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Psychopathology in underweight and weight-recovered females with anorexia nervosa

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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Objective: To compare general and eating disorder-specific psychopathology in patients with acute anorexia nervosa (acAN), weight-recovered patients (recAN) and healthy control women (HCW). Methods: One hundred anorexia nervosa patients (66 acAN and 34 recAN) and 88 HCW were included in our study. Psychopathology was assessed by self-report questionnaires [Symptom Check List 90 Revised (SCL-90-R), Eating Disorder Inventory-2 (EDI- 2)] as well as by interview [Structured Interview of Anorexia Nervosa and Bulimic Syndromes (SIAB-EX)] and compared using multivariate analysis of variance. Plasma leptin levels were determined using enzyme linked immunosorbent assay. Results: Mean comparisons indicated highly significant differences between acAN and recAN subjects on all psychopatholgy variables, except for perfectionism. RecAN subjects did not differ from HCW. Partial weight recovery was associated with decreasing levels of psychopathology. Correlational analyses suggested strong negative associations between leptin levels and psychopathology. Conclusion: Prolonged malnutrition, as indicated by suppressed plasma leptin levels, is strongly related to eating disorder-specific as well as general psychopathological symptoms. Weight recovery is associated with the absence of psychopathology. These data emphasize the interaction between somatic and psychological variables.

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References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders — Fourth Edition (DSM-IV). Washington D.C., American Psychiatric Association, 1994.

    Google Scholar 

  2. World Health Organization. The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). Geneva, World Health Organization, 2005.

    Google Scholar 

  3. Gianotti L., Lanfranco F., Ramunni J., Destefanis S., Ghigo E., Arvat E.: GH/IGF-I axis in anorexia nervosa. Eat. Weight Disord., 7, 94–105, 2002.

    CAS  PubMed  Google Scholar 

  4. Krassas G.E.: Endocrine abnormalities in Anorexia Nervosa. Pediatr. Endocrinol. Rev., 1, 46–54, 2003.

    PubMed  Google Scholar 

  5. Hebebrand J., Muller T.D., Holtkamp K., Herpertz- Dahlmann B.: The role of leptin in anorexia nervosa: clinical implications. Mol. Psychiatry, 12, 23–35, 2007.

    Article  CAS  PubMed  Google Scholar 

  6. Castro-Fornieles J., Gual P., Lahortiga F., Gila A., Casula V., Fuhrmann C., Imirizaldu M., Saura B., Martinez E., Toro J.: Self-oriented perfectionism in eating disorders. Int. J. Eat. Disord., 40, 562–568, 2007.

    Article  PubMed  Google Scholar 

  7. Steinhausen H.-C.: Anorexia nervosa. Göttingen, Hogrefe, 2005.

    Google Scholar 

  8. Ribases M., Gratacos M., Fernandez-Aranda F., Bellodi L., Boni C., Anderluh M., Cristina Cavallini M., Cellini E., Di Bella D., Erzegovesi S., Foulon C., Gabrovsek M., Gorwood P., Hebebrand J., Hinney A., Holliday J., Hu X., Karwautz A., Kipman A., Komel R., Nacmias B., Remschmidt H., Ricca V., Sorbi S., Tomori M., Wagner G., Treasure J., Collier D.A., Estivill X.: Association of BDNF with restricting anorexia nervosa and minimum body mass index: a family-based association study of eight European populations. Eur. J. Hum. Genet., 13, 428–434, 2005.

    Article  CAS  PubMed  Google Scholar 

  9. Kakizaki M., Kuriyama S., Sato Y., Shimazu T., Matsuda-Ohmori K., Nakaya N., Fukao A., Fukudo S., Tsuji I.: Personality and body mass index: a cross-sectional analysis from the Miyagi Cohort Study. J. Psychosom. Res., 64, 71–80, 2008.

    Article  PubMed  Google Scholar 

  10. Kaye W.: Neurobiology of anorexia and bulimia nervosa. Physiol. Behav., 94, 121–135, 2008.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Green M.W., Elliman N.A., Wakeling A., Rogers P.J.: Cognitive functioning, weight change and therapy in anorexia nervosa. J. Psychiatr. Res., 30, 401–410, 1996.

    Article  CAS  PubMed  Google Scholar 

  12. Fichter M.M., Quadflieg N., Hedlund S.: Twelve-year course and outcome predictors of anorexia nervosa. Int. J. Eat. Disord., 39, 87–100, 2006.

    Article  PubMed  Google Scholar 

  13. Stanga Z., Field J., Iff S., Stucki A., Lobo D.N., Allison S.P.: The effect of nutritional management on the mood of malnourished patients. Clin. Nutr., 26, 379–382, 2007.

    Article  PubMed  Google Scholar 

  14. Bardone-Cone A.M., Wonderlich S.A., Frost R.O., Bulik C.M., Mitchell J.E., Uppala S., Simonich H.: Perfectionism and eating disorders: current status and future directions. Clin. Psychol. Rev., 27, 384–405, 2007.

    Article  PubMed  Google Scholar 

  15. Holtkamp K., Muller B., Heussen N., Remschmidt H., Herpertz-Dahlmann B.: Depression, anxiety, and obsessionality in long-term recovered patients with adolescent-onset anorexia nervosa. Eur. Child Adolesc. Psychiatry, 14, 106–110, 2005.

    Article  CAS  PubMed  Google Scholar 

  16. Wagner A., Greer P., Bailer U.F., Frank G.K., Henry S.E., Putnam K., Meltzer C.C., Ziolko S.K., Hoge J., McConaha C., Kaye W.H.: Normal brain tissue volumes after long-term recovery in anorexia and bulimia nervosa. Biol. Psychiatry, 59, 291–293, 2006.

    Article  PubMed  Google Scholar 

  17. Hebebrand J., Himmelmann G.W., Herzog W., Herpertz-Dahlmann B.M., Steinhausen H.C., Amstein M., Seidel R., Deter H.C., Remschmidt H., Schafer H.: Prediction of low body weight at long-term follow-up in acute anorexia nervosa by low body weight at referral. Am. J. Psychiatry, 154, 566–569, 1997.

    CAS  PubMed  Google Scholar 

  18. Steiner H., Lock J.: Anorexia nervosa and bulimia nervosa in children and adolescents: a review of the past 10 years. J. Am. Acad. Child Adolesc. Psychiatry, 37, 352–359, 1998.

    Article  CAS  PubMed  Google Scholar 

  19. Bardone-Cone A.M., Sturm K., Lawson M.A., Robinson D.P., Smith R.: Perfectionism across stages of recovery from eating disorders. Int J Eat Disord, 2009.

    Google Scholar 

  20. Kromeyer-Hauschild K., Wabitsch M., Kunze D., Geller D., Geiss H.C., Hesse V., Hippel A., von J., U., Johnsen D., Korte W., Menner K., Müller G., Müller J.M., Niemann-Pilatus A., Remer T., Schaefer F., Wittchen H.-U., Zabransky S., Zellner K., Ziegler A., Hebebrand J.: Perzentile für den Body Mass Index für das Kindesund Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschrift für Kinderheilkunde, 149, 807–818, 2001.

    Article  Google Scholar 

  21. Bachner-Melman R., Zohar A.H., Ebstein R.P.: An examination of cognitive versus behavioral components of recovery from anorexia nervosa. J. Nerv. Ment. Dis., 194, 697–703, 2006.

    Article  PubMed  Google Scholar 

  22. Halmi K.A., Sunday S.R., Strober M., Kaplan A., Woodside D.B., Fichter M., Treasure J., Berrettini W.H., Kaye W.H.: Perfectionism in anorexia nervosa: variation by clinical subtype, obsessionality, and pathological eating behavior. Am. J. Psychiatry, 157, 1799–1805, 2000.

    Article  CAS  PubMed  Google Scholar 

  23. Nilsson K., Sundbom E., Hagglof B.: A longitudinal study of perfectionism in adolescent onset anorexia nervosa-restricting type. Eur. Eat. Disord. Rev., 16, 386–394, 2008.

    Article  PubMed  Google Scholar 

  24. Galusca B., Costes N., Zito N.G., Peyron R., Bossu C., Lang F., Le Bars D., Estour B.: Organic background of restrictive-type anorexia nervosa suggested by increased serotonin 1A receptor binding in right frontotemporal cortex of both lean and recovered patients: [18F]MPPF PET scan study. Biol. Psychiatry, 64, 1009–1013, 2008.

    Article  CAS  PubMed  Google Scholar 

  25. Smoller J.W., Wadden T.A., Stunkard A.J.: Dieting and depression: a critical review. J. Psychosom. Res., 31, 429–440, 1987.

    Article  CAS  PubMed  Google Scholar 

  26. Meehan K.G., Loeb K.L., Roberto C.A., Attia E.: Mood change during weight restoration in patients with anorexia nervosa. Int. J. Eat. Disord., 39, 587–589, 2006.

    Article  PubMed  Google Scholar 

  27. Lu X.Y.: The leptin hypothesis of depression: a potential link between mood disorders and obesity? Curr. Opin. Pharmacol., 7, 648–652, 2007.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Shanley L.J., Irving A.J., Harvey J.: Leptin enhances NMDA receptor function and modulates hippocampal synaptic plasticity. J. Neurosci., 21, RC186, 2001.

    Google Scholar 

  29. Lu X.Y., Kim C.S., Frazer A., Zhang W.: Leptin: a potential novel antidepressant. Proc. Natl. Acad. Sci. U.S.A., 103, 1593–1598, 2006.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Golden N.H., Ashtari M., Kohn M.R., Patel M., Jacobson M.S., Fletcher A., Shenker I.R.: Reversibility of cerebral ventricular enlargement in anorexia nervosa, demonstrated by quantitative magnetic resonance imaging. J. Pediatr., 128, 296–301, 1996.

    Article  CAS  PubMed  Google Scholar 

  31. Muhlau M., Gaser C., Ilg R., Conrad B., Leibl C., Cebulla M.H., Backmund H., Gerlinghoff M., Lommer P., Schnebel A., Wohlschlager A.M., Zimmer C., Nunnemann S.: Gray matter decrease of the anterior cingulate cortex in anorexia nervosa. Am. J. Psychiatry, 164, 1850–1857, 2007.

    Article  PubMed  Google Scholar 

  32. Stamatakis E.A., Hetherington M.M.: Neuroimaging in eating disorders. Nutr. Neurosci., 6, 325–334, 2003.

    Article  PubMed  Google Scholar 

  33. Swayze V.W., 2nd, Andersen A.E., Andreasen N.C., Arndt S., Sato Y., Ziebell S.: Brain tissue volume segmentation in patients with anorexia nervosa before and after weight normalization. Int. J. Eat. Disord., 33, 33–44, 2003.

    Article  PubMed  Google Scholar 

  34. Kingston K., Szmukler G., Andrewes D., Tress B., Desmond P.: Neuropsychological and structural brain changes in anorexia nervosa before and after refeeding. Psychol. Med., 26, 15–28, 1996.

    Article  CAS  PubMed  Google Scholar 

  35. Neumarker K.J., Bzufka W.M., Dudeck U., Hein J., Neumarker U.: Are there specific disabilities of number processing in adolescent patients with Anorexia nervosa? Evidence from clinical and neuropsychological data when compared to morphometric measures from magnetic resonance imaging. Eur. Child Adolesc. Psychiatry, 9, Suppl. 2, II111–121, 2000.

    Article  Google Scholar 

  36. Ahima R.S., Bjorbaek C., Osei S., Flier J.S.: Regulation of neuronal and glial proteins by leptin: implications for brain development. Endocrinology, 140, 2755–2762, 1999.

    CAS  PubMed  Google Scholar 

  37. Matochik J.A., London E.D., Yildiz B.O., Ozata M., Caglayan S., DePaoli A.M., Wong M.L., Licinio J.: Effect of leptin replacement on brain structure in genetically leptin-deficient adults. J. Clin. Endocrinol. Metab., 90, 2851–2854, 2005.

    Article  CAS  PubMed  Google Scholar 

  38. Salbach-Andrae H., Klinkowski N., Lenz K., Pfeiffer E., Lehmkuhl U., Ehrlich S.: Correspondence between self-reported and parent-reported psychopathology in adolescents with eating disorders. Psychopathology, 41, 307–312, 2007. Eating Weight Disord., Vol. 14: N. 4 - 2009 e211

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, CVK, Germany

    N. Schneider, H. Salbach-Andrae, J. V. Merle, E. Pfeiffer, U. Lehmkuhl &  S. Ehrlich

  2. Department for Psychiatry, CCM, Charité — Universitätsmedizin, Berlin, Germany

    J. Hein &  S. Ehrlich

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  1. N. Schneider
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  2. H. Salbach-Andrae
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  3. J. V. Merle
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  7. S. Ehrlich
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Correspondence to S. Ehrlich.

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Schneider, N., Salbach-Andrae, H., Merle, J.V. et al. Psychopathology in underweight and weight-recovered females with anorexia nervosa. Eat Weight Disord 14, e205–e211 (2009). https://doi.org/10.1007/BF03325118

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  • DOI: https://doi.org/10.1007/BF03325118

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