Ehlers–Danlos syndrome in a young woman with anorexia nervosa and complex somatic symptoms

Lee, Michelle; Strand, Mattias

doi:10.1002/eat.22815

Cited by 16 publications

(17 citation statements)

References 20 publications

(30 reference statements)

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“…Note the observed connection between DSE and FCR2A and EhlerDanlos and autoimmune syn dromes, respectively. Associations between anorexia nervosa and EhlerDanlos, 37 rheumatoid arthritis and systemic lupus erythematosus 38 have been documented elsewhere.…”

Section: Active Versus Remitted Versus Nedmentioning

confidence: 92%

A longitudinal, epigenome-wide study of DNA methylation in anorexia nervosa: results in actively ill, partially weight-restored, long-term remitted and non-eating-disordered women

Steiger

Booij

Kahan

et al. 2019

jpn

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Background:This study explored state-related tendencies in DNA methylation in people with anorexia nervosa. Methods: We measured genome-wide DNA methylation in 75 women with active anorexia nervosa (active), 31 women showing stable remission of anorexia nervosa (remitted) and 41 women with no eating disorder (NED). We also obtained postintervention methylation data from 52 of the women from the active group. Results: Comparisons between members of the active and NED groups showed 58 differentially methylated sites (Q < 0.01) that corresponded to genes relevant to metabolic and nutritional status (lipid and glucose metabolism), psychiatric status (serotonin receptor activity) and immune function. Methylation levels in members of the remitted group differed from those in the active group on 265 probes that also involved sites associated with genes for serotonin and insulin activity, glucose metabolism and immunity. Intriguingly, the direction of methylation effects in remitted participants tended to be opposite to those seen in active participants. The chronicity of Illness correlated (usually inversely, at Q < 0.01) with methylation levels at 64 sites that mapped onto genes regu lating glutamate and serotonin activity, insulin function and epigenetic age. In contrast, body mass index increases coincided (at Q < 0.05) with generally increased methylation-level changes at 73 probes associated with lipid and glucose metabolism, immune and inflammatory processes, and olfaction. Limitations: Sample sizes were modest for this type of inquiry, and findings may have been subject to uncontrolled effects of medication and substance use. Conclusion: Findings point to the possibility of reversible epigenetic alterations in anorexia nervosa, and suggest that an adequate pathophysiological model would likely need to include psychiatric, metabolic and immune components.

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Section: Active Versus Remitted Versus Nedmentioning

confidence: 92%

A longitudinal, epigenome-wide study of DNA methylation in anorexia nervosa: results in actively ill, partially weight-restored, long-term remitted and non-eating-disordered women

Steiger

Booij

Kahan

et al. 2019

jpn

View full text Add to dashboard Cite

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“…Ehlers–Danlos syndrome (EDS) is a heritable connective tissue disorder in which patients also complain of a constellation of GI symptoms, including abdominal pain (81%), bloating (57%), nausea (57%), reflux (48%), vomiting (43%), constipation (38%), and diarrhea (14%); delayed gastric emptying is frequently evident as well (71%), and these individuals often receive a diagnosis of an FGID (Zarate et al, 2010). There are several case reports of EDS accompanying AN, with EDS being the suspected cause and/or maintaining factor for on‐going disordered eating (Baeza‐Velasco et al, 2016; Lee & Strand, 2018; Miles et al, 2007) (Table 6). In a sample of 106 individuals diagnosed with EDS, nearly 60% complained of GI symptoms and two (1.9%) were found to have AN (Hershenfeld et al, 2016).…”

Section: Resultsmentioning

confidence: 99%

The intersect of gastrointestinal symptoms and malnutrition associated with anorexia nervosa and avoidant/restrictive food intake disorder: Functional or pathophysiologic?—A systematic review

Gibson

Watters

Mehler

2021

Intl J Eating Disorders

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Objective Although multiple pathophysiologic changes develop within the gastrointestinal (GI) system in the setting of malnutrition, the etiology of the reported multitude of symptoms in those with anorexia nervosa and avoidant restrictive intake disorder, as well as their contribution toward disordered eating, remain poorly understood. This systematic review seeks to better understand how these physiologic changes of malnutrition of the esophagus, stomach, intestines, and pancreas contribute toward the reported GI symptoms, as well as better understand how celiac disease, inflammatory bowel disease, pelvic floor dysfunction, and Ehlers–Danlos syndrome contribute toward disordered eating. Methods Studies of any design exploring the pathogenesis of complications and treatment strategies were included. Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines were used to structure and complete the review. Results A total of 146 articles were used for the review. The majority of studies were observational or case reports/case series. Discussion Pathophysiologic changes of the esophagus, stomach, and intestines develop with malnutrition, although these changes do not consistently correlate with expressed GI symptoms in patients with restrictive eating disorders. Celiac disease and inflammatory bowel disease also contribute to disordered eating through the associated somatic GI complaints, while pelvic floor dysfunction and Ehlers–Danlos syndrome contribute through both somatic symptoms and functional symptoms. Indeed, functional GI symptoms remain problematic during the course of treatment, and further research is required to better understand the extent to which these symptoms are functional in nature and remit or remain as treatment ensues.

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“…Anorexia has been reported in the literature to be associated with JHS/EDS [ 26 ]. It is thought that the extra-articular features such as gastrointestinal problems, temporomandibular disorders, and food intolerances contribute to developing and maintaining disturbed eating behaviors and significant weight loss in JHS/hEDS [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

A Young Woman with Excessive Fat in Lower Extremities Develops Disordered Eating and Is Subsequently Diagnosed with Anorexia Nervosa, Lipedema, and Hypermobile Ehlers-Danlos Syndrome

Wright¹,

Herbst

2021

Am J Case Rep

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Patient: Female, 31-year-old Final Diagnosis: Lipedema Symptoms: Bruising • leg edema • leg pain Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic • Family Medicine • Medicine, General and Internal • Metabolic Disorders and Diabetics • Plastic Surgery • Psychiatry Objective: Rare co-existance of disease or pathology Background: Lipedema is a loose connective tissue disease that causes disproportionate subcutaneous fat accumulation on the extremities. As a result of the increased subcutaneous tissue accumulation, lipedema is often confused with obesity by both physicians and patients. Poor awareness and limited diagnosis of lipedema contribute to the confusion of lipedema with obesity and can lead to decreased body image acceptance. Patients with lipedema may have anorexia nervosa, an eating disorder characterized by a distortion of body image, incorrect self-identification of being overweight, restricted eating behavior, and a relentless pursuit of weight loss. Case Report: A young woman with disproportionate fat accumulation on the lower half of her body self-identified as having obesity. She developed restrictive eating behavior and became obsessed with weight loss, resulting in anorexia nervosa. Her disproportionate subcutaneous tissue persisted despite losing weight to reach a nadir BMI of 15 kg/m 2 . After a decade-long struggle, her eating disorder resolved, and she maintained a healthy weight and BMI of 21.5 kg/m 2 but disproportionate fat remained in her lower body. She experienced increasing leg tenderness, pain, and easy bruising and was diagnosed with lipedema. Conclusions: Lack of recognition of lipedema by medical professionals and the public as a weight loss-resistant disease can affect body image acceptance. Lipedema was mistaken for obesity by the young woman in this case and likely played a role in her development of an eating disorder. Eating disorders, such as anorexia nervosa, are not rare and may be more common in women with lipedema.

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Ehlers–Danlos syndrome in a young woman with anorexia nervosa and complex somatic symptoms

Cited by 16 publications

References 20 publications

A longitudinal, epigenome-wide study of DNA methylation in anorexia nervosa: results in actively ill, partially weight-restored, long-term remitted and non-eating-disordered women

A longitudinal, epigenome-wide study of DNA methylation in anorexia nervosa: results in actively ill, partially weight-restored, long-term remitted and non-eating-disordered women

The intersect of gastrointestinal symptoms and malnutrition associated with anorexia nervosa and avoidant/restrictive food intake disorder: Functional or pathophysiologic?—A systematic review

A Young Woman with Excessive Fat in Lower Extremities Develops Disordered Eating and Is Subsequently Diagnosed with Anorexia Nervosa, Lipedema, and Hypermobile Ehlers-Danlos Syndrome

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