Tamara Pryor

Substance use among women with eating disorders

OBJECTIVE The results of past research suggest that bulimics are more likely than anorexics to engage in substance use, and that binge eating and/or purging may be an indicator of increased likelihood of substance use. We further investigated substance use among women with eating disorders. METHOD We compared women with anorexia nervosa (n = 134) to women with bulimia nervosa (n = 320) with regard to history of substance use and investigated potential relationships between eating disorder symptom presentation and substance use. RESULTS Even after controlling for age and eating disorder symptom severity, women with bulimia nervosa were more likely than those with anorexia nervosa to have used alcohol, amphetamines, barbituates, marijuana, tranquilizers, and cocaine. Independent of diagnostic category, severity of caloric restriction was predictive of amphetamine use, severity of binge eating was predictive of tranquilizer use, and severity of purging was predictive of alcohol, cocaine, and cigarette use. DISCUSSION Results are discussed in relation to the results of past research and with an emphasis on the importance of considering eating disorder symptom presentation in addition to formal eating disorder diagnosis.

Body dissatisfaction, bulimia, and depression among women: the mediating role of drive for thinness.

OBJECTIVE Past research has called into question the apparent relationship between body dissatisfaction and bulimia among women once effects of depression are statistically controlled. We further investigated interrelations among body dissatisfaction, depression, and bulimia, as well as considered individual differences in drive for thinness, within two samples of young adult women. METHOD The first sample included women diagnosed with anorexia nervosa (n = 91) or bulimia nervosa (n = 142), whereas the second sample included college student women (N = 228). Respondents completed self-report measures of bulimia, drive for thinness, negative affect, and body dissatisfaction. RESULTS At the univariate level, all of the above constructs were significantly related to body dissatisfaction. In multiple regression analyses using depression and bulimia as predictors of body dissatisfaction, both were uniquely related to body dissatisfaction. These findings were similar to the results of previous research. However, when drive for thinness was added to the regression equations, drive for thinness was a unique predictor of body dissatisfaction whereas bulimia was not (neither was depression among college women). DISCUSSION Bulimia, depression, and body dissatisfaction may be the results of incorporation of cultural standards regarding thinness, hence the apparent relationships among these variables. The role of drive for thinness in the pathogenesis of depression and body dissatisfaction among women needs to be investigated further.

Heightened sensitivity to reward and punishment in anorexia nervosa

OBJECTIVE The objective of this study is to test whether females with anorexia nervosa (AN) have increased sensitivity to punishing or rewarding stimuli, behaviors that could drive high self-control and anxious, avoidant behaviors. METHOD Sixty-four females completed the study: 33 control females (CFs, mean age 19.7 years) and 31 females with AN (mean age 19.6 years). Participants completed diagnostic exams, questionnaires for eating disorder severity and personality, and the Sensitivity to Punishment/Sensitivity to Reward Questionnaire (SPSRQ). RESULTS Females with AN scored higher than CFs on SPSRQ sensitivity to punishment (p < 0.00001) and sensitivity to reward (p = 0.005). Females with AN without anxiety or depression continued to have increased SPSRQ scores compared to CFs. DISCUSSION This is the first study comparing the SPSRQ in females with AN and CFs. Results suggest that reward and punishment sensitivity are increased in females with AN and could be potential trait markers. It is possible that harm-avoidant, anxious behaviors in females with AN are related to this heightened sensitivity.

Altered fimbria-fornix white matter integrity in anorexia nervosa predicts harm avoidance

The eating disorder anorexia nervosa (AN) is associated with high anxiety. The brain mechanisms that drive those behaviors are unknown. In this study we wanted to test whether brain white matter (WM) integrity is altered in AN, and related to heightened anxiety. Sixteen adult women with AN (mean age 24 ± 7 years) and 17 healthy control women (CW, mean age 25 ± 4 years) underwent diffusion tensor imaging (DTI) of the brain. The DTI brain images were used to calculate the fractional anisotropy (FA) of WM tracts, which is a measure for WM integrity. AN individuals compared to CW showed clusters of significantly reduced FA (p<0.05, corrected) in the bilateral fimbria-fornix and the fronto-occipital fasciculus, as well as the posterior cingulum WM. In the AN group, Harm Avoidance was predicted by FA in the left and right fimbria-fornix. Those findings were not due to WM volume deficits in AN. This study indicates that WM integrity is abnormal in AN in limbic and association pathways, which could contribute to disturbed feeding, emotion processing and body perception in AN. The prediction of Harm Avoidance in AN by fimbria-fornix WM integrity suggests that this pathway may be mechanistically involved in high anxiety in AN.

Heightened fear of uncertainty in anorexia and bulimia nervosa.

OBJECTIVE To test whether intolerance of uncertainty (IU) is related to eating disorder (ED) pathology. METHOD Thirty individuals with anorexia nervosa (AN), 19 with bulimia nervosa (BN), and 28 healthy control women (CW) completed the Intolerance of Uncertainty Scale (IUS). RESULTS AN and BN groups showed higher IU compared with CW. In AN and BN, Harm Avoidance and Depression scores were positively correlated with IU. In AN but not BN, IU was related positively to Drive for Thinness and Body Dissatisfaction. DISCUSSION Elevated IU is associated with AN and BN. Anxious traits may be inherent in EDs and IU could be a developmental factor contributing to anxiety, mood, and ED behavior in AN and BN.

The sexual experience of women diagnosed with anorexia nervosa or bulimia nervosa

OBJECTIVE Women with bulimia nervosa generally have reported greater sexual activity and experience relative to women with anorexia nervosa. However, past research has been based on small samples and has not controlled for potential confounding variables or symptom severity. We further investigated sexual experience among women diagnosed with an eating disorder. METHODS Women evaluated in an outpatient eating disorders program, and subsequently diagnosed with either anorexia nervosa (n = 131) or bulimia nervosa (n = 319), completed the Diagnostic Survey for Eating Disorders-Revised (DSED-R) at intake. Sexual experience variables (masturbation, coitus, sexual satisfaction), as well as control variables (age, weight, and menarche) and measures of symptom severity, were derived from the DSED-R. Logistic regression analyses were used to predict sexual experience. RESULTS After controlling for relevant covariates, bulimics were more likely than anorexics to have engaged in sexual intercourse. Masturbation experience, as well as self-ratings of current sexual satisfaction, were inversely related to degree of restriction of caloric intake, particularly among women with anorexia nervosa. When compared to anorexics, bulimics reported greater sexual interest and earlier age of first coitus. DISCUSSION Coitus (sexual activity involving a partner) was related to eating disorder diagnosis independent of symptoms, whereas masturbation (self-focused sexual activity) was related to caloric restriction for the sample as a whole and anorexia nervosa patients in particular. These relationships between sexual experience and eating disorder symptoms and diagnosis may illuminate the personality features of women with anorexia nervosa versus bulimia nervosa as well as the functional role of caloric restriction.

Laxative abuse among women with eating disorders: An indication of psychopathology?

OBJECTIVE The results of the scant research on laxative abuse among women with eating disorders suggest that laxative abuse is a diagnostic indicator of greater psychopathology. We further investigated the relationship of history of laxative abuse to eating and related attitudes, impulsivity, and personality pathology. METHOD Women assessed in an outpatient clinical setting and diagnosed with anorexia nervosa, binge-eating/purging type (n = 51) or bulimia nervosa, purging type (n = 280) completed measures of laxative abuse, eating and related attitudes, and personality psychopathology at intake. RESULTS More than one-half of both groups had abused laxatives at some point. History of laxative abuse was unrelated to eating disorder diagnostic category, current age or body weight, history of stealing, self-induced injury, having attempted suicide, interpersonal distrust, maturity fears, or compulsive or dependent personality features. Compared to nonabusers, laxative abusers demonstrated more perfectionism and avoidant personality features. Significant statistical interactions among variables revealed that bulimia nervosa patients who had abused laxatives exhibited the most pathological scores on scales measuring drive for thinness, body dissatisfaction, ineffectiveness, lack of interoceptive awareness, and passive-aggressive and borderline personality features. Anorexia nervosa patients who had abused laxatives had the highest scores on the histrionic scale. DISCUSSION Results are discussed with regard to past research and clinical implications. We propose that laxative abuse among eating disordered women may serve different functions depending on diagnosis and underlying personality dynamics.

Orbitofrontal Cortex Volume and Brain Reward Response in Obesity

Background/objectives:What drives overconsumption of food is poorly understood. Alterations in brain structure and function could contribute to increased food seeking. Recently, brain orbitofrontal cortex (OFC) volume has been implicated in dysregulated eating but little is known how brain structure relates to function.Subjects/methods:We examined obese (n=18, age=28.7±8.3 years) and healthy control women (n=24, age=27.4±6.3 years) using a multimodal brain imaging approach. We applied magnetic resonance and diffusion tensor imaging to study brain gray and white matter volume as well as white matter (WM) integrity, and tested whether orbitofrontal cortex volume predicts brain reward circuitry activation in a taste reinforcement-learning paradigm that has been associated with dopamine function.Results:Obese individuals displayed lower gray and associated white matter volumes (P<0.05 family-wise error (FWE)- small volume corrected) compared with controls in the orbitofrontal cortex, striatum and insula. White matter integrity was reduced in obese individuals in fiber tracts including the external capsule, corona radiata, sagittal stratum, and the uncinate, inferior fronto-occipital, and inferior longitudinal fasciculi. Gray matter volume of the gyrus rectus at the medial edge of the orbitofrontal cortex predicted functional taste reward-learning response in frontal cortex, insula, basal ganglia, amygdala, hypothalamus and anterior cingulate cortex in control but not obese individuals.Conclusions:This study indicates a strong association between medial orbitofrontal cortex volume and taste reinforcement-learning activation in the brain in control but not in obese women. Lower brain volumes in the orbitofrontal cortex and other brain regions associated with taste reward function as well as lower integrity of connecting pathways in obesity (OB) may support a more widespread disruption of reward pathways. The medial orbitofrontal cortex is an important structure in the termination of food intake and disturbances in this and related structures could contribute to overconsumption of food in obesity.

Body dissatisfaction and sexuality among women with bulimia nervosa

OBJECTIVE Past research and clinical observations have implicated sexuality as a factor involved in eating disorders. Yet little research has been conducted on possible links between body image and sexuality. We investigated such relationships within a large sample of women with bulimia nervosa. METHOD A sample of adult women (N = 221) diagnosed with bulimia nervosa, purging type, completed a widely used measure of body dissatisfaction and answered questions about basic sexual experiences (coital and masturbation experience, age of onset of these activities, and self-rated satisfaction with current sexual activity). RESULTS After controlling for age, age of onset of menses, and current body size, body dissatisfaction was unrelated to coital experience. However, even after controlling for these relevant covariates, current body dissatisfaction was predictive of lower incidence, and later onset, of masturbation. Current body dissatisfaction was marginally related (p < .10) to self-rated satisfaction with ones current sex life. DISCUSSION Results are discussed with regard to past research, directions for future research, and clinical implications.

Greater Insula White Matter Fiber Connectivity in Women Recovered from Anorexia Nervosa

Anorexia nervosa is a severe psychiatric disorder associated with reduced drive to eat. Altered taste-reward circuit white matter fiber organization in anorexia nervosa after recovery could indicate a biological marker that alters the normal motivation to eat. Women recovered from restricting-type anorexia (Recovered AN, n=24, age=30.3±8.1 years) and healthy controls (n=24, age=27.4±6.3 years) underwent diffusion weighted imaging of the brain. Probabilistic tractography analyses calculated brain white matter connectivity (streamlines) as an estimate of fiber connections in taste-reward-related white matter tracts, and microstructural integrity (fractional anisotropy, FA) was assessed using tract-based spatial statistics. Recovered AN showed significantly (range P<0.05–0.001, Bonferroni corrected) greater white matter connectivity between bilateral insula regions and ventral striatum, left insula and middle orbitofrontal cortex (OFC), and right insula projecting to gyrus rectus and medial OFC. Duration of illness predicted connectivity of tracts projecting from the insula to ventral striatum and OFC. Microstructural integrity was lower in Recovered AN in most insula white matter tracts, as was whole-brain FA in parts of the anterior corona radiata, external capsule, and cerebellum (P<0.05, family-wise error-corrected). This study indicates higher structural white matter connectivity, an estimate of fibers connections, in anorexia after recovery in tracts that connect taste-reward processing regions. Greater connectivity together with less-fiber integrity could indicate altered neural activity between those regions, which could interfere with normal food-reward circuit function. Correlations between connectivity and illness duration suggest that connectivity could be a marker for illness severity. Whether greater connectivity can predict prognosis of the disorder requires further study.