Autonomic Nervous System Function in Anorexia Nervosa: A Systematic Review

Abstract

Background: Autonomic nervous system (ANS) dysfunction has been suggested to contribute to the high prevalence of cardiovascular complications in individuals with anorexia nervosa (AN), yet has not been thoroughly investigated. The current review aimed to synthesize the evidence of basal ANS function in individuals with a current diagnosis of AN and those with a previous diagnosis who had achieved weight restoration, as compared to controls.Methods: A systematic review of nine databases was conducted and studies that were published in a peer-review journal, in English, that included at least one assessment of ANS function in individuals with a current or previous diagnosis of AN were selected. Forty-six studies were included with a total of 811 participants with a current diagnosis of AN and 123 participants with a previous diagnosis of AN.Results: ANS function was assessed through heart rate variability (n = 27), orthostatic challenge, blood pressure variability or baroreflex sensitivity (n = 11), adrenergic activity (n = 14), skin conductance level (n = 4), and pupillometry (n = 1). Individuals with AN demonstrated increased parasympathetic activity and decreased sympathetic activity, suggestive of autonomic dysregulation. Following weight restoration, autonomic function trended toward, or was equivalent to, control levels.Discussion: Autonomic dysregulation is indicated through a range of assessments in individuals with AN. Future investigations should utilize a variety of assessments together in order to conclusively establish the nature of autonomic dysfunction in AN, and following extended weight restoration. Moreover, investigation into the co-occurrence of ANS function and cardiovascular risk is required.

Real-life self-control conflicts in anorexia nervosa: An ecological momentary assessment investigation

“…They also often show increased levels of alexithymia, that is, difficulties in identifying and describing emotional states [52, 53], and decreased levels of interoception, that is, awareness of bodily signals [54]. Increased parasympathetic activity in the acute state of the disorder might also reduce the subjective experience of arousal [55, 56]. It could therefore be argued that we found conflict strength to be less relevant for self-control success in AN patients because, similarly to emotional states, self-control conflicts are experienced less intensely.…”

Momentary physiological indices related to eating disorders: A systematic and methodological review

“…Mazurak et al (2011a;20 studies; N = 739) found mixed results regarding HRV patterns in AN, and Peyser and colleagues (2021) found elevated HRV in AN compared to healthy individuals (20 studies). Jenkins et al (2021) reported increased parasympathetic and decreased sympathetic activity in AN as measured by HRV, EDA, and other PP (46 studies; N = 934). Three reviews found inconsistent results (HRV in BN [Peschel et al, 2016;17 studies;N = 1441], PP in acute stress in Binge eating disorder (BED) [Naish et al, 2019;14 studies], and HRV in BED [Christensen et al, 2023;6 studies;N = 153]).…”

“…Jenkins et al. (2021) reported increased parasympathetic and decreased sympathetic activity in AN as measured by HRV, EDA, and other PP (46 studies; N = 934). Three reviews found inconsistent results (HRV in BN [Peschel et al., 2016; 17 studies; N = 1441], PP in acute stress in Binge eating disorder (BED) [Naish et al., 2019; 14 studies], and HRV in BED [Christensen et al., 2023; 6 studies; N = 153]).…”

Sensor Technology and Intelligent Systems in Anorexia Nervosa: Providing Smarter Healthcare Delivery Systems

“…Interoception deficits (i.e., the difficulty to accurately identify internal physiological signals like hunger or satiety), have been identified as a key symptom in network analysis of AN psychopathology [ 23 ]. Therefore, there is a venue for further research on the autonomic nervous system in AN [ 24 ] using sensing technology.…”