Body distortions in Anorexia Nervosa: Evidence for changed processing of multisensory bodily signals.

Body size and shape distortion is a core feature of Anorexia Nervosa (AN) - patients experience their body as fat while objectively being very thin. The cause of this distortion is unclear and disturbances in body perception could be involved. Body perception comprises estimating shape and location of one's body and requires integrating multisensory signals. We investigated if and how body location perception is changed and tested 23 AN patients and 23 healthy controls (HC) in a Rubber Hand Illusion (RHI) reaching paradigm. We presented two types of multisensory conflicts (visual-proprioceptive hand location; visual-tactile touch synchrony) and tested if the impact of visual-proprioceptive and visual-tactile signals on hand location perception differs between AN and HC groups. We found significant group differences in shifts of reaching trajectories, indicating that the influence of proprioceptive signals on hand location estimates is reduced in AN. Hand location estimates were relatively more biased towards external visual information, and shorter illness durations predicted a larger visual bias. Although touch synchrony also significantly influenced hand location estimates, this effect did not differ between groups. Our findings provide compelling evidence that multisensory body location perception - specifically the processing of visual-proprioceptive signals - is changed in AN.

The household economic burden of eating disorders and adherence to treatment in Australia.

BACKGROUND: This study investigated the household economic burden of eating disorders and cost-related non-adherence to treatment in Australia. METHODS: Multi-centre prospective observational study using a structured questionnaire. Ninety participants were recruited from two clinic settings in New South Wales, Australia and from the community using social media. The primary outcome measures were household economic burden of illness measured in terms of out-of-pocket expenditure, household economic hardship and cost-related non-adherence. RESULTS: The pattern of out-of-pocket expenditure varied by diagnosis, with Bulimia Nervosa associated with the highest total mean expenditure (per three months). Economic hardship was reported in 96.7% of participants and 17.8% reported cost-related non-adherence. Those most likely to report cost-related non-adherence had a longer time since diagnosis. Cost-related non-adherence and higher out-of-pocket expenditure were associated with poorer quality of life, a more threatening perception of the impact of the illness and poor self-reported health. CONCLUSIONS: This study is the first to empirically and quantitatively examine the household economic burden of eating disorders from the patient perspective. Results indicate that households experience a substantial burden associated with the treatment and management of an eating disorder. This burden may contribute to maintaining the illness for those who experience cost-related non-adherence and by negatively influencing health outcomes. Current initiatives to implement sustainable and integrated models of care for eating disorders should strive to minimise the economic impact of treatment on families.

Brains of anorexia nervosa patients process self-images differently from non-self-images: an fMRI study.

The central disturbance in anorexia nervosa (AN) is a distorted body image. This perceptual error does not extend to judging others' body shapes. We used fMRI to examine if the brain processing of an image of self is different in the brains of AN patients. The sample comprised 10 patients with AN and 10 healthy control women. In a controlled epoch design, subjects were presented with images of self and non-self, matched for body mass index (BMI), in a counter-balanced fashion, and echoplanar images with blood oxygenation level dependent (BOLD) contrast were obtained on a 3T Philips scanner. Processing of non-self-images by control subjects activated the inferior and middle frontal gyri, superior and inferior parietal lobules, posterior lobe of the cerebellum and the thalamus. Patients had a similar pattern of activation with greater activation in the medial frontal gyrus. When the two groups were contrasted for the differential activation with self vs. non-self-images, control subjects had greater activation than patients in the middle frontal gyri, insula, precuneus, and occipital regions while the patients did not have greater activation in any region. AN patients had no significant regions of activation with self-images compared to baseline. We conclude that AN patients process non-self-images similarly to control subjects, but their processing of self-images is quite discrepant, with a lack of activation of the attentional system or the insula. Such discrepant emotional and perceptual processing may underlie the distortion of self-images by AN patients.

Randomized controlled trial of olanzapine in the treatment of cognitions in anorexia nervosa.

OBJECTIVE: Recovery from anorexia nervosa is confounded by intrusive anorectic cognitions and rituals. It has been observed that olanzapine, an atypical antipsychotic, can reduce this anorexic rumination. A pilot study was designed to test the effectiveness of olanzapine in this role. METHODS: A randomized trial of olanzapine versus chlorpromazine, with anorexic rumination as the primary outcome, was conducted. Of the 26 patients who presented, 15 were randomized in a balanced block design, eight to olanzapine and seven to chlorpromazine. RESULTS: Only the olanzapine group had a significant reduction in the degree of rumination. CONCLUSION: Olanzapine may be of benefit in anorexia nervosa by causing a reduction in anorexic rumination.