emotional Dysregulation and Executive Function Deficits Could Be Associated with Alcohol and Drug Abuse in Eating Disorders
by María Lozano-Madrid, Danielle Clark Bryan, Roser Granero, Isabel Sánchez, Nadine Riesco, Núria Mallorquí-Bagué, Susana Jiménez-Murcia, Janet Treasure and Fernando Fernández-Aranda
J. Clin. Med. 2020, 9(6), 1936; https://doi.org/10.3390/jcm9061936 - 21 Jun 2020
Cited by 15 | Viewed by 5068
Abstract
Background: Empirical data suggests a high comorbid occurrence of eating disorders (EDs) and substance use disorders (SUDs), as well as neurological and psychological shared characteristics. However, no prior study has identified the neuropsychological features of this subgroup. This study examines the prevalence of [...] Read more.
Background: Empirical data suggests a high comorbid occurrence of eating disorders (EDs) and substance use disorders (SUDs), as well as neurological and psychological shared characteristics. However, no prior study has identified the neuropsychological features of this subgroup. This study examines the prevalence of alcohol and/or drug abuse (A/DA) symptoms in ED patients. It also compares the clinical features and neuropsychological performance of ED patients with and without A/DA symptoms. Methods: 145 participants (74.5% females) with various forms of diagnosed EDs underwent a comprehensive clinical (TCI-R, SCL-90-R and EDI-2) and neuropsychological assessment (Stroop, WCST and IGT). Results: Approximately 19% of ED patients (across ED subtypes) had A/DA symptoms. Those with A/DA symptoms showed more impulsive behaviours and higher levels of interoceptive awareness (EDI-2), somatisation (SCL-90-R) and novelty seeking (TCI-R). This group also had a lower score in the Stroop-words measure, made more perseverative errors in the WCST and showed a weaker learning trajectory in the IGT. Conclusions: ED patients with A/DA symptoms display a specific phenotype characterised by greater impulsive personality, emotional dysregulation and problems with executive control. Patients with these temperamental traits may be at high risk of developing a SUD. Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
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18 pages, 1306 KiB  
Article
Long-Term Efficacy of the Workshop Vs. Online SUCCEAT (Supporting Carers of Children and Adolescents with Eating Disorders) Intervention for Parents: A Quasi-Randomised Feasibility Trial
by Stefanie Truttmann, Julia Philipp, Michael Zeiler, Claudia Franta, Tanja Wittek, Elisabeth Merl, Gabriele Schöfbeck, Doris Koubek, Clarissa Laczkovics, Hartmut Imgart, Annika Zanko, Ellen Auer-Welsbach, Janet Treasure, Andreas F. K. Karwautz and Gudrun Wagner
J. Clin. Med. 2020, 9(6), 1912; https://doi.org/10.3390/jcm9061912 - 18 Jun 2020
Cited by 21 | Viewed by 3751
Abstract
Interventions for main carers of adult patients with anorexia nervosa (AN) can reduce the caregiving burden and increase caregiver skills. However, the effectiveness and feasibility for carers of adolescent patients, the optimal form of the intervention and long-term outcomes are largely unknown. We [...] Read more.
Interventions for main carers of adult patients with anorexia nervosa (AN) can reduce the caregiving burden and increase caregiver skills. However, the effectiveness and feasibility for carers of adolescent patients, the optimal form of the intervention and long-term outcomes are largely unknown. We evaluated the efficacy and feasibility of the “Supporting Carers of Children and Adolescents with Eating Disorders in Austria” (SUCCEAT) workshop vs. online intervention. Main caregivers (parents) of adolescent patients with AN were randomly allocated to a workshop (n = 50) or online version (n = 50). Participants were compared to a non-randomised comparison group (n = 49) receiving multi-family or systemic family therapy. Primary (General Health Questionnaire) and secondary outcomes were obtained at baseline, three-month and 12-month follow-up. Adherence was high for workshop and online participants (6.2 and 6.7 sessions completed out of 8). Intention-to-treat analyses revealed significant pre–post reductions in the primary outcome for the workshop (d = 0.87 (95%conficence interval (CI): 0.48; 1.26)) and online (d = 0.65 (95%CI: 0.31; 0.98)) intervention that were sustained at the 12-month follow-up. There was no significant group difference (p = 0.473). Parental psychopathology and burden decreased and caregiver skills increased in all groups; the improvement of caregiver skills was significantly higher in SUCCEAT participants than in the comparison group. Online interventions for parents of adolescents with AN were equally effective as workshops. The improvements remained stable over time. Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
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13 pages, 597 KiB  
Article
Outcomes of an Accelerated Inpatient Refeeding Protocol in 103 Extremely Underweight Adults with Anorexia Nervosa at a Specialized Clinic in Prien, Germany
by Thorsten Koerner, Verena Haas, Julia Heese, Matislava Karacic, Elmar Ngo, Christoph U. Correll, Ulrich Voderholzer and Ulrich Cuntz
J. Clin. Med. 2020, 9(5), 1535; https://doi.org/10.3390/jcm9051535 - 19 May 2020
Cited by 18 | Viewed by 3819
Abstract
Background: In mildly to moderately malnourished adolescent patients with anorexia nervosa (AN), accelerated refeeding protocols using higher initial calory supply coupled with phosphate supplements were not associated with a higher incidence of refeeding syndrome (RS). It is unclear whether this is also a [...] Read more.
Background: In mildly to moderately malnourished adolescent patients with anorexia nervosa (AN), accelerated refeeding protocols using higher initial calory supply coupled with phosphate supplements were not associated with a higher incidence of refeeding syndrome (RS). It is unclear whether this is also a feasible approach for extremely malnourished, adult AN patients. Methods: Outcomes of a clinical refeeding protocol involving a targeted initial intake of ≥2000 kcal/day, routine supplementation of phosphate and thiamine as well as close medical monitoring, were evaluated. A retrospective chart review including AN patients with a body mass index (BMI) <13 kg/m² was conducted, to describe changes in weight, BMI, and laboratory parameters (phosphate, creatine kinase, hematocrit, sodium, liver enzymes, and blood count) over four weeks. Results: In 103 female patients (age, mean ± standard deviation (SD) = 23.8 ± 5.3 years), BMI between admission and follow-up increased from 11.5 ± 0.9 to 13.1 ± 1.1 kg/m² and total weight gain within the first four weeks was 4.2 ± 2.0 kg (mean, SD). Laboratory parameter monitoring indicated no case of RS, but continuous normalization of blood parameters. Conclusions: Combined with close medical monitoring and electrolyte supplementation, accelerated refeeding may also be applied to achieve medical stabilization in extremely underweight adults with AN without increasing the risk of RS. Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
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16 pages, 2140 KiB  
Article
Insular Cell Integrity Markers Linked to Weight Concern in Anorexia Nervosa—An MR-Spectroscopy Study
by Simon Maier, Kathrin Nickel, Evgeniy Perlov, Alina Kukies, Almut Zeeck, Ludger Tebartz van Elst, Dominique Endres, Derek Spieler, Lukas Holovics, Armin Hartmann, Michael Dacko, Thomas Lange and Andreas Joos
J. Clin. Med. 2020, 9(5), 1292; https://doi.org/10.3390/jcm9051292 - 30 Apr 2020
Cited by 8 | Viewed by 2173
Abstract
Objective: An insular involvement in the pathogenesis of anorexia nervosa (AN) has been suggested in many structural and functional neuroimaging studies. This magnetic resonance spectroscopy (MRS) study is the first to investigate metabolic signals in the anterior insular cortex in patients with AN [...] Read more.
Objective: An insular involvement in the pathogenesis of anorexia nervosa (AN) has been suggested in many structural and functional neuroimaging studies. This magnetic resonance spectroscopy (MRS) study is the first to investigate metabolic signals in the anterior insular cortex in patients with AN and recovered individuals (REC). Method: The MR spectra of 32 adult women with AN, 21 REC subjects and 33 healthy controls (HC) were quantified for absolute N-acetylaspartate (NAA), glutamate + glutamine (Glx), total choline, myo-inositol, creatine concentrations (mM/L). After adjusting the metabolite concentrations for age and partial gray/white matter volume, group differences were tested using one-way multivariate analyses of variance (MANOVA). Post-hoc analyses of variance were applied to identify those metabolites that showed significant group effects. Correlations were tested for associations with psychometric measures (eating disorder examination), duration of illness, and body mass index. Results: The MANOVA exhibited a significant group effect. The NAA signal was reduced in the AN group compared to the HC group. The REC and the HC groups did not differ in metabolite concentrations. In the AN group, lower NAA and Glx signals were related to increased weight concern. Discussion: We interpret the decreased NAA availability in the anterior insula as a signal of impaired neuronal integrity or density. The association of weight concern, which is a core feature of AN, with decreased NAA and Glx indicates that disturbances of glutamatergic neurotransmission might be related to core psychopathology in AN. The absence of significant metabolic differences between the REC and HC subjects suggests that metabolic alterations in AN represent a state rather than a trait phenomenon. Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
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9 pages, 511 KiB  
Article
Prevalence and Associated Factors of Nocturnal Eating Behavior and Sleep-Related Eating Disorder-Like Behavior in Japanese Young Adults: Results of an Internet Survey Using Munich Parasomnia Screening
by Kentaro Matsui, Yoko Komada, Katsuji Nishimura, Kenichi Kuriyama and Yuichi Inoue
J. Clin. Med. 2020, 9(4), 1243; https://doi.org/10.3390/jcm9041243 - 24 Apr 2020
Cited by 14 | Viewed by 4118
Abstract
Nocturnal (night) eating syndrome and sleep-related eating disorder have common characteristics, but are considered to differ in their level of consciousness during eating behavior and recallability. To date, there have been no large population-based studies determining their similarities and differences. We conducted a [...] Read more.
Nocturnal (night) eating syndrome and sleep-related eating disorder have common characteristics, but are considered to differ in their level of consciousness during eating behavior and recallability. To date, there have been no large population-based studies determining their similarities and differences. We conducted a cross-sectional web-based survey for Japanese young adults aged 19–25 years to identify factors associated with nocturnal eating behavior and sleep-related eating disorder-like behavior using Munich Parasomnia Screening and logistic regression. Of the 3347 participants, 160 (4.8%) reported experiencing nocturnal eating behavior and 73 (2.2%) reported experiencing sleep-related eating disorder-like behavior. Smoking (p < 0.05), use of hypnotic medications (p < 0.01), and previous and/or current sleepwalking (p < 0.001) were associated with both nocturnal eating behavior and sleep-related eating disorder-like behavior. A delayed sleep-wake schedule (p < 0.05) and sleep disturbance (p < 0.01) were associated with nocturnal eating behavior but not with sleep-related eating disorder-like behavior. Both nocturnal eating behavior and sleep-related eating disorder-like behavior had features consistent with eating disorders or parasomnias. Nocturnal eating behavior but not sleep-related eating disorder-like behavior was characterized by a sleep-awake phase delay, perhaps representing an underlying pathophysiology of nocturnal eating syndrome. Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
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14 pages, 320 KiB  
Article
Temperament and Character Traits of Female Eating Disorder Patients with(out) Non-Suicidal Self-Injury
by Tinne Buelens, Koen Luyckx, Margaux Verschueren, Katrien Schoevaerts, Eva Dierckx, Lies Depestele and Laurence Claes
J. Clin. Med. 2020, 9(4), 1207; https://doi.org/10.3390/jcm9041207 - 22 Apr 2020
Cited by 24 | Viewed by 3485
Abstract
Eating disorder (ED) patients show alarmingly high prevalence rates of Non-Suicidal Self-Injury (NSSI). Adolescents seem to be particularly at risk, as EDs and NSSI both have their onset in mid-adolescence. It has been suggested that personality could be a transdiagnostic mechanism underlying both [...] Read more.
Eating disorder (ED) patients show alarmingly high prevalence rates of Non-Suicidal Self-Injury (NSSI). Adolescents seem to be particularly at risk, as EDs and NSSI both have their onset in mid-adolescence. It has been suggested that personality could be a transdiagnostic mechanism underlying both EDs and NSSI. However, little attention has been given to adolescent clinical samples compared to adult and/or community samples. Therefore, the current study investigated the role of personality in a sample of 189 female inpatients with an ED (M = 15.93, SD = 0.98). Our results confirmed the high prevalence of NSSI in EDs, specifically in patients with bingeing/purging behaviours (ED-BP). Temperamental differences were found between ED-BP and the restrictive ED subtype (ED-R). Namely, ED-BP patients showed more harm avoidance and less self-directedness compared to ED-R. Temperamental differences were found in NSSI as well, regardless of ED subtype: ED patients who had engaged in NSSI during their lifetime reported less self-directedness and more harm avoidance. Interestingly, only ED patients who recently engaged in NSSI showed less novelty seeking. These temperamental profiles should be recognised as key mechanisms in the treatment of adolescent ED patients with and without NSSI. Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
17 pages, 501 KiB  
Article
Polygenic Score for Body Mass Index Is Associated with Disordered Eating in a General Population Cohort
by Mohamed Abdulkadir, Moritz Herle, Bianca L. De Stavola, Christopher Hübel, Diana L. Santos Ferreira, Ruth J. F. Loos, Rachel Bryant-Waugh, Cynthia M. Bulik and Nadia Micali
J. Clin. Med. 2020, 9(4), 1187; https://doi.org/10.3390/jcm9041187 - 21 Apr 2020
Cited by 21 | Viewed by 4278
Abstract
Background: Disordered eating (DE) is common and is associated with body mass index (BMI). We investigated whether genetic variants for BMI were associated with DE. Methods: BMI polygenic scores (PGS) were calculated for participants of the Avon Longitudinal Study of Parents and [...] Read more.
Background: Disordered eating (DE) is common and is associated with body mass index (BMI). We investigated whether genetic variants for BMI were associated with DE. Methods: BMI polygenic scores (PGS) were calculated for participants of the Avon Longitudinal Study of Parents and Children (ALSPAC; N = 8654) and their association with DE tested. Data on DE behaviors (e.g., binge eating and compensatory behaviors) were collected at ages 14, 16, 18 years, and DE cognitions (e.g., body dissatisfaction) at 14 years. Mediation analyses determined whether BMI mediated the association between the BMI-PGS and DE. Results: The BMI-PGS was positively associated with fasting (OR = 1.42, 95% CI = 1.25, 1.61), binge eating (OR = 1.28, 95% CI = 1.12, 1.46), purging (OR = 1.20, 95% CI = 1.02, 1.42), body dissatisfaction (Beta = 0.99, 95% CI = 0.77, 1.22), restrained eating (Beta = 0.14, 95% CI = 0.10, 1.17), emotional eating (Beta = 0.21, 95% CI = 0.052, 0.38), and negatively associated with thin ideal internalization (Beta = −0.15, 95% CI = −0.23, −0.07) and external eating (Beta = −0.19, 95% CI = −0.30, −0.09). These associations were mainly mediated by BMI. Conclusions: Genetic variants associated with BMI are also associated with DE. This association was mediated through BMI suggesting that weight potentially sits on the pathway from genetic liability to DE. Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
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9 pages, 231 KiB  
Article
Pragmatic Sensory Screening in Anorexia Nervosa and Associations with Autistic Traits
by Emma Kinnaird, Yasemin Dandil, Zhuo Li, Katherine Smith, Caroline Pimblett, Rafiu Agbalaya, Catherine Stewart and Kate Tchanturia
J. Clin. Med. 2020, 9(4), 1182; https://doi.org/10.3390/jcm9041182 - 20 Apr 2020
Cited by 20 | Viewed by 3560
Abstract
Background: Research suggests that people with anorexia nervosa (AN) experience subjective hypersensitivity to external sensations that may require consideration in treatment. These difficulties may be particularly pronounced in people with AN and high autistic traits. The purpose of this pilot study was to [...] Read more.
Background: Research suggests that people with anorexia nervosa (AN) experience subjective hypersensitivity to external sensations that may require consideration in treatment. These difficulties may be particularly pronounced in people with AN and high autistic traits. The purpose of this pilot study was to explore the use of a brief screening tool to assess sensory sensitivity in individuals receiving treatment for AN, and to assess if self-rated sensitivity in AN is related to autistic traits. Methods: 47 individuals receiving treatment for AN completed a brief sensory screening tool and self-rated their autistic traits. Individuals were also asked to give qualitative feedback on the screening tool. Results: People with AN and high autistic traits rated themselves as more hypersensitive compared to people with AN and low autistic traits. Feedback surrounding the use of the screener was positive. Conclusions: The results of this study suggest that the use of this screener may be beneficial in eating disorder settings to help adjust and calibrate treatment to personal needs, although further research and psychometric evaluation around the clinical use of the screener is required. The finding that people with AN and high autistic traits may experience elevated hypersensitivity also warrants further exploration in future research. Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
16 pages, 776 KiB  
Article
Emotion Recognition Abilities in Adults with Anorexia Nervosa are Associated with Autistic Traits
by Jess Kerr-Gaffney, Luke Mason, Emily Jones, Hannah Hayward, Jumana Ahmad, Amy Harrison, Eva Loth, Declan Murphy and Kate Tchanturia
J. Clin. Med. 2020, 9(4), 1057; https://doi.org/10.3390/jcm9041057 - 8 Apr 2020
Cited by 15 | Viewed by 4669
Abstract
Difficulties in socio-emotional functioning are proposed to contribute to the development and maintenance of anorexia nervosa (AN). This study aimed to examine emotion recognition abilities in individuals in the acute and recovered stages of AN compared to healthy controls (HCs). A second aim [...] Read more.
Difficulties in socio-emotional functioning are proposed to contribute to the development and maintenance of anorexia nervosa (AN). This study aimed to examine emotion recognition abilities in individuals in the acute and recovered stages of AN compared to healthy controls (HCs). A second aim was to examine whether attention to faces and comorbid psychopathology predicted emotion recognition abilities. The films expressions task was administered to 148 participants (46 AN, 51 recovered AN, 51 HC) to assess emotion recognition, during which attention to faces was recorded using eye-tracking. Comorbid psychopathology was assessed using self-report questionnaires and the Autism Diagnostic Observation Schedule–2nd edition (ADOS-2). No significant differences in emotion recognition abilities or attention to faces were found between groups. However, individuals with a lifetime history of AN who scored above the clinical cut-off on the ADOS-2 displayed poorer emotion recognition performance than those scoring below cut-off and HCs. ADOS-2 scores significantly predicted emotion recognition abilities while controlling for group membership and intelligence. Difficulties in emotion recognition appear to be associated with high autism spectrum disorder (ASD) traits, rather than a feature of AN. Whether individuals with AN and high ASD traits may require different treatment strategies or adaptations is a question for future research. Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
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19 pages, 876 KiB  
Article
Clinical and Neurophysiological Correlates of Emotion and Food Craving Regulation in Patients with Anorexia Nervosa
by Nuria Mallorquí-Bagué, María Lozano-Madrid, Giulia Testa, Cristina Vintró-Alcaraz, Isabel Sánchez, Nadine Riesco, José César Perales, Juan Francisco Navas, Ignacio Martínez-Zalacaín, Alberto Megías, Roser Granero, Misericordia Veciana De Las Heras, Rayane Chami, Susana Jiménez-Murcia, José Antonio Fernández-Formoso, Janet Treasure and Fernando Fernández-Aranda
J. Clin. Med. 2020, 9(4), 960; https://doi.org/10.3390/jcm9040960 - 31 Mar 2020
Cited by 14 | Viewed by 5351
Abstract
Background: Difficulties in emotion regulation and craving regulation have been linked to eating symptomatology in patients with anorexia nervosa (AN), contributing to the maintenance of their eating disorder. Methods: To investigate clinical and electrophysiological correlates of these processes, 20 patients with AN and [...] Read more.
Background: Difficulties in emotion regulation and craving regulation have been linked to eating symptomatology in patients with anorexia nervosa (AN), contributing to the maintenance of their eating disorder. Methods: To investigate clinical and electrophysiological correlates of these processes, 20 patients with AN and 20 healthy controls (HC) completed a computerized task during EEG recording, where they were instructed to down-regulate negative emotions or food craving. Participants also completed self-report measures of emotional regulation and food addiction. The P300 and Late Positive Potential (LPP) ERPs were analysed. Results: LPP amplitudes were significantly smaller during down-regulation of food craving among both groups. Independent of task condition, individuals with AN showed smaller P300 amplitudes compared to HC. Among HC, the self-reported use of re-appraisal strategies positively correlated with LPP amplitudes during emotional regulation task, while suppressive strategies negatively correlated with LPP amplitudes. The AN group, in comparison to the HC group, exhibited greater food addiction, greater use of maladaptive strategies, and emotional dysregulation. Conclusions: Despite the enhanced self-reported psychopathology among AN, both groups indicated neurophysiological evidence of food craving regulation as evidenced by blunted LPP amplitudes in the relevant task condition. Further research is required to delineate the mechanisms associated with reduced overall P300 amplitudes among individuals with AN. Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
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12 pages, 2523 KiB  
Article
Cortical Complexity in Anorexia Nervosa: A Fractal Dimension Analysis
by Enrico Collantoni, Christopher R. Madan, Paolo Meneguzzo, Iolanna Chiappini, Elena Tenconi, Renzo Manara and Angela Favaro
J. Clin. Med. 2020, 9(3), 833; https://doi.org/10.3390/jcm9030833 - 19 Mar 2020
Cited by 23 | Viewed by 4391
Abstract
Fractal Dimension (FD) has shown to be a promising means to describe the morphology of cortical structures across different neurologic and psychiatric conditions, displaying a good sensitivity in capturing atrophy processes. In this study, we aimed at exploring the morphology of cortical areas [...] Read more.
Fractal Dimension (FD) has shown to be a promising means to describe the morphology of cortical structures across different neurologic and psychiatric conditions, displaying a good sensitivity in capturing atrophy processes. In this study, we aimed at exploring the morphology of cortical areas by means of FD in 58 female patients with Anorexia Nervosa (AN) (38 currently underweight and 20 fully recovered) and 38 healthy controls (HC). All participants underwent high-resolution MRI. Surface extraction was completed using FreeSurfer, FD was computed using the calcFD toolbox. The whole cortex mean FD value was lower in acute AN patients compared to HC (p < 0.001). Recovered AN patients did not show differences in the global FD when compared to HC. However, some brain areas showed higher FD in patients than controls, while others showed the opposite pattern. Parietal regions showed lower FD in both AN groups. In acute AN patients, the FD correlated with age (p < 0.001), body mass index (p = 0.019) and duration of illness (p = 0.011). FD seems to represent a feasible method to explore cortical complexity in patients with AN since it demonstrated to be sensitive to the effects of both severity and duration of malnutrition. Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
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15 pages, 1662 KiB  
Article
Assessment of Physical Activity Patterns in Adolescent Patients with Anorexia Nervosa and Their Effect on Weight Gain
by Miriam Kemmer, Christoph U. Correll, Tobias Hofmann, Andreas Stengel, Julia Grosser and Verena Haas
J. Clin. Med. 2020, 9(3), 727; https://doi.org/10.3390/jcm9030727 - 7 Mar 2020
Cited by 5 | Viewed by 3331
Abstract
(1) Background: Altered physical activity (PA) affects weight recovery in anorexia nervosa (AN) patients. The study aimed to objectively characterize PA patterns and their effect on weight trajectory in adolescent AN patients. (2) Methods: PA was assessed in 47 patients on admission to [...] Read more.
(1) Background: Altered physical activity (PA) affects weight recovery in anorexia nervosa (AN) patients. The study aimed to objectively characterize PA patterns and their effect on weight trajectory in adolescent AN patients. (2) Methods: PA was assessed in 47 patients on admission to inpatient treatment, in n = 25 of these patients again 4 weeks after discharge (follow-up, FU), as well as in 20 adolescent healthy controls using the Sense Wear™ armband. The following PA categories were defined by metabolic equivalent (MET) ranges: sedentary behavior (SB), light (LPA), moderate (MPA), vigorous (VPA), and high-level PA (HLPA= MPA + VPA). (3) Results: LPA on admission was significantly higher in AN patients than in controls (103 vs. 55 min/d, p < 0.001), and LPA in AN decreased over time to 90 min/d (p = 0.006). Patients with higher admission LPA (n = 12) still had elevated LPA at FU (p = 0.003). High admission LPA was associated with a higher inpatient BMI percentage gain (ΔBMI%; 18.2% ± 10.0% vs. 12.0% ± 9.7%, p = 0.037) but with a loss of ΔBMI% at FU (−2.3% ± 3.6% vs. 0.8% ± 3.6%, p = 0.045). HLPA at baseline was associated with a lower inpatient ΔBMI% (p = 0.045). (4) Conclusion: Elevated LPA in AN patients decreased after inpatient treatment, and PA patterns had an impact on weight trajectory. Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
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Review

Jump to: Editorial, Research

25 pages, 1322 KiB  
Review
Brain Stimulation in Eating Disorders: State of the Art and Future Perspectives
by Philibert Duriez, Rami Bou Khalil, Yara Chamoun, Redwan Maatoug, Robertas Strumila, Maude Seneque, Philip Gorwood, Philippe Courtet and Sébastien Guillaume
J. Clin. Med. 2020, 9(8), 2358; https://doi.org/10.3390/jcm9082358 - 23 Jul 2020
Cited by 23 | Viewed by 9827
Abstract
The management of eating disorders (EDs) is still difficult and few treatments are effective. Recently, several studies have described the important contribution of non-invasive brain stimulation (repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and electroconvulsive therapy) and invasive brain stimulation (deep brain [...] Read more.
The management of eating disorders (EDs) is still difficult and few treatments are effective. Recently, several studies have described the important contribution of non-invasive brain stimulation (repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and electroconvulsive therapy) and invasive brain stimulation (deep brain stimulation and vagal nerve stimulation) for ED management. This review summarizes the available evidence supporting the use of brain stimulation in ED. All published studies on brain stimulation in ED as well as ongoing trials registered at clinicaltrials.gov were examined. Articles on neuromodulation research and perspective articles were also included. This analysis indicates that brain stimulation in EDs is still in its infancy. Literature data consist mainly of case reports, cases series, open studies, and only a few randomized controlled trials. Consequently, the evidence supporting the use of brain stimulation in EDs remains weak. Finally, this review discusses future directions in this research domain (e.g., sites of modulation, how to enhance neuromodulation efficacy, personalized protocols). Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
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13 pages, 240 KiB  
Review
Eating Disorders, Heredity and Environmental Activation: Getting Epigenetic Concepts into Practice
by Howard Steiger and Linda Booij
J. Clin. Med. 2020, 9(5), 1332; https://doi.org/10.3390/jcm9051332 - 3 May 2020
Cited by 25 | Viewed by 10414
Abstract
Epigenetic mechanisms are believed to link environmental exposures to alterations in gene expression, and in so doing, to provide a physical substrate for the activation of hereditary potentials by life experiences. In keeping with this idea, accumulating data suggest that epigenetic processes are [...] Read more.
Epigenetic mechanisms are believed to link environmental exposures to alterations in gene expression, and in so doing, to provide a physical substrate for the activation of hereditary potentials by life experiences. In keeping with this idea, accumulating data suggest that epigenetic processes are implicated in eating-disorder (ED) etiology. This paper reviews literature on putative links between epigenetic factors and EDs, and examines ways in which epigenetic programming of gene expression could account for gene-environment interactions acting in the EDs. The paper also presents evidence suggesting that epigenetic processes link malnutrition and life stresses (gestational, perinatal, childhood, and adult) to risk of ED development. Drawing from empirical evidence and clinical experience, we propose that an epigenetically informed understanding of ED etiology can benefit patients, caregivers, and clinicians alike, in the sense that the perspective can reduce judgmental or blameful attitudes on the part of clinicians and caregivers, and increase self-acceptance and optimism about recovery on the part of those affected. Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
14 pages, 770 KiB  
Review
Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness
by Janet Treasure, Daniel Willmott, Suman Ambwani, Valentina Cardi, Danielle Clark Bryan, Katie Rowlands and Ulrike Schmidt
J. Clin. Med. 2020, 9(3), 630; https://doi.org/10.3390/jcm9030630 - 27 Feb 2020
Cited by 112 | Viewed by 16972
Abstract
The cognitive interpersonal model was outlined initially in 2006 in a paper describing the valued and visible aspects of anorexia nervosa (Schmidt and Treasure, 2006). In 2013, we summarised many of the cognitive and emotional traits underpinning the model (Treasure and Schmidt, 2013). [...] Read more.
The cognitive interpersonal model was outlined initially in 2006 in a paper describing the valued and visible aspects of anorexia nervosa (Schmidt and Treasure, 2006). In 2013, we summarised many of the cognitive and emotional traits underpinning the model (Treasure and Schmidt, 2013). In this paper, we describe in more detail the perpetuating aspects of the model, which include the inter- and intrapersonal related consequences of isolation, depression, and chronic stress that accumulate in the severe and enduring stage of the illness. Since we developed the model, we have been using it to frame research and development at the Maudsley. We have developed and tested interventions for both patients and close others, refining the model through iterative cycles of model/intervention development in line with the Medical Research Council (MRC) framework for complex interventions. For example, we have defined the consequences of living with the illness on close others (including medical professionals) and characterised the intense emotional reactions and behaviours that follow. For the individual with an eating disorder, these counter-reactions can allow the eating disorder to become entrenched. In addition, the consequent chronic stress from starvation and social pain set in motion processes such as depression, neuroprogression, and neuroadaptation. Thus, anorexia nervosa develops a life of its own that is resistant to treatment. In this paper, we describe the underpinnings of the model and how this can be targeted into treatment. Full article
(This article belongs to the Special Issue Advances in Eating Disorders)
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