1
|
Abstract
To the extent that severe and lasting anorexia nervosa (SE-AN) is defined in terms of refractoriness to the best treatments available, it is mandatory to scrutinize the proven effectiveness of the treatments offered to patients. The array of so-called current evidence-based treatments for anorexia nervosa (AN) encompasses the entire spectrum of treatments ranging from specialized brand-type treatments to new treatments adapted to the specific characteristics of people suffering from AN. However, after several randomized control trials, parity in efficacy is the characteristic among these treatments. To further complicate the landscape of effective treatments, this "tie score" extends to the treatment originally conceived as control conditions, or treatment as usual conditions. In retrospection, one can understand that treatments considered to be the best treatments available in the past were unaware of their possible iatrogenic effects. Obviously, the same can be said of the theoretical assumptions underpinning such treatments. In either case, if the definition of chronicity mentioned above is applied, it is clear that the responsibility for the chronicity of the disorder says more about the flagrant inefficacy of the treatments and the defective assumptions underpinning them, than the nature of the disorder itself. A historical analysis traces the emergence of the current concept of "typical" AN and Hilde Bruch's contribution to it. It is concluded that today's diagnostic criteria resulting from a long process of acculturation distort rather than capture the essence of the disorder, as well as marginalizing and invalidating patients' perspectives.
Collapse
Affiliation(s)
- Emilio Gutiérrez
- Department of Clinical Psychology and Psychobiology, College of Psychology, University of Santiago, Santiago de Compostela, Spain
- Venres Clínicos Unit, College of Psychology, University of Santiago, Santiago de Compostela, Spain
| | - Olaia Carrera
- Venres Clínicos Unit, College of Psychology, University of Santiago, Santiago de Compostela, Spain
| |
Collapse
|
2
|
Roura I, Fraga Á, Gutiérrez E. Differential effects of heat in the phases of the light-dark cycle in the activity-based anorexia model. Int J Eat Disord 2020; 53:1826-1835. [PMID: 32827352 DOI: 10.1002/eat.23363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/09/2020] [Accepted: 07/27/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND This research builds on the studies on ambient temperature as a key influence in the recovery of rodents exposed to the activity-based anorexia (ABA) model. The ABA model is an experimental paradigm in which rodents under a restricted feeding schedule and with free access to an activity wheel show signs that parallel those of anorexia nervosa in humans. OBJECTIVE The present study focuses on the effects of applying heat during the different phases of the dark-light cycle in the activity levels, body weight, food intake, body temperature, and recovery rates of 30 male rats submitted to ABA. METHOD After reaching a 20% weight loss criterion, animals were randomly assigned to three experimental conditions: (a) continuous warming, (b) warming exclusively during the light phase, or (c) warming exclusively during the dark phase. RESULTS Differential effects were found depending on the modalities of warming: in comparison with either light or dark warming, continuous warming significatively decreased activity, facilitated weight gain, and maintained body temperature. Transient effects of warming were found both in the groups warmed either during light or dark periods exclusively. DISCUSSION The results suggest that both light and dark warming did not promote recovery in animals exposed to ABA. Evidence about the beneficial effects of continuous warming are in line with previous research and reinforces adding external heat as a useful tool in the treatment of anorexia nervosa.
Collapse
Affiliation(s)
- Ignacio Roura
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ángela Fraga
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Emilio Gutiérrez
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.,Unidad Venres Clínicos, Facultade de Psicoloxía, Universidade de Santiago, Santiago de Compostela, Spain
| |
Collapse
|
3
|
Fraga A, Carreira MC, Gonzalez-Izquierdo A, Diéguez C, López M, Gutiérrez E. Temperature but not leptin prevents semi-starvation induced hyperactivity in rats: implications for anorexia nervosa treatment. Sci Rep 2020; 10:5300. [PMID: 32210308 PMCID: PMC7093431 DOI: 10.1038/s41598-020-62147-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/03/2020] [Indexed: 02/06/2023] Open
Abstract
The hypothesis linking hyperactivity with weight loss associated hypoleptinemia in anorexia nervosa gained momentum after a study showing that leptin suppressed semi-starvation induced hyperactivity in rats. Alternatively, ambient temperature is a key modulating factor of activity in semi-starved rats. The aim of the study is to compare the efficacy of leptin with increased ambient temperature in the prevention of hyperactivity in semi-starved rats. 74 Sprague-Dawley male rats were employed in two experiments with the difference residing in the length of baseline. After an extended (28 days), or shorter (14 days) baseline with free access to food and the running wheel, housed at 21 °C, animals were either ad-lib feed or food restricted (60% of food ingested during previous week) and infused with same amount of leptin at 21 °C, 25 °C, or vehicle at 21 °C, 25 °C and 32 °C for a week. Animals housed at 32 °C significantly reduced wheel running and weight loss during food restriction while animals given leptin did not yield no differences in activity or weight loss. Moreover, unlike animals housed at 32 °C, body temperature of leptin infused animals housed at 21 °C was significantly reduced during food restriction. Furthermore, leptin treated rats without a preceding stable pattern of activity displayed a severe dysregulation of circadian rhythm in activity and a collapse of body temperature. Housing temperature plays a more critical role than leptin in the regulation of semi-starvation induced hyperactivity in rats, which may be of relevance for the management of hyperactivity in anorexia nervosa.
Collapse
Affiliation(s)
- Angela Fraga
- Department Psicología Clínica y Psicobiología, Facultad de Psicología, Universidad de Santiago, Campus Vida, 15782, Santiago de Compostela, Spain
| | - Marcos C Carreira
- Lab de Endocrinología Molecular, Instituto de Investigaciones Sanitarias de Santiago de Compostela (IDIS), Complej o Hospitalario de Santiago (CHUS), A Coruña, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Andrea Gonzalez-Izquierdo
- Lab de Endocrinología Molecular, Instituto de Investigaciones Sanitarias de Santiago de Compostela (IDIS), Complej o Hospitalario de Santiago (CHUS), A Coruña, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Diéguez
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.,Department Fisioloxía and Centro de Investigación en Medicina Molecular (CIMUS), Universidade de Santiago de Compostela, Instituto de Investigaciones Sanitarias de Santiago de Compostela (IDIS), Santiago de Compostela, 15782, Spain
| | - Miguel López
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.,Department Fisioloxía and Centro de Investigación en Medicina Molecular (CIMUS), Universidade de Santiago de Compostela, Instituto de Investigaciones Sanitarias de Santiago de Compostela (IDIS), Santiago de Compostela, 15782, Spain
| | - Emilio Gutiérrez
- Department Psicología Clínica y Psicobiología, Facultad de Psicología, Universidad de Santiago, Campus Vida, 15782, Santiago de Compostela, Spain. .,Unidad Venres Clínicos, Facultad de Psicología, Campus Vida, Universidad de Santiago, 15782, Santiago de Compostela, Spain.
| |
Collapse
|
4
|
Gutierrez E, Birmingham CL. Editorial: New Perspectives to Unlock the Current Impasse in Treating Anorexia Nervosa. Front Psychol 2020; 11:207. [PMID: 32132954 PMCID: PMC7040163 DOI: 10.3389/fpsyg.2020.00207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/29/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Emilio Gutierrez
- Departamento de Psicología Clínica y Psicobiología and Unidad Venres Clínicos, Facultad de Psicología, Universidad de Santiago, Santiago de Compostela, Spain
| | - C Laird Birmingham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
5
|
Affiliation(s)
- Emilio Gutiérrez
- Departamento de Psicología Clínica y Psicobiología,Facultad de Psicología,Campus Vida,Universidad de Santiago,15782 Santiago de Compostela,Spain
| | - Olaia Carrera
- Unidad Venres Clínicos,Facultad de Psicología,Campus Vida,Universidad de Santiago,15782 Santiago de Compostela,Spain
| |
Collapse
|
6
|
Parling T, Cernvall M, Ramklint M, Holmgren S, Ghaderi A. A randomised trial of Acceptance and Commitment Therapy for Anorexia Nervosa after daycare treatment, including five-year follow-up. BMC Psychiatry 2016; 16:272. [PMID: 27473046 PMCID: PMC4966749 DOI: 10.1186/s12888-016-0975-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 06/14/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND No specific psychotherapy for adult anorexia nervosa (AN) has shown superior effect. Maintenance factors in AN (over-evaluation of control over eating, weight and shape) were addressed via Acceptance and Commitment Therapy (ACT). The study aimed to compare 19 sessions of ACT with treatment as usual (TAU), after 9 to 12 weeks of daycare, regarding recovery and risk of relapse up to five years. METHODS Patients with a full, sub-threshold or partial AN diagnosis from an adult eating disorder unit at a hospital were randomized to ACT (n = 24) and TAU (n = 19). The staff at the hospital, as well as the participants, were unaware of the allocation until the last week of daycare. Primary outcome measures were body mass index (BMI) and specific eating psychopathology. Analyses included mixed model repeated measures and odds ratios. RESULTS Groups did not differ regarding recovery and relapse using a metric of BMI and the Eating Disorder Examination Questionnaire (EDE-Q). There were only significant time effects. However, odds ratio indicated that ACT participants were more likely to reach good outcome. The study was underpowered due to unexpected low inflow of patients and high attrition. CONCLUSION Longer treatment, more focus on established perpetuating factors and weight restoration integrated with ACT might improve outcome. Potential pitfalls regarding future trials on AN are discussed. Trial registration number ISRCTN 12106530. Retrospectively registered 08/06/2016.
Collapse
Affiliation(s)
- Thomas Parling
- Department of Psychology, Uppsala University, P.O. Box 1225, SE-75142, Uppsala, Sweden.
| | - Martin Cernvall
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Mia Ramklint
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | | | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|