<scp>L</scp>abeling and defining severe and enduring anorexia nervosa: A systematic review and critical analysis

Broomfield, Catherine; Stedal, Kristin; Touyz, Stephen; Rhodes, Paul

doi:10.1002/eat.22715

Cited by 92 publications

(111 citation statements)

References 61 publications

(86 reference statements)

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“…Such precession of age at onset does not seem to be a random phenomenon, as it is related to specific clinical and psychological features and to a less favourable course (Abbate‐Daga et al, ). Clearly, in those cases, a longer time needed to reach specialist ED care may imply the risk of higher degrees of chronicity and a worse outcome (Broomfield, Stedal, Touyz, & Rhodes, ). Although experts in the field have recently pleaded for the introduction of an “early intervention” approach for EDs and the reduction in the time of untreated symptoms in EDs, they have also recognized that in order to achieve such goals, services will need to be reconfigured to match different clinical phases and settings in the future (Treasure & Russell, ).…”

Section: Discussionmentioning

confidence: 99%

Pathways to specialist care for eating disorders: An Italian multicentre study

Volpe

Monteleone

Ricca

et al. 2019

Euro Eating Disorders Rev

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Two hundred forty six patients with eating disorders (EDs) recruited from eight Italian specialized treatment centres were administered with the World Health Organization “Encounter Form,” a standardized schedule that makes it possible to characterize the clinical pathways that patients follow to reach specialized care. The median time from symptoms onset to specialized care was 114 weeks. Primary “points of access to care” were general practitioners (25%), psychiatrists (18%), and clinical nutritionists (17%), followed by various other carers. All patients received specific psychotherapy, whereas only 11% of them were given psychotropic drugs. EDs are characterized by complex care pathways, with low rates of direct access to specialized care. Although the role of general practitioners remains crucial, they tend to follow different clinical routes to refer ED patients. Educational programmes on EDs should be addressed to general practitioners and clinical nutritionists, in order to ease the transition of ED patients to a mental health care setting.

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Section: Discussionmentioning

confidence: 99%

Pathways to specialist care for eating disorders: An Italian multicentre study

Volpe

Monteleone

Ricca

et al. 2019

Euro Eating Disorders Rev

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“…This finding should be interpreted cautiously because this study may have been under-powered to detect the association between duration of AN and RSFC patterns and the measure used to establish duration of illness was somewhat imprecise. Additionally, although illness duration suggested that participants were, on average, beyond the early stages of AN (Broomfield et al, 2017), it is possible that the illness duration range was too narrow to capture effects of illness chronicity on frontostriatal circuitry. However, this finding could also suggest that patterns of heterogeneity in brain functioning among individuals with AN differ according to variables other than length of illness.…”

Section: Discussionmentioning

confidence: 99%

“…However, this model further asserts that the over-training of such reward responses to illness-compatible stimuli eventually fosters a compulsive reliance on rigid and automatic eating disorder behaviors, independent of momentary dopaminergic responding (Foerde, Steinglass, Shohamy, & Walsh, 2015; Godier & Park, 2014). Thus, the habit-centered model deviates from the reward deficit model in postulating that, once an individual has fully developed AN, especially after the initial stages of illness (e.g., adolescence, <3–5 years of illness; Broomfield, Stedal, Touyz, & Rhodes, 2017), dysfunctions in dorsal frontostriatal network predominate over those in more ventral, reward-oriented regions (Godier & Park, 2014; Walsh, 2013). …”

Section: Introductionmentioning

confidence: 99%

Resting state functional connectivity of networks associated with reward and habit in anorexia nervosa

Haynos

Hall

Lavender

et al. 2018

Human Brain Mapping

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Neurobiological disturbances associated with reward and/or habit learning are theorized to maintain symptoms of anorexia nervosa (AN). Although research has investigated responses in brain regions associated with reward and habit to disorder-specific cues (e.g., food) and presumed rewards (e.g., money), little is known about the functional organization of the circuits underlying these constructs independent of stimulus. This study aimed to provide initial data on the synchrony of networks associated with reward and habit in AN by comparing resting-state functional connectivity (RSFC) patterns between AN and healthy control (HC) participants in these circuits and delineating how these patterns relate to symptoms. Using theoretically selected seeds in the nucleus accumbens (NAcc), ventral caudate, and dorsal caudate, reflecting a continuum from reward- to habit- oriented regions, RSFC patterns were compared between AN restricting subtype (n = 19) and HC (n = 19) participants (cluster threshold: p < .01). Exploratory correlations between RSFC z-scores and Eating Disorder Examination (EDE) scores, BMI, and illness duration were conducted. The AN group demonstrated lower RSFC between the NAcc and superior frontal gyrus, between the ventral caudate and frontal and posterior regions, and between the dorsal caudate and frontal, temporal, and posterior regions. In the AN group, lower NAcc- superior frontal gyrus RSFC correlated with greater EDE Global scores (r = −.58, CI: −.83, −.13). These resting-state synchrony disruptions of the ventral and dorsal frontostriatal circuits, considered in context of the broader literature, support the utility of further investigating possible reward and habit disturbances supporting symptoms in AN.

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“…Lifetime prevalence of AN is estimated to be 3.64% amongst women (Micali, Martini, et al, ), with AN incidence highest during adolescence (Micali, Hagberg, Petersen, & Treasure, ). Generally time to recovery is protracted (Strober, Freeman, & Morrell, ; Zerwas et al, ), and a significant proportion of individuals experience severe and enduring AN (Broomfield, Stedal, Touyz, & Rhodes, ), meeting full diagnostic criteria for many years (Steinhausen, ).…”

Section: Introductionmentioning

confidence: 99%

Anxiety disorders predict fasting to control weight: A longitudinal large cohort study of adolescents

Lloyd

Haase

Zerwas

et al. 2019

Euro Eating Disorders Rev

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Objective: To determine whether anxiety disorders are prospectively associated with fasting for weight-loss/to avoid weight-gain, a behaviour that precedes and is typical of anorexia nervosa (AN), during adolescence.Method: Participants were 2,406 female adolescents of the Avon Longitudinal Study of Parents and Children. Anxiety disorders were assessed when participants were aged 13-14 and 15-16; fasting was measured approximately 2 years after each anxiety assessment. Generalised estimating equation models examined whether anxiety disorders predicted later fasting, across the two longitudinal waves of data. To probe the moderating effect of time, data were stratified by wave and binary logistic regression analyses completed.Results: Across longitudinal waves, anxiety disorder presence predicted increased risk of later fasting. Evidence from wave-stratified analyses supported a positive association between anxiety disorder presence at wave 15-16 and fasting at wave 17-18, however did not indicate an association between anxiety disorders at wave 13-14 and fasting at wave 15-16.

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Labeling and defining severe and enduring anorexia nervosa: A systematic review and critical analysis

Abstract: It is the aim of the authors to inspire further research into what is the most appropriate label and defining features for the subgroup in order to facilitate a better approach and outcome for the individuals affected.

Cited by 92 publications

References 61 publications

Pathways to specialist care for eating disorders: An Italian multicentre study

Pathways to specialist care for eating disorders: An Italian multicentre study

Resting state functional connectivity of networks associated with reward and habit in anorexia nervosa

Anxiety disorders predict fasting to control weight: A longitudinal large cohort study of adolescents

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