Zaida Agüera

Executive functions profile in extreme eating/weight conditions: from anorexia nervosa to obesity

Background Extreme weight conditions (EWC) groups along a continuum may share some biological risk factors and intermediate neurocognitive phenotypes. A core cognitive trait in EWC appears to be executive dysfunction, with a focus on decision making, response inhibition and cognitive flexibility. Differences between individuals in these areas are likely to contribute to the differences in vulnerability to EWC. The aim of the study was to investigate whether there is a common pattern of executive dysfunction in EWC while comparing anorexia nervosa patients (AN), obese subjects (OB) and healthy eating/weight controls (HC). Methods Thirty five AN patients, fifty two OB and one hundred thirty seven HC were compared using the Wisconsin Card Sorting Test (WCST); Stroop Color and Word Test (SCWT); and Iowa Gambling Task (IGT). All participants were female, aged between 18 and 60 years. Results There was a significant difference in IGT score (F(1.79); p<.001), with AN and OB groups showing the poorest performance compared to HC. On the WCST, AN and OB made significantly more errors than controls (F(25.73); p<.001), and had significantly fewer correct responses (F(2.71); p<.001). Post hoc analysis revealed that the two clinical groups were not significantly different from each other. Finally, OB showed a significant reduced performance in the inhibition response measured with the Stroop test (F(5.11); p<.001) compared with both AN and HC. Conclusions These findings suggest that EWC subjects (namely AN and OB) have similar dysfunctional executive profile that may play a role in the development and maintenance of such disorders.

Association of Irisin with Fat Mass, Resting Energy Expenditure, and Daily Activity in Conditions of Extreme Body Mass Index

FNDC5/irisin has been recently postulated as beneficial in the treatment of obesity and diabetes because it is induced in muscle by exercise, increasing energy expenditure. However, recent reports have shown that WAT also secretes irisin and that circulating irisin is elevated in obese subjects. The aim of this study was to evaluate irisin levels in conditions of extreme BMI and its correlation with basal metabolism and daily activity. The study involved 145 female patients, including 96 with extreme BMIs (30 anorexic (AN) and 66 obese (OB)) and 49 healthy normal weight (NW). The plasma irisin levels were significantly elevated in the OB patients compared with the AN and NW patients. Irisin also correlated positively with body weight, BMI, and fat mass. The OB patients exhibited the highest REE and higher daily physical activity compared with the AN patients but lower activity compared with the NW patients. The irisin levels were inversely correlated with daily physical activity and directly correlated with REE. Fat mass contributed to most of the variability of the irisin plasma levels independently of the other studied parameters. Conclusion. Irisin levels are influenced by energy expenditure independently of daily physical activity but fat mass is the main contributing factor.

Do Men with Eating Disorders Differ from Women in Clinics, Psychopathology and Personality?

OBJECTIVE To determine if male and female eating disorders differ in clinics, psychopathology and personality traits when compared with a healthy group. METHODS Sixty male and 60 female eating disorder individuals (16% anorexia nervosa, 42% bulimia nervosa and 42% eating disorder not otherwise specified), matched for age and diagnostic, were compared with 120 healthy-eating participants (60 male and 60 female participants). All were diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Assessment measures included Eating Disorder Inventory--2, Symptom Checklist--Revised and Temperament and Character Inventory--Revised, as well as other clinical and psychopathological indices. RESULTS Male eating disorder participants reported significant lower laxative abuse (p = 0.020) and significant higher vomiting episodes (p = 0.019) than female eating disorder participants. Differences on drive for thinness, body dissatisfaction and some Symptom Checklist--Revised scales were found across genders in eating disorder participants. Male eating disorder participants scored significantly lower than female participants with eating disorders on harm avoidance, reward dependence and cooperativeness. CONCLUSIONS Although eating disorder clinical features were similar across genders, male eating disorder participants had less body image concern and general psychopathology than female eating disorder participants.

Lifetime substance abuse, family history of alcohol abuse/ dependence and novelty seeking in eating disorders: Comparison study of eating disorder subgroups

Aim:  To assess lifetime substance abuse, family history of alcohol abuse/dependence, and novelty seeking in three different eating disorder groups (anorexia nervosa–restrictive; anorexia nervosa–binge eating/purging; anorexia nervosa to bulimia nervosa).

Association of NTRK3 and its interaction with NGF suggest an altered cross-regulation of the neurotrophin signaling pathway in eating disorders

Eating disorders (EDs) are complex psychiatric diseases that include anorexia nervosa and bulimia nervosa, and have higher than 50% heritability. Previous studies have found association of BDNF and NTRK2 to ED, while animal models suggest that other neurotrophin genes might also be involved in eating behavior. We have performed a family-based association study with 151 TagSNPs covering 10 neurotrophin signaling genes: NGFB, BDNF, NTRK1, NGFR/p75, NTF4/5, NTRK2, NTF3, NTRK3, CNTF and CNTFR in 371 ED trios of Spanish, French and German origin. Besides several nominal associations, we found a strong significant association after correcting for multiple testing (P = 1.04 x 10(-4)) between ED and rs7180942, located in the NTRK3 gene, which followed an overdominant model of inheritance. Interestingly, HapMap unrelated individuals carrying the rs7180942 risk genotypes for ED showed higher levels of expression of NTRK3 in lymphoblastoid cell lines. Furthermore, higher expression of the orthologous murine Ntrk3 gene was also detected in the hypothalamus of the anx/anx mouse model of anorexia. Finally, variants in NGFB gene appear to modify the risk conferred by the NTRK3 rs7180942 risk genotypes (P = 4.0 x 10(-5)) showing a synergistic epistatic interaction. The reported data, in addition to the previous reported findings for BDNF and NTRK2, point neurotrophin signaling genes as key regulators of eating behavior and their altered cross-regulation as susceptibility factors for EDs.

High risk of lifetime history of suicide attempts among CYP2D6 ultrarapid metabolizers with eating disorders

High risk of lifetime history of suicide attempts among CYP2D6 ultrarapid metabolizers with eating disorders

Anger expression in eating disorders: clinical, psychopathological and personality correlates.

The goals of the study were to compare anger expressions in individuals with eating disorders and healthy controls, and to explore the relation among eating disorder symptoms, comorbid psychopathology, personality traits, and impulsive behaviours. Participants comprised 135 eating disorder patients consecutively admitted to our unit and 103 healthy controls. Assessment measures included the Eating Disorders Inventory 2 (EDI-2), Bulimic Investigatory Test Edinburgh (BITE), Symptom Checklist-Revised (SCL-90-R), Social Avoidance Distress Scale (SAD), Temperament and Character Inventory-Revised (TCI-R), State-Trait Anger Expression Inventory 2 (STAXI-2), and other clinical and psychopathological indices. In the control group also the General Health Questionnaire-28 (GHQ-28) was also used. Women with eating disorders obtained significantly higher mean scores than controls on all STAXI-2 scales except for Anger Control. When various purging methods were assessed independently, the frequency of laxative use was associated with anger suppression. Eating disorder symptoms and specific personality traits were positively associated with different forms of anger expression. Finally, patients with higher scores on anger suppression were more likely to report self-harming behaviors. Eating disorder patients may have inadequate anger expression and deficits in coping with anger and frustration. Furthermore, different purging methods may be related to different facets of anger.

ADHD symptomatology in eating disorders: a secondary psychopathological measure of severity?

BackgroundAttention-deficit/hyperactivity disorder (ADHD) has commonly been described in psychiatric disorders. Although several studies have found positive associations between abnormal eating patterns during childhood and ADHD, there is a lack of studies on ADHD and Eating Disorders (ED). The aims of this exploratory study were 1) to assess the ADHD symptoms level in ED and to ascertain whether there are differences among ED subtypes; 2) to analyze whether the presence of ADHD symptoms is associated with more severe eating disorder symptoms and greater general psychopathology; and 3) to assess whether the ADHD symptoms level is associated with specific temperament and character traits.Methods191 female ED patients were included. Assessment was carried out with the EDI-2, ASRS-v1.1, the SCL-90-R and the TCI-R.ResultsThe ADHD symptoms level was similar in bulimia, eating disorder not otherwise specified and binge eating subtypes, and lower in anorexic patients. Obsessiveness and Hostility were significantly positively associated with ADHD symptoms. A path model showed that ADHD was associated with high Novelty Seeking and low Self-Directedness, whereas ED severity was influenced by ADHD severity and low Self-Directedness.ConclusionsBingeing/purging ED subtypes have a high ADHD symptoms level, also related with more severe eating, general and personality psychopathology.

Personality Changes in Bulimia Nervosa after a Cognitive Behaviour Therapy

OBJECTIVES The goals of this study were to evaluate changes in personality traits in outpatients with bulimia nervosa and specific clinical predictors of such personality changes, after cognitive behaviour therapy (CBT). METHOD The sample comprised 100 purging bulimia nervosa outpatients (DSM-IV-TR). Assessment measures included the Eating Disorders Inventory-2, Symptom Check List Revised and Temperament and Character Inventory-Revised, as well as other clinical and psychopathological indices. All measures were administered before and after 22 weeks of group CBT. RESULTS The temperament traits of Harm Avoidance and Reward Dependence and the character traits of Self-Directedness and Self-Transcendence changed after CBT. Pre-post CBT reduction in Eating Disorders Inventory-2 total score predicted the decrease and increase in Harm Avoidance and Self-Directedness, respectively. CONCLUSIONS Results suggest that group CBT in outpatient women settings influence changes in some personality traits, which appear mainly related to an overall improvement in eating pathology.

Male Eating Disorder Patients With and Without Non‐suicidal Self‐injury: A Comparison of Psychopathological and Personality Features

In the present study, we investigated the prevalence and comorbidity of non-suicidal self-injury (NSSI) in male eating disorder (ED) patients. In total, 130 male ED patients completed a list of 10 impulse-control problems (including NSSI), the Eating Disorder Inventory-2, the Symptom Checklist-90-Revised and the Temperament and Character Inventory. Overall, 21% of the male ED patients (n = 27) engaged in at least one type of NSSI, and we did not find significant differences between the ED subtypes. Self-injurious male ED patients showed significantly more severe ED symptoms and more affective, interpersonal and impulse-control problems than ED patients without NSSI. As previously described in female ED, our data confirm the affect regulation and impulse regulation functions of NSSI in male ED patients.