Editorial: New Perspectives to Unlock the Current Impasse in Treating Anorexia Nervosa

Gutiérrez, Emilio; Birmingham, C. Laird

doi:10.3389/fpsyg.2020.00207

Cited by 7 publications

(7 citation statements)

References 22 publications

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“…This differential effectiveness of psychopharmacological intervention may be because the “mental disorders” of eating disorders differ from those of patients with mental disorders. Thus, a rating scale that dissociates anxiety from other mental disorders in patients with mental disorders did not dissociate these disorders in 358 patients with anorexia nervosa [PS and others, manuscript submitted for Gutierrez and Birmingham (2018)].…”

Section: The Standard Perspectivementioning

confidence: 99%

“…The rate of remission was estimated to 75% within on average 1 year of treatment and the rate of relapse was estimated to 10% (Bergh et al, 2013). Psychoactive drugs that had been prescribed prior to admission to treat mental symptoms were withdrawn while the patients remitted from these symptoms by re-learning how to eat (PS and others, manuscript submitted for Gutierrez and Birmingham, 2018).…”

Section: The Evolutionary Perspectivementioning

confidence: 99%

“…Thus start most accounts. But it was recently suggested that this standard perspective needs to be modified because the treatment of anorexia is at a standstill (Gutierrez and Birmingham, 2018). We will describe the standard perspective and its translation into clinical practice first and then we will describe the evolutionary perspective, with eating behavior in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Eating Behavior and the Evolutionary Perspective on Anorexia Nervosa

et al. 2019

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On the standard perspective, anorexia nervosa and other eating disorders are caused by genetically determined, neurochemically mediated mental illnesses. Standard treatment, cognitive behavioral therapy (CBT), targets cognitive processes thought to maintain the disorders. Effective neurochemically based treatments are not available and the rate of remission is ≤25% 1 year after CBT, with unknown outcomes in the long-term. With starvation as the major threat in biological history, the evolutionary perspective focuses on foraging for food and eating behavior. A neural network, including hypothalamic arcuate peptide-neurons, brainstem serotonin-and dopamine-neurons and their prefrontal cortical projections, mediates (rather than controls) the behavioral adaptations to variations in food availability; activation of the network is associated with opposing behavioral outcomes depending upon external variations. In the clinic, the control of eating behavior is therefore outsourced to a machine that provides feedback on how to eat. Hundreds of eating disorders patients have recovered by practicing eating; the rate of remission is 75% in on average 1 year of treatment, the rate of relapse is 10% over 5 years of follow-up and no patient has died. A two-parameter asymptotic exponential growth curve modeled the eating behavior of 17 healthy women but not that of 17 women with anorexia nervosa. When in remission, the eating behavior of the anorexic women approached that of the healthy women. It is suggested that the treatment of eating disorders should focus on eating behavior.

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Section: The Standard Perspectivementioning

confidence: 99%

Section: The Evolutionary Perspectivementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Eating Behavior and the Evolutionary Perspective on Anorexia Nervosa

et al. 2019

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“…As for the state of the art of current treatments, the qualifier “evidence-based” means weak evidence as we are still far from reaching the criterion of strong evidence. The “Dodo Bird” verdict defining the current landscape of psychosocial treatments in AN depicts our repeated failures in the development of an effective treatment for AN ( 186 ). We should not discard the possibility that the SE-AN category may be echoing that we have overlooked the Hippocratic dictum Primum non nocere .…”

Section: Discussionmentioning

confidence: 99%

Severe and Enduring Anorexia Nervosa: Enduring Wrong Assumptions?

Gutiérrez

Carrera

2021

Front. Psychiatry

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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.

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“…For this reason, research and treatment strategies for AN were subsumed under the discipline of psychology. However, many psychologists/psychiatrists presently consider the available treatments for ANs, including psychotherapy and pharmacotherapy, inadequate (Kaye, 2008;Bergh et al, 2013;Sodersten et al, 2019b;Gutierrez and Birmingham, 2020). Recently, it has been suggested that the ''future development of a treatment for AN should explore new routes as the current conceptualization of AN seems to be on the wrong track'' (Gutierrez and Carrera, 2018).…”

Section: Introductionmentioning

confidence: 99%

The Central Role of Hypothermia and Hyperactivity in Anorexia Nervosa: A Hypothesis

Smith

2021

Front. Behav. Neurosci.

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Typically, the development of anorexia nervosa (AN) is attributed to psycho-social causes. Several researchers have recently challenged this view and suggested that hypothermia and hyperactivity (HyAc) are central to AN. The following hypothesis will attempt to clarify their role in AN. Anorexia nervosa patients (ANs) have significantly lower core temperatures (Tcore) compared to healthy controls (HCs). This reduced temperature represents a reset Tcore that needs to be maintained. However, ANs cannot maintain this Tcore due primarily to a reduced basal metabolic rate (BMR); BMR usually supplies heat to sustain Tcore. Therefore, to generate the requisite heat, ANs revert to the behavioral-thermoregulatory strategy of HyAc. The majority of ANs (~89%) are reportedly HyAc. Surprisingly, engagement in HyAc is not motivated by a conscious awareness of low Tcore, but rather by the innocuous sensation of “cold- hands” frequently reported by ANs. That is, local hand-thermoreceptors signal the brain to initiate HyAc, which boosts perfusion of the hands and alters the sensation of “cold-discomfort” to one of “comfort.” This “rewarding” consequence encourages repetition/habit formation. Simultaneously, hyperactivity increases the availability of heat to assist with the preservation of Tcore. Additionally, HyAc induces the synthesis of specific brain neuromodulators that suppress food intake and further promote HyAc; this outcome helps preserve low weight and perpetuates this vicious cycle. Based on this hypothesis and supported by rodent research, external heat availability should reduce the compulsion to be HyAc to thermoregulate. A reduction in HyAc should decrease the production of brain neuromodulators that suppress appetite. If verified, hopefully, this hypothesis will assist with the development of novel treatments to aid in the resolution of this intractable condition.

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Editorial: New Perspectives to Unlock the Current Impasse in Treating Anorexia Nervosa

Cited by 7 publications

References 22 publications

Eating Behavior and the Evolutionary Perspective on Anorexia Nervosa

Eating Behavior and the Evolutionary Perspective on Anorexia Nervosa

Severe and Enduring Anorexia Nervosa: Enduring Wrong Assumptions?

The Central Role of Hypothermia and Hyperactivity in Anorexia Nervosa: A Hypothesis

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