A systematic review of studies probing longitudinal associations between anxiety and anorexia nervosa

Lloyd, Eva; Haase, Anne M.; Foster, Charlie; Verplanken, Bas

doi:10.1016/j.psychres.2019.05.010

Cited by 30 publications

(27 citation statements)

References 56 publications

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“…We can hypothesize that high segregation plays a protective role in AN, since it probably allows a more efficient cognitive processing, but we can also speculate that a lower integration may predispose to higher anxiety symptoms in the disorder. This finding supports the importance of therapeutically addressing anxiety symptoms when they occur in comorbidity with AN (Lloyd et al, 2019; Martín et al, 2019).…”

Section: Discussionsupporting

confidence: 78%

Functional Connectivity Patterns and the Role of 5-HTTLPR Polymorphism on Network Architecture in Female Patients With Anorexia Nervosa

et al. 2019

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IntroductionRecent neuroimaging studies suggest that anorexia nervosa (AN) symptoms emerge from failures in the relationships between spatially distributed networks that support different cognitive, emotional, and somatosensory functions. The 5-HTTLPR genotype has been shown to modulate all these abilities in AN, as well as the connectivity patterns between brain regions that support their functioning. This study aims at exploring the presence of any difference in functional connectome properties between AN patients and healthy controls (HC) by means of graph theory tools. The effect of 5-HTTLPR genotype on regional and global network characteristics in AN and HC was also explored.MethodsA sample of 74 subjects (38 HC, 36 AN) underwent a resting state functional magnetic resonance imaging and was genotyped for 5-HTTLPR polymorphism. Comparisons of network properties were made between the AN and HC groups and, within each group, between 5-HTTLPR carriers of low-functioning alleles and carriers of the long–long genotype.ResultsPatients with AN displayed lower network clustering than HC (p = 0.04 at Mann–Whitney U test). Based on both degree and betweenness, a different distribution of network hubs emerged in the two groups. In particular, the anterior part of the anterior cingulate cortex was a hub only in the patient group. A correlation emerged between differences in brain volumes between patients and HC and differences in degree values of basal ganglia, nodes in the insula, and those in the parietal cortex. Carriers of the short allele of the 5-HTTLPR polymorphism were characterized by lower small-world properties (p = 0.027) and modularity (p = 0.031) in the patient group, and a trend toward higher modularity (p = 0.033) and small-world values (p = 0.123) in the HC group.DiscussionPatients with AN showed differences in hubs distribution, providing evidence of the presence of a different functional architectural backbone in this group. Since some correlation emerged between different degree values of nodes and differences in volumes, further longitudinal studies are warranted to better understand the role of malnutrition on brain network architecture. The opposite effects of 5-HTTLPR polymorphism on global network characteristics in the two groups suggest an interaction of the short allele and malnutrition in modulating brain network properties.

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Section: Discussionsupporting

confidence: 78%

Functional Connectivity Patterns and the Role of 5-HTTLPR Polymorphism on Network Architecture in Female Patients With Anorexia Nervosa

et al. 2019

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“…The association between any anxiety disorder and subsequent AN development has been reported previously [12]. The evidence for longitudinal associations between specific anxiety disorder diagnoses and AN development is not strong [53]. However, prior analyses have tested whether particular anxiety disorder diagnoses explain variation in AN onset over and above the explanatory effects of other anxiety disorders [12,13], when large unique predictive effects may be absent.…”

Section: Discussionmentioning

confidence: 98%

Understanding the nature of association between anxiety phenotypes and anorexia nervosa: a triangulation approach

et al. 2020

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Background Evidence from observational studies suggests an association between anxiety disorders and anorexia nervosa (AN), but causal inference is complicated by the potential for confounding in these studies. We triangulate evidence across a longitudinal study and a Mendelian randomization (MR) study, to evaluate whether there is support for anxiety disorder phenotypes exerting a causal effect on AN risk. Methods Study One assessed longitudinal associations of childhood worry and anxiety disorders with lifetime AN in the Avon Longitudinal Study of Parents and Children cohort. Study Two used two-sample MR to evaluate: causal effects of worry, and genetic liability to anxiety disorders, on AN risk; causal effects of genetic liability to AN on anxiety outcomes; and the causal influence of worry on anxiety disorder development. The independence of effects of worry, relative to depressed affect, on AN and anxiety disorder outcomes, was explored using multivariable MR. Analyses were completed using summary statistics from recent genome-wide association studies. Results Study One did not support an association between worry and subsequent AN, but there was strong evidence for anxiety disorders predicting increased risk of AN. Study Two outcomes supported worry causally increasing AN risk, but did not support a causal effect of anxiety disorders on AN development, or of AN on anxiety disorders/worry. Findings also indicated that worry causally influences anxiety disorder development. Multivariable analysis estimates suggested the influence of worry on both AN and anxiety disorders was independent of depressed affect. Conclusions Overall our results provide mixed evidence regarding the causal role of anxiety exposures in AN aetiology. The inconsistency between outcomes of Studies One and Two may be explained by limitations surrounding worry assessment in Study One, confounding of the anxiety disorder and AN association in observational research, and low power in MR analyses probing causal effects of genetic liability to anxiety disorders. The evidence for worry acting as a causal risk factor for anxiety disorders and AN supports targeting worry for prevention of both outcomes. Further research should clarify how a tendency to worry translates into AN risk, and whether anxiety disorder pathology exerts any causal effect on AN.

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“…Future research regarding the enhanced recognition of specific emotions might be fruitful as some emotions may play a more crucial role in AN, for example, disgust sensitivity (Aharoni & Hertz, 2012), anger (Harrison, Genders, Davies, Treasure, & Tchanturia, 2011; Waller et al, 2003), or anxiety (Lloyd, Haase, Foster, & Verplanken, 2019).…”

Section: Discussionmentioning

confidence: 99%

Improving emotion recognition in anorexia nervosa: An experimental proof‐of‐concept study

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Stoll

et al. 2020

Intl J Eating Disorders

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Objective: Previous research has found increasing evidence for difficulties in emotion recognition ability (ERA) and social cognition in anorexia nervosa (AN), and recent models consider these factors to contribute to the development and maintenance of the disorder. However, there is a lack of experimental studies testing this hypothesis.Therefore, the present proof-of-concept study examined whether ERA can be improved by a single session of a computerized training in AN, and whether this has short-term effects on eating disorder symptoms.Method: Forty inpatients (22.20 ± 7.15 years) with AN were randomly assigned to receive a single session of computerized training of ERA (TERA) or a sham training (training the recognition of different types of clouds). ERA, self-reported eating disorder symptoms, and body mass index (BMI) were assessed within 3 days before and after training.Results: After training, both groups showed improved ERA, reduced self-reported eating disorder symptoms, and an increased BMI. As compared to patients in the control group, patients who received TERA showed greater improvements in ERA and self-reported eating disorder symptoms.Discussion: ERA can be effectively trained in patients with AN. Moreover, short-term improvements in self-reported eating disorder symptoms provide tentative support for the hypothesis that difficulties in ERA contribute to the maintenance of AN, and that specific trainings of ERA hold promise as an additional component in AN treatment. Future studies are needed to replicate these findings in larger samples, and to investigate long-term effects and transfer into real-world settings. K E Y W O R D S eating disorders, emotion perception, emotion recognition training, emotional theory of mind, social cognition, training of emotion recognition ability

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A systematic review of studies probing longitudinal associations between anxiety and anorexia nervosa

Cited by 30 publications

References 56 publications

Functional Connectivity Patterns and the Role of 5-HTTLPR Polymorphism on Network Architecture in Female Patients With Anorexia Nervosa

Functional Connectivity Patterns and the Role of 5-HTTLPR Polymorphism on Network Architecture in Female Patients With Anorexia Nervosa

Understanding the nature of association between anxiety phenotypes and anorexia nervosa: a triangulation approach

Improving emotion recognition in anorexia nervosa: An experimental proof‐of‐concept study

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