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Purpose: Recent studies hypothesized that sexual dysfunctions represent not just complications of eating disorders (EDs), rather they should be attributed to the core psychopathology of these disorders. Therefore, disorders of the embodiment and insecure attachment may play a role in maintaining an abnormal sexual functioning, given their known relations with core ED features. The aim of the study was to investigate the relationship between sexual dysfunctions and both disorders of the embodiment and attachment style in people with anorexia nervosa (AN)., Methods: 111 adult women with AN and 120 healthy subjects completed the Symptom Checklist-90, Eating Disorder Examination Questionnaire, Identity and Eating Disorders, Attachment Style Questionnaire and the Childhood Trauma Questionnaire-Short Form., Results: Patients reported worse scores than controls in all areas assessed. In patients, low sexual desire was found to be associated with general and ED-specific psychopathology, and with disorders of embodiment and attachment style. Sexual dysfunctions had no associations with traumatic experiences. Dietary restriction showed an association with low sexual desire through embodiment disorder and Discomfort with Closeness, as confirmed by the serial mediation model., Conclusion: The present study suggests that disorders of embodiment maintained by pathological eating behaviours have a key role in the development of sexual dysfunctions in EDs, through the compromise of intimacy., Level of Evidence: Level III, cross-sectional study with comparisons between cases and controls.

Background: Anorexia nervosa (AN) is the psychiatric disorder with the highest mortality rate, with a standard mortality ratio of 5.86. Despite the large use of psychotropic drugs in the clinical setting, Food and Drug Administration has not approved any psychoactive treatment for AN., Aims: The aim of this study was to perform an updated systematic review and meta-analysis of published randomized controlled trials (RCTs) investigating psychopharmacological treatment in acute-phase AN., Methods: The present paper follows the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. An extensive literature search was performed. All RCTs enrolling patients with acute-phase AN, comparing at least one psychotropic drug with another drug, placebo, treatment-as-usual or no treatment were included. The main outcome was the effect of psychoactive drugs on body mass index (BMI); data on psychopathological outcomes were also collected when available., Results: A total of 19 RCTs met all specified criteria. Of these, 11 were excluded from quantitative analyses. Of the eight studies included in the meta-analyses, five reported data on BMI, showing no significant difference between olanzapine and placebo for weight recovery. No significant result was found for AN psychopathology, depressive and anxious symptoms for any of the molecules studied., Conclusions: RCTs published in this field display methodological biases, low sample sizes and short follow-up periods. Further research efforts are needed in this field as no evidence has been demonstrated for the use of any psychotropic drug in acute-phase AN neither for weight recovery, nor for comorbid psychiatric symptoms.

The co-occurrence of gender dysphoria and anorexia nervosa has been described in the scientific literature. This paper presents two adolescents with gender dysphoria and pathological eating behaviors and questions with longitudinal observations the clinical meaning of anorexia nervosa symptoms (e.g., restricting eating behaviors and fear of gaining weight) in adolescents with gender dysphoria. Both received psychological evaluations at different times: at first admission to the gender dysphoria clinic (T0) and 6 months after starting treatment with gonadotropin-releasing analogues (GnRHa; T1). In both cases, treatment with GnRHa not only improved psychological functioning, but also resolved pathological eating behaviors. In fact, both adolescents reported quick restoring of healthy food habits with restricting eating behaviors as well as intensive exercise no longer needed after treatment with GnRHa. Therefore, pathological eating behaviors (e.g., food avoidance and weight loss) could be assessed as a dysfunctional coping strategy adopted to gain control over a body developing in an unwanted direction and to block irreversible physical pubertal changes. This psychopathological conceptualization of pathological eating behaviors in adolescents with gender dysphoria stresses the importance of providing, in selected cases, early medical intervention such as pubertal suppression with GnRHa. Mental health professionals should therefore perform a specific and detailed assessment on gender identity within the evaluation of apparent eating disorders in adolescents. Restrictive eating behaviors as well as the intense fear of gaining weight or of becoming fat may, in fact, be considered secondary to a gender dysphoria diagnosis instead of anorexia nervosa symptoms.

Introduction: Anorexia Nervosa (AN) presents the highest mortality rate among psychiatric disorders, with a standard mortality ration of 5.86 and one in five deaths in AN patients is by suicide. Despite the large use of psychotropic drugs in AN, to date, Food and Drug Administration has not approved any psychoactive treatment forAN. Objectives: To perform a systematic review and meta-analysis of published Randomized Controlled Trials investigating psychopharmacological treatment of AN, in order to define their potential efficacy and their clinical use. Methods: The reporting of this meta-analysis follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. An extensive literature search was performed. All RCTs enrolling patients with AN, comparing at least one psychotropic drug with another drug, placebo, Treatment-As-Usual (TAU) or no treatment, were included. The main outcome was the effect of psychoactive drugs on general and AN specific psychopathology, and on body mass index. Results: Figure 1 reports the studies selection process. Of the seven studies included in the meta-analysis, five showed no significant effect between olanzapine and placebo for weight recovery. No significant result was found for ANs psychopathology, depressive and anxious symptoms for every molecule studied. Conclusions: In the last years no RCT has been published on this topic and none of the novel drugs released have been studied. To date, there is no evidence for the use of any psychotropic drug inAN for weight recovery and for any comorbid psychiatric symptom. [ABSTRACT FROM AUTHOR]

It has been hypothesized that sexual dysfunctions in Anorexia Nervosa (AN) patients should be attributed to the core psychopathology of this disorder rather than being considered as merely complications of underweight and of hormonal changes. The following questionnaires were administered: Eating Disorder Examination Questionnaire (EDE-Q), Identity and Eating Disorders (IDEA), Female Sexual Function Index (FSFI), Attachment Style Questionnaire (ASQ) and Symptom Checklist-90-R (SCL-90-R). In patients sexual desire resulted to be inversely associated with EDE-Q total-score, IDEA total score and discomfort with closeness. [Extracted from the article]