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Background Hospitalization is rare in anorexia nervosa (AN) and local application of indications is heterogeneous. However, no study has evaluated the effect of these different treatment modalities on the mean length of stay. Our objective was to describe the context and modalities of a wide range of hospital care programs offered to patients with anorexia nervosa in eleven specialized French psychiatric centers for patients from childhood to adulthood. This work was carried out within the framework of the EVHAN (Evaluation of Hospitalization for AN, Eudract number: 2007-A01110-53, registered in Clinical trials) research program. The EVHAN program comprises five main lines: weight objectives at discharge, the practice or not of a separation period, the use of clear nutritional dietary objectives (cognitive/behavioral), the intensity of family involvement in treatment, and the existence or absence of a stabilization phase before ending inpatient treatment. These main lines will make it possible to study the impact of treatment modalities on the future of patients in the short and medium term (at discharge and at 1-year follow-up). Methods The eleven centers are located in France (Bordeaux, Nantes, Paris and Ile-de-France, Rouen and Saint-Etienne). Various staff members (psychiatrists, somatic doctors, nurses, dieticians, psychologists) from each center were interviewed using a semi-structured questionnaire. Data on operating modalities and context of care were collected and analyzed. Results Four of the eleven centers were exclusively child/adolescent centers, and seven of 11 were adolescent (from 11, 13 or 16 years) and young adult centers. All centers offered a graduated approach from outpatient to full hospitalization. The majority had a number of beds allocated for patients with eating disorders. The criteria for hospitalization were homogeneous with respect to somatic and/or psychic severity prefiguring the consensus criteria defined by the French Health Authority (HAS) in 2010. Child/adolescent units used the weight curve to set weight objectives at discharge (between the 10th and 50th percentiles). Most adult units used weight objectives at discharge corresponding to a body mass index between 17 and 20kg/m2. Nine centers used a written or oral care contract. One unit did not separate the patient from her/his usual environment, the others had a practice gradient of partial separation and total separation times. These were either short, lasting a maximum of 3 weeks, or long, lasting more than 3 weeks. Conversely, patients were not isolated within the unit, and benefited from a rich social life, depending on her/his physical condition. The patient's family was in contact with the team and fully supported. The longest periods of separation involved adolescents and adults. Nutritional support varied from a group approach (meals in the dining room, standardized meals of the care center) to very individualized approaches within a specific framework. All the units reported meeting with families at least once during the hospitalization; with the patient's parents for child/adolescent patients and/or unmarried patients and with the husband/wife for married patients. The majority of the centers requested a phase of weight stabilization, whatever the age before hospital discharge. Conclusion There is international and national consensus regarding the indications for hospitalization, and the main lines of multidisciplinary care to be developed within this framework. However, local application of these indications was heterogeneous resulting in diverse modalities of hospital care for anorexia nervosa in France. Specialized teams have developed management strategies arising from their "team culture". The complexity of the anorexic pathology, due to the psyche-soma intrication and the diversity of age groups, highlights the complexity of care available. The impact of this diversity of hospital care on patient outcomes will be studied as a result of this work.

Resumen Introduccion La anorexia nerviosa plantea un importante problema bioetico, ya que los pacientes, a menudo, rechazan el tratamiento a pesar del peligro que ello supone para su salud, y no esta claro que su decision sea autonoma. El objetivo de este trabajo es investigar las percepciones/actuacion de psiquiatras y psicologos clinicos ante la capacidad y el internamiento involuntario de pacientes con anorexia nerviosa. Metodos Se entrevisto a 7 psiquiatras, 4 psicologas clinicas y 1 psicologa residente de tercer ano. Se utilizo un enfoque de investigacion cualitativa basado en la teoria fundamentada. Resultados El analisis de datos mostro que estos profesionales articulan la atencion del paciente en torno a una categoria principal, a saber, el internamiento como ultimo recurso y la busqueda de la voluntariedad, lo que implica un cambio en la dinamica asistencial habitual. En torno a esa categoria central, se erigen algunos conceptos importantes; estres de rol, coercion informal, peso, familia y cronicidad. Conclusiones La dificultad de conciliar demandas profesionales puede suponer un menoscabo en la calidad de la asistencia y en la propia satisfaccion laboral, lo que pone en evidencia la necesidad de reflexionar e investigar sobre los fundamentos de las atribuciones asumidas.

Resume Introduction Il existe pour les patients atteints d‘anorexie mentale peu d’interventions de psychoeducation. L’objectif de cette etude est d’evaluer la faisabilite et l’acceptabilite d’un programme de psychoeducation. Les objectifs secondaires exploratoires concernent l’evaluation de l’efficacite du programme sur la symptomatologie. Methode Vingt-sept patientes reparties en trois groupes ont beneficie d’un groupe hebdomadaire de huit seances, en adjonction a leur prise en charge habituelle, dans une etude ouverte. Les patientes ont beneficie de trois evaluations de suivi, a la fois quantitatives et qualitatives. Resultats Soixante-dix-huit pour cent des patientes ont assiste a plus de 75 % des seances. Soixante-dix pour cent des patients ont trouve le groupe utile et 95 % declarent qu’il leur a permis d’ameliorer leurs connaissances sur la maladie et ses consequences. L’IMC moyen des participantes, les dimensions alimentaires et le fonctionnement ont significativement et positivement evolue, immediatement apres le groupe et a trois mois. Sur le plan qualitatif, les patientes sont majoritairement satisfaites du groupe et rapportent pour la plupart des changements dans leur quotidien : soit dans leur rapport aux soins et a la maladie, soit dans les relations avec leurs proches ou encore dans leur comportement alimentaire. Conclusion Les resultats a la fois qualitatifs et quantitatifs suggerent que ce programme de psychoeducation par groupe en adjonction a la prise en charge habituelle est faisable et bien accepte par les patientes. Les ameliorations cliniques constatees sont encourageantes quant a l’innocuite de ce type d’intervention et a leur eventuelle efficacite, et plaident pour une etude controlee.

Resumen Introduccion Las recomendaciones de las guias vigentes estan basadas en evidencia de baja calidad. Se requiere su actualizacion periodica considerando la evidencia reciente. Objetivo Sintetizar la mejor evidencia clinica disponible sobre eficacia y seguridad de antidepresivos y antipsicoticos de segunda generacion en pacientes con anorexia nerviosa. Metodos Revision sistematica (CRD42020150577). Se buscaron en PubMed, SCOPUS, Ovid(Cochrane), EMBASE y LILACS los ensayos clinicos aleatorizados realizados en pacientes con anorexia nerviosa que evaluasen el uso de antipsicoticos de segunda generacion o antidepresivos orales a cualquier dosis y por cualquier tiempo en el tratamiento ambulatorio y/u hospitalario tomando como resultados el peso (indice de masa corporal), las entidades psicopatologicas y la seguridad. Resultados Se incluyeron 5 estudios, 4 catalogados como con alto riesgo de sesgo. La evidencia indica que los pacientes que reciben tratamiento con olanzapina o fluoxetina tienden a mantenerse por mas tiempo dentro de los programas de tratamiento. La olanzapina mostro resultados favorables (un estudio) en cuanto al aumento de peso, pero no mostro los mismos resultados en psicopatologia, donde la evidencia es contradictoria. Conclusiones En concordancia con las revisiones anteriores, nuestro trabajo permite concluir que hay informacion contradictoria sobre la eficacia de los psicofarmacos para la anorexia nerviosa. El trabajo futuro debe enfocarse en desarrollar ensayos clinicos de alta calidad metodologica.

BackgroundA subgroup of patients with anorexia nervosa (AN) undergoing involuntary treatment (IT) seems to account for most of the IT events. Little is known about these patients and their treatment including the temporal distribution of IT events and factors associated with subsequent utilization of IT. Hence, this study explores (1) utilization patterns of IT events, and (2) factors associated with subsequent utilization of IT in patients with AN.MethodsIn this nationwide Danish register-based retrospective exploratory cohort study patients were identified from their first (index) hospital admission with an AN diagnosis and followed up for 5 years. We explored data on IT events including estimated yearly and total 5-year rates, and factors associated with subsequent increased IT rates and restraint, using regression analyses and descriptive statistics.ResultsIT utilization peaked in the initial few years starting at or following the index admission. A small percentage (1.0%) of patients accounted for 67% of all IT events. The most frequent measures reported were mechanical and physical restraint. Factors associated with subsequent increased IT utilization were female sex, lower age, previous admissions with psychiatric disorders before index admission, and IT related to those admissions. Factors associated with subsequent restraint were lower age, previous admissions with psychiatric disorders, and IT related to these.ConclusionsHigh IT utilization in a small percentage of individuals with AN is concerning and can lead to adverse treatment experiences. Exploring alternative approaches to treatment that reduce the need for IT is an important focus for future research.

Zusammenfassung. Genetische Varianten beeinflussen die Gewichtsregulation und die Entwicklung von Essstörungen. Zunächst haben familienbasierte, sogenannte formalgenetische Studien den erblichen Anteil an der Gewichtsregulation und an der Ätiologie von Essstörungen beleuchtet. In einer Vielzahl von Studien zeigten sich sowohl für die Varianz des Körpergewichts als auch für die Entstehung von Essstörungen Erblichkeitsschätzer (Heritabilitätsraten) von über 50 %. Mit diesem Wissen begab man sich in den 90er-Jahren des letzten Jahrhunderts auf die Suche nach den zugrundeliegenden Genen (genauer: genetischen Varianten), die das Körpergewicht, das Essverhalten oder beide Phänotypen auf Grundlage geteilter Mechanismen beeinflussen. Zunächst wurden Kandidatengenstudien durchgeführt. Dabei untersuchte man auf Grundlage unterschiedlicher, v. a. aber pathophysiologisch plausibler Überlegungen Gene mit hoher Relevanz für die untersuchten Phänotypen. Dieser Ansatz war für Essstörungen nicht sehr erfolgreich, für die Gewichtsregulation konnte eine Handvoll Gene identifiziert werden. Verbunden mit großen methodischen Fortschritten in der genetischen Forschung und v. a. der Etablierung sogenannter genomweiter Assoziationsstudien (GWAS) Anfang der 2000er-Jahre konnten bislang über 1000 Varianten/Genorte detektiert werden, die das Körpergewicht beeinflussen. Für die Essstörung Anorexia nervosa (AN) sind aktuell acht solcher Genorte beschrieben. Diese Ergebnisse, aber auch aktuelle Ansätze zu phänotypübergreifenden Analysen lassen Einblicke in die komplexe Regulation des Körpergewichtes zu und haben zudem unerwartete Pathomechanismen für AN aufgezeigt.

The understanding of the neural control of appetite sheds light on the pathogenesis of eating disorders such as anorexia nervosa and obesity. Both diseases are a result of maladaptive eating behaviors (overeating or undereating) and are associated with life-threatening health problems. The fine regulation of appetite involves genetic, physiological, and environmental factors, which are detected and integrated in the brain by specific neuronal populations. For centuries, the hypothalamus has been the center of attention in the scientific community as a key regulator of appetite. The hypothalamus receives and sends axonal projections to several other brain regions that are important for the integration of sensory and emotional information. These connections ensure that appropriate behavioral decisions are made depending on the individual’s emotional state and environment. Thus, the mechanisms by which higher-order brain regions integrate exteroceptive information to coordinate feeding is of great importance. In this review, we will focus on the functional and anatomical projections connecting the hypothalamus to the limbic system and higher-order brain centers in the cortex. We will also address the mechanisms by which specific neuronal populations located in higher-order centers regulate appetite and how maladaptive eating behaviors might arise from altered connections among cortical and subcortical areas with the hypothalamus.

Zusammenfassung. Die vielseitigen Wechselwirkungen des Darmmikrobioms mit dem Stoffwechsel, dem Immunsystem und dem Gehirn des Wirtes werden zunehmend zu einem relevanten Forschungsschwerpunkt. Studien legen einen Zusammenhang zwischen einem veränderten Darmmikrobiom und sowohl somatischen Erkrankungen wie Colitis ulcerosa, Morbus Crohn und Diabetes als auch psychischen Erkrankungen wie Ängsten und Depression nahe. Auch Patient_innen mit Anorexia nervosa (AN) zeigen deutliche Veränderungen des Darmmikrobioms. Diese Veränderungen scheinen unter anderem mit einer abweichenden Energieaufnahme aus der Nahrung, immunologischen und entzündlichen Prozessen, genetischer Prädisposition, hormonellen Veränderungen und einer möglicherweise erhöhten Darmpermeabilität assoziiert zu sein. Transplantation von Stuhl von Patient_innen mit AN in Ratten führte zu einer Appetitminderung und Gewichtsreduktion sowie ängstlichem und zwanghaftem Verhalten. In dieser Übersichtsarbeit fassen wir mögliche Mechanismen der Interaktion zwischen dem Darmmikrobiom und dem Wirt zusammen und stellen erste Befunde zum Mikrobiom bei AN vor. Forschung zu Ernährungsinterventionen zum Beispiel mit Prä- und Probiotika oder Nahrungssupplementen wie Omega-3 Fettsäuren, die darauf abzielen, das Darmmikrobiom positiv zu beeinflussen, könnte zu zusätzlichen Behandlungsmöglichkeiten in der Therapie von Patient_innen mit AN führen.

Resume Buts de l’etude Plusieurs auteurs identifient la motivation au changement comme un aspect important de l’intervention aupres d’individus atteints d’anorexie mentale. Le Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) a ete developpe afin d’evaluer la motivation a changer specifiquement chez cette population. Cette etude visait a valider une version francophone du ANSOCQ. Patients et methode Quatre-vingt-deux adolescents atteints d’anorexie mentale, ou d’un trouble de la conduite alimentaire non specifie, ont rempli l’ANSOCQ, l’University of Rhode Island Change Assessment Scale, le Motivation Stages of Change for Adolescents Recovering from an Eating Disorder et l’Eating Disorder Inventory-3 au debut de leur hospitalisation. Cinquante-deux ont repondu aux memes questionnaires a la fin de leur hospitalisation. Resultats L’ANSOCQ a montre une excellente coherence interne et une grande convergence entre ses sous-echelles. Sa validite a ete soutenue par des associations a d’autres questionnaires portant sur la motivation au changement. De meme, les sous-echelles du ANSOCQ etaient associees differemment a l’intensite du trouble de la conduite alimentaire et des difficultes psychosociales associees. Conclusion Ces resultats appuient la qualite psychometrique de cette version francophone de l’ANSOCQ. La pertinence de distinguer les trois sous-echelles du test semble en outre prometteuse etant donne les differences observees entre celles-ci.

Jadłowstręt psychiczny jest zespołem chorobowym obarczonym wysoką śmiertelnością i wieloletnim przebiegiem. Jego najbardziej charakterystycznym objawem jest znaczny niedobór masy ciała wywoływany i podtrzymywany przez pacjenta, który postrzega się jako osobę otyłą i wyznacza sobie niski limit masy ciała. Przebieg leczenia najczęściej jest wieloletni i angażujący znaczne grono specjalistów, a w zależności od stanu pacjenta możliwa jest opieka ambulatoryjna, opieka w oddziale dziennym lub w przypadku dużej utraty masy ciała czy pojawienia się powikłań niedożywienia konieczna jest wielomiesięczna hospitalizacja. Aktualnie widoczna jest tendencja do skracania czasu pobytu w oddziale stacjonarnym pacjentów z AN na rzecz innych form opieki. Celem artykułu jest zebranie i przedstawienie wyników niewielkiej liczby badań dotyczących czynników wpływających na długość hospitalizacji w leczeniu jadłowstrętu psychicznego. W oparciu o dostępne w chwili obecnej badania za czynnik istotnie wpływający na długość hospitalizacji należy uznać przede wszystkim wskaźnik masy ciała w momencie przyjęcia do szpitala. Dyskusja jednak pozostaje otwarta i wskazane są dalsze badania w tym zakresie. Wyjaśnienie powyższego zagadnienia może stanowić podstawę do bardziej zorientowanego na potrzeby pacjenta określania czasu trwania leczenia szpitalnego. Niezbędne będą także dalsze badania dotyczące czynników zidentyfikowanych w pojedynczych badaniach i relacji zachodzących między nimi.

The article presents the problems of nutritional rehabilitation of patients with anorexia nervosa, methods for evaluation of nutritional status, eating behavior, weight restoration and weight gain rates, stages of treatment, enteral nutrition., В статье рассматриваются проблемы нутритивной реабилитации больных нервной анорексией, методы оценки нутритивного статуса, пищевое поведение, восстановление и скорость набора веса, этапы лечения, энтеральное питание., У статті разглядаються проблеми нутритивної реабілітації хворих на нервову анорексію, методи оцінки нутритивного статусу, харчова поведінка, відновлення та швидкість набору ваги, етапи лікування, ентеральне харчування.

Deficits in interpersonal and social functioning are well established in females with Anorexia Nervosa (AN), and are thought to be key features involved in the onset and maintenance of the disease. Growing literature suggests these may be attributed to poor social cognitive processes. This systematic review evaluates whether differences in social cognition exist in adult females with AN. A total of 32 studies that compared females with AN against a healthy control group using social cognitive measures and/or questionnaires were analysed. The majority of studies were deemed to have a low or moderate risk of bias. Overall, empathy appears to be intact in AN, however greater emotion regulation difficulties, elevated alexithymia and reduced emotional awareness are evident in AN. Findings relating to emotion recognition and emotional Theory of Mind were inconsistent. The nature of the task appeared to influence the domains of cognitive ToM and social perception, warranting further research. These findings are discussed within the broader context of social cognitive models and AN rehabilitation.

Sudden death is the main cause of mortality in patients with anorexia nervosa. Contribution form Life-threatening arrhythmia was highly suspected.

Background Increased physical activity is a common feature of anorexia nervosa (AN). Although high activity levels are associated with greater risk of developing AN, particularly when combined with dieting, most individuals who diet and exercise maintain a healthy body weight. It is unclear why some individuals develop AN while most do not. A rodent model of resilience and vulnerability to AN would be valuable to research. Dopamine, which is believed to play a crucial role in AN, regulates both reward and activity and may modulate vulnerability. Methods Adolescent and young adult female C57BL/6N mice were tested in the activity-based anorexia (ABA) model, with an extended period of food restriction in adult mice. ABA was also tested in dopamine transporter knockdown mice and wild-type littermates. Mice that adapted to conditions and maintained a stable body weight were characterized as resilient. Results In adults, vulnerable and resilient phenotypes emerged in both the ABA and food-restricted mice without wheels. Vulnerable mice exhibited a pronounced increase in running throughout the light cycle, which dramatically peaked prior to requiring removal from the experiment. Resilient mice exhibited an adaptive decrease in total running, appropriate food anticipatory activity, and increased consumption, thereby achieving stable body weight. Hyperdopaminergia accelerated progression of the vulnerable phenotype. Conclusions Our demonstration of distinct resilient and vulnerable phenotypes in mouse ABA significantly advances the utility of the model for identifying genes and neural substrates mediating AN risk and resilience. Modulation of dopamine may play a central role in the underlying circuit.

Longitudinal associations between eating disorders (EDs) and comorbid psychiatric disorders are poorly understood but important to examine as comorbidities are common and can impede ED recovery. We examined two common comorbidities, major depressive disorder (MDD) and substance use disorder (SUD), in adult women with intake diagnoses of anorexia nervosa (AN) and bulimia nervosa (BN) who participated in a longitudinal study. To test the longitudinal reciprocal relations among ED, MDD, and SUD, we conducted a multi-group autoregressive cross-lagged path analysis. We tested whether ED, MDD, and SUD in a given three-month period (t – 1) each predicted ED, MDD, and SUD during the subsequent three-month period (t) over 5 years. We examined the moderating effect of intake diagnosis (AN vs. BN). Among AN (but not BN) participants, having MDD at t – 1 predicted having an ED at time t, OR = 1.98, B = .68, z = 2.49, p = .01. Among BN (but not AN) participants, having a SUD at t – 1 predicted having an ED at time t, OR = 5.16, B = 1.64, z = 2.34, p = .01. In contrast, having an ED at t – 1 did not predict MDD or SUD at time t for AN or BN participants. These results suggest for individuals with AN and MDD, treating MDD may facilitate ED recovery. For individuals with BN and SUD, treating SUD may facilitate ED recovery. These identified temporal associations between ED and comorbid disorders may guide cognitive behavioral researchers and therapists in prioritizing treatment targets given the high rate of comorbidity in EDs.

The concept of futility in the treatment of individuals with severe and enduring anorexia nervosa remains controversial and has significant legal and ethical considerations. For those who have been unremittingly ill for 8 to 12 years, full recovery, although possible, is unlikely, and alternatives to traditional, active treatment must be explored. The harm reduction model, palliative care, and end-of-life care are explored as meaningful and reasonable treatments for this population. Landmark cases demonstrating the legal and ethical controversy of such treatment are explored.

Background Anorexia nervosa is an illness for which no clear aetiology has yet been found. Patients suffering from this disease are often misunderstood and management is difficult. The difficulty of confining anorexia nervosa to one or more obvious causes – combined with the lack of an effective empirical treatment – is a major obstacle to health professionals’ sense of usefulness and professional accomplishment and, ultimately, to a lack of sense of medical action in the face of management failure. Objective To go beyond the field of linear determinism, we propose to shift from an aetiological paradigm to a teleogical paradigm to better understand anorexia nervosa. Method Philosophical reflection based on an epistemological exploration. Results We demonstrate that it is possible to think of anorexia nervosa as a pathology of intentionality. We propose to redefine anorexia nervosa as the combination of a pathological intentionality associated with an unattainable goal. Conclusion Beyond the aetiologies of the disease, it is necessary to understand anorexia nervosa in terms of goal, taking into consideration the symptom which should not be reduced to a non-eating behaviour – which would be tautological in itself – but should also be understood as a symbolic and meaningful way of expressing an ultimately pathological intention.

According to the WHO definition, “telemedicine is the provision of health services, where distance is a critical factor, by all health professionals who use information and communication technologies for the exchange of valid information for the diagnosis, treatment and prevention of diseases, research and evaluation, and for the continuous training of health professionals, all in the interest of advancing the health of individuals and their communities”. The purpose of our review work is specifically to investigate the effects of telemedicine in the treatment and prevention of eating disorders in adolescents. From June 2021 to (September 2021) in the databases of the Web of Science, EMBASE, PsycINFO and CINHAL, using search terms such as telehealth, eating disorder, adolescents, Internet/online treatments CBT and FB-T, anorexia nervosa, bulimia nervosa and binge eating disorder. The articles resulting from the search phases in the databases listed above produced a total of 176 items. Once the procedures for selecting the works were completed, only four studies were included in the review. Modern e-health psychological approaches in the treatment of eating disorders provide potential bases of continuous assistance that are decidedly less burdensome in the costs of territorial services in the case that they are not identified as necessary.

Research suggests a relationship between anorexia nervosa and autism spectrum disorder. The aim of the current study was to examine social attention in anorexia nervosa and autism spectrum disorder compared with age- and sex-matched typically developing groups, and to examine whether lowered social motivation could explain reductions in social attention across the two disorders. Participants’ eye movements were tracked while watching a dynamic social scene. The proportion of fixation duration to faces, bodies and non-social areas of interest were compared across groups. Participants with autism spectrum disorder looked at faces significantly less often than controls, however, there were no differences between anorexia nervosa and controls in attention to faces. Typically developing -normed z-scores indicated that attention to faces showed the greatest deviation from normative data compared with body or non-social areas of interest in both autism spectrum disorder and anorexia nervosa, however, differences were larger in autism spectrum disorder than in anorexia nervosa. Social motivation scores did not predict attention to faces in either autism spectrum disorder or anorexia nervosa. Our results do not support the hypothesis that differences in social motivation underlie reduced social attention in both anorexia nervosa and autism spectrum disorder. Lay abstract Research suggests a relationship between autism and anorexia nervosa. For example, rigid and inflexible behaviour, a preference for routine and social difficulties are seen in both conditions. In this study, we examined whether people with anorexia and people with autism show similarities in social attention (where they look while engaging in social interactions or watching a scene with people interacting). This could help us understand why people with anorexia and autism experience difficulties in social situations. Participants with either anorexia or autism, as well as participants with no mental health problems watched a video of a social scene while we recorded which parts of the scene they looked at with an eye-tracker. Participants also completed questionnaires to assess characteristics of autism. We found that autistic participants looked at faces less than typically developing participants. However, participants with anorexia did not show a similar reduction in attention to faces, contrary to our predictions. Autistic features were not related to attention in either group. The results suggest that autistic people may miss important social cues (like facial expressions), potentially contributing to social difficulties. However, this mechanism does not appear explain social difficulties in people with anorexia.

Background Despite a wide range of proposed risk factors and theoretical models, prediction of eating disorder (ED) onset remains poor. This study undertook the first comparison of two machine learning (ML) approaches [penalised logistic regression (LASSO), and prediction rule ensembles (PREs)] to conventional logistic regression (LR) models to enhance prediction of ED onset and differential ED diagnoses from a range of putative risk factors. Method Data were part of a European Project and comprised 1402 participants, 642 ED patients [52% with anorexia nervosa (AN) and 40% with bulimia nervosa (BN)] and 760 controls. The Cross-Cultural Risk Factor Questionnaire, which assesses retrospectively a range of sociocultural and psychological ED risk factors occurring before the age of 12 years (46 predictors in total), was used. Results All three statistical approaches had satisfactory model accuracy, with an average area under the curve (AUC) of 86% for predicting ED onset and 70% for predicting AN v. BN. Predictive performance was greatest for the two regression methods (LR and LASSO), although the PRE technique relied on fewer predictors with comparable accuracy. The individual risk factors differed depending on the outcome classification (EDs v. non-EDs and AN v. BN). Conclusions Even though the conventional LR performed comparably to the ML approaches in terms of predictive accuracy, the ML methods produced more parsimonious predictive models. ML approaches offer a viable way to modify screening practices for ED risk that balance accuracy against participant burden.

Objectives:Anorexia nervosa (AN) is associated with altered sensitivity to reward and punishment. Few studies have investigated whether this results in aberrant learning. The ability to learn from rewarding and aversive experiences is essential for flexibly adapting to changing environments, yet individuals with AN tend to demonstrate cognitive inflexibility, difficulty set-shifting and altered decision-making. Deficient reinforcement learning may contribute to repeated engagement in maladaptive behavior.Methods:This study investigated learning in AN using a probabilistic associative learning task that separated learning of stimuli via reward from learning via punishment. Forty-two individuals with Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 restricting-type AN were compared to 38 healthy controls (HCs). We applied computational models of reinforcement learning to assess group differences in learning, thought to be driven by violations in expectations, or prediction errors (PEs). Linear regression analyses examined whether learning parameters predicted BMI at discharge.Results:AN had lower learning rates than HC following both positive and negative PE (p p Conclusions:This is the first study to show lower rates of learning in AN following both positive and negative outcomes, with worse punishment learning predicting less weight gain. An inability to modify expectations about avoiding punishment might explain persistence of restricted eating despite negative consequences, and suggests that treatments that modify negative expectancy might be effective in reducing food avoidance in AN.

Acute gastric dilatation is a rare and potentially life-threatening condition that may occur in patients suffering from anorexia nervosa after ingesting large amounts of food within a short period. Frequently, this condition is considered a surgical emergency due to subsequent occurrence of complications such as gastric necrosis or perforation.Here we report a case of a young female patient (23 years) with anorexia nervosa who presented with severe abdominal pain, nausea, and inability to vomit after a period of binge eating. Abdominal computed tomography revealed an extremely dilated stomach measuring 39.0 cm × 18.0 cm in size. Initial nasal decompression therapy using gastric tubes had failed. Due to the absence of complications, it was decided to treat her solely by endoscopic means under mechanical ventilation. After undergoing multiple overtube-assisted esophagogastroduodenoscopies (EGDs), she fully recovered eventually.This case demonstrates that interventional endoscopic treatment of a patient with uncomplicated acute gastric dilatation is feasible and safe, at least under general anesthesia. Hence, this option should be considered when sole gastric tube suction fails, and there is no indication of complications such as peritonitis, sepsis, perforation, or gastric ischemia. A more invasive and aggressive surgical procedure may be avoided in selected cases, and the length of hospital stay may be shortened.Die akute Magendilatation ist ein seltenes, potenziell lebensbedrohliches Krankheitsbild, das bei Patienten mit Anorexia nervosa nach einer Fressattacke vorkommen kann. Genaue Angaben über Häufigkeiten fehlen. Bisher wird dieses Krankheitsbild v.a. wegen Komplikationen wie drohender Nekrose oder Perforation als chirurgische Notfallsituation angesehen.Wir berichten über den Fall einer jungen Frau (23 Jahre), die sich nach einer Bulimie-Attacke mit heftigsten abdominellen Schmerzen, Übelkeit und der Unmöglichkeit zu erbrechen notfallmäßig vorstellte. Die abdominelle Computertomografie zeigte einen massiv dilatierten Magen von 39 cm × 18 cm Größe, welcher die anderen Organe massiv verdrängte. Die Anlage einer dicklumigen Magensonde erbrachte keine relevante Besserung. Bei stabilen Kreislaufverhältnissen entschieden wir uns, nach Rücksprache mit der Viszeralchirurgie, für eine interventionelle endoskopische Therapie unter Beatmung mithilfe eines Übertubus. Nach mehreren Ösophagogastroduodenoskopien, während der Essensreste und Flüssigkeit entfernt wurden, bildete sich die Magendilatation zurück und die Patientin genas im weiteren Verlauf vollständig, sodass eine chirurgische Intervention vermieden werden konnte.

Abnormalities in autonomic function have been observed in people with anorexia nervosa. However, the majority of investigations have utilised heart rate variability as the sole assessment of autonomic activity. The current study utilised a variety of methodologies to assess autonomic nervous system function in women with a current diagnosis of anorexia, a past diagnosis of anorexia who were weight-restored, and healthy controls. The sample included 37 participants: 10 participants with anorexia, 17 weight-restored participants (minimum body mass index > 18.5 for minimum of 12 months) and 10 controls. Assessments of autonomic function included muscle sympathetic nerve activity (MSNA) using microneurography, heart rate variability, baroreflex sensitivity, blood pressure variability, head-up tilt table test, sudomotor function and assessment of plasma catecholamines. MSNA (bursts/min) was significantly decreased in both anorexia (10.22 ± 6.24) and weight-restored (17.58 ± 1.68) groups, as compared to controls (23.62 ± 1.01, p

Background Anorexia nervosa (AN) mainly affects women (sex ratio 1/10) and most often starts during adolescence. The prognosis of AN remains poor (10% of deaths and high risk of chronicity). Body dissatisfaction, disturbances in recognition and identification of body sensations are some of the key symptoms of AN. However, there is a contrast between this consensual observation of body image disorders in AN, and the relative deficit of specifically targeted body treatments. Our proposal for a body approach specifically dedicated to AN is based on the understanding that posture, breathing, muscle tension and body perception are closely linked to our psychological and emotional state and are therefore disturbed in patients with AN. The purpose of this monocentric randomized controlled trial is to evaluate if a targeted osteopathic protocol treatment for AN in addition to treatment as usual (TAU) is significantly more effective than TAU alone. Methods In total, 72 patients meeting the inclusion criteria will be randomly assigned to one of the two treatment groups: one receiving the specific osteopathic treatment targeted for AN in addition to the TAU (group A) and the other one, receiving TAU only (group B). The patients in group A will receive 5 30-min osteopathic treatment sessions. Soft specific palpatory techniques on the diaphragm, digestive system and cervical region will be performed. The TAU is defined by the multidisciplinary approach recommended by the French health high authority. The primary outcome is the evaluation of interoceptive sensibility and secondary outcomes include clinical and psychopathology-related symptoms with assessment of somatic dysfunctions’ evolution. A qualitative study will also be carried out, applying the Interpretative Phenomenological Analysis method. Patients will be included for a maximum of 14 weeks between the inclusion time and the last evaluation. Discussion If the results of the study are positive (statistically significant efficacy of this osteopathic treatment protocol), the study will provide arguments in favor of osteopathic sessions as a possible non-invasive additional treatment option in the multidisciplinary care approach for patients with AN. Trial registration ClinicalTrials.gov ID: NCT04666415, Release Date: December 11, 2020; N° ID-RCB: 2019-A02613-54.

Anorexia nervosa (AN), an eating disorder, is characterized by extreme weight loss and fear of weight gain. Psychosocial factors are thought to play important roles in the development and progression of AN; however, biological factors also presumably contribute to eating disorders. Recent evidence has shown that the gut microbiota plays an important role in pathogenesis of neuropsychiatric disorders including AN. In this article, we describe the possible role of the gut microbiota in the development and persistence of AN, based on the latest research works, including those of our group.

PURPOSE OF REVIEW To review the recent literature on the epidemiology of anorexia nervosa and bulimia nervosa in terms of incidence, prevalence and mortality. RECENT FINDINGS Although the overall incidence rate of anorexia nervosa is considerably stable over the past decades, the incidence among younger persons (aged

Zusammenfassung. Die Umstellung auf die 11. Revision der Internationalen Klassifikation der Krankheiten und verwandter Gesundheitsprobleme (ICD-11) bedingt wesentliche Neuerungen bezüglich i) Zusammenführung der Fütter- und Essstörungen zu einer übergeordneten Kategorie, ii) Gruppierung der Störungsbilder nach ihrer Psychopathologie im Sinne eines Kontinuums psychopathologischer Auffälligkeiten zwischen Kindheit, Adoleszenz und Erwachsenenalter sowie iii) Berücksichtigung kultureller Unterschiede. Neben der Beschreibung der Revision der Kriterien der einzelnen Störungsbilder sollen die neu in die Klassifikation aufgenommenen Diagnosen Störung mit Vermeidung oder Einschränkung der Nahrungsaufnahme (ARFID) und Binge-Eating-Störung (BES) vorgestellt werden.

This article proposes alternative understandings of certain structuralist informed (Diagnostic and Statistical Manual of Mental Disorders - DSM-IIIrd to 5th Eds.) configurations of mental disorders. Life’s negative discourses and the mind’s captive responses present a “general theory of mental suffering” which phenomena are classified as modernist, DSM mental disorders, such as addictions, depression, and obsessive-compulsive disorders. Recent research has indicated that the psychedelic drug, psilocybin, has produced safe and effective outcomes for these mental suffering states. In this context, the article draws on the concept of brain plasticity order, firstly, to identify the means for a person to move away from subjection of life’s negative, dominant discourses that “capture” the brain, and then to intentionally move towards more acceptable, preferred, ethical subjectivities. These explanations, using the phenomenon of depression, provide the foundation for further proposals that an innovative form of narrative therapy could be a safe, effective and meaningful approach for persons in relationship with other similar ways of mental suffering, such as, anxiety, addiction, obsessive-compulsive disorder, and anorexia nervosa.

Eating disorders (EDs) are complex psychiatric diagnoses requiring specialized care. Family-based treatment (FBT) is the first-line treatment for adolescent anorexia nervosa and is also efficacious for other EDs. This study describes practice changes due to the implementation of an integrated interdisciplinary FBT-aligned treatment program for EDs at a large tertiary care hospital in the United States. We examined the feasibility and acceptability of implementation, barriers to implementation, and impact on providers' roles over a one-year period. Practice changes came with shifts in roles, and were largely experienced as acceptable with good suitability. Barriers identified may inform future interdisciplinary implementation efforts.

Scholars in disability studies have recently sought to account for fatness, claiming an inseparable link between disability and fat scholarship. Interrogating the stigmas of fatness as a sign of ba...

Objective The possible role of abnormal disgust processing in the development and course of anorexia nervosa (AN) has been emphasized in theoretical models and research. However, disgust toward external stimuli and self-disgust have not yet been investigated together in a clinical sample of AN patients. Therefore, the purpose of the study was to measure these constructs and examine their role in shaping eating pathology in AN patients and healthy controls (HCs), considering comorbid depressive and anxiety psychopathology. The study also aimed at testing the possible mediational roles of both disgust types in the associations between comorbid psychopathology and eating disorders (EDs) characteristics. Method Altogether, 63 inpatients with AN and 57 HCs partook in the study. Participants completed the Eating Disorder Inventory-3, State-Trait Anxiety Inventory, Beck Depression Inventory-II, Disgust Scale-Revised and Self-Disgust Scale. Results AN patients manifested higher self-disgust and disgust sensitivity than HCs. In addition, self-disgust predicted the severity of EDs characteristics and mediated the links of depressive symptoms and trait anxiety with EDs characteristics in both groups. Discussion Our findings imply the putative role of self-disgust in the development of EDs psychopathology in HCs and in its maintenance in AN patients.

OBJECTIVE Research and theory suggest the aetiological nature and symptomatic profile of eating disorders (EDs) can be explained by multiple factors, including the development of early maladaptive schemas (EMS). Yet, there is lack of consensus regarding the evidence supporting the relationship between EMS and EDs. Therefore, this systematic review aimed to examine existing literature concerning the relationship between different ED diagnoses and EMS to provide a synthesis and evaluation of relevant research. METHOD A comprehensive literature search of four electronic databases was conducted and studies were included that examined the association between EMS and EDs. Studies were required to use a variant of Young Schema Questionnaire and establish ED diagnosis or symptomology using self-report questionnaires or clinical interview. RESULTS A total of 29 studies were included in the review. Compared to healthy controls and varying clinical populations, individuals with EDs generally reported significantly higher scores across all EMS except for Entitlement. Furthermore, Unrelenting Standards consistently appeared as a significant EMS across all ED diagnoses whilst Insufficient Self-Control was significantly lower in ED diagnoses with restrictive behaviour compared to diagnoses with binge eating or purging behaviour. DISCUSSION Research supports significant associations between EMS and EDs, which may contribute to our understanding of ED aetiology, including different diagnostic categories. This review underscores the need for studies to explore more gender and age diverse samples and highlights important implications for practitioners.

Anorexia nervosa (AN), a pathological restriction of food intake, leads to metabolic dysregulation. We conducted a metabolomics study to reveal changes caused by AN and the effect of hospital realimentation on metabolism. Both stool and serum from patients with AN and healthy controls were analyzed by NMR and MS. Statistical analysis revealed several altered biochemical and anthropometric parameters and 50 changed metabolites, including phospholipids, acylcarnitines, amino acids, derivatives of nicotinic acid, nucleotides, and energy metabolism intermediates. Biochemical and anthropometric parameters were correlated with metabolomic data. Metabolic changes in patients with AN described in our study imply serious system disruption defects, such as the development of inflammation and oxidative stress, changed free thyroxine (fT4) and thyroid-stimulating hormone (TSH) levels, a deficit of vitamins, muscle mass breakdown, and a decrease in ketone bodies as an important source of energy for the brain and heart. Furthermore, our data indicate only a very slight improvement after treatment. However, correlations of metabolomic results with body weight, interleukin 6, tumor necrosis factor α, fT4, and TSH might entail better prognoses and treatment effectiveness in patients with better system parameter status. Data sets are deposited in MassIVE: MSV000087713, DOI: 10.25345/C57R7X.

Anorexia nervosa (AN) typically emerges in adolescence. The cortico-striatal system (CSTS) and the default mode network (DMN) are brain circuits with a crucial development during this period. These circuits underlie cognitive functions that are impaired in AN, such as cognitive flexibility and inhibition, among others. Little is known about their involvement in adolescent AN and how weight and symptom improvement might modulate potential alterations in these circuits. Forty-seven adolescent females (30 AN, 17 healthy control) were clinically/neuropsychologically evaluated and scanned during a 3T-MRI resting-state session on two occasions, before and after a 6-month multidisciplinary treatment of the AN patients. Baseline and baseline-to-follow-up between-group differences in CSTS and DMN resting-state connectivity were evaluated, as well as their association with clinical/neuropsychological variables. Increased connectivity between the left dorsal putamen and the left precuneus was found in AN at baseline. At follow-up, body mass index and clinical symptoms had improved in the AN group. An interaction effect was found in the connectivity between the right dorsal caudate to right mid-anterior insular cortex, with lower baseline AN connectivity that improved at follow-up; this improvement was weakly associated with changes in neuropsychological (Stroop test) performance. These results support the presence of CSTS connectivity alterations in adolescents with AN, which improve with weight and symptom improvement. In addition, at the level of caudate-insula connectivity, they might be associated with inhibitory processing performance. Alterations in CSTS pathways might be involved in AN from the early stages of the disorder.

Objective Anorexia nervosa (AN) and bulimia nervosa (BN) impose a significant financial burden and immense sufferings on affected individuals. Yet little is known about the differences between how each disorder affects males and females, respectively. Method We performed a retrospective cost-development analysis of anonymized claims data from the German statutory health-insurance system. Insured persons who suffered from an onset of AN (F50.0; N = 1,242 females and 71 males) or BN (F50.2; N = 1,104 females and 64 males) were analyzed for cost-of-illness over a 5-year period, beginning 2 years before the index diagnosis. Results In total, all groups incurred similar distributions of total costs over the 5-year observation period, with roughly 14,000-20,000 EUR median costs. About two-thirds of the total costs for females and males with AN are associated with mental illness, whereas for females and males with BN, this applies to approximately half the total costs. Analyses revealed differences between disorders and genders for single outcomes. AN is associated with a stronger increase in costs within a short period following onset and higher inpatient treatment costs, whereas BN entails more instances of incapacity to work before and after onset. Compared to females, males incurred lower costs in outpatient treatments. Discussion Our study adds evidence as to the disparities in health-care utilizations and costs over the course of illness, in outcome ratios, and between genders, for both AN and BN.

Eating disorders such as anorexia nervosa, female athlete triad, bulimia nervosa, obesity, and binge eating initially emerge during adolescence. These disorders are present primarily in females, but males may also present with these conditions. Dentistry has a pivotal role in the management of patients with such diet-related disorders. Because dentists examine their patients at frequent intervals and may be the health care professionals with whom patients feel more comfortable discussing eating disorders, dentists must have knowledge of the etiology, diagnostic criteria, systemic effects, and intraoral manifestations of eating disorders. In addition, the dental professional may be the first health care provider to identify the condition and refer the patient appropriately to medical colleagues for subsequent treatment. This chapter provides dentists with current and relevant information to recognize, diagnose, and integrate dental treatment for their adolescent patients who may exhibit manifestations of an eating disorder.

Objective To describe the characteristics of the patients, as well as the treatment outcomes for the people treated in an Endocrinology and Nutrition unit with a diagnosis of SE-ED (> 7 years evolution despite evidence-based conventional treatment). Methods A descriptive observational study was conducted. Patients with a diagnosis of SE-ED (anorexia nervosa and bulimia nervosa) treated in the Endocrinology and Nutrition service of the Virgen del Rocío University Hospital between 2014 and 2019 were included. Results 67 patients were contacted and accepted to participate in the study. 95.5% were women. 67.2% were diagnosed with AN (anorexia nervosa) and 32.8% with BN (bulimia nervosa). Their median ages (years) at the onset of symptoms, beginning of follow-up and at present were 17, 32 and 42.5 respectively. Their median time of follow-up was 9 years. 73.1% had mental comorbitidy and AN patients had more osteoporosis (48.9% vs 22.7%, p = 0.04) and hypogonadotropic hypogonadism (31.1% vs. 4.5%, p = 0.014). Discussion The SE-ED patients in our sample began treatment years after the onset of symptoms, which may have led to their chronification. This emphasizes the importance of an early diagnosis in eating disorders. They presented with a high rate of physical complications and mental comorbidity. In the current sample, it was determined that patients with AN presented with higher rates of osteoporosis and hypogonadotropic hypogonadism than patients with BN. Level of evidence Level III: Evidence obtained from well-designed cohort or case–control analytic studies. Plain English summary At present, the criteria for severe and enduring eating disorders (SE-ED) are not sufficiently clearly defined. It has been calculated that approximately 20% of patients with anorexia nervosa (AN) and 10% of patients with bulimia nervosa (BN) suffer a chronification. We evaluated the characteristics of the patients, as well as the treatment outcomes for the people treated in an Endocrinology and Nutrition unit with a diagnosis of SE-ED (which was made based on an evolution greater than 7 years despite conventional treatment). The SE-ED patients in our sample began treatment years after the onset of symptoms, which may have led to their chronification. They presented with a high rate of physical complications and mental comorbidity. In the current sample, it was determined that patients with AN presented with higher rates of osteoporosis (health condition that weakens bones, making them fragile and more likely to break) and hypogonadotropic hypogonadism (illness in which testes or ovaries produce little or no sex hormones due to a problem in the pituitary gland) than patients with BN.

Body representation distortion (BRD) is a core criterion of Anorexia Nervosa (AN), and is usually assessed subjectively, focusing on body shape. We aimed to develop a new assessment to evaluate body representation independently from socially-mediated body image, on a body part with low emotional salience (hands). In a monocentric open label pilot study, we measured hand representations based on explicit (verbal) and implicit (tactile) instructions. Participants, with eyes closed, had to point targeted locations (knuckles and nails of each finger) based on verbal instructions and tactile stimulations to evaluate body representations respectively. Ratios between hand width and finger length were compared between AN (n = 31) and controls (n = 31) and correlated with current body mass index, AN subtype and disease duration. To control that hand distortion was specific to body representation, we also assessed object representation. Hand representation’s width/length ratio was significantly increased in patients with AN, whereas no difference was found in object representation. We found no correlation between hand wideness and clinical traits related to eating disorders. Our results propose that BRD is not limited to body parts with high emotional salience, strengthening the hypothesis that anorexia nervosa is associated with profound unspecific BRD.

In this article, we present a theoretical model that points to disgust-induced avoidance as a mechanism that can help explain the persistent and excessive food restriction in individuals with anorexia nervosa (AN). Disgust is characterized by intense negative feelings of revulsion and an overwhelming and irresistible urge to avoid potential disgust elicitors. When eating, or even the prospect of eating, elicits overwhelming feelings of disgust in individuals with AN, this could explain why food restriction persists even when someone is in a state of starvation. Following this model, disgust is elicited by the expected impact of food on the own body ("becoming fat") resulting in body-related self-disgust. We argue that limiting food intake may serve to avoid self-disgust. This implies that when self-disgust remains unchanged after treatment of AN, residual levels of self-disgust after treatment could make individuals vulnerable to relapse.

BackgroundPrevious studies provided controversial insight on the impact of starvation, disease status and underlying grey matter volume (GMV) changes on resting-state functional magnetic resonance imaging (rsfMRI) alterations in Anorexia nervosa (AN). Here we adapt a combined longitudinal and cross-sectional approach to disentangle the effects of these factors on resting-state alterations in AN.MethodsOverall, 87 female subjects were included in the study: adolescent patients with acute AN scanned at inpatient admission (N = 22, mean age 15.3 years) and at discharge (N = 21), 21 patients recovered from AN (22.3 years) and two groups of healthy age-matched controls (both N = 22, 16.0 and 22.5 years). Whole-brain measures of resting-state activity and functional connectivity were computed (Network Based Statistics, Global Correlation, Integrated Local Correlation, fractional Amplitude of Low Frequency Fluctuations) to assess rsfMRI alterations over the course of AN treatment before and after controlling for underlying GMV.ResultsPatients with acute AN displayed strong and widespread prefrontal, sensorimotor, parietal, temporal, precuneal and insular reductions of resting-state connectivity and activity. All alterations were independent of GMV and were largely normalized in short- and absent in long-term recovered AN.ConclusionsResting-state fMRI alterations in AN constitute acute and GMV independent presumably starvation-related phenomena. The majority of alterations found here normalized over the course of recovery without evidence for possible preexisting trait- or remaining “scar”-effects.

Eating disorders, such as anorexia nervosa, are challenging to treat successfully and have a very high relapse rate. Body image disturbance (BID) is a core component of these eating disorders. It is a predictor of onset, treatment outcome and future relapse. However, recent studies suggest that BID can be improved by an adaptation of cognitive bias training. This does not target the accuracy of body size judgements, but instead focuses on how a body of a particular size is categorized by a patient. This recalibration of the categorical boundary at which bodies are judged as overweight, which challenges a patient's existing preconceptions about which constitutes an acceptable body size, seems to lead to a more general reassessment of eating disordered attitudes and a significant improvement in their psychological profile. These promising findings need further trials to determine the long-term effectiveness of such a targeted intervention, but it potentially provides an important additional treatment option. In addition, this cognitive bias training may also be an effective augmentation to treatment in other conditions that feature BID, such as bulimia nervosa and body dysmorphia.

Psilocybin is a psychotropic molecule that is a partial agonist of serotonin 2A receptors and is the main psychoactive compound in hallucinogenic mushrooms. After the observation in 1953 in Mexico of ritual practices involving ingestion of such mushrooms, psilocybin was chemically characterized and synthesized in 1958 thanks to the collaboration between the Museum national d’Histoire naturelle in France and the Sandoz pharmaceutical laboratories in Switzerland. The interest of this substance in psychiatric therapy was then evaluated for the first time at the Sainte-Anne Hospital in Paris, by the team of Professor Jean Delay. Among the patients who received this substance was a 35-year-old woman who was hospitalized for compulsive manifestations emblematic of anorexia nervosa and who experienced an immediate and lasting improvement. The original 1959 article (published in the Annales de la Societe Medico-Psychologique) gives details of the patient's family background, biography and clinical examination. It then outlines the observations after two injections of psilocybin four days apart, in particular the autobiographical verbal statements that allowed the patient to understand the psychogenesis of her illness. After a long hiatus, psilocybin is once again the subject of medical research, with clinical trials now underway assessing psilocybin in the treatment of anorexia nervosa ( NCT04505189 ; NCT04052568 ; NCT04661514 ) and this 1959 case study, is the first known demonstration of the safety and efficacy of psilocybin treatment of anorexia nervosa. This case study thus provides an interesting insight into possible therapeutic mechanisms and is of great interest to the field moving forward.

We report a case of anorexia nervosa (AN) with gastroesophageal varices (GEV) in a 36-year-old woman. The patient presented to our hospital with progressive bloating due to severe ascites. She had no history of alcohol intake. Esophagogastroduodenoscopy and enhanced computed tomography revealed GEV and multiple hepatic nodules, respectively. The histological examination of a liver biopsy specimen revealed similar features to nonalcoholic fatty liver disease and showed hyperplastic nodules that were suspected to be related to the uneven distribution of portal blood flow in the liver. In conclusion, patients with long-term AN should undergo abdominal imaging to detect signs of portal hypertension.

Purpose: Anorexia nervosa (AN) and non-suicidal self-injury (NSSI) share typical onset in adolescence, greater prevalence in females and similar risk factors. Nevertheless, clinical features of eating disorders (ED) in this population are still under-investigated, especially associated to psychological features. Methods: The present study aims at comparing clinical and ED characteristics and psychopathological traits in a sample of 253 female adolescents with AN with or without NSSI and to determine possible clinical and psychological predictors on the presence of NSSI. The two groups were compared through multivariate analyses, while correlation and regression analyses were conducted to determine possible associations and predictors. Results: AN + NSSI group showed higher prevalence of binging–purging-type AN (p