1. Researchers implicate genetic locus on chromosome 12 in anorexia nervosa

    May 21, 2017 by Ashley

    From the University of North Carolina Health Care press release:

    A landmark study led by UNC School of Medicine researchers has identified the first genetic locus for anorexia nervosa and has revealed that there may also be metabolic underpinnings to this potentially deadly illness.

    The study, which is the most powerful genetic study of anorexia nervosa conducted to date, included genome-wide analysis of DNA from 3,495 individuals with anorexia nervosa and 10,982 unaffected individuals.

    If particular genetic variations are significantly more frequent in people with a disorder compared to unaffected people, the variations are said to be “associated” with the disorder. Associated genetic variations can serve as powerful pointers to regions of the human genome where disorder-causing problems reside, according to the National Human Genome Research Institute.

    “We identified one genome-wide significant locus for anorexia nervosa on chromosome 12, in a region previously shown to be associated with type 1 diabetes and autoimmune disorders,” said lead investigator, Cynthia Bulik, PhD, FAED, founding director of the UNC Center of Excellence for Eating Disorders and a professor at Karolinska Institutet in Stockholm, Sweden.

    “We also calculated genetic correlations — the extent to which various traits and disorders are caused by the same genes,” said Bulik.

    Anorexia nervosa was significantly genetically correlated with neuroticism and schizophrenia, supporting the idea that anorexia is indeed a psychiatric illness.”

    “But, unexpectedly, we also found strong genetic correlations with various metabolic features including body composition (BMI) and insulin-glucose metabolism. This finding encourages us to look more deeply at how metabolic factors increase the risk for anorexia nervosa,” Bulik said.

    This study was conducted by the Psychiatric Genetics Consortium Eating Disorders Working Group — an international collaboration of researchers at multiple institutions worldwide.

    “In the era of team science, we brought over 220 scientists and clinicians together to achieve this large sample size. Without this collaboration we would never have been able to discover that anorexia has both psychiatric and metabolic roots,” said Gerome Breen, PhD, of King’s College London.

    “Working with large data sets allows us to make discoveries that would never be possible in smaller studies,” said Laramie Duncan, PhD, of Stanford University, who served as lead analyst on the project.

    The researchers are continuing to increase sample sizes and see this as the beginning of genomic discovery in anorexia nervosa. Viewing anorexia nervosa as both a psychiatric and metabolic condition could ignite interest in developing or repurposing medications for its treatment where currently none exist.


  2. Even after treatment, brains of anorexia nervosa patients not fully recovered

    March 19, 2017 by Ashley

    From the University of Colorado Anschutz Medical Campus press release:

    Even after weeks of treatment and considerable weight gain, the brains of adolescent patients with anorexia nervosa remain altered, putting them at risk for possible relapse, according to researchers at the University of Colorado Anschutz Medical Campus.

    The study, published last week in the American Journal of Psychiatry, examined 21 female adolescents before and after treatment for anorexia and found that their brains still had an elevated reward system compared to 21 participants without the eating disorder.

    “That means they are not cured,” said Guido Frank, MD, senior author of the study and associate professor of psychiatry and neuroscience at the University of Colorado School of Medicine. “This disease fundamentally changes the brain response to stimuli in our environment. The brain has to normalize and that takes time.”

    Brain scans of anorexia nervosa patients have implicated central reward circuits that govern appetite and food intake in the disease. This study showed that the reward system was elevated when the patients were underweight and remained so once weight was restored.

    The neurotransmitter dopamine might be the key, researchers said.

    Dopamine mediates reward learning and is suspected of playing a major role in the pathology of anorexia nervosa. Animal studies have shown that food restriction or weight loss enhances dopamine response to rewards.

    With that in mind, Frank, an expert in eating disorders, and his colleagues wanted to see if this heightened brain activity would normalize once the patient regained weight. Study participants, adolescent girls who were between 15 and 16 years old, underwent a series of reward-learning taste tests while their brains were being scanned.

    The results showed that reward responses were higher in adolescents with anorexia nervosa than in those without it. This normalized somewhat after weight gain but still remained elevated.

    At the same time, the study showed that those with anorexia had widespread changes to parts of the brain like the insula, which processes taste along with a number of other functions including body self-awareness.

    The more severely altered the brain, the harder it was to treat the illness, or in other words, the more severely altered the brain, the more difficult it was for the patients to gain weight in treatment.

    Generalized sensitization of brain reward responsiveness may last long into recovery,” the study said. “Whether individuals with anorexia nervosa have a genetic predisposition for such sensitization requires further study.”

    Frank said more studies are also needed to determine if the continued elevated brain response is due to a heightened dopamine reaction to starvation and whether it signals a severe form of anorexia among adolescents that is more resistant to treatment.

    In either case, Frank said the biological markers discovered here could be used to help determine the likelihood of treatment success. They could also point the way toward using drugs that target the dopamine reward system.

    “Anorexia nervosa is hard to treat. It is the third most common chronic illness among teenage girls with a mortality rate 12 times higher than the death rate for all causes of death for females 15-24 years old,” Frank said. “But with studies like this we are learning more and more about what is actually happening in the brain. And if we understand the system, we can develop better strategies to treat the disease.”


  3. Study suggests estrogen replacement therapy may help reduce anxiety in anorexia nervosa patients

    June 19, 2013 by Ashley

    From the Endocrine Society press release via ScienceDaily:

    black_woman_eating_saladEstrogen replacement therapy is associated with a significant decrease in anxiety symptoms among girls with anorexia nervosa, a new clinical trial finds. The results will be presented today at The Endocrine Society’s Annual Meeting in San Francisco.

    “This is the first study to show that estrogen replacement ameliorates the tendency for anxiety in anorexia nervosa and may prevent increasing body dissatisfaction with weight gain,” said the study’s lead author Madhusmita Misra, MD, MPH, pediatric endocrinologist and associate professor of pediatrics at the Massachusetts General Hospital and Harvard Medical School in Boston, MA. “This is very important given that anorexia nervosa can be difficult to treat, and underlying anxiety, eating attitudes and concerns of body shape with increasing weight during treatment may reduce the success of treatment programs.”

    Anorexia nervosa is a severe eating disorder that primarily affects teenage girls, although boys, as well as older and younger people, can also develop it. Approximately 0.2-1 percent of teenage girls suffer from the disorder.

    The disorder is characterized by a distorted body image, which causes patients to view themselves as heavy, or fat, even when their body-mass index is well below the normal range. As the disease progresses, patients become increasingly preoccupied with weight loss through restricting food and/or increasing activity with intense, frequent exercising. Some resort to purging behaviors to rid themselves of any food that they consume.

    Complications include depression, increased risk of suicide and weakened bones, which increase the risk of fractures and osteoporosis. Among girls, menstrual periods stop occurring as body weight and estrogen production drop. If left untreated, the disorder can cause death. Unfortunately, anorexia can be quite difficult to treat, and relapse is common.

    In this study, investigators found that anxiety scores on a standardized questionnaire decreased as estrogen levels increased. This relationship was unaffected by weight gain. Additionally, if weight gain did occur, estrogen replacement appeared to prevent a worsening of attitudes toward body image and food, as assessed using the Eating Disorders Inventory-II questionnaire.

    “Identification of therapies that reduce the tendency to experience anxiety and reduce body dissatisfaction with weight gain may have a major impact in reducing relapse,” Misra said. “These findings have the potential to impact therapy in anorexia nervosa with early implementation of estrogen replacement in girls who are estrogen deficient.”

    Participants included 72 teenage girls diagnosed with anorexia nervosa. At the start of the study, all were between 13 and 18 years old, and had a measured bone age of at least 15 years.

    Investigators randomly assigned participants to receive estrogen or placebo for 18 months. Of the 72 initial participants, 38 received estrogen and 34 received placebo. At the study’s start and end, participants completed questionnaires designed to assess anxiety, and attitudes toward eating and body image. Thirty-seven participants completed the study, with 20 receiving estrogen and 17 receiving placebo.

    The National Institutes of Health’s National Institute of Diabetes, Digestive and Kidney Disorders funded the study.


  4. Study suggests body image disturbances in anorexia may influence unconscious movements

    June 11, 2013 by Ashley

    From the Public Library of Science press release via EurekAlert!:

    skinIndividuals suffering from anorexia nervosa perceive their bodies as being larger than they are and this disturbed body representation affects their movements, according to research published May 29 in the open access journal PLOS ONE by Anouk Keizer and colleagues from Utrecht University in the Netherlands.

    Previous studies of anorexia nervosa have largely focused on patients’ disturbed perception of body image. Here, researchers examined how these disturbances may extend to unconscious, action-related representations of the body by asking anorexic and healthy participants to walk through a door and observing when they began to rotate their shoulders to squeeze through.

    While healthy participants started to turn when a doorway was about 25% wider, anorexic participants began to do so even when the opening was 40% wider than their shoulders.

    Based on these observations, the authors conclude that anorexic patients’ disturbed representations of their body size are more pervasive than previously thought, affecting both conscious and unconscious actions. The study concludes, “It appears that for anorexia nervosa patients, experiencing their body as fat goes beyond thinking and perceiving themselves in such a way, it is even reflected in how they move around in the world.”

    Keizer adds, “This is why we believe that current therapeutic interventions should not only focus on changing how patients think about their body and how they look at it, but also target the body in action, in other words, treatment should aim to improve the experience of body size as a whole.”


  5. Study suggests rethinking treatment goals improves results for those with persistent anorexia

    May 10, 2013 by Ashley

    From the University of Chicago Medicine press release via HealthCanal:

    body dysmorphiaA new, multinational randomized clinical trial has found that patients with severe and enduring anorexia nervosa will not only stick with treatments but also make significant improvements with just a slight modification of the standard goals and methods of treatment.

    More than 85 percent of those who enrolled in the trial completed treatment–almost three times the usual retention rate. After eight months of outpatient treatment, patients in both treatment groups reported improved quality of life, reduced symptoms of mood disorders and enhanced social adjustment.

    One crucial element of this trial was the decision to reprioritize how the goals of treatment were presented to those enrolled in this study. Treatment of newly diagnosed adolescents and young adults tends to focus on weight recovery. For this study, conducted at the University of Sydney, University of London and University of Chicago, treatment goals were set collaboratively, by the care team and the patient, with less emphasis on weight gain and more on quality of life, reduction of mood disorders, and enhanced social adjustment.

    “Our goal was to peel back the negative impact of anorexia and to shift the traditional pressure to gain weight to an emphasis on improving quality of life and overall functioning,” said the study’s lead author Stephen Touyz, PhD, from the Centre for Eating and Dieting Disorders at the University of Sydney. “By refocusing the core of treatment, we were able to engage highly resistant individuals with severe and enduring anorexia nervosa in treatment, circumvent the notoriously high dropout rates and help them make their lives a little better.

    Patients with severe and enduring anorexia nervosa (SE-AN) are notoriously difficult to treat. Most of them develop anorexia as adolescents and do not respond to treatment. Participants in this study had suffered from severe anorexia for at least seven years, with an average duration of illness of more than 15 years.

    Anorexia nervosa has the highest mortality rate of any psychiatric disorder. Most individuals with SE-AN have been through multiple unsuccessful treatment episodes. Repeated failure leaves them with low motivation and a self image dominated by illness.

    After prolonged malnourishment, many of those with SE-AN are disabled and unable to hold a job. They often suffer from neurocognitive, cardiac or liver problems, as well as osteoporosis. Insurance companies frequently refuse to pay for treatment because so few individuals improve.

    This study, published online by the journal Psychological Medicine on May 3, 2013, was the first randomized clinical trial for chronic anorexia nervosa. It compared two standard treatments but modified them in ways that made them more suitable for individuals with such a profound and persistent disorder. The treatments–cognitive behavioral therapy (CBT) and specialist supportive clinical management (SSCM)–were altered to focus on retention, improved quality of life and to avoid “further failure experiences.”

    The researchers enrolled 63 patients, all female, at two clinical centers: at the University of Sydney and St George’s Hospital, University of London. The average body mass index of study participants was 16.2, with a range from 11.8 to 18.5. (Normal BMI ranges from 18.5 to 25.) The University of Chicago served as the data-coordinating center.

    Thirty-one patients were assigned to CBT and 32 to SSCM. Both treatments involved 30 outpatient therapy sessions over eight months. Patients were assessed at the end of treatment, with follow-up assessments six and 12 months later.

    Results from both treatments were comparable, with significant improvements ranging from “moderate” to “large” on many measures. CBT had a greater impact on eating-disorder symptoms and readiness to change. SSCM produced larger improvements in health-related quality of life and depression. Average BMI for both groups increased from 16.2 to 16.8, about 4 percent.

    “The results were far better than most people in the field would have expected,” said Daniel Le Grange, PhD, professor of psychiatry and director of the eating disorders program at the University of Chicago and the principal investigator for the data-coordinating center. “Many of these patients were profoundly ill. The prevailing wisdom is that current treatments have not been effective and patients are best served by refeeding in the hospital setting. This study showed that specific modification of these behavioral approaches could overcome the high dropout rates and lead to meaningful positive change.”

    Limitations of the study include a moderate sample size, 63 study participants, and a relatively short follow-up period, 12 months for a disorder that had been present for more than seven years. Despite the limitations, the high retention rate and the magnitude of improvement in most of the outcome measures were very encouraging, especially in the setting of a disorder with poor compliance and limited previous clinical success.

    This study clearly shows that SE-AN patients do respond to, and benefit from, two specialized treatments when done by clinicians with specialist knowledge,” the authors wrote. “This study should provide hope for those suffering from severe and enduring AN as well as stimulate interest in the development of new psychosocial treatment approaches.”

    The Australian National Health and Medical Research Council, the NHS Trust (United Kingdom), the Butterfly Foundation (Australia) and the University of Western Sydney funded this study. Additional authors include H. Lacey of St George’s Hospital; P. Hay and B. Bamford of the University of Western Sydney; R. Smith and S Macguire of the University of Sydney; K.M. Pike of Columbia University in New York; and R.D. Crosby of the University of North Dakota. The paper, “Treating severe and enduring anorexia nervosa: a randomized clinical trial,” can be found at: http://dx.doi.org/10.1017/S0033291713000949.

     


  6. Study finds altered connectivity in brain network for body perception in anorexics

    February 5, 2013 by Ashley

    From the Ruhr-Universität Bochum press release via EurekAlert!:

    mirror_dysmorphiaWhen people see pictures of bodies, a whole range of brain regions are active. This network is altered in women with anorexia nervosa.

    In a functional magnetic resonance imaging study, two regions that are important for the processing of body images were functionally more weakly connected in anorexic women than in healthy women.

    The stronger this “connection error” was, the more overweight the respondents considered themselves. “These alterations in the brain could explain why women with anorexia perceive themselves as fatter, even though they are objectively underweight” says Prof. Dr. Boris Suchan of the Institute of Cognitive Neuroscience at the Ruhr-Universität. Together with Prof. Dr. Dietrich Grönemeyer (University of Witten-Herdecke), Prof. Dr. Silja Vocks (University of Osnabrück) and other colleagues, the Bochum researchers report in the journal Behavioural Brain Research.

    Anorexics misperceive their body shape

    The researchers tested ten anorexic and fifteen healthy women of similar age. To start with, all the women judged on the computer which of several different silhouettes corresponded best to their own body shape. Ten control subjects who did not participate in the MRI scan answered the same question by matching a photo of the test subject to the right silhouette.

    Both healthy and anorexic women estimated their body shape differently than outsiders: healthy subjects rated themselves as thinner than the control subjects. Anorexic women on the other hand perceived themselves to be fatter than the control subjects did.

    Brain areas for body perception examined with MRI

    In MRI scanners, the researchers then recorded the brain activity of the 25 participants while they observed photos of bodies. Above all, they analysed the activity in the “fusiform body area” (FBA) and the “extrastriate body area” (EBA), because previous studies showed that these brain regions are critical for the perception of bodies. To this end, the neuroscientists from Bochum calculated the so-called effective connectivity between the FBA and EBA in both hemispheres. This is a measure of how much the activity in several brain areas is temporally correlated. A high degree of correlation is indicative of a strong connection.

    Brains of anorexics structurally and functionally altered

    The connection between the FBA and EBA was weaker in women with anorexia nervosa than in healthy women. In addition, the researchers found a negative correlation between the EBA-FBA connection in the left hemisphere and the misjudgement of body weight: the weaker the effective connectivity between the EBA and FBA was, the fatter the subjects with anorexia falsely estimated themselves to be.

    “In a previous study we found that there are structural changes in the brains of patients with anorexia“, says Boris Suchan. They have a lower density of nerve cells in the EBA. “The new data shows that the network for body processing is also functionally altered.”

    The EBA, which has a lower cell density in anorexics, is also the area that stood out in the connection analysis: it receives reduced input from the FBA. “These changes could provide a mechanism for the development of anorexia”, says Suchan.


  7. Study suggests possible ways to spot hidden eating disorders in emergency room

    November 23, 2012 by Sue

    From the University of Michigan Health System press release via EurekAlert!:

    twin teensCould the emergency room be a good place to spot undiagnosed eating disorders among teens, and help steer them to treatment? A new study from the University of Michigan suggests that could be the case.

    Researchers screened more than 940 teens and young adults aged 14 years to 20 years for eating disorders, as part of their visit to the U-M Emergency Department for any non-psychiatric reason.

    They found that 16 percent – more than one in every 6 – had indications of an eating disorder. Those that did were also much more likely to also show signs of depression and substance abuse – conditions that often go hand-in-hand with eating disorders.

    The results are published in the November issue of the International Journal of Eating Disorders.

    The researchers, from the U-M Medical School’s Department of Emergency Medicine and Department of Psychiatry, and the Center for Eating Disorders of Ann Arbor, MI, also noted that more than a quarter of the patients with signs of eating disorders were male – a higher percentage than might be expected.

    Contrary to most people’s perceptions of eating disorders, but consistent with what experts know about the condition, the patients who screened positive for eating disorders in the ER were more than three times as likely to be obese than those without eating issues.

    Although anorexia nervosa is the most commonly known eating disorder, and calls to mind images of unhealthily skinny teens, bulimia and binge eating are also eating disorders – and are known to be associated with overweight and obesity.

    Suzanne Dooley-Hash, M.D., who led the study, works as an emergency physician at U-M. She started the effort because she had a sense that eating disorders were more common among ER patients than the care teams there might think – it’s just that no one was asking about it.

    For many teens and young adults, ER visits are more common than regular doctor visits — or the only form of medical care they get. In fact, teens who received public assistance of some sort were more likely to have signs of eating disorders in the ER study population.

    So the idea of screening for eating disorders there, and helping at-risk teens get treatment after they leave the ER, could be an effective way of stemming problems before they become even more serious. Similar approaches have been taken for drug and alcohol abuse, risky driving, and other risky behaviors.

    The new study was part of the UConnect study, led by Rebecca Cunningham, M.D., who is senior author of the new paper and an associate professor of emergency medicine, and Maureen Walton, MPH, Ph.D., a co-author of the new paper and research associate professor of psychiatry. Cunningham also holds an associate professorship at the U-M School of Public Health and directs the U-M Injury Center.

    The researchers acknowledge that the study represents patients from one hospital, located in a university town, and say that further research would be needed to confirm the findings’ applicability before any interventions are designed.

    They come in for other things – and it’s up to health care providers to know what to look for,” says Dooley-Hash, an assistant professor of emergency medicine who has worked to educate her fellow emergency physicians about eating disorders and how to spot high-risk teens. “ER teams can be equipped to refer patients for care, just as we do for substance abuse. It could be a wakeup call, a teachable moment, a chance to tell them they need to seek help and direct them to resources.”

    She notes that many teens with eating disorders may come to their physician or an ER with stomach-related complaints but not want to acknowledge that their symptoms are related to an eating issue. Many go undiagnosed for years. On the other end of the spectrum, she says she has seen teens die in the ER after struggling with eating disorders and the depression and suicidal tendencies that often accompany them.

    While treatment for eating disorders is not a surefire thing, and can take years, the earlier a patient is diagnosed the better their chances are, she says.


  8. Study suggests patients with anorexia judge own body size inaccurately, view others’ accurately

    August 22, 2012 by Sue

    From the Public Library of Science press release via EurekAlert!:

    Patients with anorexia have trouble accurately judging their own body size, but not others’, according to research published Aug. 22 in the open access journal PLOS ONE.

    In the study, led by Dewi Guardia of the University Hospital of Lille in France, 25 patients with anorexia and 25 controls were shown a door-like aperture and asked to judge whether or not it was wide enough for them to pass through, or for another person present in the room to pass through. In previous similar experiments, anorexic patients felt they could not pass through the door even when it was easily wide enough, and in the current study, the researchers found that the anorexic patients were more accurate at judging others’ ability to pass through the aperture than their own. They also found a correlation between the perception of their own ability to pass through the aperture and their body size prior to becoming anorexic, suggesting that the patients may still think of themselves as their previous size.

    Citation: Guardia D, Conversy L, Jardri R, Lafargue G, Thomas P, et al. (2012) Imagining One’s Own and Someone Else’s Body Actions: Dissociation in Anorexia Nervosa. PLoS ONE 7(8): e43241.  http://dx.plos.org/10.1371/journal.pone.pone.0043241


  9. Study finds brain circuitry differences in women with anorexia and obesity

    May 14, 2012 by Sue

    From the University of Colorado Denver press release via EurekAlert!:

    Why does one person become anorexic and another obese? A study recently published by a University of Colorado School of Medicine researcher shows that reward circuits in the brain are sensitized in anorexic women and desensitized in obese women. The findings also suggest that eating behavior is related to brain dopamine pathways involved in addictions.

    Guido Frank, MD, assistant professor director of the Developmental Brain Research Program at the CU School of Medicine and his colleagues used functional magnetic resonance imaging (fMRI) to examine brain activity in 63 women who were either anorexic or obese. Scientists compared them to women considered “normal” weight. The participants were visually conditioned to associate certain shapes with either a sweet or a non-sweet solution and then received the taste solutions expectedly or unexpectedly. This task has been associated with brain dopamine function in the past.

    The authors found that during these fMRI sessions, an unexpected sweet-tasting solution resulted in increased neural activation of reward systems in the anorexic patients and diminished activation in obese individuals. In rodents, food restriction and weight loss have been associated with greater dopamine-related reward responses in the brain.

    “It is clear that in humans the brain’s reward system helps to regulate food intake” said Frank. “The specific role of these networks in eating disorders such as anorexia nervosa and, conversely, obesity, remains unclear.”

    Scientists agree that more research is needed in this area. The study was published in Neuropsychopharmacology.


  10. Study suggests lack of support following traumatic events may trigger eating disorders

    April 24, 2012 by Sue

    From the Wiley-Blackwell press release via AlphaGalileo:

    Eating disorders can be triggered by lack of support following traumatic events such as bereavement, relationship problems, abuse and sexual assault, according to research published in the May issue of the Journal of Clinical Nursing. Even changing school or moving home can prove too much for some young people and lead to conditions such as anorexia or bulimia.

    Researchers from the University of Minnesota, USA, spoke to 26 women and one man aged from 17 to 64 receiving treatment from a specialist outpatient clinic. They had suffered from eating disorders for an average of 20 years.

    “The aim of our study was to find out if there was any link between transitional events in family life and the onset of eating disorders” says lead author Dr Jerica M Berge, Assistant Professor in the Department of Family Medicine and Community Health at the University. “Eating disorders are an important public health issue and knowing what causes them can help us to develop more effective treatment and support.”

    The patients had a median age of 27 years and had been receiving treatment for between ten months and 18 years. Nine had anorexia nervosa, three had bulimia nervosa, one had both and the other 14 had eating disorders that did not meet the diagnostic criteria for any one specific condition.

    Six key themes covered the transitional events that preceded eating disorders:

    School transition. Some talked about the problems they had adapting to the more independent world of junior high school and others talked about leaving home to go to college and how they missed friends and family.

    Starting college was very hard for one woman. “Nobody knew who I was…I was incredibly lonely with no support and I just stopped eating.” Another struggled to cope without regular support. “You don’t receive the daily love that you are used to growing up, you are left to provide that for yourself and I just wasn’t able to do it.”

    Relationship changes. Breaking up with a partner affected some participants and others talked about their parents splitting up and moving on.

    When her father got a new girlfriend when she was seven, one woman lost the close relationship they had enjoyed. “Overnight she became the most important thing in his life…his girlfriend would be really mean to me and my dad wouldn’t defend me.” Another woman described how her dad left for “the perfect Barbie”, adding “I was so mad at my dad for choosing her over us…I think that is when my eating disorder really began.”

    Death of a family member. The death of a family member or close friend often proved traumatic, with people saying that they didn’t not know how to deal with their grief and that they received little support.

    One woman’s sister died when she was five, but no-one talked about this “major event” in her life. “I started to eat – to compensate for feelings of anxiety.” Another lost her mother to an eating disorder when she was 11. She found herself living in a single-parent household where she was given “so much freedom with not much emotional support… I lost control.”

    Home and job transition. Some were affected by their family relocating or losing their job and described how they felt lonely, unsupported and lacked close relationships during these transitions.

    A new job left one woman with little time for friends and she struggled to relate to her workmates who were all much older than her. “I felt really alone and had no-one to talk to or hang out with.” Moving house at 16 was really hard for another woman. “I just felt lost and my eating problems began.”

    Illness/hospitalisation. A number had been ill and some said that their weight loss made them feel good and prompted positive comments from others.

    Having viral meningitis scared one woman – she realised she had no control over her illness, but could control her eating. “I guess I was thinking that if I could be this small, people would kind of take care of things for me.” Being diagnosed with hypo-glycaemia and being told she needed to eat frequently was the start of another woman’s problems. “I started to think constantly about food…since then I’ve had a real struggle with bingeing.”

    Abuse/sexual assault/incest. Some talked about abusive events and how they felt let down or deserted by the very friends and family they needed to support them. Two said they ate more to become unattractive or bigger and intimidating.

    Being sexually abused by her brother triggered one woman’s eating disorder. “I think in a way I developed the eating disorder just to get away from it…Just to kill the pain because I couldn’t tell anyone.” Another woman started eating to try and stop the abuse and violence from her partner. “I thought if I gained weight that he would leave me alone or I could fight him back.”

    Dr Berge says the study confirms that eating disorders can be triggered by a number of life changes and that lack of support was a common theme. “We hope that our findings will be of interest to parents as well as health professionals as they underline the need for greater awareness and support at times of change and stress.”

    http://wileyonlinelibrary.com/journal/JOCN