Eating Disorders

"Patients read enormous amounts about their illness and are often aware of the genetic research on eating disorders yet they struggle to understand what the data mean for them and the challenges they face every day during recovery. Helping patients to understand the genetic literature is a first step. Although they might not initially see its relevance to their situation, helping them map how disordered eating and temperamental traits track in their families by using techniques such as labeling family trees can provide a useful context for understanding genetic and environmental contributions to their current situation. An understanding of genetic and environmental interplay can provide them with an explanatory model for not only their illness, but also for understanding their sensitivity to the environment. It can help provide them with the motivation to acquire skills that may help buffer them from the environment and combat their biology most effectively."

"Clinical observation has long suggested a link between personality and eating disorders. Research has consistently linked anorexia (particularly when the patient does not also have bulimic symptoms) to personality traits such as introversion, conformity, perfectionism, rigidity, and obsessive-compulsive features. The picture for bulimia is more mixed. Traits such as perfectionism, shyness, and compliance have consistently emerged in studies of individuals with bulimia or with anorexia, although research has often found bulimic patients to be extroverted, histrionic, and affectively unstable. Research on personality disorders has also examined the relation between eating disorders and personality and has documented considerable, but highly variable, rates of comorbidity, ranging from 21% to 97% for the presence of any personality disorder in patients with various eating disorder diagnoses. Conversely, patients with personality disorders have a higher than normal prevalence rate for eating disorders. The situation is similar for many axis I disorders, such as mood and anxiety disorders, for which comorbidity with axis II disorders hovers around 50%."

"The findings of this study raise questions about the concept of comorbidity as applied to eating disorders and suggest the likely utility for both research and clinical practice of considering eating-disordered symptoms in their characterological context (e.g., references 12, 34). The data from this study suggest that individuals who develop eating disorders who are constricted in most areas of their lives—e.g., who are passive and unassertive, emotionally constricted, and interpersonally avoidant—are likely to express this pattern with anorexic, rather than bulimic behavior. Clinically, these patients tend to be just as constricted in their sexual lives as they are with food, denying themselves pleasure, avoiding sexual relationships, feeling too ashamed or guilty to indicate to their partners what feels good, and so forth. Conversely, individuals with eating disorders whose ability to regulate their impulses and affects is tenuous—as expressed in spiraling emotions, tantrums, clinging to others for soothing, self-mutilation, and other impulsive acts—are likely to lose control over their eating in binges and to use self-destructive compensatory measures such as vomiting that momentarily help them regulate their affects. From this point of view, the question of whether bulimic symptoms should be regarded as impulsive behavior may be misplaced. The answer is probably that it depends on the personality configuration within which bulimic symptoms are contextualized. In low-functioning, emotionally dysregulated, type II bulimic patients, binge eating and purging may be functional equivalents of substance abuse, self-mutilation, and promiscuity. For these patients, bulimic symptoms may represent desperate efforts to regulate intense negative affects that call for immediate, and often maladaptive, responses. In contrast, high-functioning, perfectionistic, type I bulimic patients do not struggle with affects of the same intensity, and they have more adaptive coping strategies at their disposal for dealing with their distress. For these patients, binge eating is not equivalent to impulsive behaviors such as drinking or self-mutilation. More broadly, the data suggest that eating-disordered symptoms can be one expression, albeit a highly visible and sometimes life-threatening one, of a more general pattern of impulse and affect regulation. Thus, treating eating disorders primarily as disorders of food intake—and hence focusing primarily on altering the behavior, providing nutritional information (to patients who often know more about calories than the nutritionists who work with them), and so forth—may be taking the symptoms too literally. As in the treatment of trauma survivors, safety must be the clinician’s primary concern in treating patients with eating disorders when their symptoms are life-threatening or pose serious consequences for their current or future health. Particularly at those times, pharmacological and cognitive behavioral interventions can be essential components of a treatment plan, as they may be at various other points in the treatment."

"At the same time, however, symptom-focused treatment strategies may fail to address the personality structure that provides a context for understanding disordered eating. Patients whose personality profiles match the overcontrolled, constricted prototype, for example, rarely recognize their stance toward their own impulses and relationships as a problem. What brings them into treatment is typically someone else’s concern about their weight. If their attitudes toward their needs and feelings in general (and not just toward food) do not become the object of therapeutic attention, they are likely to change with treatment from being starving, unhappy, isolated, and emotionally constricted people to being relatively well fed, unhappy, isolated, and emotionally constricted people. The data also raise questions about the extent to which axis II is adequate for describing clinically meaningful patterns of personality pathology, at least for women with eating disorders. Patients in the high-functioning/perfectionistic cluster generally lacked diagnosable axis II pathology; indeed, in our study (as in the other studies that have isolated a similar cluster), they were defined by the absence of such pathology. These patients are articulate, conscientious, and empathic, and they tend to elicit liking in others. Yet they clearly have personality pathology—that is, enduring, problematic patterns of thought, feeling, motivation, and behavior. They are self-critical, perfectionistic, competitive, anxious, and guilt-ridden, and these aspects of their personality require clinical attention. The data reported here make sense in light of other findings that roughly 60% of patients treated for clinically significant personality pathology do not have problems severe enough to be diagnosable on axis II and that their personality problems (e.g., perfectionism and chronic feelings of guilt) generally are not reducible to any axis I syndrome (21, 22). Available data suggest that these patients represent the majority of patients treated in clinical practice and are not simply the “worried well.” Either axis II needs to be expanded from a personality disorderaxis to a personalityaxis that includes the range of functioning (from relatively healthy to relatively impaired), or subtypes such as those uncovered here need to be built into axis I. From a methodological standpoint, the results of this study suggest that we should routinely test for subtypes in our data sets rather than assuming homogeneity of categories. Group means may not be very meaningful when substantial intracategory heterogeneity exists, particularly if this heterogeneity is ordered, not random. The problem is particularly pronounced if pathology can be expressed in phenotypically opposite directions, leading to means that cancel out patterned within-group variability. Thus, although the etiological data on sexual abuse reported here are correlational and preliminary, they suggest that the same risk factor—sexual abuse—may manifest in opposite personality and behavioral styles—constriction and inhibition on the one hand, and dyscontrol and promiscuity on the other. Whether this is true of other etiologically significant psychosocial variables, such as harsh parental criticism (which, from a clinical point of view, appears sometimes to lead to self-criticism, sometimes to hostility and criticism toward others, and sometimes to both in adulthood), is an important question for future research."

"Because eating disorders (EDs) and obsessive compulsive disorder (OCD) co-occur at high rates and can have functionally similar clinical presentations, it has been suggested that both constructs might be part of a common spectrum of disorders. Identifying the relationship between EDs and OCD may lead to the discovery of important shared core disease processes and/or mechanisms for maintenance. The objective of this paper is to understand the relationship between EDs and OCD by systematically reviewing epidemiological, longitudinal and family studies guided by five models of comorbidity posited by Klein and Riso (1993) and others. Though this literature is relatively small, the preponderance of evidence from these studies largely suggests that OCD/ED co-occur because of a shared etiological relationship."

"Because of their remote location, the Fiji islands did not access to television until 1995, when a single station was introduced. It broadcasts programs from the United States, Great Britain, and Australia. Until that time, Fiji had no reported cases of eating disorders, and a study conducted by anthropologist Anne Becker showed that most Fijian girls and women, no matter how large, were comfortable with their bodies. In 1998, just three years after the station began broadcasting, 11 percent of girls reported vomiting to control weight, and 62 percent of girls surveyed reported dieting during the previous months. Becker was surprised by the change; she had though that Fijian cultural traditions, which celebrate eating and favor voluptous bodies, would “withstand” the influence of media images. Her explanation for the Fijian’s vulnerability? They were not sophisticated enough about media to recognize that the television images were not “real.”"

"Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood or later in life. These disorders affect both genders, although rates among women are higher than among men. Like women who have eating disorders, men also have a distorted sense of body image. For example, men may have muscle dysmorphia, a type of disorder marked by an extreme concern with becoming more muscular."

"The results of this study confirm our hypothesis that women with eating disorders show high levels of obsessive-compulsive personality traits in childhood, relative to healthy comparison subjects. There was a strong increasing relationship between the number of reported childhood traits and the odds of developing an eating disorder, with each extra reported trait increasing the odds of developing an eating disorder nearly sevenfold. We also confirmed our subsidiary hypothesis of developmental continuity in that the presence of childhood perfectionism and rigidity identified a subgroup of people with eating disorders with a significantly higher prevalence of obsessive-compulsive personality disorder later in life."

"Our results confirm and extend findings from previous studies. Fairburn et al. assessed perfectionism in childhood with a single item (high personal standards) and identified it as a risk factor for anorexia and bulimia in eating disorder patients, compared with healthy subjects (odds ratio=3.9, 95% CI=2.1–7.4, and odds ratio=2.6, 95% CI=1.5–4.6, respectively). The instrument we developed retrospectively examined a broader spectrum of obsessive-compulsive personality traits, including perfectionism, by using a range of behavioral examples. Approximately two-thirds of the subjects with anorexia nervosa reported perfectionism and rigidity in childhood. This prevalence is consistent with that reported by Rastam (22) for premorbid obsessive-compulsive (or anankastic) personality disorder in anorexia nervosa. We are not aware of any similar studies conducted for patients with bulimia nervosa. However, previous findings that perfectionism, obsessionality, excessive concern about mistakes, and doubt about actions persist after recovery from both disorders suggest that they represent persistent traits (10, 13, 16)."

"The findings suggest that childhood obsessive-compulsive personality traits are important risk factors for later development of eating disorders, particularly anorexia nervosa. Furthermore, the findings suggest that childhood perfectionism and rigidity may offer a more specific and homogenous phenotypic determination for genetic studies. Further studies are needed to determine whether these traits are specific for eating disorders or are also linked to other psychiatric disorders, such as depression or OCD. Personality traits may also act as maintaining factors and as such may have an important influence on the prognosis of the disorder. Studies of people who have recovered from an eating disorder would be needed to explore the influence of childhood obsessive-compulsive-personality traits on the length of illness and its severity. Female subjects were included in this study because the prevalence of eating disorders is approximately nine times higher in women than in men. However, further studies that include male subjects are needed to better understand the role of the assessed traits. To our knowledge, the interview scale described here is the first to measure these personality trait risk factors in a broad and comprehensive way. The finding that perfectionism and rigidity represent strong risk factors suggests that these items might also be also used to identify people at high risk for developing an eating disorder later in life. Prospective studies are needed to replicate these findings."

"Dancers, in general, had a higher risk of suffering from eating disorders in general, anorexia nervosa and EDNOS, but no higher risk of suffering from bulimia nervosa. The study concluded that as dancers had a three times higher risk of suffering from eating disorders, particularly anorexia nervosa and EDNOS, specifically designed services for this population should be considered"

"At follow-up in girls, 3.6% (15 of 422) in control schools compared with 1.2% (4 of 327) in intervention schools reported engaging in disordered weight-control behaviors (P = .04). Multivariate analyses indicated that the odds of these behaviors in girls in intervention schools were reduced by two thirds compared with girls in control schools (odds ratio, 0.33; 95% confidence interval, 0.11-0.97). No intervention effect was observed in boys."

"Results add compelling support for the effectiveness of an interdisciplinary, school-based obesity prevention intervention to prevent disordered weight-control behaviors in early adolescent girls."

"This review first identifies diseases with which eating disorders are often confused and then explores features in the history, physical examination, and laboratory studies, which can provide clues to the cause of the patient's symptoms. In addition, it discusses the recommended evaluation and treatments for the gastrointestinal diseases that most commonly mimic the presentation of eating disorders including Crohn disease (CrD), celiac disease, gastroesophageal reflux disease (GERD), and eosinophilic esophagitis (EoE)."

"The ubiquitous nature of the gastrointestinal complaints requires the clinician to consider a broad differential diagnosis when evaluating a patient for an eating disorder."

"ADHD girls were 3.6 times more likely to meet criteria for an eating disorder throughout the follow-up period compared to control females. Girls with eating disorders had significantly higher rates of major depression, anxiety disorders, and disruptive behavior disorder compared to ADHD girls without eating disorders. Girls with ADHD and eating disorders had a significantly earlier mean age at menarche than other ADHD girls. No other differences in correlates of ADHD were detected between ADHD girls with and without eating disorders."

"Social cognitive theory would warn that the high prevalence of interaction opportunities in the pro–eating disorder community has the potential to be extremely harmful if viewers are learning dangerous behaviors from one another, particularly if they are similar in age and gender. Other studies suggest that discussing techniques and perceived benefits may also have contagious effects on those not yet committed to the behaviors.5 The disclaimers included on pro–eating disorder Web sites may warn unsuspecting readers away from distressing content but also may entice vulnerable individuals to read further. Although there is no evidence as to the impact of warnings or disclaimers on pro–eating disorder sites, research on other media such as movies and video games with adult ratings suggests that labels might entice young viewers to want to see media that are not appropriate for them. Behavioral and communication theories, such as the social cognitive and cultivation theories mentioned earlier,8,9 would also suggest that the most deleterious components of these sites are the evocative images depicted coupled with constant social support encouraging extreme behaviors. On these Web sites, striving to be underweight is deemed not only as normative but as a signal of success. Only 13% of site maintainers offered an overt statement indicating that their own eating disorder was a problem. In addition, the Internet's easy accessibility allows users to tap into a site's features at any time of day or night. Social interaction is the most common reason young people use the Internet. This may be particularly relevant to the eating disorder online community, as research shows that individuals suffering from eating disorders have difficulty relating with same-age peers, attempt to hide their eating disorder behaviors, and often experience shame and isolation. Online venues for interaction with friends or strangers may seem like a safer and even appropriate place to disclose personal information. Furthermore, the Internet allows one to not only maintain relative anonymity but also easily retreat from criticism or uncomfortable situations."

"The Structured Clinical Interview for DSM-III-R (SCID and SCID II) was administered to 105 eating disorder in-patients in order to examine rates of comorbid psychiatric disorders and the chronological sequence in which these disorders developed. Eighty-six patients, 81.9% of the sample, had Axis I diagnoses in addition to their eating disorder. Depression, anxiety and substance dependence were the most common comorbid diagnoses. Anorexic restrictors were significantly more likely than bulimics (all subtypes) to develop their eating disorder before other Axis I comorbid conditions. Personality disorders were common among the subjects; 69% met criteria for at least one personality disorder diagnosis. Of the 72 patients with personality disorders, 93% also had Axis I comorbidity. Patients with at least one personality disorder were significantly more likely to have an affective disorder or substance dependence than those with no personality disorder."

"Alcohol use disorders were significantly more prevalent in women with ANBN and bulimia nervosa than in women with anorexia nervosa (p =.0001). The majority of individuals reported primary onset of the eating disorder, with only one third reporting the onset of the AUD first. After eating disorder subtype was controlled for, AUDs were associated with the presence of major depressive disorder, a range of anxiety disorders, and cluster B personality disorder symptoms. In addition, individuals with AUDs presented with personality profiles marked by impulsivity and perfectionism."

"Individuals with eating disorders and AUDs exhibit phenotypic profiles characterized by both anxious, perfectionistic traits and impulsive, dramatic dispositions. These traits mirror the pattern of control and dyscontrol seen in individuals with this comorbid profile and suggest that anxiety modulation may be related to alcohol use in this group."

"Eating disorders and alcohol use disorders (AUDs) commonly co-occur, although the patterns of comorbidity differ by eating disorder subtype. Our aim was to explore the nature of the co-morbid relation between AUDs and eating disorders in a large and phenotypically well-characterized group of individuals."

"In a large study of psychiatric outpatients, their eating disorders were mainly classed as "not otherwise specified" (NOS) — rather than as bulimia, anorexia, or binge eating — and most patients failed to meet the full diagnostic criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition ( DSM-IV). This suggests that DSM-IV diagnostic thresholds for eating disorders are too restrictive, the researchers, led by Mark Zimmerman, MD, from Brown University School of Medicine, in Providence, Rhode Island, write. Dr. Zimmerman told Medscape that their findings "strongly suggest that there are problems with the diagnostic criteria in the DSM category for eating disorders, because most individuals with an eating disorder don't meet the formal diagnostic criteria." He added that this contrasts with other categories of diagnosis — such as anxiety, personality, and depressive disorders — where "the overwhelming majority" of individuals meet the formal diagnostic criteria. "The conclusion is that there are significant problems with the eating-disorder diagnostic category in the DSM," he said."

"Personality traits have been implicated in the onset, symptomatic expression, and maintenance of eating disorders (EDs). The present article reviews literature examining the link between personality and EDs published within the past decade, and presents a meta-analysis evaluating the prevalence of personality disorders (PDs) in anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) as assessed by self-report instruments versus diagnostic interviews. AN and BN are both consistently characterized by perfectionism, obsessive-compulsiveness, neuroticism, negative emotionality, harm avoidance, low self-directedness, low cooperativeness, and traits associated with avoidant PD. Consistent differences that emerge between ED groups are high constraint and persistence and low novelty seeking in AN and high impulsivity, sensation seeking, novelty seeking, and traits associated with borderline PD in BN. The meta-analysis, which found PD rates of 0 to 58% among individuals with AN and BN, documented that self-report instruments greatly overestimate the prevalence of every PD."

"BN and BED are associated with childhood abuse, whereas AN shows mixed results. Individuals with similar trauma should be monitored for early recognition of EDs."

"Both depressive disorders and eating disorders are multidimensional and heterogeneous disorders. This paper examines the nature of their relationship by reviewing clinical descriptive, family-genetic, treatment, and biological studies that relate to the issue. The studies confirm the prominence of depressive symptoms and depressive disorders in eating disorders. Other psychiatric syndromes which occur with less frequency, such as anxiety disorders and obsessive-compulsive disorders in anorexia nervosa, or personality disorders, anxiety disorders, and substance abuse in bulimia nervosa, also play an important role in the development and maintenance of eating disorders. Since few studies have controlled for starvation-induced physical, endocrine, or psychological changes which mimic the symptoms considered diagnostic for depression, further research will be needed. The evidence for a shared etiology is not compelling for anorexia nervosa and is at most suggestive for bulimia nervosa. Since in contemporary cases dieting-induced weight loss is the principal trigger, women with self-critical or depressive features will be disproportionately recruited into eating disorders. The model that fits the data best would accommodate a relationship between eating disorders and the full spectrum of depressive disorders from no depression to severe depression, with somewhat higher rates of depression in bulimic anorectic and bulimia nervosa patients than in restricting anorexia nervosa patients, but the model would admit a specific pathophysiology and psychopathology in each eating disorder."

"The Stroop task has been adapted from cognitive psychology to be able to examine attentional biases in various forms of psychopathology, including the eating disorders. This paper reviews the research on the Stroop task in the eating disorders research area in both descriptive and meta-analytic fashions. Twenty-eight empirical studies are identified, which predominantly examine food and body/weight stimuli in bulimic, anorexic, or dieting/food-restricted samples. It is concluded that there is evidence of an attentional bias in bulimia for a range of stimuli but that the effect seems to be limited to body/weight stimuli in anorexia. The evidence to date is that there is no attentional bias in dieting samples."

"Dieting is common among adolescent girls and may place them at risk of using unhealthy weight-control behaviors (UWCBs), such as self-induced vomiting, laxatives, diet pills, or fasting. Research has suggested that social factors, including friends and broader cultural norms, may be associated with UWCBs. The present study examines the relationship between the school-wide prevalence of current weight loss efforts among adolescent girls, friends' dieting behavior, and UWCBs, and investigates differences in these associations across weight categories. Survey data were collected in 31 middle and high schools in ethnically and socio-economically diverse communities in Minnesota, USA. The response rate was 81.5%. Rates of UWCBs were compared across the spectrum of prevalence of trying to lose weight and friends' involvement with dieting, using chi(2) analysis and multivariate logistic regression, controlling for demographic factors and clustering by school. Girls with higher body mass index (BMI) were more likely to engage in UWCBs than those of lower BMI. Multivariate models indicated that friends' dieting behavior was significantly associated with UWCBs for average weight girls (OR = 1.57, CI = 1.40-1.77) and moderately overweight girls (OR = 1.47, CI = 1.19-1.82). The school-wide prevalence of trying to lose weight was significantly, albeit modestly, related to UWCBs for average weight girls (15th-85th percentile; OR = 1.17, CI = 1.01-1.36), and marginally associated for modestly overweight girls (85th-95th percentile; OR = 1.21, CI = .97-1.50), even after controlling for friends' dieting behaviors. The social influences examined here were not associated with UWCBs among underweight ( < 15th percentile) or overweight ( > 95th percentile) girls. Findings suggest that social norms, particularly from within one's peer group, but also at the larger school level may influence UWCBs, particularly for average weight girls. Implications for school-based interventions to reduce UWCBs are discussed."

"The similarities between the mentalities of anorexia nervosa, bulimia, and sexual repression among young women are undeniable. Young women starve their bodies until they can no longer resist both physical and sexual hungers. But the guilt associated with indulging becomes overwhelming and purging and punishment ensues. Both biological and sexual hungers are natural. However the messages sent to young women by their culture are that neither of these hungers are normal and, in fact, are immoral and inexcusable."

"Among the whole sample, the factor most strongly associated with suicide attempt or suicidal ideation was the diagnostic category, with the highest odds ratio for bulimia nervosa followed by anorexia nervosa of the binging/purging subtype. Among diagnostic subgroups, the strongest factors were drug use, alcohol use, and tobacco use."

"Parental influence has been shown to be an intrinsic component in the development of eating behaviors of children. This influence is manifested and shaped by a variety of diverse factors such as familial genetic predisposition, dietary choices as dictated by cultural or ethnic preferences, the parents' own body shape and eating patterns, the degree of involvement and expectations of their children's eating behavior as well as the interpersonal relationship of parent and child. This is in addition to the general psychosocial climate of the home and the presence or absence of a nurturing stable environment. It has been shown that maladaptive parental behavior has an important role in the development of eating disorders."

"Adams and Crane (1980), have shown that parents are influenced by stereotypes that influence their perception of their child's body. The conveyance of these negative stereotypes also affects the child's own body image and satisfaction. Hilde Bruch, a pioneer in the field of studying eating disorders, asserts that anorexia nervosa often occurs in girls who are high achievers, obedient, and always trying to please their parents. Their parents have a tendency to be over-controlling and fail to encourage the expression of emotions, inhibiting daughters from accepting their own feelings and desires. Adolescent females in these overbearing families lack the ability to be independent from their families, yet realize the need to, often resulting in rebellion. Controlling their food intake may make them feel better, as it provides them with a sense of control."

"Body dissatisfaction, disordered eating and depression differentially affect adolescent girls (compared to boys); however, these variables have not been examined in relation to ethnicity. A review of the literature finds that Black adolescent girls are more satisfied with their bodies than White adolescent girls and engage much less frequently in dieting or disordered eating than do White girls in the US. A central question raised by this review is whether body dissatisfaction and pubertal timing are as relevant to our understanding of the etiology of depression in Black girls as they appear to be in White girls. Based on the available data, it does not seem that a risk factor model supporting the role of early pubertal timing, weight increases and body dissatisfaction in the development of depression applies to Black adolescent girls. This review underscores the need for future research with a variety of ethnic minority groups to better understand the etiology of adolescent depression."

"Suicide is the third most frequent cause of death among teenagers and young adults. Reviews and meta-analyses have shown that suicidal behaviour is more frequent among people with eating disorders than in the general population. The course of illness and the follow up period is of great importance for the correct evaluation of suicidality in this class of patients.5 Suicide may occur not only in the late phases of the illness but in periods of symptomatic remission. Franko et al assessed suicidality every 6–12 months over 8.6 years. This is a most important and innovative contribution to the international literature. This approach should be implemented in everyday clinical practice, as it provides a greater opportunity to predict and prevent suicidal behaviour. However, such an approach may work only with certain resources and with increased staff motivation. We agree with the scales employed by the authors; however scales specifically designed for suicide risk assessment should be used in future studies. The evaluation of suicidality using tools that aim to recognise the possibility of committing suicide may contribute to the definition of a suicidal spectrum among people with eating disorders. Franko et al’s results are also very interesting as they found that suicide attempts were more frequent among people with anorexia than among people with bulimia. This finding may have implications for clinical practice, both for treatment and for seeking confirmation of this evidence. The generalisability of Franko et al’s results will depend on further longitudinal studies with similar features. One of the authors’ aims was to identify predictors of suicide and suicide attempts. This should also be the aim of all mental health professionals involved in the treatment of people with eating disorders. However, future studies would benefit from a careful consideration of the diagnostic tools used, the evaluation of suicide risk and the recognition of comorbid Axis I disorders or personality disorders that may increase suicide risk dramatically."

"Disturbances of volume-regulating mechanisms have already been implicated in the pathophysiology of eating disorders like anorexia or bulimia nervosa with the peptide hormones vasopressin and atrial natriuretic peptide (ANP) being of special interest. Aim of the present study was to investigate, whether the expression of the corresponding genes was altered and if so, if these changes could be explained by epigenetic mechanisms such as DNA methylation. We analyzed blood samples of 46 women suffering from anorexia (n=22) or bulimia nervosa (n=24) as well as of 30 healthy controls. Peripheral mRNA expression and DNA methylation of the vasopressin and the ANP precursor genes were assessed using real-time PCR. We found significantly lower levels of ANP mRNA in patients with eating disorders. This downregulation was accompanied by a hypermethylation of the ANP gene promoter in the bulimic subgroup. We did not find differences regarding expression or methylation of the vasopressin gene. ANP mRNA expression was inversely associated with impaired impulse regulation. We conclude that epigenetic mechanisms may contribute to the known alterations of ANP homeostasis in women with eating disorders."

"The pathophysiology of eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN) has been linked to an impaired dopaminergic neurotransmission, still the origin of this disturbance remains unknown. The aim of the present study was, therefore, to evaluate whether the expression of dopaminergic genes is altered in the blood of patients suffering from eating disorders and if these alterations can be explained by changes in the promoter specific DNA methylation of the genes."

"Our study shows a disturbed expression of dopaminergic genes that is accompanied by a dysregulation of the epigenetic DNA methylation. Further studies are necessary to provide more insight into the epigenetic dysregulation of the dopaminergic neurotransmission in the pathophysiology of eating disorders."

"There is no one sign of an eating disorder, however there are red flags. These can include excessive “fat, weight or calorie talk,” a pattern of eating a limited choice of low-calorie food or a pattern of occasional binge eating of calorie-dense foods. People with anorexia nervosa may excessively exercise or excessively stand, pace or fidget. Affected individuals may severely limit the amount of calories they consume or may avoid weight gain following meals by inducing vomiting or abusing laxative, diuretic and diet pills. Feeling self-conscious about one’s eating behavior is common. Affected individuals often avoid social eating settings and eat alone."

"There is no single cause of an eating disorder. We know that genetics play a large role, but genetic vulnerability is only part of the story. Environment plays a role too, especially in triggering onset, which often occurs in adolescence. Pressure to diet or weight loss related to a medical condition can be the gateway to anorexia nervosa or bulimia. For those who are genetically vulnerable to anorexia nervosa, once they lose the first five to 10 lbs, dieting becomes increasingly compelling and rewarding. Looked at another way, if eating disorders were the result solely of social pressure for thinness we would expect eating disorder rates to have increased as obesity has in the past few decades, yet anorexia nervosa and bulimia remain relatively rare and often cluster in families."

"Treatment for an eating disorder is challenging. It involves interrupting behaviors that have become driven and compelling. Recovery takes a team, which includes family, friends and other social supports, as well as medical and mental health professionals. Be empathic, but clear. List signs or behaviors you have noticed and are concerned about. Help locate a treatment provider and offer to go with your friend or relative to an evaluation. Be prepared that the affected individual may be uncertain about seeking treatment. Treatment is effective, many are able to achieve full recovery and the vast majority will improve with expert care. Treatment assists affected individuals to change what they do. It helps them normalize their eating and reframe the irrational thoughts that sustain eating disordered behaviors. Food is central to many social activities and the practice of eating meals with supportive friends and family is an important step in recovery."

"Eating disorders do not discriminate and can affect anyone. Although they are most common in young women, it is not unusual for older women to have an eating disorder. Some have had one all their life, others were only mildly affected until some life event triggers clinical worsening – a stressor, physical illness or a co-occurring psychiatric illness, such as depression or anxiety. Recent evidence strongly suggests that anxiety disorders, especially social anxiety disorder, and obsessive compulsive personality traits increase individual vulnerability to an eating disorder. Eating disorders occur in men too. An estimated 10 percent of people with anorexia nervosa and bulimia and a third or more of people with binge eating disorder are male. More"

"Eating disorders have morbidity and mortality rates that are among the highest of any mental disorders and are associated with significant functional impairment. This article provides an up-to-date review on recent developments and expanding knowledge in adolescent anorexia nervosa, bulimia nervosa, and related disorders. It covers diagnoses and assessment, recognition of typical symptoms, medical and psychiatric comorbidities, and current trends in epidemiology."

"A wide range of childhood adversities were associated with elevated risk for eating disorders and problems with eating or weight during adolescence and early adulthood after the effects of age, childhood eating problems, difficult childhood temperament, parental psychopathology, and co-occurring childhood adversities were controlled statistically. Numerous unique associations were found between specific childhood adversities and specific types of problems with eating or weight, and different patterns of association were obtained among the male and female subjects. Maladaptive paternal behavior was uniquely associated with risk for eating disorders in offspring after the effects of maladaptive maternal behavior, childhood maltreatment, and other co-occurring childhood adversities were controlled statistically. Childhood adversities may contribute to greater risk for the development of eating disorders and problems with eating and weight that persist into early adulthood. Maladaptive paternal behavior may play a particularly important role in the development of eating disorders in offspring."

"Three core beliefs were found to moderate the relationship between paternal rejection and aspects of eating psychopathology. The predictive validity of paternal rejection on aspects of eating symptomatology was found to decrease as dysfunctional core beliefs increased. When levels of social isolation, vulnerability to harm, and self-sacrifice core beliefs were high, recalled parental relationships were no longer relevant to current eating psychopathology. The findings provide further evidence that core beliefs are important factors in eating disorder psychopathology and may be clinically useful in identifying targets for treatment."

"Osteoporosis has been reported in anorexia nervosa (AN), but not in other eating disorders. Thirty-three patients, 8 AN, 17 bulimia nervosa (BN), and 8 eating disorder not otherwise specified (EDNOS), were evaluated by bone densitometry (radius, spine, femur) to determine the prevalence and distribution of osteoporosis and the role of physical parameters, exercise and estrogen. All three diagnostic subgroups had evidence of decreased bone density, worst in the EDNOS subgroup and least in the BN subgroup. The most affected site was the femur, least the spine; the radius was intermediate. Age, body surface area, age of onset, and length of illness weakly correlated with the femur and spine density in the BN and EDNOS subgroups. Exercise was related to bone density in the AN subgroup in the femur, moderate exercise having a protective effect and strenuous exercise being detrimental. No significant correlation of bone density measurements with estradiol levels and/or history of amenorrhea was identified. Eating disorder patients are at risk for osteoporosis, which has multiple contributing factors including physical parameters and exercise. Estrogen deficiency by itself may not be a major causative factor."

"About 60% of eating disorder cases are attributable to biological and genetic components. Other cases are due to external reasons or developmental problems."

"Anxiety disorders commonly had their onset in childhood before the onset of an eating disorder, supporting the possibility they are a vulnerability factor for developing anorexia nervosa or bulimia nervosa."

"Kaye, WH; Bulik, CM; Thornton, L; Barbarich, N; Masters, K (2004). "Comorbidity of anxiety disorders with anorexia and bulimia nervosa". The American Journal of Psychiatry. 161 (12): 2215–21. doi:10.1176/appi.ajp.161.12.2215. PMID 15569892."

"The authors explore the extent to which eating disorders, specifically anorexia nervosa (AN) and bulimia nervosa (BN), represent culture-bound syndromes and discuss implications for conceptualizing the role genes play in their etiology. The examination is divided into 3 sections: a quantitative meta-analysis of changes in incidence rates since the formal recognition of AN and BN, a qualitative summary of historical evidence of eating disorders before their formal recognition, and an evaluation of the presence of these disorders in non-Western cultures. Findings suggest that BN is a culture-bound syndrome and AN is not. Thus, heritability estimates for BN may show greater variability cross-culturally than heritability estimates for AN, and the genetic bases of these disorders may be associated with differential pathoplasticity."

"Epidemiological, cross-cultural, and longitudinal studies underscore the importance of the idealization of thinness and resulting weight concerns as psychosocial risk factors for eating disorders. Personality factors such as negative emotionality and perfectionism contribute to the development of eating disorders but may do so indirectly by increasing susceptibility to internalize the thin ideal or by influencing selection of peer environment. During adolescence, peers represent self-selected environments that influence risk."

"Peer context may represent a key opportunity for intervention, as peer groups represent the nexus in which individual differences in psychological risk factors shape the social environment and social environment shapes psychological risk factors. Thus, peer-based interventions that challenge internalization of the thin ideal can protect against the development of eating pathology."