It is the position of the Academy for Eating Disorders (AED) that anorexia nervosa and bulimia nervosa, along with their variants, are biologically based, serious mental illnesses (BBMI) that warrant the same level and breadth of health care coverage as conditions currently categorized in this way (e.g., schizophrenia, bipolar disorder, depression, obsessive-compulsive disorder). As set forth below, we advocate this position unequivocally based on an emerging science that affirms with a reasonable degree of medical and scientific certainty that eating disorders are significantly heritable; influenced by alterations of brain function; significantly impair cognitive function, judgment, and emotional stability; and restrict the life activities of persons afflicted with these illnesses. Accordingly, the denial or restriction of equitable and sufficient treatment necessary to avert serious health consequences and risk of death is untenable and should be vigorously protested. Commentary

Academy for eating disorders position paper: eating disorders are serious mental illnesses.

The purpose of the current article is to summarize the evidence-based medical complications and treatments that are both common and unique to adolescents with anorexia nervosa (AN). Recent literature relating to the cardiovascular complications,refeedingsyndrome,alterations in linear growth, impaired bone mineralaccretion,andstructuralandfunctional brain changes was reviewed. The literature suggests that the medical complications in adolescents with AN are different from those reported in adults. The unique clinical presentation, the early onset, and the unknown impact of these

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Medical complications in adolescents with anorexia nervosa: A review of the literature

Structural imaging studies demonstrate brain tissue abnormalities in eating disorders, yet a quantitative analysis has not been done. In global and regional meta-analyses of 9 voxel-based morphometry (VBM) studies, with a total of 228 eating disorder participants (currently ill with anorexia nervosa), and 240 age-matched healthy controls, we compare brain volumes using global and regional analyses. Anorexia nervosa (AN) patients have global reductions in gray (effect size = −0.66) and white matter (effect size = −0.74) and increased cerebrospinal fluid (effect size = 0.98) and have regional decreases in left hypothalamus, left inferior parietal lobe, right lentiform nucleus and right caudate, and no significant increases. No significant difference in hemispheric lateralization was found. Global and regional meta-analyses suggest that excessive restrained eating as found in those with anorexia nervosa coincides with structural brain changes analogous to clinical symptoms.

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Anorexia nervosa is linked to reduced brain structure in reward and somatosensory regions: a meta-analysis of VBM studies

Twenty-nine adult female patients with eating disorders (17 with bulimia nervosa, 12 with restrictive anorexia nervosa) were compared with 18 age-matched female healthy controls, using voxel-based morphometry. Restrictive anorexia nervosa patients showed a decrease of grey matter, particularly affecting the anterior cingulate cortex, frontal operculum, temporoparietal regions and the precuneus. By contrast, patients with bulimia nervosa did not differ from healthy controls. A positive correlation of “drive for thinness” and grey matter volume of the right inferior parietal lobe was found for both eating disorder groups. The strong reduction of grey matter volume in adult patients with restrictive anorexia nervosa is in line with results of adolescent patients. Contrary to other studies, this first voxel-based morphometry report of bulimic patients did not find any structural abnormalities. The inferior parietal cortex is a critical region for sensory integration of body and spatial perception, and the correlation of “drive for thinness” with grey matter volume of this region points to a neural correlate of this core psychopathological feature of eating disorders.

Voxel-based morphometry in eating disorders: Correlation of psychopathology with grey matter volume

Background Brain structure alterations have been reported in anorexia nervosa, but findings have been inconsistent. This may be due to inadequate sample size, sample heterogeneity or differences in methodology. Method High resolution magnetic resonance images were acquired of 33 adult participants with anorexia nervosa and 33 healthy participants, the largest study sample to date, in order to assess whole-brain volume, ventricular cerebrospinal fluid, white matter and grey matter volume. Voxel-based morphometry was conducted to assess regional grey matter volume. Levels of depression, anxiety, obsessionality and eating disorder-related symptoms were measured and used to explore correlations with brain structure. Results Participants with anorexia nervosa had smaller brain volumes as well as a global decrease in grey matter volume with ventricular enlargement. Voxel-based morphometry revealed a decrease in grey matter volume spanning across the cerebellum, temporal, frontal and occipital lobes. A correlation was found between grey matter volume loss and duration of illness in the cerebellum and mesencephalon. No correlations were found with clinical measures. Conclusions Findings are in accordance with several previous studies on brain structure and match functional studies that have assessed the symptomatology of anorexia nervosa, such as body image distortion and cognitive bias to food. The correlation with duration of illness supports the implication of cerebellar atrophy in the maintenance of low weight and disrupted eating behaviour and illustrates its role in the chronic phase of anorexia nervosa. The lack of other correlations suggests that these findings are not related to the presence of co-morbid disorders.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0033291713002389

Alterations in brain structure in adults with anorexia nervosa and the impact of illness duration.

Anorexia nervosa (AN) commonly arises during adolescence and is associated with significant medical morbidity Abnormalities in brain structure and function are among the most common, early, and concerning physical consequences Advances in neuroimaging technology have played an important role in delineating the structural and functional changes found in patients with AN Studies using computed tomography and magnetic resonance imaging have demonstrated changes in brain structure in the low-weight stages of AN In addition, functional neuroimaging techniques have demonstrated altered brain metabolism Debate continues as to whether these brain abnormalities are fully reversible with weight restoration Neuropsychological research has demonstrated that cognitive dysfunction is also a common feature of AN Multiple studies have indicated deficits in various neuropsychological domains Whether the reported cognitive deficits are reversible with weight gain remains unknown To date, some preliminary evidence suggests that reported cognitive deficits in patients with AN may be associated with structural brain abnormalities This chapter reviews the current literature about neuroimaging studies and cognitive function in adolescents with AN, discusses the possible underlying mechanisms causing these changes, and explores the possible association between them

Nogah C Kerem

Papers

Brain structure and function in adolescents with anorexia nervosa.