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Evidence for the effectiveness of existing treatments of patients with eating disorders is weak. Here we describe and evaluate a method of treatment in a randomized controlled trial. Sixteen patients, randomly selected out of a group composed of 19 patients with anorexia nervosa and 13 with bulimia nervosa, were trained to eat and recognize satiety by using computer support. They rested in a warm room after eating, and their physical activity was restricted. The patients in the control group (n ‫؍‬ 16) received no treatment. Remission was defined by normal body weight (anorexia), cessation of binge eating and purging (bulimia), a normal psychiatric profile, normal laboratory test values, normal eating behavior, and resumption of social activities. Fourteen patients went into remission after a median of 14.4 months (range 4.9 -26.5) of treatment, but only one patient went into remission while waiting for treatment (P ‫؍‬ 0.0057). Relapse is considered a major problem in patients who have been treated to remission. We therefore report results on a total of 168 patients who have entered our treatment program. The estimated rate of remission was 75%, and estimated time to remission was 14.7 months (quartile range 9.6 > 32). Six patients (7%) of 83 who were treated to remission relapsed, but the others (93%) have remained in remission for 12 months (quartile range 6 -36). Because the risk of relapse is maximal in the first year after remission, we suggest that most patients treated with this method recover. E ating disorders, i.e., anorexia and bulimia nervosa, are serious health problems in young women (less than 5% of patients are men), characterized by a disordered intake of food. Thus, anorexics eat only small amounts of food and lose body weight; bulimics eat large quantities of food and vomit or use other methods to maintain normal body weight. About 1% of all women develop anorexia at the age of 14-19 years, and 1-3% develop bulimia when 20-23 years old (1). Anorexics have less than a 50% chance of recovery within 10 years after the onset of the disorder, 25% develop into chronicity, and mortality can be as high as 25% (2). Bulimics have a better prognosis, but fewer than 50% recover, and 30% continue to binge eat and purge (2, 3).There is a considerable amount of data on the time course and outcome of anorexia and bulimia nervosa (2-4), but the effect of treatment interventions has not been extensively evaluated. Hence, there is little scientific evidence for the selection of one kind of treatment rather than another. In fact, it was recently pointed out that the effects of most treatments are unknown (5). Evaluation of medical interventions should be done in randomized controlled trials (RCT) (6). Three RCTs have compared treatment effects in young anorexic patients. In the first, family therapy was effective in comparison with individual therapy in 10 patients who had been ill for about 1 year and who had been treated on average once before (7). The treatment had no effect in 70 other patients who participa...

It is suggested that the function of the dopaminergic system, possibly mediating positive and negative reward, and the noradrenergic system, possibly mediating selective attention, is changed in pathological gambling.

In the fifty years since the organizational hypothesis was proposed, many sex differences have been found in behavior as well as structure of the brain that depend on the organizational effects of gonadal hormones early in development. Remarkably, in most cases we do not understand how the two are related. This paper makes the case that overstating the magnitude or constancy of sex differences in behavior and too narrowly interpreting the functional consequences of structural differences are significant roadblocks in resolving this issue.

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Restricted food intake is associated with increased physical activity, very likely an evolutionary advantage, initially both functional and rewarding. The hyperactivity of patients with anorexia nervosa, however, is a main problem for recovery. This seemingly paradoxical reward of hyperactivity in anorexia nervosa is one of the main aspects in our framework for the neurobiological changes that may underlie the development of the disorder. Here, we focus on the neurobiological basis of hyperactivity and reward in both animals and humans suggesting that the mesolimbic dopamine and hypothalamic orexin neurons play central roles. The paper represents an invited review by a symposium, award winner or keynote speaker at the Society for the Study of Ingestive Behavior [SSIB] Annual Meeting in Portland, July 2009.

Many studies have indicated that neuropeptide Y (NPY) stimulates and leptin inhibits food intake. In line with this, intracerebroventricular injection of NPY (10 microg) stimulated and leptin (10 microg) inhibited intake of a sucrose solution when female rats were required to obtain the solution from a bottle. However, NPY inhibited and leptin stimulated intake if the solution was infused intraorally. Thus NPY stimulates the responses used to obtain food but inhibits those used to consume food, and leptin has the opposite effects. To test the specificity of these responses the sexual behavior of male rats was examined. NPY-treated males showed minor deficits in sexual behavior but chose to ingest a sucrose solution rather than copulate with a female if offered the choice. By contrast, leptin-treated males ingested little sucrose and displayed an increase in ejaculatory frequency if given the same choice. It is suggested that NPY is not merely an orexigenic peptide, but one that directs attention toward food. Similarly, leptin may not be an anorexic peptide, but one that diverts attention away from food toward alternate stimuli.

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