Eating disorders are psychological illnesses defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. There are many causes of eating disorders, including biological, psychological and/or environmental abnormalities.

Articles in Pubmed and MeSH Database, using 'pathogenesis of eating disorders'. Also activated filters: publication date from 2013/01/01 to 2014/01/01.

The update of the lastest publications on pathogenesis of eating disorders.

We select seven studies (three reviews and four clinical trial) because of the topic relation and the high leve of evidence.

Gray matter (GM) and white matter (WM) were strongly reduced in acute AN. The completeness of brain volume rehabilitation remained equivocal.

Psychosocial resources were found to have strong associations with symptomatology. These findings provide additional support for the association between traumatization and ED. Clinical interventions for traumatized ED patients may benefit from a focus on post-traumatic stress symptomatology and personal resources.

We suggest that identifying comorbid ADHD is crucial for these patients and argue for the use of a structured interview, collateral history and investigation of onset of symptoms to establish a diagnosis of ADHD in adults with bulimia nervosa. Comorbidities and overlap of symptomatology need to be taken into account.

And maternal eating disorders together with comorbid psychopathology increase risk for psychiatric disorders in childhood and early adolescence, in particular for emotional disorders. This has important implications for prevention and future research.

Body image disturbance and eating disorders among the young population are increasing.

The aim of our study was to investigate the perception of body image and its relationship with eating disorders among tunisian medical students.

METHODS :

A total of 100 Tunisian medical students were interviewed using :

• - a self-administered questionnaire which explores clinical data,

• - a scale of screening of eating disorders : Eating Attitudes Test (EAT-26).

• - the Stunkard’s figure rating scale (FRS) which consists of 9 silhouette figures. The difference between ideal body and perceived body can be interpreted as a measure of body image satisfaction.

The mean age of the sample was 24.12 years, 71% were female and 29% male.

The average body mass index (BMI) was 22.72 kg/m2.

Students have normal weight (BMI 18.5–24.9) in 62 % of cases.

Sixty six percent of students who were ‘‘normal weight’’ were not satisfied of their body image and thirty eight percent of them showed a desire for thinness.

Seventy-three of students had a body image dissatisfaction. A BMI outside normal parameters influenced significantly the perception of body image (p=0.048).

Nineteen percent of students had eating disorders. These students had an abnormal BMI (p=0.047) and a body image dissatisfaction (p=0.018).

CONCLUSION :

Our study shows that the physical aspect of the students has a significant effect on their feeding behavior, it is thus essential to sensitize their circle of acquaintances to favor a healthy perception of body image.

Although Eating Disorders (ED) are more prevalent among female population, in the last decades they are gaining importance among males.

The aim was to review prevalence, specific characteristics, comorbidity, diagnosis, treatment and prognosis of ED in male population.

We searched in MEDLINE selecting studies from 2000 until the present related to ED among males. We report a case of an 18-year old male who was hospitalized with a severe hyponatremia in the context of potomania and abuse of diuretics and laxatives and who was diagnosed with purgative Anorexia nervosa.

Males with ED have higher rates of family history of ED and higher percentages of Substance Use Disorders and Alcohol Use Disorders. They tend to have more medical complications and comorbidity. Levels of previous overweight and subsequent malnutrition are higher, and purgative behaviours and compulsive exercise more frequent. They show significantly less desire to lose weight, express dissatisfaction with the upper rather than the lower body, and they are more concerned of muscle development.

The prevalence of ED among male population has increased in the last decades, probably due to the clinician´s underdiagnosis of malnutrition related symptoms in this group. In addition, scales and diagnostic criteria are adapted to female population, which increases the difficulty at he time of diagnosing. The clinical debut in males tends to be later and it is associated with more and severe physical complications. Clinicians should be aware of loss of weight in men and consider ED as a possible diagnosis.

Anorexia Nervosa (AN) is characterized by body-size overestimation that reflects a distortion of body-representation. Self-body recognition can be both implicit and explicit. The former is based on cognitive and perceptual mechanisms, the latter relies on motor simulation. Previous studies showed that participants, when submitted to a hand laterality judgment task (Implicit task) that required mental rotation showed better performances when the stimuli consisted of their own rather than other's hand (self-advantage). By contrast, the self-advantage was absent when self-recognition (Explicit task) was explicitly required.

This study aimed to investigate whether the overestimation of anorexic's own body size extended to the motor representation of the bodily-self influencing the implicit self-advantage. Furthermore, we assessed the possible relationship between the implicitly recognition of one's own body part and Interoceptive Sensitivity (IS; sensitivity to stimuli originating inside of the body).

Healthy Controls (HC) and restrictive AN patients were submitted both to Implicit and Explicit tasks with self and other's hands presented in the original size or modified to look fatter or thinner. We also assessed participants’ IS by means of a heartbeat perception task.

As previously reported, HC showed specific self-advantage effect only when a motor simulation is required. Furthermore higher IS is related to faster performances only in the implicit task in which a mental motor rotation. The differences between AN patients and HC concerning IS and bodily-self recognition will be also discussed.

Pregnancy represents a critical life stage for its physical and emotional changes. Maternal thoughts are often oriented to the worry to lose control on their body, and to their new physical shape. According to this, literature on eating disorder (ED) highlights how pregnancy is usually associated to a temporary interruption of the dysfunctional eating habits due to the move of concerns about the self and the body toward the caregiving of the baby.

The goal of the present study is to explore the impact of generalized difficulties in emotion regulation (as a stable trait) versus specific difficulties in emotion regulation (as pregnancy-related) in women with pre-pregnancy eating problems.

The sample is made by 15 women previously overweight and recruited during their 3^rd trimester of pregnancy. The following measures were administered: Difficulties in Emotion Regulation Scale (DERS), Eating Attitudes Test (EAT-26), Emotional Difficulties Specific to Pregnancy Scale (EDS), and the Adult Attachment Interview (AAI).

Preliminary findings have shown how higher scores on the DERS Impulse scale as well as higher difficulties in handling emotional states related to pregnancy (e.g. fear of the delivery) are associated to the existence of dysfunctional eating behaviors during the 3rd trimester.

Emotion regulation has emerged as a transversal skill during the life cycle. Difficulties in this area seem to represent a stable trait in the individual functioning, with the risk to affect the eating behaviors, as well as the health of the mother and the baby during pregnancy.

A growing body of research has indicated that difficulties in emotion regulation (ER) are associated to eating disorders as well as to weight changes. However, it has not been clearly investigated the intergenerational transmission of ER and its role on the onset of early feeding and weight problems of the child.

The goals of the present study are: 1) to examine the relationship between maternal ER during pregnancy and the feeding practices at 8 months of the baby; 2) and to assess the predictive role of ER on the onset of overweight at 3 years of age.

The sample is made up by 65 dyads distributed to 2 different groups based on their BMI. During pregnancy they were administered DERS. 8 months after the delivery they were videotaped during the meal time with baby through the Feeding Observational Scale (Ammaniti et al., 2002). Weight outcome of the baby was reported by the mother at 3 years of age.

Findings has shown that overweight mothers emerged as more emotional dysregulated during pregnancy. Their feeding interaction with the baby was also featured by greater difficulties compared to the control group. ER during pregnancy was able to predict the affective state of the dyad and the interactional conflict during the mealtime at 8 months. The affective state of the dyad at 8 months predicted the weight gain of the baby at 3.

The maternal and the dyadic emotional functioning play a key role in shaping the risk for childhood obesity.

To determine the efficacy, acceptability, and tolerability of second-generation antipsychotic drugs (SGAs) in anorexia nervosa.

We covered all randomized controlled trials (RCTs) comparing a pharmacotherapy with SGAs to placebo or no treatment in anorexia nervosa. Primary outcome was weight gain assessed by mean change in body mass index (BMI). Secondary outcomes were change of anorectic symptoms assessed by the Yale–Brown–Cornell Eating Disorders Scale (YBC-EDS) score and the Eating Disorders Inventory (EDI) score, and premature discontinuation of treatment. Using the random-effects model of Der-Simonian and Laired standardized mean differences based on Hedges's g and risk ratios were calculated.

Seven RCTs investigating olanzapine (N=4), quetiapine (N=2), and risperidone (N=1) with 201 subjects were included. There was no significant between-group difference in mean BMI change when comparing the pooled group of SGA drugs with the pooled control group (N=6, n=152; Hedges's g=0.17, 95% CI: -0.14-0.48; p=0.28). None of the examined single SGAs was significantly superior to placebo/no treatment in achieving BMI gain. We found no significant between-group differences for all secondary outcomes with the exception of the EDI total score which decreased statistically significant more in the pooled control group. The antipsychotic medication was well tolerated.

Because of lacking evidence SGAs cannot be generally recommended in anorexia nervosa although some individuals or subgroups of patients might respond to an antipsychotic medication. Further research is needed to identify which anorectic patients could probably benefit from treatment with antipsychotic drugs. The medication with SGAs was well accepted and tolerated in anorectic patients.

The athletic population seem to be vulnerable to eating disorders (ED) but is this in relation to their ability to express their emotions or alexithymia?

Studying the prevalence of ED in a population of athletes, and establish the relationship between the ED and alexithymia .

It was a descriptive and analytical cross-sectional study of 45 persons practicing sport. We used:

1. - The Eating Attitudes Test (EAT-26).

2. - The Toronto Alexithymia Scale (TAS-20).

The average age of participants was 26,44 years; the sex ratio (M/W) was 0,5. Their average weight was 67.18% Kg, their average size was 1.68 m and had an average BMI of 23.45; 73,3% had a normal BMI and 26,7% were overweigh (BMI ≥05; 25). They practiced a collective sport in 53.3% of cases, with an average number of hours / week: 4.18 ± 2,70.

The average score of the EAT-26 was 12.71 ± 6.75 and prevalence of TCA was 22.2%. The average score of TAS-20 was 49,93 9,77 and alexithymia was found in 17.8% of participants. A significant correlation was found between alexithymia and ED (p = 0,03) and between ED and the nature of sports (p = 0,01).

It’s clear from our study an association between alexithymia and the ED. The practice of sport is a way to express themselves, lack of verbal expression. Hence the importance of educating people with ED and encourage them to practice sports, so ideally with psychotherapeutic care.

Expressed Emotion (EE) is a measure of the intensity of the affective family climate and plays a role in disease course and outcome. Especially in urban settings, obesity is a severe problem with serious implications as far as health risks are concerned. Having a high EE caregiver has been suggested to correlate with a worse treatment compliance in obese patients.

To measure level of EE, stressful events and anxiety in obese patients and their caregivers; to investigate the possible correlations between compliance with treatment and emotional temperature of families.

We have already recruited more than 150 obese patients and their caregivers. Assessment included: Level of Expressed Emotion Scale (LEE), one version for patients and one for relatives in order to evaluate 4 dimensions: intrusiveness, emotional response, attitude toward disease, tolerance and expectation; the Paykel’s Interview for Recent Life Events; STAI Y1 concerning state anxiety and STAI Y2 concerning trait anxiety. Furthermore we collected demographic characteristics and BMI (Body Mass Index).

Data collection and analyses are still ongoing. Preliminary results suggest a correlation between obesity and level of anxiety. We expect to find a correlation between level of EE and variation of BMI.

Levels of EE and anxiety should be considered when planning treatment interventions to enhance compliance in obese patients and to support change in their life-style.

The importance of combined treatment of EDs is widely acknowledged. We describe the good outcome of a combined treatment in a 43 year old woman, affected by severe Anorexia Nervosa – Binge Purging (BMI 9.1), since early adolescence. She sought treatment only after giving birth to her second-born when she became aware of her illness. Despite intensive treatment (as an inpatient in hospitals and specialized rehabilitation centres, and in Day Hospital facilities), her condition gradually worsened, and her personal, social, working and family functioning was severely compromised (Global Assessment of Functioning Scale 35),

A multidisciplinary team including psychiatrist, psychotherapist, family psychotherapist, nutritionist, dietician, nurses was involved in treatment, working together to a common treatment strategy. The Psychiatrists role (psicopharmacology, therapeutic process, helping acknowledging and avoiding manipulation) and the nurses role (establishing a therapeutic relationship with the patient, assisting her during meals and supporting the overall therapeutic process), are discussed.

A gradual psychopathologic and somatic improvement occurred across a 12-months period: she spent two months in a Psychiatry ward, four more months in a rehab centre and six months in an ED therapeutic community. She gained weight (BMI 21.4) and regained an excellent personal, social and family functioning. She returned to her husband (they previously separated), and the relationship with her daughters, who previously rejected her, improved (GAF 90).

The cooperation of the multidisciplinary equipe and the involvement of the patient’s relatives succeeded in reducing anxiety, depression, dysmorphophobia and interrupting the manipulating attitudes typical of the illness.

Alexithymia is characterized by difficulties identifying and communicating feelings, and problems differentiating between feelings and bodily sensations; its concrete cognitive style focused on the external environment is typical of psychosomatic patients. Patients with eating disorders (EDs) have high levels of alexithymia, particularly difficulties identifying and describing their feelings.

The aims of our study are (1) to assess the alexythimia, emotional empathy, facial emotion identification skills and social inference abilities in a sample of ED patients; (2) to compare these variables between ED patients and healthy controls (HC); and (3) to correlate levels of alexithymia with the severity of the ED as measured by the Eating Disorder Inventory-3 (EDI-3) EDRC score in the ED group.

ED (N=42) and HC (N=42) were tested with the Toronto Alexithymia Scale (TAS-20), Eating Disorder Inventory (EDI-3), Facial Emotion Identification Test (FEIT), The Awareness of Social Inference Test (TASIT) and Interpersonal Reactivity Index (IRI).

Data collection is being completed and the results’ analysis is ongoing. We expect the ED sample to show greater alexythimia and a poorer performance at FEIT and TASIT than HCs. We expect to find a linear correlation between the TAS-20 and EDRC score.

A better understanding of the role of alexithymia in ED etiology and maintenance might allow the development of targeted treatment approaches to help patients improve their skills in identifying and expressing emotions.

Perfectionism and perseverative negative thinking/PNT are both associatedwith eating disorders symptoms. PNT is a prime candidate when investigating the pathway that links perfectionism to psychopathology.

To investigate if PNT mediates the relationshipbetween perfectionismcognitions and ED symptoms.

114 young women(mean age=23.78±6.340; mean BMI=21.59±3.127; 49.4% students) fill in the Portuguese validated versions of Eating Attitudes Test/EAT-25 (to evaluateBulimic behaviors, Diet and Social pressure to eat), MultidimensionalPerfectionism Cognitions Inventory (Concern over mistakes/CM, Personal standards/PS,Pursuit of Perfection) and Perseverative Thinking Questionnaire/PTQ-15(Repetitive Thought/RT, Cognitive interference and unproductiveness). Onlyvariables significantly correlated with the outcomes (EAT-25_Total and itsdimensions) were entered in the multiple regression models. Mediation analysesusing Preacher and Hayes bootstrapping methodology were performed.

Significantpredictors of EAT_Total were CM (b=.180)and RT (b=.169)(both p<.05). RT partially mediatedthe relationship between EAT_Total and CM. (95%CI=.0671-.0290).

Bulimicbehaviors were predicted by the same variables (b=.359;b=.154;p<.05) and RT also partially mediated the relationship between Bulimic behaviorsand CM (95%CI=.0071-.0190). Diet and Social Pressure to Eat were only predictedby PS (b=.154;b=.257,respectively; p<.05).

Although PNT mediates the relationship between perfectionist cognitions andbulimic behavior, the effect of the perfectionism on other disordered eatingdimensions, such as diet and SPE, seems to be independent of the PNT levels. Aspreviously reported in other studies with community samples, disordered eatingbehaviors are associated to negative perfectionism dimensions, but also todimensions that have been considered not entirely maladaptive.

Obesity Unit of Psychiatry Department was created to offer first-class medical treatment to patients with obesity in a district of Madrid (Vallecas) since 2011. The main objective is to obtain diagnostic information about the patients in order to decrease the prevalence of obesity in our community.

We are presenting the data of the 100 first patients referred to our Unit, 5 people were excluded due to exclusion criteria. Sociodemographic and clinical data were obtained from evaluation interviews and were complemented by a battery of psychometric tests.

The average BMI is 41 (SD 6.8). The average age, 41.7 (SD 12.7) and 76 patients were women. 85% of the patients were not able to maintain weight loss. 50% of the patients had consulted a physician before. 95% of patients have taken a pharmacological treatment. No one had followed a combined treatment, addressing physical and emotional aspects together.

A specific multidisciplinary treatment is recommended in these patients. In addition to pharmacological treatment, our integral attention program also includes a psychoeducational group one a month and a psychotherapy group one a week.

The Eating Disorders Unit (EDU) of the Santa Cristina Hospital (Madrid) is an intensive treatment resource addressed to chronic patients diagnosed with eating disorders (ED) with repeated therapeutic failures and / or psychiatric comorbidities.

In recent years the number of patients referred with overweight and obesity is increasing more and more, becoming the 21% of the treated patients.

Considering the increasing demand to treating patients with overweight and obesity and their differential clinical features we created a specific treatment program specially for this population.

EDU is a partial hospitalization resource with two shifts, the one in the afternoon is addressed to patients with impulse control deficit, diagnosed with Bulimia Nervosa and Binge Eating Disorder. The treatment at this Unit is essentially multidisciplinary and mainly based on group dynamics.

Overweight and obese patients attend to a specific program to manage eating symptoms, disease awareness and motivation to change, and futhermore to enhance weight loss promoting moderate physical exercise and the acquisition of healthy habits based on the Mediterranean Diet. They are also provided a more homogeneous space to deal with their body dissatisfaction.

Patients who follow the specific overweight / obesity program experience strong group cohesion that is very motivating to introduce progressive changes in self-care.

Clinical management of overweight and obesity is complicated when there is a comorbid eating disorder. A specific and intensive multidisciplinary treatment is recommended in these type of patients.

When we want to approach eating disorders in infancy and childhood we can not forget the importance of relations with the relational patterns figures. The bond with the primary attachment figure is critical to the physical and emotional development. The “be fed” is a task essential to life, through it, it helps the child regulate their states, differ feelings / emotions. … to food and environment are created and entrenched relational patterns exist when feeding problems is essential to evaluate the interactive situation and the representational world of the attachment figure. Only then can we understand the disorder and help participants to solve (R. Feldman, Karen M., 2004).

In this paper the study of possible empathic failures in the original development of attachment in relation to disordered eating behavior is presented. To do this, we have taken a sample of 10 patients with DSM-IV criteria for an eating disorder diagnosis and valued the relationship with the attachment figure reference.

Try, therefore, to analyze the basic elements that come into play around the feeding in the first year of life: the child with its biological characteristics and temperament and adult relationship leading figure, which is the one with food to the child and gives.

Hedonic eating refers to the consumption of food uniquely because of its </div><div>gustatory rewarding properties and not for homeostatic needs; so the subject eats also when not in a </div><div>state of energy depletion. Hedonic eating may stimulate powerfully food intake; hence, </div><div>understanding its physiological modulation could improve our knowledge of the pathophysiology of </div><div>obesity. Furthermore, obese people often present binge-eating behaviours, and binge-eating is </div><div>experienced as rewarding. Endocannabinoids, including anandamide (AEA) and 2-</div><div>arachidonoylglycerol (2-AG), and endocannabinoid-related compounds, oleoylethanolamide (OEA) </div><div>and palmitoylethanolamide (PEA), are involved in the modulation of food-related reward. </div><div>

Therefore, in the present study we aimed to investigate the responses </div><div>of endocannabinoids and endocannabinoid-related compounds to hedonic eating in obese patients </div><div>with and without binge eating disorder (BED). </div><div>

Peripheral levels of AEA, 2-AG, OEA and PEA were measured in 7 obese patients </div><div>with BED and 7 obese patients without BED after eating hedonic and non-hedonic food, and </div><div>compared to those of normal weight healthy controls. </div><div>

Peripheral levels of endocannabinoids and endocannabinoid-related compounds </div><div>exhibited different response patterns to hedonic eating among the groups. </div><div>

These data confirm the role of endocannabinoids and endocannabinoid-related </div><div>compounds in food-related reward and suggest a dysregulation of their physiology in obesity and in </div><div>the BED. These findings may have potential relevance to the prevention and treatment of obesity </div><div>and BED.</div>

Childhood trauma exposure is a risk factor for adult psychopathology in general.

The biological mechanisms mediating this increased risk involve the endogenous stress response

system, including the hypothalamus-pituitary-adrenal (HPA) axis, that undergoes trauma-induced

functional changes, which may persist later in life. Since an association between stressful life events

and the onset/course of anorexia nervosa (AN) or bulimia nervosa (BN) has been demonstrated, a

role for the HPA axis in their pathophysiology seems likely.

The cortisol awakening response (CAR) is a useful method to assess

the functioning of HPA axis. Therefore, we conducted an explorative study aiming to examine

possible associations between childhood maltreatments and HPA axis functioning, as assessed by the CAR, in adult patients with AN or BN.

Saliva samples were collected in 24 patients with acute AN, 22 with acute BN and

31 healthy controls at wakening and after 15, 30 and 60 min. They filled in the Childhood Trauma

Questionnaire (CTQ), which assesses five specific forms of childhood maltreatment.

As compared to control group, no-maltreated AN group exhibited an enhanced CAR

whereas no-maltreated BN group showed a normal CAR. Moreover, both AN and BN patients with

childhood maltreatment exhibited a statistically significant blunted CAR as compared to no-maltreated patients.

Present findings suggest that childhood adverse experiences may affect the CAR

in adults with AN or BN and this may represent a functional background of the endogenous stress

response system, which may have relevant implications in the pathophysiology of EDs.

Number of women of reproductive age with obesityhas grown in recent years and represents an important aspect of the overall growthin the number of obese people worldwide. Pregnancy is an ideal moment for healthprofessionals’ intervention.

To understand the emotional experiencesreported by obese pregnant women that had adequate variation in weight during thepre-natal.

Clinical Qualitative Method. The sample of subjects was intentional and closed by the criterion of information saturation with 13 participants. The technique of semi directed interview with open questions in depth was used. After full transcript of interviews. Qualitative Content Analysis has included:free-floating rereading to unveil cores of meanings from interviewees' discourseand categorization in topics for discussion under a psychodynamic theoretical framework.

Data analysis for this work indicates four categories. Three of them show a path of caution with the body that obese women have taken during thepregnancy: 1) The body begins to be thought; 2) The challenge of the diet; 3) The relationship with the prenatal health team. The fourth category reveals a sourceof motivation for changing: 4) Fear as enhancer changes.

Thepregnancy is an opportune moment for women to come into greater contact with themselvesand to notice their emotional conflicts. Through the changes in the body, the woman can start a more refined process of self-care and the experience of body-mind unit. The relationship with the professional health team plays an important role in motivational support to pregnant obese women.