Multimodal neuroimaging in anorexia nervosa.

Anorexia nervosa (AN) is a severe and complex psychiatric disorder characterized by intense fear about weight gain and finalized to food-related control behaviors. Growing interest has been demonstrated about neurobiological processes subtend to AN physiopathology. The present review aimed to collect neurostructural and neurofunctional available data from 2010 to 2019. Results have been organized according to the neuroimaging technique employed, also including a specific section on electroencephalographic results, mostly neglected in previous reviews. Diffuse cerebral vulnerability has been demonstrated and the contribution of several structures has been identified. Insula, cingulate cortex, parietal and frontal areas are primarily involved both by structural and functional perspectives. Moreover, consistent alterations in white matter integrity and brain electrical activity have been reported. Neuroimaging findings give a substantial contribution to AN pathophysiological description, also in order to understand altered but reversible processes in the passage from acute illness phase to disorder's remission, useful also for defining therapy.

Giovanni Liotti (1945-2018): the Pied Noir of research in attachment and psychotherapy.

This article is a portrait of Giovanni Liotti, eminent psychiatrist and scholar of attachment theory who recently passed away. In this paper, we recall some fundamental steps in his professional and personal life: Liotti's encounter and friendship with Bowlby; Liotti's construction of a bridge between cognitive therapy (of which he was a pioneer) and attachment theory; the interest in attachment disorganization as a precursor of dissociative symptoms and syndromes in adolescence and adulthood; his appreciation for Janet's ideas (which Liotti helped bring back to the attention of clinicians and researchers) and his contribution in highlighting the role of real traumatic experiences in the development of psychopathology; Liotti's attempt to go beyond attachment theory and formulate for the clinical context an evolutionary theory of motivation, which analyzes different interpersonal motivational systems beyond attachment and caregiving, an emphasizes in particular the importance of cooperation in psychotherapy.

Embodiment of underweight and normal-weight avatars affects bodily self-representations in anorexia nervosa.

Body image distortion (BID) is a crucial aspect of anorexia nervosa (AN), leading to body overestimation, dissatisfaction, and low self-esteem. BID significantly influences the onset, maintenance, and relapse of the pathology. We assessed whether a Full Body Illusion (FBI) using under and normal-weight avatars' bodies affects perceptual body image and body schema estimations in both individuals with anorexia nervosa (AN) and healthy controls (HC). After each embodiment procedure, we asked participants to estimate the width of their hips (Perceptual Body Image Task) and the minimum aperture width of a virtual door necessary to pass through it (Body Schema Task). Additionally, we asked participants to rate the avatars in terms of self-similarity, attractiveness, and implicit disgust (i.e., pleasant/unpleasant body odour). Whereas participants with AN (N = 26) showed changes in body schema estimations after embodying the normal-weight avatar, no changes were found in HC (N = 25), highlighting increased bodily self-plasticity in AN. Notably, individuals with AN rated the normal weight avatar as the most similar to their real body, which was also considered the least attractive and the most repulsive. These ratings correlated with BID severity. Furthermore, at the explicit level, all participants reported feeling thinner than usual after embodying the underweight avatar. Overall, our findings suggest that BID in AN engages multiple sensory channels (from visual to olfactory) and components (from perceptual to affective), offering potential targets for innovative non-invasive treatments aimed at modifying flexible aspects of body representation.

Blood SIRT1 Shows a Coherent Association with Leptin and Adiponectin in Relation to the Degree and Distribution of Adiposity: A Study in Obesity, Normal Weight and Anorexia Nervosa.

Sirtuin 1 (SIRT1) is a sensor of cell energy availability, and with leptin and adiponectin, it regulates metabolic homeostasis. Widely studied in tissues, SIRT1 is under evaluation as a plasmatic marker. We aimed at assessing whether circulating SIRT1 behaves consistently with leptin and adiponectin in conditions of deficiency, excess or normal fat content. Eighty subjects were evaluated: 27 with anorexia nervosa (AN), 26 normal-weight and 27 with obesity. Bloodstream SIRT1, leptin and adiponectin (ELISA), total and trunk fat mass (FM) %, abdominal visceral adipose tissue, liver steatosis and epicardial fat thickness (EFT) were assessed. For each fat store, the coefficient of determination (R2) was used to evaluate the prediction capability of SIRT1, leptin and adiponectin. Plasma SIRT1 and adiponectin coherently decreased with the increase of FM, while the opposite occurred with leptin. Mean levels of each analyte were different between groups (p < 0.005). A significant association between plasma variables and FM depots was observed. SIRT1 showed a good predictive strength for FM, particularly in the obesity group, where the best R2 was recorded for EFT (R2 = 0.7). Blood SIRT1, adiponectin and leptin behave coherently with FM and there is synchrony between them. The association of SIRT1 with FM is substantially superimposable to that of adiponectin and leptin. Given its homeostatic roles, SIRT1 may deserve to be considered as a plasma clinical/biochemical parameter of adiposity and metabolic health.

An ecological approach to the behavioral assessment of executive functions in anorexia nervosa.

The use of ecological tests to assess executive functions (EFs) in patients with anorexia nervosa (AN) has not examined extensively. The objective of this study was to analyze and compare the performance of patients with AN and healthy controls (HCs) on standard versus ecologically valid tests on EFs. Sixty-two females aged between 16 and 42 who were diagnosed with AN and 70 matched HCs completed 2 neuropsychological test batteries: standard tests (WCST, TMT, Stroop, ToL, fluency test) and the Behavioral Assessment of Dysexecutive Syndrome (BADS). On the standard tests, patients with AN produced more perseverative response and were slower than HCs in the TMT; in contrast, they scored as well as HCs on tasks that assessed categorization, interference in color naming, planning and semantic fluency. Conversely, there were differences in the ecological tests with patients with AN systematically slower in the resolution of complex tasks. Results demonstrated the power of ecological tests in capturing selective impairments in multifaceted and unstructured tests. Patients with AN experienced systematic deceleration in the resolution of ecological tasks. Also, the increased time needed to solve the tasks, was not reflected in overall improvement in performance. This evidence is further discussed with respect to central coherence.

[Seeking compulsory treatment as life-saving in the presence of eating disorders: a complex choice]. / Il trattamento sanitario obbligatorio come salvavita in presenza di disturbi dell'alimentazione: una scelta complessa.

Eating disorders (and especially anorexia nervosa) are associated with severe disability, poor quality of life and high mortality rate. Anorexia nervosa ranks among the main causes of death among young women. Despite physical and psycho-social impairment, patients suffering from anorexia nervosa do not recognize low body weight and extreme calorie restriction as a clinical problem and are ambivalent towards treatment. Some patients with anorexia nervosa refuse treatments though presenting severe medical complications and having a high mortality risk. Hence the need to evaluate when it could be appropriate to prescribe a compulsory treatment in the more complex cases who refuse interventions, deemed necessary for them. To date, the compulsory treatment in anorexia nervosa is still under debate: some authors take into account the negative impact on the therapeutic relationship, other authors consider it as a compassionate treatment or as life-saving therapy. Indeed, compulsory treatment for eating disorders must always be weighed very carefully because it is considered by law as the highest form of restriction of personal freedom. Political Institutions must provide a clear framework for the society and for professionals, while the health care services must face the problem of the adequacy of available resources (not only in terms of hospital beds but also of skilled professionals) compared to patients' needs, considering the organization and the integration of clinical services dedicated to the treatment of eating disorders.

The two dimensions of the body representation in women suffering from Anorexia Nervosa.

A core symptom of Anorexia Nervosa (AN) is a severe alteration of body representations. Evidence from somatoperception studies point to a generic disturbances of somatosensory components of body representations. Here we have investigated whether AN patients (N=18) and controls differed in the perception of tactile stimuli differently oriented along the body axes. We tested the hypothesis that patients perceive and represent their body selectively larger in only one dimension. To this aim we used elementary tactile measures for tactile acuity (Von Frey's test and two-point discrimination thresholds - 2PD) and tactile discrimination measures. The rationale is based on the assumption that AN patients have a wider body representation, and that tactile body representation tasks (Tactile Distance task) oriented across the bodies (horizontally) are influenced by distorted body representations compared with tactile stimuli oriented along the bodies (vertically) which should not be influenced by body representations. Results showed that patients judged horizontal tactile stimuli significantly wider than the same stimuli oriented vertically.These results suggest that human brain perceives things differently based on body representations and that the beliefs concerning body size influence the specific somatosensory process of tactile experience.

An exploratory assessment of theory of mind and psychological impairment in patients with bulimia nervosa.

This study aimed to investigate psychosocial functioning and different dimensions of theory of mind (ToM) in people with bulimia nervosa (BN) and Eating Disorder Not Otherwise Specified-BN type (EDNOS-BN). Psychosocial functioning and ToM were assessed in a sample of young adult females, 16 BN and 16 EDNOS-BN outpatients and 16 healthy controls (HCs). They were assessed using the Eating Disorder Inventory-Symptom Checklist-2 (EDI-2 SC) for evaluating psychological traits associated with eating disorders; the Symptom Checklist-90-Revised (SCL-90-R) for evaluating psychopathological status; and the Theory of Mind Assessment Scale (Th.o.m.a.s.), a semi-structured interview aimed at assessing a person's different dimensions of ToM. The BN and EDNOS-BN groups exhibited worse performance than the control group on all dimensions of the SCL-90-R, and on all dimensions of the EDI-2 SC. The only difference for perfectionism was that BN obtained higher scores than EDNOS-BN group. Our results also revealed an impairment of third-person and second-order ToM in patients with bulimia (BN and EDNOS-BN) with respect to control subjects. These preliminary data have important implications for future empirical work, in that they provide valuable information regarding the importance of investigating the various facets of ToM ability separately, in order to provide a more detailed profile of ToM functioning in the clinical samples.