The implications of previous history of anorexia nervosa in patients with current bulimia nervosa: Alterations in daily functioning, decision-making, and bone status.

OBJECTIVE: It is not yet clear what role previous history of anorexia nervosa (AN) plays in the clinical course of bulimia nervosa (BN). We aimed to investigate, using a comprehensive assessment, involving clinical characteristics, daily functioning, cognitive functions, and nutritional and physical markers in BN patients with a history of AN, and compare them with BN patients without a history of AN. METHODS: Eighty-five patients with a current episode of BN (35 with a lifetime history of AN) were analysed. Diagnoses were established according to the DSM-5 criteria. Patients completed neuropsychological tests and filled out validated psychiatric questionnaires. Sociodemographic data and nutritional and somatic illness markers were collected and investigated. RESULTS: BN patients with a history of previous lifetime AN had worse decision-making ability, worse general and specific functioning, decreased bone density, more antecedent of lifetime suicide attempts, more dietary restraint, and more frequent use of laxatives. The multivariate model shows that the history of AN is closely associated with worse decision-making ability, worse general function, and higher likelihood of lifetime suicide attempts. DISCUSSION: Prior history of AN is an important clinical question that should receive proper attention when treating BN patients, as this subgroup of patients may have specific care needs.

Improving decision-making and cognitive impulse control in bulimia nervosa by rTMS: An ancillary randomized controlled study.

OBJECTIVE: Impaired decision-making and inhibitory control may be involved in the pathophysiology of psychiatric disorders like bulimia nervosa (BN). Their improvement after neuromodulation may underpin clinical improvement. We assessed the effects of rTMS on these cognitive functions in a sample of women with BN. METHODS: Thirty-nine participants (22 in a sham group and 17 in an rTMS group) were assessed before and after 10 high frequency rTMS sessions over the left dorsolateral prefrontal cortex (DLPFC). RESULTS: The between-group analyses revealed no differences in the final neuropsychological performances. The within-group analyses showed that inhibitory control improved in both the go/no-go task (p = .03) and the BIS cognitive impulsivity subscale (p = .01) in the rTMS group only. Switches toward good choices on the Iowa gambling task significantly improved in the rTMS group only (p = .002), and understanding of the task contingencies increased between the two assessments, also in the rTMS group only (p = .03). DISCUSSION: This preliminary evidence suggests that modulation of left DLPFC might improve two putative cognitive biomarkers of BN.

Structural differences in eating disorder psychopathology after history of childhood abuse: Insights from a Bayesian network analysis.

Childhood abuse is frequent among individuals with eating disorders and is associated with complex clinical presentations. However, to date, the differences in the presentations of eating disorders between these groups are poorly understood. The present study employed a Bayesian network approach to model the interactive network structure of eating disorder psychopathology, and to investigate the differences in symptom importance and network structure between individuals with eating disorders with and without an experience of childhood abuse in a sample 327 treatment-seeking individuals. Among individuals with a history of childhood abuse, a specific 4-symptom pathway emerged, leading from overvaluation of shape and weight and ending in overeating (overvaluation of weight and shape → loss of control → depressed mood → overeating). Loss of control eating and depressed mood emerged as the more important driving symptoms. In contrast, the eating disorder symptom network among the group with no abuse was organized around a heightened investment in weight and shape, and resulting efforts to control or alter weight and shape through dieting and exercise behaviors. The symptoms with the highest importance in this nonabuse group were overeating and overvaluation of weight and shape. These results support the existence of a distinct eating disorder symptom network characteristic of individuals with a history of childhood trauma, and add to the hypotheses of a maltreated eco-phenotype in eating disorders. They may be also inform treatment target in abused people with eating disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).