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Bethesda, Maryland | September 19-21, 2013
F1
Application of the Perspectives of Psychiatry to the Understanding of
Anorexia Nervosa and All Psychiatric Disorders
Arnold E Andersen
U of Iowa, Iowa City, IA, USA
APPLICATION OF THE PERSPECTIVES OF PSYCHIATRY TO THE
UNDERSTANDING OF ANOREXIA NERVOSA AND ALL PSYCHIATRIC
DISORDERS Arnold E. Andersen, M.D. Anorexia Nervosa (AN) has
been understood from multiple conflicting viewpoints, including as
a sociocultural disorder, an endocrine disorder, or a
forme fruste
of
depression or OCD. The Perspectives of Psychiatry (McHugh and
Slavney) move beyond the checklist approach of the DSM model
to a categorical understanding of AN as a disorder viewed from the
Perspective of an abnormal Behavior. In contrast, schizophrenia best
fits the Disease Perspective, while personality disorders are understood
as Dimensional disorders, and finally, the Life Story encompasses
psychodynamic understanding of vulnerabilities meeting life stresses. This
presentation advances the Perspectives model by demonstrating how all
Four Perspectives can be applied in an evidence based manner to AN,
comparing it to the application of the Perspectives to schizophrenia. A
radically different understanding of AN and other eating disorders, from
the expanded application of the Perspectives, in line with the way internal
medicine has progressed, will advance both the etiological and therapeutic
understanding of eating disorders. NIMH and other organization are all
rethinking the iterations of the checklist approach.
F2
Evaluating the Severity of Eating Pathology Associated With
Excessive Exercise in College Students
Drew A. Anderson, Katherine E. Schaumberg, Lisa M. Anderson, Erin E.
Reilly
University at Albany - State University of New York, Albany, NY, USA
Introduction
:
This study examined the frequency of excessive exercise
use in college students along with the severity of eating pathology
associated with this compensatory behavior strategy.
Method
:
A large
sample of undergraduates (N = 1128) completed the Eating Disorder
Examination Questionnaire (EDE-Q).
Results
:
Nearly half of participants
(47.8%)
in this sample indicated that they had engaged in a compensatory
behavior at least once over the past 28 days. Of the individuals who
had engaged in compensatory behaviors, 79.3% reported excessive
exercise as their only compensatory behavior, with a mean of 9.27 ± 7.67
episodes in the past 28 days. Overall, there was a relationship between
type of compensatory behavior strategy endorsed and subscale scores
of the EDE-Q. Individuals who reported laxative use or vomiting had the
highest level of risk on the EDE-Q subscales, above those who reported
only excessive exercise.
Conclusions
:
Overall, individuals who reported
excessive exercise appeared to score similarly on the EDE-Q to other
nonclinical undergraduate samples, despite the fact that many were
reporting rates of excessive exercise that would meet the frequency of
compensatory behaviors criteria for BN. Further investigations which
examine the accuracy of self-reports of excessive exercise on the EDE-Q
and differentiate healthy from unhealthy exercise appear important for
promoting college students’ health.
F3
The Neurocognitive Basis of Insight Into Illness in Anorexia Nervosa:
A Pilot Metacognitive Study
Reout Arbel
1
,
Danny Koren
2
,
Ehud Klein
3
,
Yael Latzer
1
1
University of Haifa, Faculty of Social Welfare &Health Sciences, Haifa,
Israel, Haifa, Israel,
2
University of Haifa, Psychology Department, Haifa,
Israel, Haifa, Israel,
3
Technion Medical School, Department of Psychiatry
at the Rambam Medical Center, Haifa, Israel, Haifa, Israel,
4
University of
Haifa, Faculty of Social Welfare &Health Sciences, Haifa, Israel, Haifa,
Israel
Introduction
:
The overarching goal of the current study, was to
investigate the possibility of neurocognitive impairments in the basis of
poor illness into illness in Anorexia Nervosa. Specifically, we assessed
the differential and joint links between insight into illness and cognitive vs.
metacognitive performance.
Methods
:
The study includes 50 women; 25
with Anorexia Nervosa (AN) and 25 healthy comparisons (HC). Insight into
illness was assessed with the Scale of Unawareness of Mental Disorder
(
SUMD). Cognitive and Metacognitive performance were assessed with
computerized version of the Wisconsin Card Sorting Task (WCST) and
the Computerized Body-Size Discrimination task (CBSD). In addition to
the standard administration of the tasks, subjects were also asked to rate
their level of confidence in the correctness of each sort and to choose
whether they wanted each sort to be ‘’counted’’ toward their overall
performance score on the test.
Results
:
In the Body-Size Discrimination
Task Prediction of poor insight was significantly improved when adding the
new, free-choice metacognitive measures to the conventional measures in
both tasks, but not the other way around. Results from the Wisconsin Card
Sorting Task show a mix trend.
Conclusions:
These preliminary results
suggest that metacognition might be an important mediator between basic
cognitive deficits and poor insight and that it might be even more relevant
to poor insight than cognitive deficits per se.
F4
Measurement of Non-exercise Physical Activity in Individuals with
Anorexia Nervosa (AN) and Healthy Volunteers
Evelyn Attia
1,2
,
Kathryn Keegan
3
,
B. Timothy Walsh
1
,
Diane Klein
3
,
Edward
Sazonov
4
,
Esther Levine
5
1
Columbia University Medical Center, New York, NY, USA,
2
Weill Cornell
Medical College, New York, NY, USA,
3
New York University School of
Medicine, New York, NY, USA,
4
University of Alabama, Tuscaloosa, AL,
USA,
5
Harvard School of Dental Medicine, Boston, MA, USA
PURPOSE
:
This study aimed to 1) collect preliminary data using the
SmartShoe, a novel activity monitor, and 2) use the SmartShoe to
measure non-exercise activity in individuals with AN and a comparison
group of healthy volunteers.
METHODS
:
Ten controls wore the SmartShoe
and other validated activity monitors while engaging in a sequence of
non-walking activities. Data from devices were compared for consistency
of activity counts and sensitivity to small movements. Also, 11 individuals
with AN and 10 controls wore the SmartShoe while engaging in quiet
activities. Activity, calculated for each participant, was quantified. Also,
Pearson correlation coefficients were calculated to determine the
relationship between activity and duration of illness, percentage of ideal
body weight (%IBW), Beck Depression Inventory (BDI), Beck Anxiety
Inventory (BAI).
RESULTS:
Patients tolerated the SmartShoe and this
device was sensitive to small movements (e.g., fidgeting). Patients had
significantly higher average activity levels than healthy controls (p =
0.045).
There was no significant correlation between duration of illness or
%
IBW and average activity levels in patients; there was a trend toward
a significant association between activity and BDI (r = 0.575, p = 0.064)
and BAI( r = 0.0579, p = 0.062).
CONCLUSIONS
:
Individuals with AN had
higher levels of non-exercise activity compared with controls. Depressive
and anxiety symptoms were associated with fidgeting in patients but not in
controls.
F5
Reward-Related Alterations in Enkephalin Gene Expression and
Dopamine Release in the Accumbens as a Result Of Activity-Based
Anorexia in the Rat
Nicole M Avena
1,2
,
Susan M Murray
1,2
,
Nicole C Barbarich-Marsteller
3,4
,
Pedro V Rada
5
1
University of Florida, McKnight Brain Institute, College of Medicine,
Department of Psychiatry, Gainesville, FL, USA,
2
Princeton University,
Department of Psychology and Neuroscience Institute, Princeton,
NJ, USA,
3
Columbia University College of Physicians and Surgeons,
Department of Psychiatry, New York, NY, USA,
4
New York State
Psychiatric Institute, New York, NY, USA,
5
University of Los Andes,
Department of Physiology, Merida, Venezuela
Purpose
.
Activity-based anorexia (ABA) is an animal model of anorexia
nervosa (AN) characterized by limited food access and unlimited
access
to an exercise wheel, conditions known to elicit excessive running and
weight loss. It has been hypothesized that this phenomenon may reflect
or result in alterations in reward regions of the brain. To test this, we
measured levels of opioid gene expression and dopamine (DA) in the
nucleus accumbens (NAc) of ABA and control rats.
Methods
.
In Exp.
1,
rats (n=6/group) were assigned to five groups: ABA, Palatable Food,
Recovered ABA, Exercise Control, and Control. RT-PCR was used to
measure enkephalin mRNA. In Exp. 2, rats (n=7-8/group) were assigned
to an ABA or control group.
In vivo
microdialysis was used to measure
extracellular DA levels during baseline, running, running and chow, and
post sample.
Results
.
Enkephalin mRNA was elevated in the NAc of ABA
rats, rats with access to palatable food, and recovered ABA rats. Higher
levels of extracellular DA were also found in ABA rats when running vs.
controls.
Conclusions
.
These findings suggest alterations in reward-
related neurochemicals in ABA rats. This may help to explain why these
rats exhibit increased exercise, as the reinforcing effects of running may
be enhanced when coupled with food restriction. These results may have
translational implications for understanding the neurological basis of AN.
F6
Perfectionistic Self-Presentation and Body Surveillance as Mediators
of the Link Between Relationship Contingent Self-Worth and
Disordered Eating Attitudes and Behaviors
Anna M. Bardone-Cone, Laura Martin, Ellen E. Fitzsimmons-Craft
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Relationship contingent self-worth is associated with body dissatisfaction
and disordered eating, but the underlying mechanisms are unclear. This
study tested perfectionistic self-presentation and body surveillance as
mediators of the relation between relationship contingent self-worth and
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