Typical and atypical restrictive anorexia nervosa: Weight history, body image, psychiatric symptoms, and response to outpatient treatment

Santonastaso, Paolo; Bosello, Romina; Schiavone, Paolo; Tenconi, Elena; Degortes, Daniela; Favaro, Angela

doi:10.1002/eat.20706

Cited by 42 publications

(56 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is in keeping with a treatment study of young adults with AN, finding that weight restoration was not associated with improvements in body image anxiety nor body avoidance behaviors, and indeed that individuals at higher weights had greater body image anxiety (Bamford, Attoe, Mountford, Morgan, & Sly, 2014). Another study found that body dissatisfaction in young adults with full and subthreshold AN is similar regardless of weight status (Santonastaso, Bosello, Schiavone, Tenconi, Degortes, & Favaro, 2009). While similar research in adolescents with AN is sparse, weight and shape concerns appear to increase with BMI percentile in adolescent girls at large, with higher body dissatisfaction in girls starting at the 50 th BMI-for-age percentile (Calzo, Sonneville, Haines, Blood, Field, & Austin, 2012).…”

Section: Discussionmentioning

confidence: 99%

Is weight gain really a catalyst for broader recovery?: The impact of weight gain on psychological symptoms in the treatment of adolescent anorexia nervosa

Accurso

Ciao

Fitzsimmons‐Craft

et al. 2014

Behaviour Research and Therapy

100

View full text Add to dashboard Cite

The main aims of this study were to describe change in psychological outcomes for adolescents with anorexia nervosa across two treatments, and to explore predictors of change, including baseline demographic and clinical characteristics, as well as weight gain over time. Participants were 121 adolescents with anorexia nervosa from a two-site (Chicago and Stanford) randomized controlled trial who received either family-based treatment or individual adolescent supportive psychotherapy. Psychological symptoms (i.e., eating disorder psychopathology, depressive symptoms, and self-esteem) were assessed at baseline, end of treatment, 6-month, and 12-month follow-up. Conditional multilevel growth models were used to test for predictors of slope for each outcome. Most psychological symptoms improved significantly from baseline to 12 month followup, regardless of treatment type. Depressive symptoms and dietary restraint were most improved, weight and shape concerns were least improved, and self-esteem was not at all improved. Weight gain emerged as a significant predictor of improved eating disorder pathology, with earlier weight gain having a greater impact on symptom improvement than later weight gain. Adolescents who presented with more severe, complex, and enduring clinical presentations (i.e., longer duration of © 2014 Elsevier Ltd. All rights reserved. * Corresponding author: The University of Chicago, 5841 S. Maryland Ave., MC 3077, Chicago, IL 60637, eaccurso@uchicago.edu, Phone: 773.834.1007, Fax: 773.702.9929. a Department of Psychiatry and Behavioral Neuroscience, The University of Chicago b Department of Psychiatry and Behavioral Sciences, Stanford University Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript illness, greater eating disorder pathology, binge-eating/purging subtype) also appeared to benefit more psychologically from treatment. Keywordsadolescent anorexia nervosa; psychological recovery; outcome; family-based treatmentResearch indicates that adolescent anorexia nervosa (AN) frequently co-occurs with other psychological symptoms and disorders. For clinical and sub-clinical adolescent AN, the most common co-occurring diagnoses include mood disorders (e.g., major depression) and anxiety disorders (e.g., separation anxiety disorder, obsessive-compulsive disorder, generalized anxiety disorder, and social phobia) (O'Brien & Vincent, 2003;Touchette et al., 2010). In addition, adolescents with eating disorders report greater eating disorder psychopathology, greater d...

show abstract

Section: Discussionmentioning

confidence: 99%

Is weight gain really a catalyst for broader recovery?: The impact of weight gain on psychological symptoms in the treatment of adolescent anorexia nervosa

Accurso

Ciao

Fitzsimmons‐Craft

et al. 2014

Behaviour Research and Therapy

100

View full text Add to dashboard Cite

show abstract

“…This disruption may cause restrictive eating behaviours to persist [10], as evidenced by a significant correlation between motor imagery performance levels and prognostic factor such as the EDI-2 “drive for thinness” subscale [8]. Nutritional states, body size and weight changes in AN which constitute potential sources of bias because malnutrition could lead to the impairment of sensory integration and/or changes in body size.…”

Section: Discussionmentioning

confidence: 99%

Imagining One’s Own and Someone Else’s Body Actions: Dissociation in Anorexia Nervosa

et al. 2012

View full text Add to dashboard Cite

BackgroundPatients with anorexia nervosa (AN) usually report feeling larger than they really are. This body overestimation appears to be related not only to the patient’s body image but also to an abnormal representation of the body in action. In previous work on a body-scaled anticipation task, anorexic patients judged that they could not pass through a door-like aperture even when it was easily wide enough - suggesting the involvement of the body schema. In the present study, we sought to establish whether this erroneous judgment about action is specifically observed when it concerns one’s own body or whether it is symptomatic of a general impairment in perceptual discrimination.MethodsTwenty-five anorexic participants and 25 control participants were presented with a door-like aperture. They had to judge whether or not the aperture was wide enough for them to pass through (i.e. first-person perspective, 1PP) and for another person present in the testing room to pass through (i.e. third-person perspective, 3PP).ResultsWe observed a higher passability ratio (i.e. the critical aperture size to shoulder width ratio) in AN patients for 1PP but not for 3PP. Moreover, the magnitude of the passability ratio was positively correlated not only with the extent of the patient’s body and eating concerns but also with the body weight prior to disease onset. Our results suggest that body overestimation can affect judgments about the capacity for action but only when they concern the patient’s own body. This could be related to impairments of the overall network involved in the emergence of the body schema and in one’s own perspective judgments.ConclusionOverestimation of the body schema might occur because the central nervous system has not updated the new, emaciated body, with maintenance of an incorrect representation based on the patient’s pre-AN body dimensions.

show abstract

“…First, studies have not uniformly relaxed diagnostic criteria rendering the comparison of results across studies difficult (Dellava et al, 2009; Dingemans et al, 2006; Dominguez et al, 2007; Haas et al, 2009; Kaye et al, 2008; Kaye et al, 2000; Keel et al, 2005; Klump et al, 2001; Loeb et al, 2007; Perkins et al, 2005; Reba et al, 2005; Sanci et al, 2008; Schebendach et al, 2008; Wild et al, 2009). Second, women with subthreshold AN differ from women with threshold AN on eating disorder behaviors, psychiatric comorbidities, and some temperament and personality characteristics (Becker et al, 2009; Dalle Grave et al, 2008; Gendall et al, 2006; Santonastaso et al, 2009) and these differences might impact the results of research studies. Third, the extent to which genetic factors influence development of threshold and subthreshold AN might differ (Bulik et al, 2010) and inclusion of subthreshold cases could increase the number of phenocopies in the sample.…”

Section: Introductionmentioning

confidence: 99%

“…For example, eating disorder pathology has been reported to be lower in those not meeting criterion B (fear of weight gain at a low weight) (Becker et al, 2009; Thomas et al, 2009) and inconsistent in those not meeting criterion A (Santonastaso et al, 2009; Thomas et al, 2009) or criterion D (Dalle Grave et al, 2008; Gendall et al, 2006), compared with women with threshold AN. Table 1 highlights observed similarities and differences.…”

Section: Introductionmentioning

confidence: 99%

Impact of broadening definitions of anorexia nervosa on sample characteristics

Dellava

Thornton

Lichtenstein

et al. 2011

Journal of Psychiatric Research

View full text Add to dashboard Cite

Practical limitations and sample size considerations often lead to broadening of diagnostic criteria for anorexia nervosa (AN) in research. The current study sought to elucidate the effects of this practice on resultant sample characteristics in terms of eating disorder behaviors, psychiatric comorbidities, temperament and personality characteristics, and heritability point estimates. Three definitions of AN were created: meeting all Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for AN (AN-DSM-IV), meeting all DSM-IV criteria except criterion D, amenorrhea, (AN-noD), and broadening DSM-IV AN criteria by allowing a higher body mass index value, eliminating criterion D, and allowing less stringent body weight concerns (AN-Broad). Using data from the Swedish Twin Registry, 473 women fit one of the three definitions of AN. Women with AN-DSM-IV reported significantly more eating disorder behaviors than women with AN-Broad. Women with AN-noD reported more comorbid psychiatric disorders than women with AN-DSM-IV and AN-Broad. Temperament and personality characteristics did not differ across the three groups. Heritability point estimates decreased as AN definition broadened. Broadening the diagnostic criteria for AN results in an increased number of individuals available for participation in research studies. However, broader criteria for AN yield a more heterogeneous sample with regard to eating disorder symptoms and psychiatric comorbidity than a sample defined by narrower criteria.

show abstract

Typical and atypical restrictive anorexia nervosa: Weight history, body image, psychiatric symptoms, and response to outpatient treatment

Cited by 42 publications

References 33 publications

Is weight gain really a catalyst for broader recovery?: The impact of weight gain on psychological symptoms in the treatment of adolescent anorexia nervosa

Is weight gain really a catalyst for broader recovery?: The impact of weight gain on psychological symptoms in the treatment of adolescent anorexia nervosa

Imagining One’s Own and Someone Else’s Body Actions: Dissociation in Anorexia Nervosa

Impact of broadening definitions of anorexia nervosa on sample characteristics

Contact Info

Product

Resources

About