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The Problem of Anorexia Nervosa: Psychobiological Considerations

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phenomenology and treatment of Psychophysiological Disorders
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Abstract

This chapter will address the many questions about primary anorexia nervosa (AN) that remain unanswered, with particular attention given to certain factual aspects of the syndrome that are well-established but unexplained. I shall refrain from mentioning the observations that have been made by psychiatric and psychoanalytic clinicians (1). These observations have led to concepts about the nature of the remorseless self-starvation, or the excessive control over eating, that are an important but not the invariant feature of the behavior of some patients with AN. Therefore, these concepts can only account for some aspects of the syndrome, and do not explain the fact that the syndrome begins with amenorrhea in about half the patients.

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References

  1. Bruch, H. Eating and Eating Disorders: Obesity, Anorexia Nervosa and the Person Within. New York: Basic, 1973.

    Google Scholar 

  2. Kron, L., Katz, J.L., Gorzynski, G. Anorexia nervosa and gonadal dysgenesis: further evidence of a relationship. Arch. Gen. Psychiat. 34: 332–35, 1977.

    Article  PubMed  CAS  Google Scholar 

  3. Askevold, F. Personal communication.

    Google Scholar 

  4. Fries, H. & Nillius, S.J. Dieting anorexia nervosa and amenorrhea after oral contraceptive treatment. Acta Psych. Scand. 49: 669–79, 1973.

    Article  CAS  Google Scholar 

  5. Katz, J.L. & Weiner, H. Unpublished observations.

    Google Scholar 

  6. Duddle, M. An increase of anorexia nervosa in a university population. Brit. J. Psychiat. 123:711–12, 1973.

    Article  PubMed  CAS  Google Scholar 

  7. Theander, S. Anorexia nervosa, a psychiatric investigation of 94 female patients. Acta Psych. Scand. 214: 1–190, 1970.

    CAS  Google Scholar 

  8. Crisp, A.H., Palmer, R.L., & Kalucy, R. How common is anorexia nervosa? A prevalence study. Brit. J. Psychiat. 128: 549–54, 1976.

    Article  PubMed  CAS  Google Scholar 

  9. Halmi, K.A., Goldberg, S.C., & Eckert, E. Pretreatment evaluation in anorexia nervosa. In Vigersky, R. (Ed.), Anorexia Nervosa. New York: Raven, 1977.

    Google Scholar 

  10. Kron, L., Katz, J.L., Gorzynski, G. Hyperactivity in anorexia nervosa: a fundamental clinical feature. Compr Psychiat. 19: 433–40, 1978.

    Article  PubMed  CAS  Google Scholar 

  11. Nylander, I. The feelings of being fat and dieting in a school population: epidemiological interview investigation. Acta Sociomed. Scand. 3: 17–45, 1971.

    PubMed  CAS  Google Scholar 

  12. Folstein, M.F., Wakeling, A., & DeSouza, V. Analogue scale measurement of the symptoms of patients suffering from anorexia nervosa. In Vigersky, R. (Ed.), Anorexia Nervosa. New York: Raven, 1977.

    Google Scholar 

  13. Brown, G.M., Garfmkel, P.E., Jeuniewic, N. Endocrine profiles in anorexia nervosa. In Vigersky, R. (Ed.), Anorexia Nervosa. New York: Raven, 1977.

    Google Scholar 

  14. Casper, R.C., Davis, J.M., & Pandey, G.N. The effect of the nutritional status and weight changes on hypothalamic function tests in anorexia nervosa. In Vigersky, R. (Ed.), Anorexia Nervosa. New York: Raven, 1977.

    Google Scholar 

  15. Frankel, R.J. & Jenkins, J.S. Hypothalamic-pituitary function in anorexia nervosa.Acta Endocrinol. (KbH) 78: 209–21, 1975.

    CAS  Google Scholar 

  16. Garfmkel, P.E., Brown, G.M., Stancer, H.C. Hypothalamic-pituitary function in anorexia nervosa.Arch. Gen. Psychiat. 32: 739–44, 1975.

    Article  Google Scholar 

  17. Landon, J., Greenwood, G.D., Stamp, T.C.B. The plasma sugar, free fatty acid, Cortisol and growth hormone response to insulin and the comparison of this procedure with other tests of pituitary and adrenal function. II. In patients with hypothalamic or pituitary dysfunction or anorexia nervosa. J. Clin. Invest. 45: 437–49, 1966.

    Article  PubMed  CAS  Google Scholar 

  18. Vigersky, R.A. & Loriaux, D.L. Anorexia nervosa as a model hypothalamic dysfunction. In Vigersky, R. (Ed.), Anorexia Nervosa. New York: Raven, 1977.

    Google Scholar 

  19. Katz, J.L., Boyar, R.M., & Roffwarg, H. Weight and circadian LH secretory pattern in anorexianervosa. Psychosom. Med. 40: 549–67, 1978.

    PubMed  CAS  Google Scholar 

  20. Katz, J.L., Boyar, R.M., Hellman, L. LHRH responsiveness in anorexia nervosa: intactnessdespite prepubertal circadian LH pattern. Psychosom. Med. 39: 241–51, 1977.

    PubMed  CAS  Google Scholar 

  21. Katz, J.L., Boyar, R.M., Weiner, H. Toward an elucidation of the psychoendocrinology of anorexia nervosa. In Sachar, E. (Ed.), Hormones, Behavior and Psychopathology. New York: Raven, 1976.

    Google Scholar 

  22. Mecklenburg, R.S., Loriaux, D.L., Thompson, R.H. Hypothalamic dysfunction in patients with anorexia.Medicine 53: 147–59, 1974.

    Article  PubMed  CAS  Google Scholar 

  23. Vigersky, R. (Ed.). Anorexia Nervosa. New York: Raven, 1977.

    Google Scholar 

  24. Wakeling, A., De Souza, V., & Beardwood, C.J. Effects of administered estrogen on luteinizing hormone release in subjects with anorexia nervosa in acute and recovery stages. In Vigersky, R. (Ed.), Anorexia Nervosa. New York: Raven, 1977.

    Google Scholar 

  25. Wakeling, A., Marshall, J.C., Beardwood, C.J. The effects of clomiphene citrate on the hypothalamic-pituitary-gonadal axis in anorexia nervosa. Psychosom. Med. 6: 371–80, 1977.

    Google Scholar 

  26. Beumont, P.J.V., George, G.G., Pimstone, B.L. Body weight and the pituitary response to hypothalamic releasing hormones in patients with anorexia nervosa. J. Clin. Endocrinol. Metab. 43: 487–96, 1976.

    Article  PubMed  CAS  Google Scholar 

  27. Danowski, TS., Livstone, E., Gonzales, A.R. Fractional and partial hypopituitarism in anorexia nervosa. Hormones 3: 105–18, 1972.

    Article  PubMed  CAS  Google Scholar 

  28. Hurd, H.P., Palumbo, P.J., & Charib, H. Hypothalamic-endocrine dysfunction in anorexianervosa.Mayo Clin. Proc. 52: 711–16, 1977.

    PubMed  CAS  Google Scholar 

  29. Palmer, R.L., Crisp, A.H., MacKinnon, P.C.B. Pituitary sensitivity to 50 fig LH/FSH/RH in subjects with anorexia nervosa in acute and recovery stages. Brit. Med. J. 1: 179–82, 1975.

    Article  PubMed  CAS  Google Scholar 

  30. Russell, G.F.M. Metabolic aspects of anorexia nervosa. Proc. R. Soc. Med. 58: 811–14, 1965.

    PubMed  CAS  Google Scholar 

  31. Russell, G.F.M. Psychological and nutritional factors in disturbances of menstrual function and ovulation. Postgrad. Med. J. 48: 10–13, 1972.

    Article  PubMed  CAS  Google Scholar 

  32. Sherman, B.M., Halmi, K.A., & Zamudio, R. LH and FSH response to gonadotropic-releasing hormone in anorexia nervosa: effect of nutritional rehabilitation. J. Clin. Endocrinol. Med. 41: 135–42, 1975.

    Article  CAS  Google Scholar 

  33. Vigersky, R.A., Andersen, A.E., Thompson, R.H. Hypothalamic dysfunction in secondary amenorrhea associated with simple weight loss. New Eng. J. Med. 297: 1,141–45, 1977.

    Article  Google Scholar 

  34. Boyar, R.M., Ramsey, J., Chipman, P. Regulation of gonadotropin secretion in Turner’s syndrome. New Eng. J. Med. 298: 1,328–31, 1978.

    Google Scholar 

  35. Walsh, B.T., Katz, J.L., Weiner, H. Unpublished observations.

    Google Scholar 

  36. Espinosa-Campos, J., Robles, C., Gual, C. Hypothalamic, pituitary, and ovarian function assessment in a patient with anorexia nervosa. Fertil. Steril. 25(5): 453–57, 1974.

    PubMed  CAS  Google Scholar 

  37. Wiegelman, W. & Solbach, H.G. Effects of LH-RH on plasma levels of LH and FSH in anorexia nervosa. Horm. Metab. Res. 4: 404, 1972.

    Article  Google Scholar 

  38. Crosignani, P.G., Reschini, E., D’Alberton, A. Variability of gonadotropin response to luteinizing hormone-releasing hormone in amenorrheic women. Am. f. Ob. Gyn. 120: 376–84, 1974.

    CAS  Google Scholar 

  39. Mortimer, C.H., Besser, G.M., McNeilly, A.S. Luteinizing hormone and follicle stimulating hormone-releasing hormone test in patients with hypothalamic-pituitary-gonadal dysfunction. Brit. Med. J. 4: 73–7, 1973.

    Article  PubMed  CAS  Google Scholar 

  40. Travaglini, P., Beck-Peccoz, P., Ferrari, C. Some aspects of hypothalamic-pituitary function in patients with anorexia nervosa. 81: 252–62, 1976.

    Google Scholar 

  41. Jequier, A.M., O’Shea, A., & Jacobs, H.S. Functional and post-oral contraceptive amenorrhea: response to luteinizing hormone releasing hormone (LH-RH).Brit. J. Ob. Gyn. 82: 333–36, 1975.

    Article  CAS  Google Scholar 

  42. Warren, M.P. Weight loss and responsiveness to LH-RH. In Vigersky, R. (Ed.), Anorexia Nervosa. New York: Raven, 1977.

    Google Scholar 

  43. Warren, M.P., Jewelewicz, R., Dyrenfurth, R. The significance of weight loss in the evaluation of pituitary response to LH-RH on women with secondary amenorrhea.J. Clin. Endocrinol. Metab. 40: 601–11, 1975.

    Article  PubMed  CAS  Google Scholar 

  44. Vigersky, R.A., Loriaux, D.L., Andersen, A.E. Delayed pituitary hormone response to LRF and TRF in patients with anorexia nervosa and with secondary amenorrhea associa with simple weight loss. J. Clin. Endocrinol. Metab. 43: 893–900, 1967.

    Article  Google Scholar 

  45. Vigersky, R.A., & Loriaux, D.L. Anorexia nervosa as a model hypothalamic dysfunction. In Vigersky, R. (Ed.), Anorexia Nervosa. New York: Raven, 1977.

    Google Scholar 

  46. Nillius, S.J. & Wide, L. Gonadotropin-releasing hormone treatment for induction of follicular maturation and ovulation in amenorrheic women with anorexia nervosa. Brit. Med. J. 3: 405–408, 1975.

    Article  PubMed  CAS  Google Scholar 

  47. Nillius, S.J., Fries, H., & Wide, L. Successful induction of follicular maturation and ovulation by prolonged treatment with LH-releasing hormone in women with anorexia nervosa. Am.J. Ob. Gyn. 122: 921–28, 1975.

    CAS  Google Scholar 

  48. Nillius, S.J. & Wide, L. The pituitary responsiveness to acute and chronic administrations of gonadotropic-releasing hormone in acute and recovery stages of anorexia nervosa. In Vigersky, R. (Ed.), Anorexia Nervosa. New York: Raven, 1977.

    Google Scholar 

  49. Yoshimoto, Y., Moridera, K., & Imura, H. Restoration of normal pituitary gonadotropic reserve by administration of luteinizing-hormone-releasing hormone in patients with hypogonadot- ropic hypogonadism. New Eng. J. Med. 292: 242–45, 1975.

    Article  PubMed  CAS  Google Scholar 

  50. Franchimont, P., Demoulin, A., & Bourgignon, J.P. Clinical use of LH-RH test as a diagnostic tool. Horm. Res. 6: 177–91, 1975.

    Article  PubMed  CAS  Google Scholar 

  51. Vandekerckhove, A., Dhont, M., & Van Eyck, J. Diagnostic value of the LH-releasing hormone stimulation tests in functional amenorrhea. Acta Endocrinol. (KbH) 78: 625–33, 1975.

    CAS  Google Scholar 

  52. Franchimont, P., Becker, H., Ernould, C. The effect of hypothalamic luteinizing hormone releasing hormone (LH-RH) on plasma gonadotropin levels in normal subjects. Clin. Endocrinol. 3: 27–39, 1974.

    Article  CAS  Google Scholar 

  53. Job, J.C., Gamier, P.E., Chaussain, J.L. Evaluation of serum gonadotropins (LH and FSH) after releasing hormone (LH-RH) injection in normal children and in patients with disorders of puberty. J. Clin. Endocrinol. Metab. 35: 473–76, 1972.

    Article  PubMed  CAS  Google Scholar 

  54. Roth, J.C., Kelch, R.P., Kaplan, S.L. FSH and LH response to luteinizing hormone-releasing factor in prepubertal and pubertal children, adult males and patients with hypogonadotropic and hypergonadotropic hypogonadism.J. Clin. Endocrinol. Metab. 35: 926–30, 1972.

    Article  PubMed  CAS  Google Scholar 

  55. Akande, E.O., Carr, P.J., Dutton, A. Effect of synthetic gonadotropin-releasing hormone in secondary amenorrhea. Lancet 2: 112–16, 1972.

    Article  PubMed  CAS  Google Scholar 

  56. Beumont, P.J.V., George, G.C., Pimstone, B.L. Body weight and the pituitary response to hypothalamic releasing hormones in patients with anorexia nervosa.J. Clin. Endocrinol. Metab. 43: 487–96, 1976.

    Article  PubMed  CAS  Google Scholar 

  57. Jeuniewic, N., Brown, G.M., Garfmkel, P.E. Hypothalamic function as related to body weight and body fat in anorexia nervosa. Psychosom. Med. 40: 187–98, 1978.

    PubMed  CAS  Google Scholar 

  58. Taymor, M.L., Thompson, I.E., Berger, M.J. Luteinizing hormone-releasing hormone (LH-RH) as a diagnostic and research tool in gynecologic endocrinology.Am. J. Obstet. Gyn. 120: 721–32, 1974.

    CAS  Google Scholar 

  59. Mortimer, R.H., Fleischer, N., Lev-Gur, M. Correlation between integrated LH and FSH levels and the response to luteinizing hormone releasing factor (LRF). J. Clin. Endocrinol. Metab. 43: 1,240–49, 1976.

    Article  Google Scholar 

  60. Nillius, S.J. & Wide, L. The LH-releasing hormone test in 31 women with secondary amenorrhoea. Brit.J. Ob. Gyn. 79: 874–82, 1972.

    Article  CAS  Google Scholar 

  61. Bermudez, F., Surks, M.I., & Oppenheimer, J.H. High incidence of decreased serum triiodothyronine concentration in patients with nonthyroidal disease. J. Clin. Endocrinol. Metab. 41: 27–40, 1975.

    Article  PubMed  CAS  Google Scholar 

  62. Carter, J.N., Eastman, C.J., Corcoran, J.M. Effect of severe, chronic illness on thyroid function. Lancet 2: 971–74, 1974.

    Article  PubMed  CAS  Google Scholar 

  63. Chopra, I.J. & Smith, S.R. Circulating thyroid hormones and thyrotropin in adult patients with protein calorie malnutrition. J. Clin. Endocrin. Metab. 40: 221–27, 1975.

    Article  CAS  Google Scholar 

  64. Chopra, I.J., Chopra, U., Smith, S.R. Reciprocal changes in serum concentrations of 3, 3’, 5’-triiodo-thyronine (reverse T3) and 3, 3’ 5-triiodothyronine (T3) in systemic illness. J. Clin. Endocrin. Metab. 41: 1,043–49, 1975.

    Google Scholar 

  65. Nomura, S. & Pittman, C.S. Hypothyroidism in liver patients due to failure of the peripheral conversion of thyroxine (T4) to triiodothyronine. J. Clin. Invest. 53: 57a, 1974.

    Google Scholar 

  66. Portnay, G.I., O’Brien, J.T., Bush, J. The effect of starvation on the concentration and binding of thyroxine and triiodothyronine in serum and the response to TRH. J. Clin. Endocrinol. Metab. 39: 191–94, 1974.

    Article  PubMed  CAS  Google Scholar 

  67. Reichlin, S., Bollinger, J., Nejad, I. Tissue thyroid concentration of rat and man determined by radioimmunoassay: biologic significance. Mt. Sinai J. Med. (NY) 40: 502–10, 1973.

    CAS  Google Scholar 

  68. Miyai, K., Yamamoto, T, Azukizawa, M. Serum thyroid hormones and thyrotropin in anorexia nervosa. J. Clin. Endocrinol. Metab. 40: 334–38, 1975.

    Article  PubMed  CAS  Google Scholar 

  69. Moshang, T., Jr., Parks, J.S., Baker, L. Low serum triiodothyronine in patients with anorexia nervosa. J. Clin. Endocrinol. Metab. 40: 470–73, 1975.

    Article  PubMed  Google Scholar 

  70. Moshang, T., Jr. & Utiger, R.D. Low triiodothyronine euthyroidism in anorexia nervosa. In Vigersky, R. (Ed.), Anorexia Nervosa. New York: Raven Press, 1977.

    Google Scholar 

  71. Boyar, R.M., Bradlow, H.L. Studies of testosterone metabolism in anorexia nervosa. In Vigersky, R. (Ed.), Anorexia Nervosa. New York: Raven, 1977.

    Google Scholar 

  72. Boyar, R.M., Hellman, L.D., Roffwarg, H.P. Cortisol secretion and metabolism in anorexia nervosa. New Eng. J. Med. 296: 190–93, 1977.

    Article  PubMed  CAS  Google Scholar 

  73. Bliss, E.L. & Migeon, C.J. Endocrinology of anorexia nervosa. J. Clin. Endocrinol. Metab. 17: 766–76, 1957.

    Article  PubMed  CAS  Google Scholar 

  74. Perloff, W.H., Lasche, E.M., Nodine, J.H. The starvation state and functional hypopituitarism. JAMA 155: 1,307–13, 1954.

    Article  Google Scholar 

  75. Thorn, G.W., Forsham, P.H., Frawley, E.G. The clinical usefulness of ACTH and cortisone. New Eng. J. Med. 242: 783–93, 1950.

    Article  PubMed  CAS  Google Scholar 

  76. Walsh, B.T., Katz, J.L., Levin, J. Adrenal activity in anorexia nervosa.Psychosom. Med. 40: 499–506, 1978.

    PubMed  CAS  Google Scholar 

  77. Warren, M.P. & Vande Wiele, R.L. Clinical and metabolic features of anorexia nervosa. Am.;. Ob. Gyn. 117: 435–49, 1973.

    CAS  Google Scholar 

  78. Bethge, H., Nagel, A.M., Solbach, H.G. Zentrale Regulationsstörung der Nebennierenrinden-funktion bei der anorexia nervosa.Materia Medica Nordmark 22: 204–14, 1970.

    Google Scholar 

  79. Alleyne, C.A.O. & Young, V.H. Adrenocortical function in children with severe protein-calorie malnutrition. Clin. Sci. 33: 189–200, 1967.

    PubMed  CAS  Google Scholar 

  80. Garces, L.Y., Kenny, F.M., Drash, A. Cortisol secretion rate during fasting of obese adolescent subjects. J. Clin. Endocrin. Metab. 28: 1,843–47, 1968.

    Article  Google Scholar 

  81. Jackson, I.M.D. & Mowat, J.I. Hypothalamic-pituitary-adrenal function in obesity and the Cortisol secretion rate following prolonged starvation. Acta Endocrinol. (KbH) 63: 415–22, 1970.

    CAS  Google Scholar 

  82. Smith, S.R., Bledsoe, T., & Chhetri, M.K. Cortisol metabolism and the pituitary-adrenal axis in adults with protein-calorie malnutrition. J. Clin. Endocrin. Metab. 40: 43–52, 1975

    Article  CAS  Google Scholar 

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Weiner, H. (1982). The Problem of Anorexia Nervosa: Psychobiological Considerations. In: Fann, W.E., Karacan, I., Pokorny, A.D., Williams, R.L. (eds) phenomenology and treatment of Psychophysiological Disorders. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-7289-9_9

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