Almut Zeeck

Emotion and eating in binge eating disorder and obesity.

This study compares 20 binge eaters (BED), 23 obese patients (OB) and 20 normal weight controls (CO) with regard to everyday emotions and the relationship between emotions, the desire to eat and binge eating. Modified versions of the Differential Affect Scale and Emotional Eating Scale were used and the TAS-20 and Symptom-Check-List-27 administered to assess overall psychopathology and alexithymia. BED-subjects show a more negative pattern of everyday emotions, higher alexithymia scores and the strongest desire to eat, especially if emotions are linked to interpersonal aspects. The emotion most often reported preceding a binge was anger. Feelings of loneliness, disgust, exhaustion or shame lead to binge eating behaviour with the highest probability.

Amygdala hyperreactivity in restrictive anorexia nervosa

Functional imaging studies had often investigated heterogeneous samples of anorexia nervosa (AN) patients with varying paradigms and methodologies that had resulted in divergent results. The present study aimed to examine these issues by studying a well-defined sample of restrictive AN patients with a disorder-specific paradigm which had been used previously. Subjects showed increased blood oxygen level dependent responses of the cingulate, frontal, insular and parietal cortices. Group comparisons demonstrated increased activity of the right amygdala in the sample of restrictive AN patients. Our results are in support of other recently published functional imaging studies and point to a pivotal role of the right amygdala in AN. Signals of the midcingulum were reduced in comparison to healthy controls. The constellation of increased activity of the amygdala and decreased activity of the cingulate cortex likely represents parts of a negative feedback loop of emotional processing. Disgust ratings correlated with the amygdala signal negatively, which points to the complex role of this structure within eating disorders.

Psychological Treatment for Anorexia Nervosa: A Meta-Analysis of Standardized Mean Change

Background: For the German treatment guidelines for eating disorders, the literature on psychological treatment of anorexia nervosa (AN) was reviewed systematically. As a common meta-analysis of randomized clinical trials proved to be impossible, a review of all available clinical trials was conducted, statistically integrating standardized mean change scores. Research questions comprised differential effects of therapeutic techniques and settings as well as determining which weight gains could be expected. Methods: After an extensive literature search, studies were selected, rated by 3 independent raters. Weight gain as the main outcome criterion was transformed into standardized mean change scores. Effect sizes were checked for homogeneity. Results: 57 studies containing 84 treatment arms and 2,273 patients could be integrated. Studies differed considerably in quality. The strongest bias identified was reporting selectively on completers or failures, versus intention-to-treat samples. No significant differences between effect sizes could be identified concerning treatment setting, technique or patient characteristics. If treatment time is taken into account, inpatient treatment produced a faster weight gain than outpatient treatment. Conclusion: The study describes weight gains which can be reached in outpatient and inpatient settings. It yielded no salient results speaking for a certain therapy technique, setting or procedure. Treatment guidelines for psychological treatment of AN still have to rely on lower level evidence.

The Diagnosis and Treatment of Eating Disorders

BACKGROUND Eating disorders are of major significance both in clinical medicine and in society at large. Anorexia and bulimia nervosa almost exclusively afflict young persons, severely impairing their physical and mental health. The peak ages for these diseases are in late adolescence and young adulthood; patients therefore suffer setbacks both in school and/or in their occupational careers. This scientifically based S3 guideline was developed with the intention of improving the treatment of eating disorders and motivating future research in this area. METHODS The existing national and international guidelines on the three types of eating disorders were synoptically compared, the literature on the subject was systematically searched, and meta-analyses on bulimia nervosa and binge-eating disorder were carried out. 15 consensus conferences were held, as a result of which 44 evidence-based recommendations were issued. RESULTS Anorexia and bulimia nervosa are diagnosed according to the ICD-10 criteria (International Classification of Diseases), binge-eating disorder according to those of the DSM (Diagnostic and Statistical Manual of Mental Disorders). Psychotherapy is the mainstay of treatment for all three disorders, and cognitive behavioral therapy is the form of psychotherapy best supported by the available evidence. The administration of selective serotonin reuptake inhibitors (SSRI) can be recommended as a flanking measure in the treatment of bulimia nervosa only. The evidence does not support any type of pharmacotherapy for anorexia nervosa or binge-eating disorder. Bulimia nervosa and binge-eating disorder can usually be treated on an outpatient basis, as long as they are no more than moderately severe; full-fledged anorexia nervosa is generally an indication for in-hospital treatment. CONCLUSION This guideline contains evidence- and consensus-based recommendations for the diagnosis and treatment of eating disorders. If strictly implemented, it should result in improved care for the affected patients.

Grey matter deficit in long-term recovered anorexia nervosa patients.

OBJECTIVE Cerebral grey matter (GM) reduction has repeatedly been shown in anorexia nervosa (AN). Evidence concerning completeness of GM restitution in recovered patients is contradictory. METHODS Five long-term recovered patients with AN were compared to symptomatic subjects and healthy controls using voxel-based morphometry. Whole brain GM, white matter and cerebrospinal fluid fractions were studied. Additionally, voxels that had shown significant GM reductions in symptomatic patients were investigated. RESULTS Recovered subjects had been severely affected when symptomatic (mean body mass index: 12.1 kg/m²) and were in remission for a very long time period (>5 years). Whole brain tissue fractions did not differ from controls. Regional analysis showed persistent GM volume reduction, in particular of the precuneus. CONCLUSIONS This study further supports the assumption that GM volume restitution is incomplete in subjects, who had previously been severely affected by anorexia nervosa. The meaning of GM reduction in long-term recovered AN patients, that is, its pathophysiological relevance, however, remains unclear. Furthermore, the precise aetiology of GM reduction remains an open question.

Electrocortical Processing of Food and Emotional Pictures in Anorexia Nervosa and Bulimia Nervosa

Objective: To compare the electrocortical processing of food pictures in participants with anorexia nervosa (n = 21), bulimia nervosa (n = 22), and healthy controls (HCs) (n = 32) by measuring the early posterior negativity, an event-related potential that reflects stimulus salience and selective attention. Methods: We exposed these three groups to a rapid stream of high- and low-calorie food pictures, as well as standard emotional and neutral pictures. Results: Event-related potentials in the time range of 220 milliseconds to 310 milliseconds on posterior electrodes differed between groups: patients with eating disorders showed facilitated processing of both high- and low-calorie food pictures relative to neutral pictures, whereas HC participants did so only for the high-calorie pictures. Subjective palatability of the pictures was rated highest by patients with anorexia nervosa, followed by the HC and bulimia nervosa groups. Conclusions: Patients with eating disorders show a generalized attentional bias for food images, regardless of caloric value. This might explain the persistent preoccupation with food in these individuals.ANOVA = analysis of variance; AN = anorexia nervosa; BN = bulimia nervosa; EDs = eating disorders; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; EPN = early posterior negativity; EEG = electroencephalography; ERPs = event-related potentials; fMRI = functional magnetic resonance imaging; high-cal = high-calorie; IAPS = international affective picture system; LPP = late positive potential; low-cal = low-calorie; RSVP = rapid serial visual presentation.

Frontocingular Dysfunction in Bulimia Nervosa when Confronted with Disease‐specific Stimuli

OBJECTIVE Bulimia nervosa (BN) is characterized by dysregulation of impulse control, in other words, uncontrolled eating. Functional neuroimaging studies have been sparse and have used variable methodologies. METHOD Thirteen medication-free female BN patients and 13 female healthy controls were investigated by functional magnetic resonance imaging using a disease-specific food paradigm. Stimuli were rated after the scanning procedure. RESULTS Bulimia nervosa patients showed increased fear ratings and a trend for increased disgust. Magnetic resonance imaging data of 10 BN patients could be analysed. Three BN patients had to be excluded from the analysis because of minimal blood oxygen level dependent signals. Compared with healthy controls, BN patients showed less activation of the anterior cingulate cortex, which extended into the lateral prefrontal cortex. Furthermore, the right temporal pole showed decreased reactivity. DISCUSSION This study substantiates a key role of lateral prefrontal dysfunction in BN, a brain region involved in impulse control. Furthermore, the anterior cingulate cortex, which plays a key role in emotion processing, is dysfunctional. A major limitation of this study is the small sample size.

Is brief psychodynamic psychotherapy in primary fibromyalgia syndrome with concurrent depression an effective treatment? A randomized controlled trial

OBJECTIVE There are no studies investigating the efficacy of short-term psychodynamic psychotherapy in primary fibromyalgia syndrome (FMS). We conducted a randomized controlled trial evaluating an adapted form of individual short-term psychodynamic psychotherapy (ASTPP) versus primary care management (TAU). The study focused on FMS patients with psychiatric comorbidity. METHODS Forty-six female patients with FMS and an International Classification of Diseases, 10th Revision diagnosis of a comorbid depression or anxiety disorder were recruited in a hospital setting. Participants were randomized to receive either ASTPP (25 sessions, 1 session/week) or TAU (4 consultations/6 months). Outcome measures included the Fibromyalgia Impact Questionnaire (FIQ), the Hospital Anxiety and Depression Scale (HADS), the Pain Disability Index, the Symptom Checklist 27 and the health-related quality of life. Primary endpoints of the outcome assessment were the FIQ total score and the HADS depression scale at 12-month follow-up. RESULTS Both treatments were effective in reducing the FIQ total score (ES=0.56 and ES=0.75, respectively). Intent-to-treat analyses failed to provide evidence suggesting a marked superiority of individual psychodynamic psychotherapy as compared to TAU. CONCLUSIONS A high-standard routine treatment focusing on the improvement of health behavior and including antidepressant and analgesic medication is equally effective as a short-term individual psychodynamic psychotherapy in improving fibromyalgia-related symptoms.

Association study in eating disorders: TPH2 associates with anorexia nervosa and self induced vomiting

Twin studies suggest that genetic factors play a substantial role in anorexia nervosa (AN) and self‐induced vomiting (SV), a key symptom that is shared among different types of eating disorders (EDs). We investigated the association of 25 single nucleotide polymorphisms (SNPs), capturing 71–91% of the common variance in candidate genes, stathmin (STMN1), serotonin receptor 1D (HTR1D), tryptophan hydroxylase 2 (TPH2) and brain‐derived neurotrophic factor (BDNF), with AN and EDs characterized by regular SV. The first allele frequencies of all the SNPs were compared between a Dutch case group (182 AN, 149 EDs characterized by SV) and 607 controls. Associations rendering P‐values < 0.05 from this initial study were then tested for replication in a meta‐analysis with two additional independent ED case–control samples, together providing 887 AN cases, 306 cases with an ED characterized by SV and 1914 controls. A significant effect for the minor C‐allele of tryptophan hydroxylase 2 rs1473473 was observed for both AN [odds ratio (OR) = 1.30, 95% CI 1.08–1.57, P < 0.003] and EDs characterized by SV (OR = 1.52, 95% CI 1.28–2.04, P < 0.006). In the combined case group, a dominant effect was observed for rs1473473 (OR = 1.38, 95% CI 1.16–1.64, P < 0.0003). The meta‐analysis revealed that the tryptophan hydroxylase 2 polymorphism rs1473473 was associated with a higher risk for AN, EDs characterized by SV and for the combined group.