Recovery from anorexia nervosa: a sociological perspective

OBJECTIVE: The focus of this article is on the process of recovery from anorexia nervosa, rather than on its etiology. It seeks for sociological, instead of clinical, reasons for recovery. METHOD: The article begins with a discussion of clinical outcome studies. It then reports on a phenomenological study of 32 former sufferers contacted through a newspaper article which included the author's own recovery story. Participants' narratives were analyzed to elucidate the social sources of recovery. RESULTS: The analysis refers to the coherence and mythological structure of the narratives and to their rituals of recovery and its "spiritual" nature, as understood by participants. DISCUSSION: Anorexia and recovery are conceptualized as two phases in an ascetic rite of passage which involves a confrontation with death and an eventual return to fuller community life. Suggestions are offered concerning the ways this insight can be translated into clinical practice.     

Body size estimation in anorexia nervosa patients: the significance of overestimation

Using the video distortion method on a life-size screen, we have studied body size estimation in 100 female restricting anorexia nervosa patients. About half of the patients were accurate in estimating their own body dimensions and only 20% clearly showed overestimation. We then tested whether differences in accuracy of estimation were related to scores on the following questionnaires: Eating Disorder Inventory; Body Attitude Test; and Symptom Checklist (SCL-90). Overestimators reported a more negative body attitude and a more "neurotic profile" on the SCL-90. These differences might have both prognostic and therapeutic implications.     

On the course of anorexia nervosa

The authors trace three phases in the course of anorexia nervosa and compare its physical and psychological symptoms with those of starvation. Phase I, which may occur months or years before the illness, usually includes precipitating events that result in loss of self-esteem and increased self-consciousness about physical appearance. During phase II patients develop the "anorectic attitude," an unreasonable fear of eating, and show pride in their ability to lose weight. By phase III patients are forced by the severity of starvation symptoms to admit that they are ill. Although many of the physical symptoms of starvation and anorexia nervosa are similar, anorectic patients, in contrast to victims of starvation, show high initiative, the ability to suppress hunger, restless hyperactivity, and body image distortion.     

Long-term outcome of children and adolescents with anorexia nervosa: study of comorbidity

A large number of new glycans, derived from glycoproteins, has been characterized in the past few years. O-linked fucose was found in epidermal growth factor-like domains of several proteins. For the N-linked glycans of Helix pomatia hemocyanin, novel types of antennae were identified. The positions of noncarbohydrate substituents were established in N-glycans. C-mannosylation of a tryptophan residue was discovered in human ribonuclease 2 and is the first example of C-glycosylation in glycoproteins.     

Biological aspects of anorexia nervosa and bulimia nervosa.

In this article, we review biological factors relevant to the understanding of anorexia nervosa and bulimia nervosa. We consider the physical presentation of these disorders; the medical complications of starvation, binging, and purging; and the cognitive and behavioral effects of starvation. We also review neurophysiological and neurochemical aspects of these illnesses and their biological treatments. These biological variables are most prominent in the perpetuation of the eating disorders. Effective treatment approaches must consider psychosocial as well as biological variables to be optimally effective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Colonic and anorectal function in constipated patients with anorexia nervosa

OBJECTIVES: Many patients with eating disorders complain of severe constipation. Previous studies have suggested that constipation in patients with anorexia nervosa may be associated with slow colonic transit. However, it is unclear whether a refeeding program will alter colonic transit in these patients. The aim of this study was to investigate colorectal function by measuring colonic transit and anorectal function in anorexic patients with constipation during treatment with a refeeding program. METHODS: We prospectively studied 13 female patients with anorexia nervosa who were admitted to an inpatient treatment unit and compared them to 20 previously studied, age-matched, healthy female control subjects. Patients underwent colonic transit studies using a radiopaque marker technique and anorectal manometry measuring anal sphincter function, rectal sensation, expulsion dynamics, and rectal compliance. Patients were studied both early (< 3 wk) and late (> 3 wk) in their admission. We restudied two patients who had slow colonic transit. All patients also underwent structured interviews. RESULTS: Four of six patients studied within the first 3 wk of their admission had slow colonic transit, defined as > 70 h (108.0 +/- 17.0 h, mean +/- SEM), on initial evaluation. In contrast, none of the seven patients studied later than 3 wk into their admission had slow colonic transit. Two of the four patients with slow transit were restudied later in their admission and were found to have normal transit times. Rectal sensation, internal anal sphincter relaxation threshold, rectal compliance, sphincter pressures, and expulsion pattern were normal in all subjects. CONCLUSIONS: Despite complaints of severe constipation, colonic transit is normal or returns to normal in the majority of patients with anorexia nervosa once they are consuming a balanced weight gain or weight maintenance diet for at least 3 wk.     

Diagnosis and treatment of anorexia nervosa

Anorexia nervosa is much like other psychogenic or psychosomatic disorders in that it tends to run a chronic, relapsing course, with a proportion of patients never fully recovering. It is unlike them, however, in that significant mortality rates have been reported. With epidemiological studies now suggesting an increased incidence of the disorder, and follow-up studies indicating the importance of early treatment to favorable outcome, the vital role of family physicians in diagnosis and treatment becomes evident. This paper draws on both published accounts and original case material to summarize the primary diagnostic criteria and secondary signs of anorexia nervosa. An illustrative history of a young woman with chronic anorexia nervosa is followed by a discussion of treatment alternatives. Although still in the experimental stage, behavior therapy is presented for its apparent efficacy and adaptability to the outpatient family practice setting.     

Contribution to a systemic interpretation of anorexia nervosa

The different ways in which anorexia nervosa has been understood throughout history are briefly described. Reference is made to those investigations underlining the role of the family in its pathogenesis, mainly to the papers on this subject that the authors themselves have published in the decade of the 70s. Then, an attempt of a systemic interpretation of anorectic syndrome is made, starting from the assumption that this acquires specific interactional characteristics in and for the family system in which uit has emerged. The more specific goals of this paper would be: to accurately describe the interaction forms of the system and sub-systems of anorexia nervosa; to put in evidence the function of the fundamental symptom, starvation; and finally, to make an approach to an eventual therapeutic intervention on the "anorectic" system.     

Inpatient treatment of anorexia nervosa: review and recommendations

Inpatient treatment of anorexia nervosa, difficult and at times complex, has been shown to promote enduring change. An integrated treatment approach that includes medical, psychological, nursing, and social interventions can restore patients to a healthy weight, improve abnormal eating behaviors, and ameliorate many of the central psychopathological attitudes and illness-driven behaviors characteristic of the disorder. This article reviews inpatient treatment of anorexia nervosa, evaluating empirical studies and providing a critique of their methodology and potential applicability, combining available published studies with clinical experience to suggest a comprehensive pragmatic treatment approach, and noting research needs for the future. More controlled double-blind studies are urgently needed to assess virtually every aspect of inpatient care, especially methods for promoting safe and rapid weight restoration. Comparative studies on the efficacy of behavioral, psychotherapeutic, and pharmacological approaches and determination of the optimum step-wise preparation for discharge into a weight-preoccupied society are also needed.     

Patterns and predictors of recovery in anorexia nervosa and bulimia nervosa

OBJECTIVE: The purpose of this study was to assess the course and outcome of anorexia nervosa and bulimia nervosa at 1 year in a large cohort of women with eating disorders. METHOD: A prospective, naturalistic, longitudinal design was used to map the course of 225 women with anorexia nervosa, bulimia nervosa, and mixed anorexia and bulimia nervosa. Structured interviews were conducted quarterly. Follow-up data are presented in terms of patterns of recovery, clinical features predictive of time to recovery, and the role of comorbid disorders as fixed predictors. RESULTS: The recovery rate of bulimics was significantly better than that of anorexic or mixed subjects, yet nearly half the anorexic and mixed subjects no longer met full DSM-III-R criteria for at least 8 consecutive weeks during the first year of follow-up. Percent ideal body weight and type of eating disorder were significantly associated with outcome. CONCLUSIONS: Our findings suggest that the diagnosis of anorexia nervosa has severe implications.     

Psychoneurotic characteristics of patients with anorexia nervosa before and after treatment and at follow-up 4-7 years later

In normotensive (NR) and spontaneously hypertensive rats (SHR) the cardiac vagal component of baroreceptor reflex was checked before and after intravenous infusion of clonidine (25-30 microgram/kg). 1) The decrease of heart rate due to the arterial baroreceptor reflex was the same in NR and in SHR. 2) Intravenous injection of clonidine produced much greater decrease of the heart rate in SHR than in NR. 3) After administration of clonidine the stimulation of arterial baroreceptors decreased the heart rate to the same low level in NR and SHR. In these conditions the maximal neurogenic slowing of the heart rate was probably achieved. 4) Atropine abolished almost completly heart rate change following baroreceptor stimulation or/and clonidine administration.     

Eating in anorexia nervosa and bulimia nervosa: An application of the tripartite model of anxiety.

Investigated anxiety in 40 women before, during, and after eating, as well as during an earlier neutral activity. Ss were 10 restricting-anorexics, 10 bulimic-anorexics, 10 bulimic, and 10 normal-weight females. Anxiety was assessed by self-report (ratings of pleasure, arousal, and anxiety), psychophysiological indicators (heart rate and skin conductance), and food consumption measures. Controls reported little or no anxiety and ate almost all of the test meal. The eating-disordered Ss reported a high level of anxiety throughout the study. Bulimics and controls ate similar amounts, whereas the anorexics ate much less. Psychophysiological arousal during eating was high in all groups. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family issues in the pathogenesis of anorexia nervosa

Factors residing in family systems have been implicated in the pathogenesis of anorexia nervosa. In this paper I critically review literature that bears on this issue: the transmission of anorexia nervosa in families; family stress patterns, personality and psychopathological characteristics of parents, parent-child interactions, and whole family systems. Much additional research is needed to accurately determine the precise nature of such factors and the extent to which they actually contribute to the appearance of this syndrome.     

Implications of a diagnosis of anorexia nervosa in a ballet school

A growth curve is presented, that using the Tanner and Whitehouse's 50th centile, plots the height versus weight, both for males and females. The age is gives as parameter on the curves. In this way, weight, height and age are merged on a single chart for every sex. After exemplifying its advantages, the simpler relief of deviation from the values of the height-weight medians on the various ages, because the values of weight refer to the real height (and back), not to the age. With the same rule, curves relating to 10th and 90th centiles are processed by Tanner and Whitehouse's values. Collating between them, curves allow some morphological relief. Moreover, for both referred to the 50th centile of Tanner and Whitehouse curves (for the male sex and the female one), is presented a simple mathematical expression of interpolation, which shows and excellent representation of the measured dates. This expression is composed of a third-degree polynomial (cubic), which is fitted to the dates by the method of least square. The result of the correlation height-weight allows both to synthesize the dates in a sole expression and a simpler relief of discordance in the growth.     

Hypoleptinemia in patients with anorexia nervosa: loss of circadian rhythm and unresponsiveness to short-term refeeding

The human neurotropic papovavirus JC, a close relative of simian virus 40, has been associated with the formation of brain tumors in humans because of its ability to induce such tumors in other primates under experimental conditions. Here we have analyzed 30 brain tumors classified as either oligodendroglioma or astrocytoma and 22 cell lines derived from human gliomas for the presence of JC viral sequences using polymerase chain reaction with two different sets of primers. None of the tumors or cell lines contained JC viral sequences. Similarly, we failed to detect expression of JC T antigen in any of 26 human glioma lines analyzed in this study. We conclude that JC virus is not a major cause of human brain tumors.     

Schizophrenia, schizophrenia-like disorders and delusional disorders in patients with anorexia nervosa: literature review and report of 3 cases

This study compared specific phenotypic and potential virulence characteristics of Staphylococcus aureus isolates from invasive infections and nasal carriers. Three hundred and sixty isolates were studied; 154 from septicaemia (69 line associated, 85 non-line), 79 from continuous ambulatory peritoneal dialysis (CAPD) peritonitis, 64 from bone/joint infections and 64 from healthy nasal carriers. The isolates were tested for production of enterotoxins (SE) A, B, C or E, toxic shock syndrome toxin-1 (TSST-1) protein A, and also for lipolytic, proteolytic, fibrinolytic and haemolytic activities. In addition phage typing, crystal violet reaction, urease and galactose breakdown were studied. Seventy-one percent of isolates were enterotoxigenic. Production of SEA was significantly lower amongst the bone/joint isolates. Production of SEB, was lower among the control group compared with CAPD, bone/joint, and non-line septicaemia isolates. SEE production was higher among the bone/joint isolates compared with the CAPD and non-line septicaemias and production of TSST-1 was significantly higher among nasal isolates compared with isolates causing infection. Almost all of the isolates were lipolytic, with highest activity amongst nasal and bone/joint isolates. Fibrinolytic activity was similar in the five groups of isolates. Proteolytic activity ranged from 35 to 62% of isolates with the lowest frequency among septicaemia isolates. In all, 80-90% of isolates were haemolytic, although CAPD isolates were less likely to be haemolytic. Isolates from the control and CAPD group more frequently belonged to phage group I. TSST-1 does not appear to be an important requirement for invasive infections, but SEB may be. Proteolysis and intensity of lipolysis appear to be less important in septicaemia, and haemolysis may not be important in CAPD peritonitis.