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1.
Behav Res Ther ; 48(7): 634-45, 2010 Jul.
Article in English | MEDLINE | ID: mdl-20398895

ABSTRACT

Anorexia nervosa (AN) is perhaps the most lethal mental disorder, in part due to starvation-related health problems, but especially because of high suicide rates. One potential reason for high suicide rates in AN may be that those affected face pain and provocation on many fronts, which may in turn reduce their fear of pain and thereby increase risk for death by suicide. The purpose of the following studies was to explore whether repetitive exposure to painful and destructive behaviors such as vomiting, laxative use, and non-suicidal self-injury (NSSI) was a mechanism that linked AN-binge-purging (ANBP) subtype, as opposed to AN-restricting subtype (ANR), to extreme suicidal behavior. Study 1 utilized a sample of 787 individuals diagnosed with one or the other subtype of AN, and structural equation modeling results supported provocative behaviors as a mechanism linking ANBP to suicidal behavior. A second, unexpected mechanism emerged linking ANR to suicidal behavior via restricting. Study 2, which used a sample of 249 AN patients, replicated these findings, including the second mechanism linking ANR to suicide attempts. Two potential routes to suicidal behavior in AN appear to have been identified: one route through repetitive experience with provocative behaviors for ANBP, and a second for exposure to pain through the starvation of restricting in ANR.


Subject(s)
Anorexia Nervosa/psychology , Habits , Models, Psychological , Self-Injurious Behavior , Starvation , Suicide , Adolescent , Adult , Aged , Binge-Eating Disorder/psychology , Feeding Behavior , Female , Humans , Male , Middle Aged , Young Adult
2.
Personal Disord ; 1(4): 250-7, 2010 Oct.
Article in English | MEDLINE | ID: mdl-22448667

ABSTRACT

One of the primary facets of borderline personality disorder (BPD) is behavioral dysregulation, a wide array of behaviors that are difficult to control and harmful to the individual. The purpose of this study was to explore the association between BPD and a variety of dysregulated behaviors, some of which have received little empirical attention. Using a large sample of individuals diagnosed with anorexia nervosa, 41 individuals diagnosed with BPD were compared to the rest of the sample on the presence of dysregulated behaviors using logistic regression analyses. Anorexia nervosa subtypes, age, and other Cluster B personality disorders were used as covariates. Results support an association between BPD and alcohol misuse, hitting someone/breaking things, provoking fights/arguments, self-injury, overdosing, street drug use, binge-eating, impulsive spending, shoplifting/stealing, and risky sexual behaviors. Differences between dichotomous and continuous measures of BPD yielded somewhat different results. Information on co-occurring anorexia nervosa and BPD was generated.


Subject(s)
Anorexia Nervosa/psychology , Borderline Personality Disorder/psychology , Adolescent , Adult , Aged , Aged, 80 and over , Anorexia Nervosa/complications , Anorexia Nervosa/diagnosis , Borderline Personality Disorder/complications , Borderline Personality Disorder/diagnosis , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Interview, Psychological , Logistic Models , Middle Aged , Risk-Taking , Self-Injurious Behavior/psychology , Substance-Related Disorders/psychology , Theft/psychology , Violence/psychology , Young Adult
3.
Int J Eat Disord ; 43(7): 577-83, 2010 Nov 01.
Article in English | MEDLINE | ID: mdl-19728374

ABSTRACT

OBJECTIVE: The pathophysiology of eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN) has been linked to an impaired dopaminergic neurotransmission, still the origin of this disturbance remains unknown. The aim of the present study was, therefore, to evaluate whether the expression of dopaminergic genes is altered in the blood of patients suffering from eating disorders and if these alterations can be explained by changes in the promoter specific DNA methylation of the genes. METHOD: We used quantitative real-time PCR to measure both the expression and the promoter specific DNA methylation of the dopamine transporter (DAT), and the D2 (DRD2) and D4 receptor (DRD4) gene in the blood of 46 patients (22 AN, 24 BN) and 30 healthy controls. RESULTS: Patients showed an elevated expression of DAT mRNA when compared with the controls and a downregulation of the DRD2 expression. The upregulation of the DAT gene was accompanied by a hypermethylation of the gene's promoter in the AN and BN group while a significant hypermethylation of the DRD2 promoter was only present in the AN group. No differences in expression or methylation were found for the other dopamine receptors investigated. DISCUSSION: Our study shows a disturbed expression of dopaminergic genes that is accompanied by a dysregulation of the epigenetic DNA methylation. Further studies are necessary to provide more insight into the epigenetic dysregulation of the dopaminergic neurotransmission in the pathophysiology of eating disorders.


Subject(s)
Dopamine Plasma Membrane Transport Proteins/genetics , Dopamine/genetics , Epigenesis, Genetic/genetics , Feeding and Eating Disorders/genetics , Receptors, Dopamine D2/genetics , Case-Control Studies , DNA Methylation/genetics , Dopamine/blood , Dopamine Plasma Membrane Transport Proteins/blood , Down-Regulation , Feeding and Eating Disorders/physiopathology , Female , Humans , Polymerase Chain Reaction , Promoter Regions, Genetic , RNA, Messenger/genetics , RNA, Messenger/metabolism , Receptors, Dopamine D2/blood , Up-Regulation
4.
Neuropsychobiology ; 58(1): 48-52, 2008.
Article in English | MEDLINE | ID: mdl-18799894

ABSTRACT

Alpha-synuclein (alpha-Syn) is a neuronal protein involved in the regulation of brain serotonin and dopamine levels. We analyzed the peripheral expression of alpha-Syn mRNA and Beck Depression Inventory scores in female patients suffering from anorexia nervosa (n = 18) or bulimia nervosa (n = 24). We found a significant positive association between alpha-Syn mRNA expression and the total scores of the Beck Depression Inventory (linear regression; R(2) = 0.20; p = 0.003). alpha-Syn may play a pathophysiological role in depressive symptoms associated with eating disorders. Further investigations in patients with depression as a sole diagnosis are needed to support its role in the pathogenesis of major depression.


Subject(s)
Depression/diagnosis , Feeding and Eating Disorders/complications , RNA, Messenger/blood , Severity of Illness Index , alpha-Synuclein/genetics , Adolescent , Adult , Body Mass Index , Cross-Sectional Studies , Depression/blood , Depression/complications , Feeding and Eating Disorders/blood , Female , Humans , Predictive Value of Tests , Psychological Tests , Young Adult
5.
Neuropsychopharmacology ; 33(11): 2605-9, 2008 Oct.
Article in English | MEDLINE | ID: mdl-18172431

ABSTRACT

Disturbances of volume-regulating mechanisms have already been implicated in the pathophysiology of eating disorders like anorexia or bulimia nervosa with the peptide hormones vasopressin and atrial natriuretic peptide (ANP) being of special interest. Aim of the present study was to investigate, whether the expression of the corresponding genes was altered and if so, if these changes could be explained by epigenetic mechanisms such as DNA methylation. We analyzed blood samples of 46 women suffering from anorexia (n=22) or bulimia nervosa (n=24) as well as of 30 healthy controls. Peripheral mRNA expression and DNA methylation of the vasopressin and the ANP precursor genes were assessed using real-time PCR. We found significantly lower levels of ANP mRNA in patients with eating disorders. This downregulation was accompanied by a hypermethylation of the ANP gene promoter in the bulimic subgroup. We did not find differences regarding expression or methylation of the vasopressin gene. ANP mRNA expression was inversely associated with impaired impulse regulation. We conclude that epigenetic mechanisms may contribute to the known alterations of ANP homeostasis in women with eating disorders.


Subject(s)
Atrial Natriuretic Factor/antagonists & inhibitors , Atrial Natriuretic Factor/metabolism , Down-Regulation/genetics , Epigenesis, Genetic/genetics , Feeding and Eating Disorders/genetics , Impulsive Behavior/genetics , RNA, Messenger/biosynthesis , Vasopressins/biosynthesis , Adolescent , Adult , Atrial Natriuretic Factor/genetics , DNA Methylation/genetics , Feeding and Eating Disorders/metabolism , Female , Gene Expression Regulation/genetics , Humans , Impulsive Behavior/metabolism , Middle Aged , Promoter Regions, Genetic , RNA, Messenger/antagonists & inhibitors , Vasopressins/genetics
6.
Neuropsychology ; 21(6): 742-50, 2007 Nov.
Article in English | MEDLINE | ID: mdl-17983288

ABSTRACT

In addition to the core psychopathology of bulimia nervosa (BN), patients with BN often show impulsive behavior that has been related to decision making deficits in other patient groups, such as individuals with anorexia nervosa and pathological gamblers. However, it remains unclear whether BN patients also show difficulties in decision making. In this study, 14 patients with BN and 14 healthy comparison subjects, matched for age, gender, education, body mass index, and intelligence, were examined with the Game of Dice Task (M. Brand, E. Fujiwara, et al., 2005), a gambling task that has fixed winning probabilities and explicit rules for gains and losses, as well as with a neuropsychological test battery and personality questionnaires. On the task, the patients with BN chose the disadvantageous alternatives more frequently than did the comparison subjects. Performance on the Game of Dice Task was related to executive functioning but not to other neuropsychological functions, personality, or disease-specific variables in the BN group. Thus, in patients with BN, decision making abnormalities and executive reductions can be demonstrated and might be neuropsychological correlates of the patients' dysfunctional everyday-life decision making behavior. Neurocognitive functions should be considered in the treatment of BN.


Subject(s)
Bulimia Nervosa/physiopathology , Decision Making/physiology , Neuropsychological Tests , Adolescent , Adult , Female , Humans
7.
Psychiatr Genet ; 16(5): 205-8, 2006 Oct.
Article in English | MEDLINE | ID: mdl-16969275

ABSTRACT

OBJECTIVE: There is growing evidence, that genetic variants contribute to the pathogenesis of anorexia nervosa and bulimia nervosa. Genetic studies have revealed candidate genes, but no satisfactory associations with the disorders have been found so far. The aim of the present study was to evaluate, whether behavioral and attitudinal traits of the disorders can serve as phenotypes with a possible association with two common functional polymorphisms of the monoaminergic pathways. METHOD: Forty-five female in-patients of a specialized hospital for eating disorders were included into the study. Eating disorder symptomatology was assessed using the Eating Disorder Inventory-2. The functional catecholamine-O-methyltransferase (COMT) 158 Val-->Met polymorphism and the deletion/insertion polymorphism of the serotonin transporter promoter 5-HTTLPR were determined. RESULTS: Carriers of at least one Met-allele of the COMT gene had significantly higher total scores of the Eating Disorder Inventory-2, as well as significantly higher scores on the subscales bulimia, ineffectiveness, interoceptive awareness, maturity fears and impulse regulation. Carriers of the deletion of the 5-HTTLPR had significantly higher scores on the subscales drive for thinness and body dissatisfaction. CONCLUSION: We found associations between the COMT and the 5-HTTLPR polymorphisms and specific clinical, behavioral and attitudinal traits of eating disorders. These polymorphisms may predispose their carriers to exhibit certain symptoms of eating disorders or confer a general risk for more severe forms of these disorders.


Subject(s)
Attitude , Catechol O-Methyltransferase/genetics , Feeding and Eating Disorders/genetics , Promoter Regions, Genetic , Serotonin Plasma Membrane Transport Proteins/genetics , Adolescent , Adult , Base Sequence , DNA Primers , Feeding and Eating Disorders/enzymology , Feeding and Eating Disorders/psychology , Female , Genotype , Humans , Middle Aged
8.
Int J Eat Disord ; 32(2): 135-45, 2002 Sep.
Article in English | MEDLINE | ID: mdl-12210655

ABSTRACT

OBJECTIVE: This study compares weight gain and therapy duration in two groups of patients with anorexia nervosa, the first receiving a normal diet aimed at promoting weight gain, the second receiving high-caloric supplements in addition to this normal diet. The study includes patients from two clinics with comparable psychotherapeutic treatment settings except for the substitution. METHODS: Eighty-four patients were examined. Of these, 29 patients with substitution were compared with 29 patients without substitution. In addition, 13 patients without substitution from the first clinic were compared with 13 patients without substitution from the second clinic to exclude potential differences between the two institutions independent of the substitution. RESULTS: Substitution leads to more rapid weight gain, to greater weight on discharge, and to shorter therapy duration. Differences could be observed between patients severely or less severely underweight on admission and between patients with restrictive or bulimic anorexia. CONCLUSION: Within the framework of inpatient psychosomatic treatment involving a psychotherapeutic treatment setting, substitution facilitates weight gain.


Subject(s)
Anorexia Nervosa/diet therapy , Dietary Supplements , Energy Intake , Adult , Anorexia Nervosa/diagnosis , Anorexia Nervosa/rehabilitation , Body Mass Index , Combined Modality Therapy , Female , Follow-Up Studies , Hospitalization , Humans , Psychotherapy , Retrospective Studies , Severity of Illness Index , Weight Gain
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