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 5,670 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One hundred and thirty-three patients with anorexia nervosa have been treated in a prospective study from 1958 to 1976. The doctor and the patient alone formed the therapeutic team, the doctor playing the role as an instructor in the pathophysiology of hunger without discussing social or psychological problems. At follow-up 58% of the patients were grouped as 'good', and 28% as 'intermediate', figures which are in accordance with those obtained from other authors. Fourteen per cent of the patients were grouped as 'poor'. None of the patients died. That therapists with different attitudes to treatment may obtain fairly similar results strengthens our view of a strong tendency to spontaneous recovery in anorexia nervosa. The outlook for patients with a short history of anorexia nervosa seems good.
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PMID:A prospective study of 133 patients with anorexia nervosa treatment and outcome. 718 77

The differentiation of the distinct clinical syndrome of anorexia nervosa from atypical cases is based on the following distinguishing features: a relentless pursuit of thinness; an almost delusional disturbance of body image; an inability to correctly identify hunger from other bodily or tension states; a lack of an identity awareness; and a paralyzing sense of ineffectiveness. This sense of ineffectiveness, pervasive of all thought and action, is connected with the perception of the self as acting only in response to the demands of others and is camouflaged by negativism and defiance. The core developmental issues of being unable to experience the control over one's own body and of lacking the conviction of living one's own life are based on the severe deficits in autonomy and initiative, originating from the distortion and mislabeling of feelings, sensation and moods in early childhood. The treatment process focuses on evoking awareness in these patients of their impulses, feelings and needs as originating within themselves as an essential step in the development of a sense of competence and self-esteem.
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PMID:Developmental considerations of anorexia nervosa and obesity. 729 31

Anorexia nervosa (AN) is associated with a paradoxical reduction in hunger ratings following 2-deoxy-D-glucose (2DG) induced glucose insufficiency. Because of the relationship between exercise and AN, there is interest in the weight-loss phenomenon produced by exercise in food restricted rats. This investigation determined if the weight-loss phenomenon is associated with a paradoxical suppression of food intake following 2DG and if the effect is related to reductions in prevailing glucose and insulin levels. Weight-matched, normal-weight exercised and normal-weight unexercised rats served as controls. As predicted, 2DG reduced food intake in animals subjected to the phenomenon (1.5 h/day food access and 22.5 h/day running wheel access). This effect was related to reductions in plasma glucose and insulin under the conditions that prevailed at the time of injection. Since these changes also occurred in weight-matched controls, they were attributed to the general effects of weight loss. A situational specificity for the "anorexia" of the weight-loss syndrome was also demonstrated. Finally, the strengths and weaknesses of the phenomenon as a model of AN were considered.
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PMID:Exercise in food-restricted rats produces 2DG feeding and metabolic abnormalities similar to anorexia nervosa. 787 8

Sleep-related eating disorders distinct from daytime eating disorders have recently been shown to be associated with sleepwalking (SW), periodic limb movement (PLM) disorder and triazolam abuse in a series of 19 adults. We now report eight other primary or combined etiologies identified by clinical evaluations and polysomnographic monitoring of 19 additional adults (mean age 40 years; 58% female): i) obstructive sleep apnea (OSA), with eating during apnea-induced confusional arousals (n = 3); ii) OSA-PLM disorder (n = 1); iii) familial SW and sleep-related eating (n = 2); iv) SW-PLM disorder (n = 1); v) SW-irregular sleep/wake pattern disorder (n = 1); vi) familial restless legs syndrome and sleep-related eating (n = 2); vii) anorexia nervosa with nocturnal bulimia (n = 2) and viii) amitriptyline treatment of migraines (n = 1). In our cumulative series of 38 patients (excluding six with simple obesity from daytime overeating), 44% were overweight (i.e. > 20% excess weight) from sleep-related eating. Nightly sleep-related binge eating (without hunger or purging) had occurred in 84% of patients. Onset of sleep-related eating was also closely linked with i) acute stress involving reality-based concerns about the safety of family members or about relationship problems (n = 6), ii) abstinence from alcohol and opiate/cocaine abuse (n = 2) and iii) cessation of cigarette smoking (n = 2). Current treatment data indicate a primary role of dopaminergic agents (carbidopa/L-dopa; bromocriptine), often combined with codeine and clonazepam, in controlling most cases involving SW and/or PLM disorder. Fluoxetine was effective in two of three patients. Nasal continuous positive airway pressure therapy controlled sleep-related eating in two OSA patients.
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PMID:Additional categories of sleep-related eating disorders and the current status of treatment. 810 56

A mixed retrospective-prospective study of 70 Chinese anorexic patients in Hong Kong shows that although they were similar to Western anorexics in most other ways, 41 (58.6%) of them did not exhibit any fear of fatness throughout their course of illness. Instead, these non-fat phobic patients used epigastric bloating (31.4%), no appetite/hunger (15.7%) or simply eating less (12.9%) as legitimating rationales for food refusal and emaciation. Compared to fat phobic anorexics, they were significantly slimmer pre-morbidly (P < 0.0001) and were less likely to exhibit bulimia (P = 0.001). The possible explanations for the absence of fat phobia and the interpretive dilemma this provokes are discussed from historical, pathoplastic and cultural anthropological perspectives. It is argued that anorexia nervosa may display phenomenological plurality in a Westernizing society, and its identity may be conceptualized without invoking the explanatory construct of fat phobia exclusively. As non-fat phobic anorexia nervosa displays no culturally peculiar features, it is not strictly speaking a Western culture-bound syndrome, but may evolve into its contemporary fat phobic vogue under the permeative impact of Westernization. Its careful evaluation may help clarify the aetiology and historical transformation of eating disorder, foster the development of a cross-culturally valid taxonomy of morbid states of self-starvation, and exemplify some of the crucial issues that need to be tackled in the cross-cultural study of mental disorders.
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PMID:Fat phobic and non-fat phobic anorexia nervosa: a comparative study of 70 Chinese patients in Hong Kong. 813 23

Hospitalized women with anorexia nervosa and/or bulimia nervosa and dietarily restrained and unrestrained, clinically normal women were provided with a multi-item breakfast meal. Eating patterns and hunger and satiety ratings were assessed. Subjects were offered three foods which varied in fat and carbohydrate contents. Anorectic-restrictors differed most from the control subjects: they had a longer meal duration, a slower overall rate of eating, more frequent pauses during the meal, and more short bouts of eating. They also displayed abnormal ratings of hunger and satiety: they were generally less hungry, had less urge to eat, and were more full than controls of bulimics. Both anorectic and bulimic patients showed more variability in total energy intake than did the controls. Patients usually displayed one of two patterns - either severe restriction or overeating. Abnormal hunger and satiety patterns indicating confusion typified the responses of bulimics; additionally, they showed more urge to eat in the post-meal period than did the controls. A higher proportion of fat in the initial part of the breakfast was related to a larger meal size for the bulimics. It is suggested that these techniques may be useful in evaluating the outcome of treatment for eating disorder patients.
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PMID:Micro- and macroanalyses of patterns within a meal in anorexia and bulimia nervosa. 866 30

Two models for conceptualizing eating behavior are presented and the development of the experimental methodology to examine eating behavior is described in historical context. Specific studies of eating behavior in eating disorder patients are described with emphasis on how these studies examine aspects of the two hypothetical models that are presented on eating behavior. The studies present and focus on hunger and satiety perceptions, cognitive sets, and the neurotransmitter associated with satiety, serotonin. Unfortunately, no single investigation can encompass all of the variables that need to be measured that affect eating behavior. The studies described of both acutely ill and short-term recovered eating disorder patients indicate there may be some perceptual and physiological traits that are present in anorexia nervosa and bulimia nervosa. Studies over a longer period of time are needed to substantiate this. An eventual integrative explanation of disturbed eating behavior that is documented in eating disorder patients will be possible only after extensive investigations of the components.
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PMID:The psychobiology of eating behavior in anorexia nervosa. 873 12

The 3 eating disorders--anorexia nervosa, bulimia nervosa, and binge eating--occur at a frequency far greater than usually realized. Anorexia has been found to be present in up to 1% of teenage and young adult women, whereas estimates of bulimia have ranged up to 5%. The prevalence of binge-eating disorder is not known, but may be higher than bulimia. Anorexia nervosa is characterized by weight loss, body image disturbance, and a morbid fear of weight gain. Bulimia nervosa is characterized by binge eating and compensatory purging by vomiting; use of laxatives, diuretics, or diet pills; exercise; or fasting. Binge-eating disorder is characterized by binge behavior and loss of control of food intake, with an absence of purging. Eating disorders create significant mortality and morbidity. Medical complications associated with anorexia are those related to malnutrition and semistarvation. Medical complications associated with bulimia are those related to electrolyte imbalance and the physical effects of vomiting. The mortality rate of eating disorders may be as high as 15%, including deaths from arrhythmia, gastric hemorrhaging, and suicide. The core struggle within women with anorexia is the "2 Ps": feeling powerless and striving towards perfectionism. The core conflict within a bulimic person appears to be the "2 Ds": deprivation and dependency. The treatment of eating disorders includes psychotherapy, and, frequently, psychopharmacologic intervention. The psychotherapy primarily addresses issues of chaotic eating, hunger, inadequate caloric intake, conditioned response, and profound fear of expressing impulses and feelings, especially those of anger and sadness. Antidepressants, especially serotonergic agents, have been found to be useful, particularly in the treatment of bulimia.
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PMID:What's New in the Treatment of Anorexia Nervosa and Bulimia? 974 43

Hunger sensation (HS) is a perception with a daily (circadian) and within-day (ultradian) recursive pattern. In human beings, circadian repeatability was investigated by means of the Single Cosinor method, while the ultradian recursivity was investigated by means of the spectral analysis, both applied to the 24-h HS profile (orexigram). Orexigrams were provided by each subject investigated, who self-rated her subjective orectic stimulus (OS) (from 1 to 10 hunger units) every half hour. The study was performed in 19 female patients aged 13-52 newly diagnosed as in the first episode of Anorexia Nervosa Restricting Type, with a BMI below 18.7. The control group consisted of 10 clinically healthy women aged 21 to 52 years with a BMI from 23 to 25. Two types of orexigrams were found. The first was characterized by a low profile with negligible ultradian variability, in which the HS circadian rhythm (CR) was still detectable, but the power spectrum (PS) was composed of unusual ultradian components associated with a very diminished amplitude for the circadian harmonics. The second was characterized by an almost regular profile, in which the ultradian variability was clearly detectable, the CR regularly fluctuated, and the PS was almost regularly composed. These findings indicate that anorectic patients (AP) can be recognized by their orexigram as "hyporectic", or "eurectic". Therefore, the term "anorexia" seems to be appropriate for AP who exhibit the first type of orexigram (anorectic aphagia nervosa), whereas the second identifying those who could be defined as suffering from "eurectic aphagia nervosa".
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PMID:Hunger sensation: a chronobiometric approach to its within-day and intra-day recursivity in anorexia nervosa restricting type. 1072 60

Humans and other warm-blooded animals living with continuous access to a variety of good-tasting foods tend to eat too much and suffer ill health as a result--a finding that is incompatible with the widely held view that hunger and eating are compensatory processes that function to maintain the body's energy resources at a set point. The authors argue that because of the scarcity and unpredictability of food in nature, humans and other animals have evolved to eat to their physiological limits when food is readily available, so that excess energy can be stored in the body as a buffer against future food shortages. The discrepancy between the environment in which the hunger and eating system evolved and the food-replete environments in which many people now live has led to the current problem of overconsumption existing in many countries. This evolutionary perspective has implications for understanding the etiology of anorexia nervosa.
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PMID:Hunger, eating, and ill health. 1202 68


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