Restlessness and an Increased Urge to Move (Drive for Activity) in Anorexia Nervosa May Strengthen Personal Motivation to Maintain Caloric Restriction and May Augment Body Awareness and Proprioception: A Lesson From Leptin Administration in Anorexia Nervosa

Abstract

Anorexia nervosa (AN), a disorder of voluntary food restriction leading to severe weight loss in female adolescents, remains an enigma. In particular, the appropriation of the starved thin body into the self-concept in AN is a process insufficiently researched and still poorly understood. Healthy humans undergoing starvation experience a slowing of movements and avoid voluntary exercise. By contrast, AN tends to be not infrequently associated with voluntary, sometimes excessive and/or compulsive exercise. Such deliberate exercise, not reported in starvation, seems to be facilitated by an increased urge for movement and physical restlessness, particular to AN. The increased urge to move would reflect spontaneous daily activity, the energy expended for everything that is not sleeping, eating, or voluntary exercise. Our hypothesis is that the starvation-induced increased urge to move and restlessness may promote the development of AN. Reversal of the fasting state, by either high caloric food or by leptin administration, would be expected to reduce restlessness and the increased urge to move along with improvement in other symptoms in AN. This review explores the idea that such restless activation in AN, in itself and through accelerating body weight loss, might foster the integration of the starving body into the self-concept by (1) enhancing the person’s sense of self-control and sense of achievement and (2) through invigorating proprioception and through intensifying the perception of the changing body shape. (3) Tentative evidence from studies piloting leptin administration in chronic AN patients which support this hypothesis is reviewed. The findings show that short term administration of high doses of leptin indeed mitigated depressive feelings, inner tension, intrusive thoughts of food, and the increased urge to be physically active, easing the way to recovery, yet had little influence on the patients’ personal commitment to remain at a low weight. Full recovery then requires resolution of the individuals’ personal unresolved psychological conflicts through psychotherapy and frequently needs specialized treatment approaches to address psychiatric co-morbidities. AN might be conceptualized as a hereditary form of starvation resistance, facilitated by the effects of starvation on fitness allowing for an exceptionally intense personal commitment to perpetuate food restriction.

Reduced GABA transmission onto ventral tegmental area dopamine neurons underlies vulnerability for hyperactivity in a mouse model of Anorexia Nervosa

“…Indeed, ABA-exposed mice expend more energy because they may be “restless” and activation of VTA GABA neurons decrease excessive locomotor activity. This is particularly relevant in the context of AN since restlessness is a symptom of AN [4, 61] and our results may contribute to a new therapeutic avenue to explore. Overall this study contributes to further understanding of how changes in VTA neuronal activity and neural circuit interact to impact on the susceptibility to develop anorectic behavior in the ABA model.…”

“…Anorexia nervosa (AN) is a metabo-psychiatric eating disorder characterized by a fear of gaining weight and self-starvation, leading to life-threatening weight loss [1, 2]. Although not part of the formal diagnostic criteria, increased drive for activity is an important aspect of this disorder, with up to 80% of AN patients engaging in excessive exercise and displaying restlessness [3, 4]. Hyperactivity interferes with weight gain and has been found to predict relapse and chronicity of AN and therefore represents a major barrier to recovery [5, 6].…”

Humans have a basic physical and psychological need to move the body: Physical activity as a primary drive

“…A case for “drive for activity” has also been made in certain clinical conditions, such as anorexia nervosa ( Davis and Woodside, 2002 ; Scheurink et al, 2010 ; Casper, 2018 , 2022 ). Aversive sensations associated with a lack of movement are also hallmarks of various disorders, such as Restless Leg Syndrome ( Garcia-Borreguero et al, 2011 ; Khan et al, 2017 ), akathisia ( Iqbal et al, 2007 ), exercise addiction/dependence ( Hausenblas and Downs, 2002 ; Ferreira et al, 2006 ; Garland et al, 2011 ; Lichtenstein and Jensen, 2016 ; Stults-Kolehmainen et al, 2022b ), and hyperactivity ( Willerman, 1973 ; Scheurink et al, 2010 ).…”

“…Feeling antsy has connotations of an external source of stimulation (i.e., literally “ants in the pants”), and “cooped up” typically refers to conditions of constraint, while being “wired” usually refers to consumption of excess caffeine or other external stimuli ( Levitt et al, 1993 ) and “feeling hyper” often describes responses to medications ( Hauser and Zesiewicz, 1997 ; Rabkin et al, 2004 ). Many other terms also exist: drive for activity ( Casper, 2018 , 2022 ), urges, cravings, and appetence ( Ferreira et al, 2006 ). The collection of these has been generally referred to as “affectively-charged motivation states” (ACMS) for physical activity ( Stults-Kolehmainen et al, 2020a , 2022a ).…”

“…These data should be combined with biomarkers likely associated with drive for activity, including orexin (i.e., hypocretin), leptin, testosterone, cortisol, dopamine, activity in the nucleus accumbens, ventral tegmental area and substantia nigra, vagal drive/HRV/RSA, genetics and the microbiome ( Willerman, 1973 ; España et al, 2002 ; Salamone and Correa, 2002 ; Aoyagi et al, 2003 ; Furlong et al, 2009 ; Scheurink et al, 2010 ; Garland et al, 2011 ; Casper, 2022 ; Dohnalová et al, 2022 ). There is likely huge inter-individual variability in drive, which may be related to stress coping style, temperament, impulse control, personality, and other factors ( Rhodes and Smith, 2006 ; Garland et al, 2011 ; Seli et al, 2014 ).…”