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Background: This study explored state-related tendencies in DNA methylation in people with anorexia nervosa. Methods: We measured genome-wide DNA methylation in 75 women with active anorexia nervosa (active), 31 women showing stable remission of anorexia nervosa (remitted) and 41 women with no eating disorder (NED). We also obtained postintervention methylation data from 52 of the women from the active group. Results: Comparisons between members of the active and NED groups showed 58 differentially methylated sites (Q < 0.01) that corresponded to genes relevant to metabolic and nutritional status (lipid and glucose metabolism), psychiatric status (serotonin receptor activity) and immune function. Methylation levels in members of the remitted group differed from those in the active group on 265 probes that also involved sites associated with genes for serotonin and insulin activity, glucose metabolism and immunity. Intriguingly, the direction of methylation effects in remitted participants tended to be opposite to those seen in active participants. The chronicity of Illness correlated (usually inversely, at Q < 0.01) with methylation levels at 64 sites that mapped onto genes regulating glutamate and serotonin activity, insulin function and epigenetic age. In contrast, body mass index increases coincided (at Q < 0.05) with generally increased methylation-level changes at 73 probes associated with lipid and glucose metabolism, immune and inflammatory processes, and olfaction. Limitations: Sample sizes were modest for this type of inquiry, and findings may have been subject to uncontrolled effects of medication and substance use. Conclusion: Findings point to the possibility of reversible epigenetic alterations in anorexia nervosa, and suggest that an adequate pathophysiological model would likely need to include psychiatric, metabolic and immune components., Introduction Anorexia nervosa can devastate medical, psychological and social adjustments, and despite treatment advances, only about half of people with the condition achieve full remission after 10 or more years. [...]

Background: Previous research has shown that many people experience a temporary worsening of mood following acute tryptophan depletion (ATD) and that concurrent use of serotonergic medications may influence such mood responses. We investigated mood and other consequences of ATD in women with bulimia nervosa who were or were not using concurrent serotonergic medications compared with women without bulimia. Methods: Women self-referred for treatment of bulimia who were either not currently using psychoactive medications (n= 26) or who were using serotonin reuptake inhibitor medications exclusively (n= 13), as well as medication-free normaleater control women (n= 25) completed interviews and questionnaires assessing eating and comorbid psychopathology and then participated in an ATD procedure involving balanced and tryptophan-depleted conditions. Results: In the tryptophan-depleted condition, the groups displayed similar and significant decrements in plasma tryptophan levels and mood. Women with bulimia who were using serotonin reuptake inhibitors, but not the other groups, also reported an increased urge to binge eat in the tryptophan-depleted condition. Limitations: Application of medication in participants with bulimia was not random. Conclusion: Acute reductions in serotonin availability produced similar mood-reducing effects in bulimic and nonbulimic women. To the extent that ATD affected subjective experiences pertinent to eating (i.e., urge to binge eat), such effects appeared to depend upon ATD-induced competition with the therapeutic effects of serotonergic medications., Introduction Bulimia nervosa has been associated with alterations in central serotonin (5-HT) function, (1) thought to implicate constitutional (e.g., hereditary) influences (2-5) and state-related (e.g., dietary) factors. (2,6) Whereas pertinent [...]

Background: Low-function alleles of the serotonin transporter promoter polymorphism (5HTTLPR) have been linked to various psychopathological entities, especially in individuals exposed to prior stressors. In women with bulimic syndromes, we [...]

Past research has suggested that negative affect may be a causal factor for eating disordered behaviors. More specifically, research has shown that anger appears to be one aspect of negative affect that is particularly relevant in bulimic patients. Previous studies have also shown that the relationship between negative affect and eating disordered behaviors may partially depend upon personality variables such as impulsivity. The present study examined whether the relationship between anger and eating disordered behaviors is moderated by impulsivity. Subjects completed an ecological momentary assessment (EMA) protocol for an average of 2 weeks. Findings revealed that overall antecedent anger level and the variability of antecedent anger predicted binge-eating episodes and that these relationships were moderated by participants' level of impulsivity. These findings suggest that personality variables impact the way that anger and eating behaviors relate. They also suggest that the variability of antecedent anger may be a fruitful avenue for future research for those interested in causal variables associated with bulimia nervosa. Keywords. Mood; Anger; Impulsivity; Bulimia; Eating disorder

The relationship between impulsivity and compulsivity in patients with bulimia nervosa (BN) is investigated. Impulsivity and compulsivity can coexist in BN patients and that both traits may provide useful information about comorbid problems in women with BN.

The implications of the 5-hydroxytryptamine (5-HT) transporter gene (5HTTLPR) allele for eating symptoms, psychopathologic traits and platelet [3H-] paroxetine binding in 59 women with bulimic spectrum syndromes are investigated. The results showed proneness to impulsivity, affective dys-regulation and reduced central 5HTTLPR polymorphism.

Research indicates that women with eating disorders exhibit a higher degree of body esteem attribution than women without eating disorders. Body esteem attribution is the assignment of positive outcomes to personal appearance, such as 'I believe my appearance will help me get asked out.'

It is important to determine what psychopathological characteristics in bulimic syndromes are state-related disturbances, linked only with the actively bulimic state, and what characteristics are trait disturbances, existing whether the patient is in an active phase of eating disorder or not. It has been found that psychopathological features characteristic of active bingers seem to differ from features characteristic of such cases when they are in remission. The latter features are seen as trait tendencies. If depression and anxiety are frequently state disturbance in bulimic syndromes, such symptoms may often resolve with the resolution of eating disorder.

This study used a 6- to 22-day experience-sampling procedure to test for hypersensitivity to social interactions in bulimic individuals. Ratings on daily social interactions, self-concepts, moods, and eating behaviors from 55 actively bulimic, 18 formerly bulimic, and 31 noneating-disordered women were obtained. Hierarchical linear modeling analyses showed negative social interactions to be associated with significant increases in self-criticism (SC) and deteriorations in mood in all participants. However, bulimic participants (active or in remission) showed larger increases in SC following negative social interactions than did normal eaters (and thus seemed to be hypersensitive to interpersonal experiences). Additional analyses indicated that binge episodes tended to be preceded by poorer than average social experiences, self-concepts, and moods and followed by deteriorations in self-concept, mood, and social perception. The authors discuss possible perpetuating influences of interpersonal sensitivity in bulimic syndromes.

The trait of narcissism in people with eating disorders (ED) was examined. The personality traits of subjects with ED, with another psychiatric disturbance and without apparent disturbance, were measured using selected subscales from the Dimensional Assessment for Personality Pathology. This was to test the hypotheses that narcissism should load more heavily in ED subjects, and that the level of narcissism should be similar for restricter and binger/purger patients. It was found that ED patients exhibited similar tendencies toward narcissism regardless of differences in ED types.

A dual-process family model reveals that dysfunctional family environment predisposes high school adolescent girls to the development of eating and psychiatric pathology, through two interrelated pathways. The model incorporates dysfunctional family relationships and self-concept deficits. Family preoccupation with appearance and weight directly effects body dissatisfaction and eating pathology. Family dysfunction directly affects the negative self-esteem, and indirectly affects eating and psychiatric symptoms, through negative self-esteem.

The comorbidity of Axis-II personality disorder (PD) in bulimic patients has stronger impact on unfavourable outcomes in psychiatric symptoms than in eating symptoms. Bulimic patients with borderline PDs show more severe generalized psychiatric symptoms than those with other PDs during both treatment and long-term posttreatment follow ups. This difference between borderlines and nonborderlines is less significant with regard to outcome of bulimic symptoms. Theoretical and clinical implications of the association between eating and psychiatric symptoms, and Axis-II PDs are discussed.

Familial specificities and tendencies of psychopathological traits are examined in relation to familial eating concerns. Eating concerns are found to be independent of generalized psychopathological traits. Variations on general psychopathology are represented by the factors of narcistic traits, affective instability, and compulsive and emotional constriction. Heritability of these psychopathological factors is not established, but there is a suggestion of familial tendency.

The family may be more important in the transmission of psychopathology than in the transmission of eating disorders per se. The study compared patients from an eating disorders clinic, patients with psychiatric problems warranting therapy and normal controls. Parental affective problems were more likely to show up in children than eating disorders. The role of the family in eating disorder transmission may thus be that of transmitting psychopathology which makes one more vulnerable to eating disorders, not transmitting the eating disorders per se.

Affects and states of self-awareness of individuals before they indulged in binge eating were monitored with a view to getting an insight into the binge eating antecedents among people with bulimic disorder.

The association between eating disorders (EDs) and various component dimensions of the impulsivity construct are examined. The results suggest that binge-eating behavior coincides with problems of response inhibition, whereas a risk-taking attitude might be a unique characteristic of individuals with bulimia nervosa.

A study was conducted to establish the relation linking dietary restraint to urges to binge and actual binge eating through preprogrammed computers monitoring eating episodes, dietary restraints and binge cravings in a group of women over a period of time. Results revealed dietary restraint to be a contributing factor to binge eating, though not necessarily leading to binge episodes.

Research suggests an association between psychopathologic traits and the likelihood of abuse, especially when women were abused as children and adults. Bulimic women reported significantly higher abuse rates than nonbulimic women, and more severe abuse often produced severe cases of bulimia.

Thirty-one eating-disordered (ED) women and 11 normal women completed tests of sex-role identity, dysfunctional cognitions, and body image. Anorexics, not bulimics, exhibited body-image distortion. All EDs (distorters and nondistorters) showed 'hyperfeminine' identifications. Maladaptive cognitions were present in all EDs, but more marked in 'overestimators.' Body weight predicted BID better than other measures of eating pathology, which suggests important effects of weight per se in producing BID.

Dietary Control is generally linked with Urge to Binge in sufferers of bulimic syndromes. However, results in particularly impulsive individuals indicate that Dietary Control and Urge to Binge are quite desynchronous or randomly connected. The apparent lack of a connection between Dietary Control and Urge to Binge observed in impulsive people could have significant theoretical implications. It is suggested that impulsive bulimics may not respond well to interventions focused on dietary restraint.

Anorexia nervosa is a multiply determined syndrome, thought to require integrated, multimodal treatment. In this article, we discuss the place of psychodynamically inspired psychotherapy techniques in the treatment of Anorexia Nervosa, and attempt to provide a practical heuristic for the application of such techniques with anorexic clients. Our recommendations for therapy emphasize confrontation of interpersonal patterns arising within the therapeutic dyad and linkage of these patterns to parallel adaptations that structure the client's generalized patterns of coping and eating symptoms. Case vignettes, drawn from different clinical contexts, are used to illustrate dynamic themes that frequently emerge in psychotherapeutic work with anorexic clients, and techniques that use interactions that occur in the therapeutic relationship to (i) expose implicit metaphors between interpersonal adaptations and eating symptoms, and (ii) balance against the intensity of anorexic preoccupations.