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Dedicated to making eating disorder research more accessible to the public, Science of Eating Disorders summarizes and reviews recent findings in peer-reviewed research on the genetics, neurobiology and psychiatry of eating disorders.
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- February 25, 2013
- 05:30 PM
- 168 views
Rigid Food Rules in Eating Disorders: Is Perfectionism to Blame?
by Tetyana Pekar in Science of Eating Disorders
I remember cutting baby carrots into 6 pieces. Rushing home to eat because I wasn’t “allowed” to eat after 7 pm. Eating the exact portion size–no more, no less. (Oh the rules. I don’t miss them.) Rigid food rules are very common among eating disorder sufferers. These rules can be about anything: the foods you are allowed to eat, how you are allowed to eat them, the time you are allowed to eat them, and so on.
But where do they come from? Why do some individuals have more rules and more ritualistic behaviours than others?
It is a complex question, but a recent study suggests that perfectionism might play a role. Specifically, the authors explored the idea that perfectionism mediates adherence to food rules in disordered eating behaviours. In order words, food rules might be a way in which perfectionism “expresses itself” in eating disorders.
Why perfectionism?
Previous studies have shown that self-imposed food rules may lead to even more preoccupation with food, “setting the stage for more rigid adherence to these rules” and “increasing the likelihood of binge eating” when the temptation is too strong. This might set up a positive feedback loop, whereby rules …
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Brown, A., Parman, K., Rudat, D., & Craighead, L. (2012) Disordered eating, perfectionism, and food rules. Eating Behaviors, 13(4), 347-353. DOI: 10.1016/j.eatbeh.2012.05.011
- February 22, 2013
- 09:28 PM
- 192 views
Chewing and Spitting: A Neglected Symptom in Eating Disorders?
by Shelly Fan in Science of Eating Disorders
Dear Science of Eating Disorders readers, please welcome Shelly, our newest contributor! Shelly is a PhD Candidate in Neuroscience at the University of British Columbia. You can find out more about Shelly on the ‘About Shelly‘ page. Check out her neuro(science) blog, Neurorexia and follow her on Twitter. Email shelly@scienceofeds.org to get in-touch.
Just a note, do keep in mind that I (Tetyana) try to give as much freedom as possible to guest writers and contributors to write about their own interests and viewpoints. That means that we don’t all necessary agree; there is no joint agenda. My primary reason for wanting more contributors is to widen the content, vary the writing styles, and negate the individual biases we all have. Our desire to understand, translate, and summarize peer-reviewed ED literature is what we all share in common.
Eating disorders come in all shapes and sizes, but all of them are characterized by the same goal: to avoid weight gain or induce weight loss. While behaviours such as food restriction, purging, and laxative abuse are relatively well studied, chewing and spitting (CHSP) is not. A simple Google search, however, reveals over 1.5 million results for the term “chewing …
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Guarda, A., Coughlin, J., Cummings, M., Marinilli, A., Haug, N., Boucher, M., & Heinberg, L. (2004) Chewing and spitting in eating disorders and its relationship to binge eating. Eating Behaviors, 5(3), 231-239. DOI: 10.1016/j.eatbeh.2004.01.001
- February 20, 2013
- 09:16 PM
- 156 views
Lifetime Prevalence of Eating Disorders Among Eating Disorder Professionals
by Tetyana Pekar in Science of Eating Disorders
How many professionals that treat eating disorders have a personal history of struggling with an eating disorder? It is a crucial question to ask (and answer) because there are important implications for patient treatment and for the health of the afflicted professionals. It is true that many (or most?) individuals who go into mental health do so because of personal experiences–whether due to their own personal history or the experiences of a loved one–so it is useful to ask, just how common are eating disorders among ED treatment professionals?
This is the question that Nicole Barbarich asked in a survey mailed to 823 members of the Academy for Eating Disorders.
Barbarich developed a 14-item self-report questionnaire that assessed everything from basic demographics to personal eating disorder history and their employer’s hiring policies. Out of 823 potential participants, 399 completed the questionnaire.
I’ve summarized the main findings below:
The prevalence of anorexia nervosa and bulimia nervosa in adolescent and young adult females is about 0.5-1% and 1-2%, respectively. In this study, the prevalence was 13% and 14% for anorexia and bulimia, respectively. In total, 33% of female and 2% of male ED professionals surveyed had a prior history of eating …
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BARBARICH, N. (2002) Lifetime Prevalence of Eating Disorders Among Professionals in the Field. Eating Disorders, 10(4), 305-312. DOI: 10.1080/10640260214505
- February 17, 2013
- 11:45 PM
- 200 views
Shared Genetics Between Disordered Eating and Periods (Menses)
by Tetyana Pekar in Science of Eating Disorders
Puberty at an early age increases the risk for disordered eating behaviours such as bingeing and purging (Jacobi et al., 2004; Kaltiala-Heino et al., 2001). What’s more, the hormone estradiol moderates the risk of disordered eating behaviours. More precisely, in a group of twins with low estradiol levels, differences in disordered eating are likely due to environmental factors (such as family, school, friends), but in a group of twins with high estradiol levels, the differences in disordered eating are more likely due to genetic factors. (I blogged about it here.)
Essentially, estradiol partially moderates the extent of to which genes effect disordered eating.
This is interesting because the estrogen system has a role in regulating body weight and food intake, influences eating behaviours during the menstrual cycle, and obviously plays an important role during puberty. Moreover, one study showed that estrogen receptor genes (proteins that bind estrogen) are associated with eating disorder symptomatology (Eastwood et al., 2002), though I don’t know if that finding has been replicated.
All of this is even more interesting because genetic effects on disordered eating are basically non-existent in prepubertal girls but increase to 50-60% postpuberty. This means that any variation we see in …
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Baker JH, Thornton LM, Bulik CM, Kendler KS, & Lichtenstein P. (2012) Shared genetic effects between age at menarche and disordered eating. The Journal of Adolescent Health, 51(5), 491-6. PMID: 23084171
- February 14, 2013
- 11:58 PM
- 232 views
Personality Traits after Recovery from Eating Disorders: Do Anorexia and Bulimia Patients Differ?
by Tetyana Pekar in Science of Eating Disorders
When we think about eating disorders, we tend to think about eating disorder subtypes: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder. A lot of previous work has shown that individuals with AN and BN tend to be anxious, depressed, perfectionistic, and harm-avoidant. Patients with AN also tend to score low on novelty-seeking, impulsivity, and self-directedness, whereas patients with BN score high on novelty-seeking and impulsivity. More recently, however, some researchers began to wonder if there was another way to categorize patients–not according to symptoms, but according to personality traits?
They identified three clusters of personality subtypes that seemed to “cut across” eating disorder diagnoses, outlined below (taken from a previous post):
However, that research was done in ill patients, and so the question remained: Do these personality clusters persist after recovery? This is the question that Angela Wagner and colleagues asked in their study, published in 2006.
Specifically, they asked:
What are the personality traits in individuals who have recovered from an ED?
Are there personality-based clusters in individuals recovered from an ED? And if so, do they resemble those present in ill individuals?
For their study, Wagner et al recruited 47 healthy controls and …
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Wagner, A., Barbarich-Marsteller, N., Frank, G., Bailer, U., Wonderlich, S., Crosby, R., Henry, S., Vogel, V., Plotnicov, K., McConaha, C.... (2006) Personality traits after recovery from eating disorders: Do subtypes differ?. International Journal of Eating Disorders, 39(4), 276-284. DOI: 10.1002/eat.20251
- February 10, 2013
- 02:07 AM
- 221 views
Bingeing and Purging Marathons: Repeated Binge/Purge Cycles in Bulimia Nervosa
by Tetyana Pekar in Science of Eating Disorders
I used to call them bingeing and purging marathons. If I binged and purged in the morning, chances were, I’d binge and purge throughout the day. The next time I’d eat, I was likely to end up–whether I wanted to or not–bingeing and purging. Not all individuals with bulimia nervosa binge and purge every day (or purge everything they eat, for that matter), but many do, and some binge and purge multiple times a day. In recovery, many people start by trying not to binge and purge before a certain time of the day–because once they binge and purge, it triggers a continuous cycle of bingeing and purging until they become to exhausted or otherwise end up going to bed.
I always wondered why that was, why was it so hard to keep a single episode of bingeing and purging from initiating a repeated cycle of bingeing and purging?
On days I didn’t binge and purge, my eating was fairly normal. I had little trouble eating a normal-sized meal, keeping it down, and recognizing when I was full. I wasn’t too hungry or too full. I knew when I was hungry and when I was full. But on days I’d binge and …
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Johnson, W., Jarrell, M., Chupurdia, K., & Williamson, D. (2010) Repeated binge/purge cycles in bulimia nervosa: Role of glucose and insulin. International Journal of Eating Disorders, 15(4), 331-341. DOI: 10.1002/eat.2260150404
- February 7, 2013
- 11:59 PM
- 220 views
Medical Complications of Purging in Bulimia Nervosa
by Tetyana Pekar in Science of Eating Disorders
Eating disorders are mental disorders with physical complications. Sometimes lots of them. I’ve blogged before about medical complications that are likely to come up in an emergency room setting, but that was a while ago. So I thought that today I’ll focus specifically on medical complications that occur in bulimia nervosa as a result of purging (self-induced vomiting, laxative abuse, and diuretic abuse).
These complications are particularly important because (1) patients with bulimia nervosa often appear healthy and thus can hide their disorder, meaning that treatment is often initiated many years after the disorder first started, and (2) the duration of BN is often long and the recovery rates are lower than they should be (in one study, the 5-year recovery rate was a little more than 50%), which means that these complications can persist for many years.
I. COMPLICATIONS OF SELF-INDUCED VOMITING
Oral complications of self-induced vomiting:
cheilosis (painful lesions at the corner of the mouth)
pharyngeal soreness (soreness at the back of the throat from the acidic stomach contents)
dental erosions, dental cavities, and periodontal disease (“inflammation and infection that destroys the tissues that support the teeth, including the gums, the periodontal ligaments, and …
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Mehler, P. (2010) Medical complications of bulimia nervosa and their treatments. International Journal of Eating Disorders. DOI: 10.1002/eat.20825
- February 4, 2013
- 11:56 PM
- 232 views
Is Anorexia Nervosa An Anxiety Disorder?
by Tetyana Pekar in Science of Eating Disorders
Anxiety disorders (ADs) are common among patients with eating disorders. In one study of female inpatients, around 50-65% had a comorbid anxiety disorder (see my post here). Anxiety disorders in patients with anorexia nervosa (AN) typically begin before the eating disorder and often persist after weight restoration and recovery (Bulik et al., 1997; Casper, 1990). Moreover, previous twin studies have suggested that there’s a “correlation between eating disorders and certain anxiety and depressive disorders, suggesting they comprise a spectrum of inherited phenotypes” (Hudson et al., 2003; Mangweth et al., 2003).
In this paper, Michael Strober and colleagues hypothesized that anxiety disorders and anorexia nervosa share common genetic, neural, and/or behavioural mechanisms. As such, they sought to investigate the association of AN with ADs by studying the prevalence of ADs in first-degree relatives of AN patients and comparing it to the prevalence of ADs in first-degree relatives of healthy controls.
Their rationale was that,
Just to note, this study only investigated the relatives of restrictive-type AN patients, and in addition to ADs, they included obsessive compulsive personality disorder (OCPD) (not to be confused with obsessive compulsive disorder (OCD)).
Here’s a table summarizing the prevalence of ADs and OCPD …
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Strober, M., Freeman, R., Lampert, C., & Diamond, J. (2007) The association of anxiety disorders and obsessive compulsive personality disorder with anorexia nervosa: Evidence from a family study with discussion of nosological and neurodevelopmental implications. International Journal of Eating Disorders, 40(S3). DOI: 10.1002/eat.20429
- February 2, 2013
- 11:11 PM
- 145 views
Over-Exercise is Associated With Suicidality in Individuals with Disordered Eating
by Tetyana Pekar in Science of Eating Disorders
Last week, I blogged about a study that examined personality traits and clinical variables associated with excessive exercise in eating disorder patients. In that study, 2 out of 5 participants engaged in excessive exercise Today, I’m going to discuss a study that suggests over-exercise in disordered eating patients is associated with suicide behaviour.
Suicide rates in eating disorder patients are high. One meta-analysis suggested that out of all eating disorder related deaths, 1 in 5 are suicides. (Keep in mind, these numbers are really hard to pin down as they depend a lot on the sample population, sample size, and how the authors did their statistics, among other things.)
Another analysis found that the standardized mortality ratio (ratio of observed deaths in the study sample/expected deaths in the population of the same age but without the disease/disorder you are studying) for suicide in eating disorders was 31 for patients with anorexia nervosa and 7.5 for patients with bulimia nervosa. Moreover, around 25-35% of bulimia nervosa and 3-20% of anorexia nervosa patients attempt suicide at least once in their lifetime (Bulik et al., 1999; Corcos et al., 2002; Franko and Keel, 2006).
Clearly, understanding what sub-population of ED patients …
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Smith, A., Fink, E., Anestis, M., Ribeiro, J., Gordon, K., Davis, H., Keel, P., Bardone-Cone, A., Peterson, C., Klein, M.... (2012) Exercise caution: Over-exercise is associated with suicidality among individuals with disordered eating. Psychiatry Research. DOI: 10.1016/j.psychres.2012.11.004
- January 30, 2013
- 01:45 AM
- 143 views
What Really Goes On Inside Pro-Ana Communities? (Maybe They Are Not So Bad After All)
by Tetyana Pekar in Science of Eating Disorders
Ambivalence is a great word to describe how many eating disorder patients feel about recovery. Many people that follow my Science of Eating Disorders tumblr run thinspo blogs. But, they follow me, and many probably follow fyoured, which offers pro-recovery advice. Many people might want to recover someday, but they feel they can’t let go of the behaviours now. They are not denying their illness, or that recovery will happen, or that it really IS a disorder, but, right now, recovery is just not an option.
Bear with me for a moment. Suspend your judgement and gut-reactions to “pro-ana/mia”.
Eating disorders are highly stigmatized. Most people don’t understand them. Physicians, nurses, and healthcare staff are often no better than the public. Treatment itself can have negative consequences. In a recent study, “more than half of all nurses and residents (58.2%) thought that ED patients were responsible for their disease “always” or “in most cases.”"
This stigma, hostility, and ignorance leads people to form on-line communities where they can openly discuss their experiences and connect with others. This is not unique to anorexia, mental health, or health in general.
But problems occur when the discussions that on-line users seek to …
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Brotsky SR, & Giles D. (2007) Inside the "pro-ana" community: a covert online participant observation. Eating disorders, 15(2), 93-109. PMID: 17454069
- January 26, 2013
- 11:35 PM
- 188 views
Excessive Exercise in Eating Disorders
by Tetyana Pekar in Science of Eating Disorders
Excessive exercise (EE) is common among eating disorder patients. Indeed, in the study I’ll write about today, 39% of patients engaged in EE. Previous studies have tried to find psychopathological and personality correlates of EE but the results have been inconsistent. Some studies have suggested that impulsivity and addictiveness are highly correlated with EE whereas others found that anxious and depressive traits were more closely associated.
In this multi-site study, Shroff and colleagues wanted to examine the prevalence of EE across eating disorder subtypes and the personality traits and clinical variables that were associated with EE in a large sample of women (1,857 in this study).
But first, what exactly is “excessive exercise”?
In this study, participants were deemed to be excessive exercisers when they endorsed at least one of the following with regard to exercise: “(1) severe interference with important activities; (2) exercising more than 3 h/day and distress if unable to exercise; (3) frequent exercise at inappropriate times and places and little or no attempt to suppress the behavior; and (4) exercising despite more serious injury, illness or medical complication.”
PREVALENCE OF EXCESSIVE EXERCISE ACROSS ED SUBTYPES
Shroff et al. found that EE was more common among purging-type anorexia nervosa patients and least common among purging-type bulimia …
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Shroff, H., Reba, L., Thornton, L., Tozzi, F., Klump, K., Berrettini, W., Brandt, H., Crawford, S., Crow, S., Fichter, M.... (2006) Features associated with excessive exercise in women with eating disorders. International Journal of Eating Disorders, 39(6), 454-461. DOI: 10.1002/eat.20247
- January 25, 2013
- 11:58 PM
- 160 views
Characteristics of Women with Midlife-Onset Eating Disorders
by Tetyana Pekar in Science of Eating Disorders
Since the late 1990′s, Remuda Ranch Program for Eating Disorders has experienced a 400% increase in patients 40 years of age and older, according to the authors of this paper. However, we don’t really know what the similarities and differences are between women who develop eating disorders in adolescence and those who develop their eating disorders in midlife (40-65 years-of-age).
In this paper, Edward Cumella and Zina Kally present a summary of 50 women who first developed eating disorders at the age of 40 or above and were admitted to inpatient treatment at Remuda Ranch. They “assessed patients’ sociodemographics, severity-of-illness, comorbid diagnoses, personality profiles, and short-term treatment outcomes.”
Cumella and Kally wanted to find out more specifically how this group of women differed from adolescents with eating disorders in terms of diagnosis characteristics, self-harm, suicide, and sexual abuse histories, as well as psychiatric comorbidities and general ED psychopatology. They did not assess a group of adolescents with eating disorders but compared their findings with previous reports in the literature.
What about psychiatric comorbidities?
These findings are informative, but they become really interesting once you compare them to what has been published about adolescents with eating disorders.
For example, on the …
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Cumella, E., & Kally, Z. (2008) Profile of 50 Women with Midlife-Onset Eating Disorders. Eating Disorders, 16(3), 193-203. DOI: 10.1080/10640260802016670
- January 23, 2013
- 10:17 PM
- 159 views
Pregnancy, Motherhood, and Eating Disorders: Women’s Experiences
by Tetyana Pekar in Science of Eating Disorders
There is a common misconception that eating disorders somehow disappear during pregnancy; that becoming a mother stops all those silly worries about being slim and attractive. This is not necessarily the case, but unfortunately, there is a lot of stigma associated with talking about disordered eating behaviours during pregnancy. Openly admitting it is an invitation, it seems, to being called selfish and vain. The implication is that eating disorders are something only young girls struggle with, and that pregnancy and motherhood are such big and important things that they should be enough to overcome an eating disorder.
In a large population-based study of 12,254 pregnant women in the UK, over 4% of women experienced past or present eating disorders (Micali et al., 2007). In this study, Tierney and colleagues wanted to find out how those women with present or past eating disorders experienced pregnancy and early motherhood.
They interviewed eight women between the ages of 17 to 37 about their experiences during pregnancy and (if applicable) motherhood. Some women were expecting their first child while others already had three. Five out of eight women were interviewed post pregnancy (from 2 months to 24 months post pregnancy). All had an eating disorder prior …
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Tierney, S., Fox, J., Butterfield, C., Stringer, E., & Furber, C. (2011) Treading the tightrope between motherhood and an eating disorder: A qualitative study. International Journal of Nursing Studies, 48(10), 1223-1233. DOI: 10.1016/j.ijnurstu.2010.11.007
- January 14, 2013
- 11:47 PM
- 203 views
Dopamine and Anorexia Nervosa: Tackling the Myths – Part IV (Treatment with Antipsychotics)
by Tetyana Pekar in Science of Eating Disorders
This is part IV in my mini-series on the role of dopamine in anorexia nervosa. In part I, I did a a little introduction on dopamine and dopamine signalling in the brain. In part II, I discussed preclinical studies using animal models to study the role of dopamine in AN. Finally, in part III, I talked about clinical studies using patients with AN to assess dopamine function. In this final post, I’ll review the evidence for using drugs that modulate the dopamine system in order to treat anorexia nervosa.
It is going to be short, because there’s really not that much evidence that any pharmacological agents help in treating anorexia nervosa. To quote the authors of this review study,
Most importantly,
However, in the last two posts, I provided some evidence suggesting that dopamine systems are affected in anorexia nervosa. If one of the problems in anorexia nervosa is increased dopaminergic receptor activity or increased dopaminergic signalling, one way to augment that might be through the use of antipsychotics, which work, in part, by blocking dopamine receptors.
One antipsychotic drug that has been receiving a lot of attention with respect to anorexia nervosa is olanzapine, also known on the market as zyprexa. In the table below I summarized some of the studies on antipsychotics in anorexia nervosa, including olanzapine. I adopted this table from Kontis & Theochari (2012), taking out most case studies (except for one).
As you can see, when it comes to anorexia …
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Kontis, D., & Theochari, E. (2012) Dopamine in anorexia nervosa. Behavioural Pharmacology, 23(5 and 6), 496-515. DOI: 10.1097/FBP.0b013e328357e115
- January 12, 2013
- 09:02 AM
- 167 views
Mobile Therapy: Using Text-Messaging to Treat Bulimia Nervosa
by Tetyana Pekar in Science of Eating Disorders
Cognitive-behavioural therapy (CBT) is one of the most commonly used approaches to treat bulimia nervosa, but even CBT (or any treatment) doesn’t work for everyone. Sometimes, even if CBT is helping, a weekly 50 minute therapy session is just not enough. Moreover, like with many other eating disorder treatments, drop-out and relapse rates are high.
What can be done to help the individuals that don’t benefit (benefit fully) from CBT, or those that relapse after CBT?
Shapiro and colleagues had the idea that maybe using text-messaging (in conjunction with CBT) would increase self-monitoring and accountability of bulimia nervosa patients.
The rationale is that text-messaging might provide an immediate way of engaging with the therapist. The patients are provided feedback and support immediately, and have the knowledge (or a sense of) being held accountable for their actions (i.e., binges and purges).
It is like a daily check-in. It means you don’t have to remember or wait until your next appointment to talk about how a particular day went, or get feedback on your behaviours. You also don’t have to write lengthy diary entries, you just have to send a text.
This study was very small: a total of 25 participants (women over the age of 18 with BN who did not have major depression) were recruited, and 15 completed the study. Individuals were assessed at baseline, after the 12 week CBT program, and 12 weeks after the completion of the CBT program.
The text-messaging part was an add-on to the standard CBT treatment. The text-messaging …
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Shapiro, J., Bauer, S., Andrews, E., Pisetsky, E., Bulik-Sullivan, B., Hamer, R., & Bulik, C. (2010) Mobile therapy: Use of text-messaging in the treatment of bulimia nervosa. International Journal of Eating Disorders, 43(6), 513-519. DOI: 10.1002/eat.20744
- January 10, 2013
- 11:58 PM
- 221 views
Dopamine and Anorexia Nervosa: Tackling the Myths – Part III (Clinical Studies)
by Tetyana Pekar in Science of Eating Disorders
This is part III of my series on the role of dopamine in anorexia nervosa. In my first post I did a little introduction on dopamine and dopaminergic signalling. In the second post I talked about preclinical studies that used animal models of anorexia nervosa. In this post I’ll briefly go over some of the research that has used patients with anorexia nervosa to understand the role of dopamine in this disorder.
I’ve got to be honest here: I wish things were simpler. I wish the research wasn’t so contradictory–but it often is. When you first start to explore a topic, and you are not even sure you are asking exactly the right question, things often look messy. I find this is true for my own research as well, and as a graduate student, it is hard to accept contradictory results. Yet, it is also hard as a science blogger to write about contradictory findings because it can be confusing, and messy.
But, stay with me. I’ll try to make it as simple as possible.
In the last post I concluded by saying that despite some contradictory findings, the majority of the studies seemed to point to the conclusion that in animal models of anorexia nervosa there was increased dopaminergic activity. What about human studies?
One way to study dopamine activity in anorexia nervosa is to study its role indirectly: by looking at the levels and activity of hormones regulated by dopamine. For example, dopamine inhibits the release of prolactin…
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Kontis, D., & Theochari, E. (2012) Dopamine in anorexia nervosa. Behavioural Pharmacology, 23(5 and 6), 496-515. DOI: 10.1097/FBP.0b013e328357e115
- January 7, 2013
- 10:34 PM
- 209 views
Dopamine and Anorexia Nervosa: Tackling the Myths – Part II (Contradictory Findings in Preclinical Studies)
by Tetyana Pekar in Science of Eating Disorders
This is part II in my series of posts on the role of dopamine in anorexia nervosa. (You can find the first part, which covers the basics of dopamine signalling, here.) In this post I’m going to discuss the findings from preclinical studies (studies in animal models).
I don’t think I’ve talked about animal models of anorexia nervosa before on the blog, but believe or not, they exist. The most well-known one is called activity-based anorexia (ABA). ABA works like this: rats are simultaneously restricted in the amount of food they can eat and given access to a running wheel. As the rats experience a reduction in their caloric intake, they begin to spend more and more time running on the wheel. A similar model with basically the same premise is called starvation-induced hyperactivity. These models are thought to mimic both the restriction/weight-loss and excessive exercise components of anorexia nervosa.
The ABA model has been used to study various aspects of anorexia nervosa, including the relationship between AN and over-exercise. Given that dopamine is known to be involved in feeding behaviours, reward, motivation, and motor activity, its role in anorexia has also been investigated using the ABA model.
First, a quick reminder of the two theoretical models that have been proposed for the role of dopamine in anorexia nervosa:
So, what have researchers studying rats and mice found?
An early study in 1990 by Broocks et al found that a reduction in feeding (leading to a 30% drop in body weight) led to …
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Dopamine and Anorexia Nervosa: Tackling the Myths – Part 1 (Intro)
The Anorexic Brain: A Summary of Neuroimaging Studies – Part 1
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Kontis, D., & Theochari, E. (2012) Dopamine in anorexia nervosa. Behavioural Pharmacology, 23(5 and 6), 496-515. DOI: 10.1097/FBP.0b013e328357e115
- January 5, 2013
- 07:59 PM
- 222 views
Dopamine and Anorexia Nervosa: Tackling the Myths – Part 1 (Intro)
by Tetyana Pekar in Science of Eating Disorders
There is this prevalent myth on tumblr eating disorder blogs that increased dopamine (DA) receptor activity or increased DA signalling causes anorexia nervosa. It has left me quite perplexed, as I have never come across a single paper that has shown increased DA activity causes anorexia nervosa. My research for this post also left me empty-handed. I have no idea where this myth comes from, but I thought I’d blog about what research on DA activity in anorexia has shown. This topic will take me a few (not necessarily successive) posts to cover. This first post is a very brief introduction to DA signalling.
First, what is dopamine?
DA is a neurotransmitter–a molecular that one neuron releases to another in order to send a signal. Dopamine is released from one cell (the presynaptic neuron) and binds to its receptors on the other (postsynaptic) neuron. There are five different DA receptors in the human brain, called D1, D2, D3, D4 and D5. (To add to the complexity, there is often more than one version of the receptor, called an “isoform”). The receptors have different (but overlapping) patterns of expression in the brain (areas where the receptors can be found):
There are also several dopaminergic pathways (a neuronal pathway connects neurons from one region to neurons in another brain region), which are also involved in different aspects of behaviour and function. The main ones are described in the image below:
What’s important is not so much that DA is released but the specific receptor it …
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Kontis, D., & Theochari, E. (2012) Dopamine in anorexia nervosa. Behavioural Pharmacology, 23(5 and 6), 496-515. DOI: 10.1097/FBP.0b013e328357e115
Beaulieu, J., & Gainetdinov, R. (2011) The Physiology, Signaling, and Pharmacology of Dopamine Receptors. Pharmacological Reviews, 63(1), 182-217. DOI: 10.1124/pr.110.002642
- January 2, 2013
- 10:44 PM
- 219 views
Self-Harm is Common Among Adolescents With Eating Disorders
by Tetyana Pekar in Science of Eating Disorders
Self-harm (SH) or non-suicidal self-injury (SI) are common among adolescents, particularly among adolescents with eating disorders. Previous studies have shown that SI seems to be associated with sexual trauma, mood disorders, and substance abuse. The present study aimed to find out whether (1) SI is associated with any specific eating disorder symptoms, such as bingeing, or purging, and (2) how often clinicians screen for SI behaviours (and whether particular patients are more likely to be screened than others).
Dr. Rebecka Peebles and colleagues looked retrospectively at intake evaluations of 1,432 patients between the ages of 10-21 (mean age 15). Three quarters of the patients were Caucasian, and slightly over 9% were male. Sixty-three percent had an intake diagnosis of eating disorder not otherwise specified (EDNOS).
These findings suggest that health care providers who do intake evaluations and screen for various behaviours might be biased as “they were more likely to screen patients who fit a profile of a self-injurer.” This means that the associations between bingeing/purging and history of abuse may or may not remain once providers screen all incoming patients for SI. This is because the associations above are based only on 42.7% of patients, we don’t know about the SI status of the other 57.3%.
This means that more effort must be made to ensure that all clinicians and intake nurses/staff screen every incoming patient for SI behaviours.
Readers, what do you think of the findings in this study? Do you think the associations between bingeing/purging and …
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Peebles, R., Wilson, J., & Lock, J. (2011) Self-Injury in Adolescents With Eating Disorders: Correlates and Provider Bias. Journal of Adolescent Health, 48(3), 310-313. DOI: 10.1016/j.jadohealth.2010.06.017
- December 30, 2012
- 09:14 PM
- 203 views
Extreme Medical Negligence: Failure to Feed Patients with Anorexia Nervosa
by Tetyana Pekar in Science of Eating Disorders
They are crazy stories, really. It is hard to believe they are true.
A 28-year-old woman with anorexia nervosa complained about weakness and nausea following the insertion of a feeding tube. Her gastroenterologist sent her to the emergency room (ER). The woman was in the emergency room for two days without receiving any food. She was discharged home after she was told her lab tests and X-rays came back normal. Unfortunately, her X-rays weren’t normal. Her gastroenterologist determined she had a bowel obstruction and sent her back to the hospital. She lost a substantial amount of weight in those 3 days.
The second story is even worse.
A 26-year-old woman with a feeding tube was discharged prematurely from a residential facility. She began to feel dizzy and weak, and was admitted to a hospital. She did not receive any food for the 6 days she was there, despite extremely low blood sugar levels (half of what is defined as the threshold for low blood sugar). For reasons that are not clear, an …
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Powers, P., & Cloak, N. (2013) Failure to Feed Patients With Anorexia Nervosa and Other Perils and Perplexities in the Medical Care of Eating Disorder Patients. Eating Disorders, 21(1), 81-89. DOI: 10.1080/10640266.2013.741994
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