Assessing body image in anorexia nervosa using biometric self-avatars in virtual reality: Attitudinal components rather than visual body size estimation are distorted.

BACKGROUND: Body image disturbance (BID) is a core symptom of anorexia nervosa (AN), but as yet distinctive features of BID are unknown. The present study aimed at disentangling perceptual and attitudinal components of BID in AN. METHODS: We investigated n = 24 women with AN and n = 24 controls. Based on a three-dimensional (3D) body scan, we created realistic virtual 3D bodies (avatars) for each participant that were varied through a range of ±20% of the participants' weights. Avatars were presented in a virtual reality mirror scenario. Using different psychophysical tasks, participants identified and adjusted their actual and their desired body weight. To test for general perceptual biases in estimating body weight, a second experiment investigated perception of weight and shape matched avatars with another identity. RESULTS: Women with AN and controls underestimated their weight, with a trend that women with AN underestimated more. The average desired body of controls had normal weight while the average desired weight of women with AN corresponded to extreme AN (DSM-5). Correlation analyses revealed that desired body weight, but not accuracy of weight estimation, was associated with eating disorder symptoms. In the second experiment, both groups estimated accurately while the most attractive body was similar to Experiment 1. CONCLUSIONS: Our results contradict the widespread assumption that patients with AN overestimate their body weight due to visual distortions. Rather, they illustrate that BID might be driven by distorted attitudes with regard to the desired body. Clinical interventions should aim at helping patients with AN to change their desired weight.

Attentional impulsivity in binge eating disorder modulates response inhibition performance and frontal brain networks.

BACKGROUND: A subgroup of overweight and obese people is characterized by binge eating disorder (BED). Increased impulsivity has been suggested to cause binge eating and subsequent weight gain. In the current study, neuronal correlates of increased impulsivity in binge eating disorder during behavioral response inhibition were investigated. METHODS: Magnetic brain activity and behavioral responses of 37 overweight and obese individuals with and without diagnosed BED were recorded while performing a food-related visual go-nogo task. Trait impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11). RESULTS: Specifically, increased attentional impulsiveness (a subscale of the BIS-11) in BED was related to decreased response inhibition performance and hypoactivity in the prefrontal control network, which was activated when response inhibition was required. Furthermore, participants with BED showed a trend for a food-specific inhibition performance decline. This was possibly related to the absence of a food-specific activity increase in the prefrontal control network in BED, as observed in the control group. In addition, an increase in activity related to the actual button press during prepotent responses and alterations in visual processing were observed. CONCLUSIONS: Our results suggest an attentional impulsiveness-related attenuation in response inhibition performance in individuals with BED. This might have been related to increased reward responsiveness and limited resources to activate the prefrontal control network involved in response inhibition. Our results substantiate the importance of neuronal markers for investigating prevention and treatment of obesity, especially in specific subgroups at risk such as BED.

Food-related impulsivity in obesity and binge eating disorder--a systematic review.

Impulsivity towards food has been recognized as a potential factor leading to increased food intake in obesity. Patients suffering from binge eating disorder (BED) form a specific subgroup of obese people that might be characterized by increased impulsivity. These assumptions, although, have yet to be verified. Therefore, this review evaluates evidence for food-related impulsivity in obese people with and without BED and examines possible differences between both populations. More precisely, evidence for the two components of impulsivity is analyzed separately: evidence for reward sensitivity, specifically, the urge for appetitive stimuli and evidence for rash-spontaneous behaviour such as acting disinhibited with no regard for the consequences. Our search resulted in 51 articles demonstrating generally increased food-related impulsivity. We found particular emphasis on increased reward sensitivity in obese people, which appeared to be more pronounced in people with BED. There was little and conflicting evidence, however, concerning increased rash-spontaneous behaviour in obese people without BED, but consistent evidence of an increase in obese people with BED. All in all, the evidence supports the view that BED represents a specific phenotype of obesity with increased food-related impulsivity. Taking these specific deficits into account can enhance the effectiveness of weight reduction programmes and psychotherapy.

[Chronic inflammatory bowel disease or psychogenic eating disorder - Case 1/2012. Interdisciplinary challenges in clinical diagnosis and treatment]. / Chronisch entzündliche Darmerkrankung oder psychogene Essstörung - Fall 1/2012. Interdisziplinäre Herausforderungen an Diagnostik und Therapie.

HISTORY AND ADMISSION FINDINGS: A 33-year-old female patient with chronic anorexia nervosa was admitted for inpatient psychosomatic treatment after a recent severe weight loss. In addition, an inflammatory bowel disease had been suspected in the past 4 years. The patient was convinced that the weight loss had purely organic reasons. She reported frequent diarrhea after meals. Also laxative abuse was suspected because of melanosis coli. DIAGNOSIS: An MR Sellink showed no evidence for actual intestinal inflammation. No increased inflammation parameters were found in blood tests. Diarrhea could not be proved by investigation of excrements or a symptom diary. TREATMENT AND COURSE: Treatment consisted of a multimodal approach with focus on cognitive behavioural therapy. Treatment revealed eating disorder specific cognitions, fears and behaviour. A partial acceptance of gastrointestinal symptoms and weight loss as eating disorder symptomatology could be achieved. CONCLUSION: Diagnostics and treatment of chronic anorexia nervosa are complicated by a coincidental (or suspected) organic intestinal disease. Gastrointestinal problems are common in eating disorders. Organic symptoms are often difficult to distinguish from psychosomatic symptoms. Somatic fixation complicates treatment of eating disorders.