Although it is well accepted that most patients with anorexia nervosa are perfectionistic, little work has been done in characterizing this behavior. Anorexics were assessed by two new multidimensional instruments that were designed to measure multiple aspects of perfectionism. Both scales confirm that underweight, malnourished patients with anorexia nervosa are perfectionistic. Importantly, elevated perfectionism scores persisted after weight restoration. Anorexics experienced their perfectionism as selfimposed, and not as a response to other's expectations. Perfectionism is a dimension of the rigid, obsessive behaviors that may contribute to resistance to treatment and relapse in anorexia nervosa. Thus, these scales may be of value in assessing response to treatment. © 1995 by John Wiley & Sons, Inc.

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Objective Depression, anxiety, and obsessionality frequently are present in underweight, malnourished patients with anorexia nervosa. It is less certain if these symptoms persist after recovery. Thus, we assessed these symptoms in anorexic women at three states of illness (underweight, short‐term weight restored, and long‐term weight restored) in comparison to a group of healthy women. Method: We used standardized self‐ and trained rater instruments to assess depression (Hamilton Depression Rating Scale and Beck Depression Inventory), anxiety (Spielberger State‐Trait Anxiety Inventory and Hamilton Anxiety Rating Scale), and obsessions and compulsions (Yale‐Brown Obsessive Compulsive Scale). Results: A similar pattern was found for all symptoms. That is, scores for depression, anxiety, and obsessionality were most elevated in the underweight state. These symptoms improved with weight restoration. However, milder but significantly elevated symptoms persisted in long‐term weight‐restored anorexic women compared to healthy control women. Discussion: These data suggest that malnutrition intensifies the severity of depression, anxiety, and obsessionality in anorexia nervosa. However, the fact that mild to moderate symptoms persisted after long‐term weight restoration raises the possibility that such behaviors are related to the pathogenesis of this illness. © 1997 by John Wiley & Sons, Inc. Int J Eat Disord 21: 367–376, 1997.

Persistent serotonergic and behavioral abnormalities after recovery raise the possibility that these psychobiological alterations might be trait-related and contribute to the pathogenesis of BN.

Men with anorexia and bulimia nervosa account for 10% of people with this condition and for binge eating disorder they account for as many as 25%. Risk factors in men include athletics, sexuality, psychiatric co-morbidity and negative life experiences. Differences in eating disorders exist between men and women relating to behavior and psychological symptoms. Men are much more likely than women to underestimate body size and desire a more muscular body. Men are less likely than women to engage in typical compensatory behaviors such as vomiting and more likely to engage in activities such as excessive exercise to attempt to lose weight or counteract the effects of eating. Men are more likely than women to binge rather than restrict due to negative body image. Studies show that men with eating disorders are less likely to seek treatment than women are. Obstacles to treatment include cultural biases toward eating disorders because they are considered to be female disorders, a lack of trained professionals and a lack of treatment setting that specifically deals with male eating disorders patients. Finally, even with little research to guide treatment of eating disorders, the outcome seems to be similar for men and women.

This study examined dimensional personality and temperamental characteristics in women with eating disorders. Clinical symptoms, personality, and temperament were examined in 30 women with anorexia nervosa (AN), 32 women with bulimia nervosa with no history of anorexia nervosa (BN), and 20 women with comorbid anorexia and bulimia nervosa (AB). Temperament differed markedly across the groups on the Tridimensional Personality Questionnaire (TPQ) with AN women showing greater reward dependence, BN women scoring higher on novelty seeking subscales, and AB women showing high harm avoidance. The TPQ subscales also displayed higher classification accuracy than other personality and symptom measures. Temperamental features are distinct across eating disorder subtypes. Temperament could reflect differential vulnerabilities for the development of specific eating disorder symptom clusters. 0 1995

To determine whether short periods of fasting can suppress the activity of the reproductive axis in normal healthy men, eight men were studied on a fed day and again after 48 h of fasting. Subjects were between 20-32 yr of age and ranged from 84-119% of normal body weight. Blood samples were collected on day 1 (a fed day) and day 3 (after 48 h of fasting) at 15-min intervals from 0800-1600 h through indwelling venous catheters. Fasting for 48 h resulted in a significant decrease in mean LH, FSH, and testosterone concentrations. The mean LH concentration decreased from 2.94 +/- 0.59 IU/L on the fed day to 1.07 +/- 0.14 IU/L after 48 h of fasting, and there was an accompanying decrease in LH pulse frequency (from 5.13 +/- 0.29 to 2.63 +/- 0.62 pulses/8 h) and mean baseline LH concentration (from 1.83 +/- 0.52 to 0.51 +/- 0.07 IU/L), but no significant decrease in LH pulse amplitude. In a second study, blood samples were collected from five subjects who were allowed to eat normally between days 1 and 3; these individuals showed no difference in LH secretion. To begin to examine the possibility that an activation of the hypothalamic-pituitary-adrenal axis leads to the suppression of reproductive hormone levels that occurred after 48 h of fasting, cortisol levels were measured in all plasma samples. There was no significant difference in mean cortisol concentrations on fed vs. fasted days or when cortisol concentrations were examined as hourly means across the 2 days. These results indicate that activity of the reproductive axis can be suppressed in normal healthy men by 48 h of fasting. It appears unlikely that activation of the adrenal axis is the cause of this suppression of reproductive axis activity.

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