A biopsychosocial proposal to progress the field of anorexia nervosa

Phillipou, Andrea; Musić, Selma; Rossell, Susan L.

doi:10.1177/0004867419849487

Cited by 12 publications

(17 citation statements)

References 7 publications

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“…CREAT is one of the first studies of AN that will allow us to parse unique environmental, genetic, and medical contributions (e.g., sequelae of undernutrition) of the disorder and therefore advances the debate of identifying underlying risk factors across different domains [ 88 ]. The comprehensive investigation optimizes the natural experiment of MZ twins who are discordant for AN.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, the disorder places a major social and financial burden on patients, family members, and the health care system [112]. No medications are effective in the treatment of the core symptoms of AN [130] and drug development has been hindered by a lack of understanding of the (neuro) biology of the disorder and a systematic integration of those biological factors with environmental components [88]. Until we gain a deeper understanding of the biology of the illness, we will be unable to determine which factors place individuals, or more nuanced questions such as which factors enable individuals with AN who do not die from the disorder to maintain dangerously low body mass indices (BMI), often for prolonged periods of time, without succumbing to medical complications of severe starvation or other opportunistic illnesses [16].…”

Section: Introductionmentioning

confidence: 99%

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Study protocol of comprehensive risk evaluation for anorexia nervosa in twins (CREAT): a study of discordant monozygotic twins with anorexia nervosa

et al. 2020

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Background Anorexia nervosa (AN) is a severe disorder, for which genetic evidence suggests psychiatric as well as metabolic origins. AN has high somatic and psychiatric comorbidities, broad impact on quality of life, and elevated mortality. Risk factor studies of AN have focused on differences between acutely ill and recovered individuals. Such comparisons often yield ambiguous conclusions, as alterations could reflect different effects depending on the comparison. Whereas differences found in acutely ill patients could reflect state effects that are due to acute starvation or acute disease-specific factors, they could also reflect underlying traits. Observations in recovered individuals could reflect either an underlying trait or a “scar” due to lasting effects of sustained undernutrition and illness. The co-twin control design (i.e., monozygotic [MZ] twins who are discordant for AN and MZ concordant control twin pairs) affords at least partial disambiguation of these effects. Methods Comprehensive Risk Evaluation for Anorexia nervosa in Twins (CREAT) will be the largest and most comprehensive investigation of twins who are discordant for AN to date. CREAT utilizes a co-twin control design that includes endocrinological, neurocognitive, neuroimaging, genomic, and multi-omic approaches coupled with an experimental component that explores the impact of an overnight fast on most measured parameters. Discussion The multimodal longitudinal twin assessment of the CREAT study will help to disambiguate state, trait, and “scar” effects, and thereby enable a deeper understanding of the contribution of genetics, epigenetics, cognitive functions, brain structure and function, metabolism, endocrinology, microbiology, and immunology to the etiology and maintenance of AN.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Study protocol of comprehensive risk evaluation for anorexia nervosa in twins (CREAT): a study of discordant monozygotic twins with anorexia nervosa

et al. 2020

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“…Anorexia nervosa (AN) is considered a biopsychosocial condition, with biological, psychological, and sociocultural factors postulated to contribute to illness development and maintenance (Phillipou, Musić, & Lee Rossell, in press). Despite AN being a condition that can result in serious psychological and physical outcomes, the mechanisms involved in the course of the illness are still poorly understood.…”

Section: Introductionmentioning

confidence: 99%

High‐definition transcranial direct current stimulation in anorexia nervosa: A pilot study

Phillipou

Kirkovski

Castle

et al. 2019

Intl J Eating Disorders

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Objective Anorexia nervosa (AN) is a serious psychiatric condition often associated with poor outcomes. Biologically informed treatments for AN, such as brain stimulation, are lacking, in part due to the unclear nature of the neurobiological contributions to the illness. However, recent research has suggested a specific neurobiological target for the treatment of AN, namely stimulation of the inferior parietal lobe (IPL). The aim of this study was to stimulate—noninvasively—the left IPL in individuals with AN using high‐definition transcranial direct current stimulation (HD‐tDCS). Method Twenty participants will be randomized to receive 10 daily sessions of HD‐tDCS or sham HD‐tDCS (placebo). Assessments will be carried out at baseline and end point, as well as 4‐ and 12‐week follow‐ups. Discussion This pilot investigation will primarily determine the feasibility and acceptability of this intervention.

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“…Anorexia nervosa bears some resemblance to other serious mental illnesses where a substantial number of sufferers remain symptomatic with cognitive and social decline despite what Phillipou et al (2019) describe rather naively as 'effective evidencebased treatments'. Genetic studies have shown an overlap between schizophrenia, mood disorders and anorexia nervosa.…”

mentioning

confidence: 99%

“…It might be said, however, that food is the miracle drug in anorexia nervosa -if only patients could be persuaded to take it! A number of potentially reversible neurobiological phenomena have been demonstrated including loss of white and grey matter, changes in brain metabolites, altered connectivity (Phillipou et al, 2019) and reward processes secondary to dysregulated endocannabinoids and oxytocin where potential treatment benefits have been demonstrated (Brockmeyer et al, 2018;Russell et al, 2019). Neuromodulation has shown therapeutic promise (Brockmeyer et al, 2018) while at the other end of the body,…”

mentioning

confidence: 99%