Background. Previous studies have highlighted the role of the brain reward and cognitive control systems in the etiology of anorexia nervosa (AN). In an attempt to disentangle the relative contribution of these systems to the disorder, we used functional magnetic resonance imaging (fMRI) to investigate hemodynamic responses to reward-related stimuli presented both subliminally and supraliminally in acutely underweight AN patients and age-matched healthy controls (HC). Methods. fMRI data were collected from a total of 35 AN patients and 35 HC, while they passively viewed subliminally and supraliminally presented streams of food, positive social, and neutral stimuli. Activation patterns of the group × stimulation condition × stimulus type interaction were interrogated to investigate potential group differences in processing different stimulus types under the two stimulation conditions. Moreover, changes in functional connectivity were investigated using generalized psychophysiological interaction analysis. Results. AN patients showed a generally increased response to supraliminally presented stimuli in the inferior frontal junction (IFJ), but no alterations within the reward system. Increased activation during supraliminal stimulation with food stimuli was observed in the AN group in visual regions including superior occipital gyrus and the fusiform gyrus/parahippocampal gyrus. No group difference was found with respect to the subliminal stimulation condition and functional connectivity. Conclusion. Increased IFJ activation in AN during supraliminal stimulation may indicate hyperactive cognitive control, which resonates with clinical presentation of excessive self-control in AN patients. Increased activation to food stimuli in visual regions may be interpreted in light of an attentional food bias in AN.

Background: There is sound evidence that the hypothalamic-pituitary-thyroid axis plays a role in mood regulation. Alterations in this axis, particularly low triiodothyronine syndrome, are a common neuroendocrine adaptation to semi-starvation in patients with anorexia nervosa (AN), who also frequently suffer from co-existing depressive symptoms. We therefore aimed to investigate the associations between pituitary-thyroid function and psychopathology, in particular depressive symptoms, at different stages of AN using a combined cross-sectional and longitudinal study design. Methods: Pituitary-thyroid status (FT3, free triiodothyronine; FT4, free thyroxine; conversion ratio FT3/FT4; TSH, thyroid-stimulating hormone) was assessed in 77 young acutely underweight females with AN (acAN) and in 55 long-term weight-recovered individuals with former AN (recAN) in a cross-sectional comparison to 122 healthy controls (HC). Further, pituitary-thyroid status of 48 acAN was reassessed after short-term weight-restoration. We performed correlation analyses of pituitary-thyroid parameters with self-reported measures of psychopathology. Results: AcAN showed significantly lower FT3, FT4, FT3/FT4 ratio, and TSH levels compared to HC. Pituitary-thyroid alterations were partly reversed after short-term weight-restoration. RecAN still had lower FT3 concentrations than HC. Lower FT3 concentrations and FT3/FT4 ratios were associated with more severe depressive symptoms in acAN, occurring prominently in cases of manifest low triiodothyronine syndrome. Longitudinally increasing FT3/FT4 ratios (change scores) were inversely correlated with depressive and general psychiatric symptoms after short-term weight-restoration. Conclusions: Our results suggest a potential modulation of the severity of depressive symptoms by temporarily decreased FT3 concentrations and inhibited thyroid hormone conversion (FT3/FT4 ratios) in acutely underweight AN. Associations between conversion ratios FT3/FT4 and psychopathology seem to persist across short-term weight-restoration. The findings of our study might have relevant clinical implications, ranging from thyroid monitoring to experimental low-dose thyroid hormone supplementation in certain patients with AN showing severe psychiatric impairment and overt thyroid hormone alterations.

Punishments can help inform us to make adaptive changes in behavior. However, previous research suggested that only low punishment-sensitive individuals “learn” from punishment, whereas high punishment-sensitive individuals do not. Here we used a flanker interference task with performance-contingent punishment signals to test the hypothesis that a clinical group characterized by heightened punishment sensitivity (i.e., patients with anorexia nervosa [AN]) would fail to adapt to conflict following punishment. To distinguish between state and trait factors, we tested for between-group differences in separate cohorts of acutely underweight patients (acAN; n = 40) and weight-recovered former patients (recAN; n = 25) relative to age-matched healthy controls (n = 48). The acAN patients showed an abnormally reversed congruency-sequence effect in error rates following punishment, despite generally superior accuracy, suggesting that punishment distracted acAN patients and interfered with interference control. The influence of punishment was more subtle in recAN and did not reach statistical significance, but both reaction time and error rate data hinted that elevated sensitivity to punishment negatively affects cognitive control even after long-term weight normalization. Together, these findings emphasize that punishment sensitivity may be a clinically relevant trait marker in AN and provide novel experimental evidence that punishment may have a detrimental impact on adaptive behavior in the disorder. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Background The amygdala is a subcortical limbic structure consisting of histologically and functionally distinct subregions. New automated structural magnetic resonance imaging (MRI) segmentation tools facilitate the in vivo study of individual amygdala nuclei in clinical populations such as patients with anorexia nervosa (AN) who show symptoms indicative of limbic dysregulation. This study is the first to investigate amygdala nuclei volumes in AN, their relationships with leptin, a key indicator of AN-related neuroendocrine alterations, and further clinical measures. Methods T1-weighted MRI scans were subsegmented and multi-stage quality controlled using FreeSurfer. Left/right hemispheric amygdala nuclei volumes were cross-sectionally compared between females with AN (n = 168, 12–29 years) and age-matched healthy females (n = 168) applying general linear models. Associations with plasma leptin, body mass index (BMI), illness duration, and psychiatric symptoms were analyzed via robust linear regression. Results Globally, most amygdala nuclei volumes in both hemispheres were reduced in AN v. healthy control participants. Importantly, four specific nuclei (accessory basal, cortical, medial nuclei, corticoamygdaloid transition in the rostral-medial amygdala) showed greater volumetric reduction even relative to reductions of whole amygdala and total subcortical gray matter volumes, whereas basal, lateral, and paralaminar nuclei were less reduced. All rostral-medially clustered nuclei were positively associated with leptin in AN independent of BMI. Amygdala nuclei volumes were not associated with illness duration or psychiatric symptom severity in AN. Conclusions In AN, amygdala nuclei are altered to different degrees. Severe volume loss in rostral-medially clustered nuclei, collectively involved in olfactory/food-related reward processing, may represent a structural correlate of AN-related symptoms. Hypoleptinemia might be linked to rostral-medial amygdala alterations.

Anorexia nervosa (AN) is an eating disorder characterised by severe emaciation due deliberate restriction of food intake and an intense fear of gaining weight. Theoretical accounts of AN have to date focused predominately on cognitive elements of the disorder, yet resulting treatments have been inadequate and outcome for AN remains poor. Understanding the processes that maintain the disorder is an important step in developing effective strategies to augment existing treatments. With this in mind, the question arises: what processes drive AN? Novel frameworks for AN suggest that particular information processing configurations or “modes” may underpin many symptoms of AN, such as preoccupation with control of eating, weight and shape. More specifically, it is proposed that a ruminative mode of processing may function as an avoidance strategy in AN, enabling individuals to neglect salient and rewarding stimuli, such as food, and thus uphold restrictive eating practices. Whilst empirical studies have examined processes such as rumination, avoidance and reward in depression, they have seldom been studied in AN. The aim of this thesis is therefore to understand the role of rumination and reward processes in AN. Chapter 1 reviews the literature on AN, rumination and reward processing. Chapter 2 presents data demonstrating to what extent the content of rumination in AN differs from rumination in depression and the effect that rumination may have on ED symptoms. The study conducted in Chapter 3 examines whether individuals with AN can be switched out of rumination around meal times and what effect this has on AN psychopathology. Chapter 4 presents neuroimaging data which elucidates the brain regions involved in processing rewarding and aversive food stimuli after recovery from AN. The study reported in Chapter 5 teases apart hedonic (liking) versus motivational (wanting) aspects of food reward in AN. The final study (Chapter 6) provides further evidence using neuroimaging that rumination may be an important process in AN which may override appetitive responses to rewarding stimuli, such as food. The studies reported support the notion that rumination and aberrant reward processing may be involved in the maintenance of AN.

This research focused primarily on exploring the talk of mothers of daughters with Anorexia Nervosa, paying specific attention to their emic perceptions of the underlying causes of Anorexia Nervosa. The research sought to reveal the discourses underpinning participants talk. Further, the way in which these discourses serve to construct Anorexia Nervosa in particular ways as well as the function these discourses serve were explored. This study is qualitative and exploratory in design and provides a unique understanding of Anorexia Nervosa in the form of emic accounts gleaned from mothers' own experiences. The findings of this research suggest that mothers of daughters with Anorexia Nervosa primarily reproduce a discourse on the causality of Anorexia Nervosa that is family or biomedically focused. Through analysis of the discourses embedded in participants’ talk, it became evident that participants reproduce discourses of gender and femininity and are influenced by societal pressure as well as the constructions of womanhood and motherhood. Insight into a side of the mother of the Anorectic, often concealed in the literature, was revealed through a semi-structured interview process with nine urban, middle-class, white South African mothers of daughters with Anorexia Nervosa. Interviews were then transcribed and analysed according to Braun and Clarke's thematic analysis. Incorporating the silenced voices of mothers of daughters with Anorexia Nervosa appears to have allowed for the emergence of a more generous view of the mother and has contributed to a larger set of discursive repertoires through which to understand Anorexia Nervosa. This research further gave rise to the realisation of a need for a critical education program whereby taken for granted notions can be revealed and actively engaged. This program would ideally seek to free the anorexic woman as well as the mother from the constraints of the uncritically constructed conceptualisations of Anorexia Nervosa and femininity.

Made available in DSpace on 2015-04-14T13:22:23Z (GMT). No. of bitstreams: 1 389421.pdf: 295139 bytes, checksum: 7db76d47f8c1b5184fe7b80df83f5cbd (MD5) Previous issue date: 2007-03-19 / Nesse artigo dois fatores de risco para os transtornos alimentares s?o analisados, bem como sua inter-rela??o contribuinte no desenvolvimento e manuten??o da anorexia nervosa e da bulimia nervosa, em mulheres: a rela??o m?e-filha e a auto-estima. Entre as necessidades humanas est? a de estima, ou seja, a necessidade de auto-estima e estima por parte dos outros. As m?es tendem a vivenciar suas filhas mulheres como menos separadas delas, devido a componentes narcisistas que prevalecem nesta dupla como identifica??o e simbiose. No caso das mulheres com transtorno alimentar algo se inverteu no processo de intera??o entre m?e-filha prejudicando o v?nculo entre elas. A forma??o da adequada auto-estima depende profundamente do olhar amoroso de aprecia??o por uma pessoa significativa, a m?e, porque nunca ? com seus pr?prios olhos que a crian?a se v?, mas sempre com os olhos do outro. O ver-se numa identifica??o com esse olhar dirigido para si constitui o narcisismo, a sua pr?pria auto-estima e dependendo do tipo de apego existente entre essa dupla, a auto-estima da filha ter? nuances diferenciadas. A pesquisa teve como foco a dificuldade na rela??o prim?ria entre m?e-filha e auto-estima em mulheres com transtornos alimentares. A amostra se constituiu de 51 participantes distribu?das em tr?s grupos: anorexia nervosa (Gr1), bulimia nervosa (Gr2) e controle (Gr3). Os instrumentos utilizados foram: a T?cnica de Rorschach, para avaliar a rela??o prim?ria com a figura materna; Escala de Rosenberg, para avaliar a auto-estima e um question?rio para levantamento de dados s?cio-demogr?ficos e caracter?sticas da amostra. O EAT-26 e o MINI foram utilizados para triar o grupo controle. A an?lise estat?stica foi por meio do Teste ANOVA e do Teste Qui-quadrado, com ?ndice de signific?ncia aceito de ≤0,05. Observou-se que os grupos 1 e 2 apresentaram indicadores de maior dificuldades na rela??o prim?ria com a figura materna, nos relacionamentos interpessoais e baixa auto-estima, comparados com o Gr3

The present study aimed to examine the relationship between maladaptive schemas and treatment outcomes of adolescent and adult women with an eating disorder receiving residential treatment. Existing data were obtained from 67 females aged 11 to 47 years (m =18.61) that had entered residential treatment for anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder not otherwise specified (EDNOS) at a Western United States residential eating disorder treatment facility. Pre- and posttreatment data were collected by the personnel at the facility on eating disorder symptomatology, mood, and core beliefs. Three hypotheses were tested: (a) that maladaptive schemas would be positively correlated with eating disorder symptom severity, (b) that females endorsing more maladaptive schemas at admission or those with stable maladaptive schemas across their course of treatment would have less favorable posttreatment outcomes at the time of their discharge from residential treatment than females with lower scores initially or improved scores over the course of their treatment and follow-up, and (c) that females endorsing more maladaptive schemas or with greater stability of their maladaptive schemas across treatment will spend more time in residential treatment. To address the above hypotheses a series of hierarchical linear regressions, linear mixed-effects models, and Cox proportional-hazards regressions were conducted. Results ndicated that maladaptive schemas at the start of treatment were predominantly predictive of admit rather than discharge symptomatology. Different combinations of maladaptive schemas were found to have both positive and negative relationships to one's symtomatology across time. The most common maladaptive schemas found to be significantly associated with symptomatology were impaired limits, impaired autonomy and performance, and overvigilance and inhibition. Lastly, a relationship existed between both impaired limits and overvigilance and inhibition and a participant's length of stay in treatment. The results of this study suggest that maladaptive schemas provide some predictability of treatment outcomes and are important targets for psychological interventions aimed at recovery. Furthermore, the results of the study highlight the complexity associated with maladaptive schemas in females with eating disorders and the need for longitudinal research to examine common patterns and therapeutic targets based on diagnosis and status in treatment.

<p>Researchers have recently combined clinical and cognitive areas of research in order to investigate the role of cognitive factors in explaining how emotional disorders are developed and maintained. It is believed that biased cognitive processing of emotionally relevant information can greatly affect emotional responses and behaviour where insights into such cognitive processes can have invaluable clinical implications.</p><p>The present thesis investigates the role of cognitive biases for information related to food and body appearance in individuals with eating disorders (ED) and those with non-clinically eating disorder-related concerns (NED). Are ED characterised by cognitive biases toward such information related to their specific concerns? Are such cognitive biases specific to clinical ED or present also in NED samples? Are cognitive biases operating at both conscious and unconscious levels of cognitive processing?</p><p>The tasks used to pursue these questions were: the emotional Stroop task, an Internet version of the emotional Stroop, Jacoby’s white noise paradigm and a recognition task. The influence of priming on the emotional Stroop task was also investigated in order to test whether the use of this task could be extended to more complex investigations than selective attention.</p><p>Results provide support for that cognitive processing of information related to eating and body appearance is biased in individuals with ED. It is, however, unclear whether such biased processing is specific to clinical ED. Findings further suggest that cognitive biases occur primarily at unconscious levels of cognitive processing. Support was also obtained for that the emotional Stroop task is sensitive to priming where initial body perception may be one factor influencing cognitive responses toward negative self referent words following exposure to thin ideal images. Results further suggest that the emotional Stroop task successfully can be administered via the Internet where manipulating task delivery and response mode may increase the sensitivity of this task. Some of the advantages of administering the emotional Stroop task via Internet over traditional methods are access to more heterogeneous samples, more ecologically valid situations, reduced costs and minimisation of demand characteristics.</p>

Researchers have recently combined clinical and cognitive areas of research in order to investigate the role of cognitive factors in explaining how emotional disorders are developed and maintained. It is believed that biased cognitive processing of emotionally relevant information can greatly affect emotional responses and behaviour where insights into such cognitive processes can have invaluable clinical implications. The present thesis investigates the role of cognitive biases for information related to food and body appearance in individuals with eating disorders (ED) and those with non-clinically eating disorder-related concerns (NED). Are ED characterised by cognitive biases toward such information related to their specific concerns? Are such cognitive biases specific to clinical ED or present also in NED samples? Are cognitive biases operating at both conscious and unconscious levels of cognitive processing? The tasks used to pursue these questions were: the emotional Stroop task, an Internet version of the emotional Stroop, Jacoby’s white noise paradigm and a recognition task. The influence of priming on the emotional Stroop task was also investigated in order to test whether the use of this task could be extended to more complex investigations than selective attention. Results provide support for that cognitive processing of information related to eating and body appearance is biased in individuals with ED. It is, however, unclear whether such biased processing is specific to clinical ED. Findings further suggest that cognitive biases occur primarily at unconscious levels of cognitive processing. Support was also obtained for that the emotional Stroop task is sensitive to priming where initial body perception may be one factor influencing cognitive responses toward negative self referent words following exposure to thin ideal images. Results further suggest that the emotional Stroop task successfully can be administered via the Internet where manipulating task delivery and response mode may increase the sensitivity of this task. Some of the advantages of administering the emotional Stroop task via Internet over traditional methods are access to more heterogeneous samples, more ecologically valid situations, reduced costs and minimisation of demand characteristics.