Psychological and Neurobiological Aspects of Eating Disorders (eBook)

Nathalie Burkert is a clinical and health psychologist. Since 2010 she works as a university assistant at the Institute of Social Medicine and Epidemiology at the Medical University of Graz. Her research focuses on eating disorders, weight, nutrition, and associations with health.

Acknowledgements 8
Contents 12
Abbreviations 16
List of figures 18
List of tables 20
Zusammenfassung 22
Abstract 26
1 Scientific background 29
1.1 Introduction 29
1.2 Anorexia nervosa 30
1.2.1 Medical issues and complications of the disease 34
1.2.2 Psychopharmacological treatment 34
1.2.3 Recovery 35
1.3 Psychological aspects of anorexia nervosa 36
1.3.1 Etiopathogenetic factors 36
1.3.2 Personality aspects 37
1.3.3 Stress and Coping 38
1.3.4 Self-injurious behavior, suicide and mortality 38
1.4 Neurobiological aspects of anorexia nervosa 40
1.4.1 Structural changes 41
1.4.2 Structural alteration of the hippocampus 43
1.4.3 Neurobiological aspects concerning taste processing 45
1.4.4 Brain activity as a response to body images 46
1.4.5 Cognitive processing of taste-related stimuli 47
1.4.6 Viewing images of food 49
1.4.7 Administration of taste stimuli 51
2 Method 57
2.1 Objectives 57
2.2 Participants 58
2.2.1 Inclusion and exclusion criteria 58
2.3 Test procedure 59
2.4 MRI design 65
2.4.1 Magnetic resonance measurement 65
2.4.2 Taste stimulation 66
2.5 Data analysis 69
2.5.1 Sociodemographic, medical and psychological data 69
2.5.2 Structural brain data 70
2.5.3 fMRI data 71
3 Results 73
3.1 Characteristics 73
3.1.1 General characteristics 73
3.1.2 Health behavior 74
3.1.3 Weight limit 75
3.1.4 Psychiatric disorders in relatives 75
3.1.5 Co-morbid disorders 75
3.1.6 Medical issues/complications 76
3.1.7 Treatment and medication 76
3.1.8 Subjective health 76
3.2 Psychological aspects of anorexia nervosa 77
3.2.1 Personality 77
3.2.2 Coping Strategies 78
3.3 Neurobiological aspects of anorexia nervosa 86
3.3.1 Structural changes in overall brain volume and volume of the various brain areas 86
3.3.2 Volume of the hippocampal sub-structures 89
3.3.3 Associations between the total hippocampal volume and other brain areas, stress, and coping 91
3.3.4 Brain activity in response to taste stimuli: whole brain analyses 93
3.3.5 Brain activity in response to the different taste stimuli in the regions of interest 95
3.3.6 Associations between the brain activity in response to a taste in general and psychological aspects 98
3.3.6.1 Association between the brain activity due to a taste in general and stress 98
3.3.6.2 Association between the brain activity due to a taste in general and anxiety ratings concerning the taste 100
3.3.6.3 Association between the brain activity due to a taste in general and pleasantness ratings concerning the taste 103
3.3.6.4 Association between brain activity due to a taste in general and depression 103
3.3.6.5 Association between the brain activity due to a taste in general and anxiety 106
3.3.6.6 Association between the brain activity due to a taste in general and obsession 108
3.3.6.7 Association between the brain activity due to a taste in general and obsessional control 111
3.3.6.8 Association between the brain activity due to a taste in general and the duration of the illness 111
4 Discussion 115
4.1 Psychological aspects of anorexia nervosa 115
4.1.1 Personality 117
4.1.2 Stress and coping 118
4.1.3 Body image 119
4.2 Neurobiological aspects of anorexia nervosa 120
4.2.1 Structural changes 120
4.2.2 Hippocampal changes and associations with psychological symptoms in AN patients 121
4.2.3 Brain activity as a response to a taste in general 124
4.2.4 Brain activity as a response to sucrose, umami, and citric acid in regions of interest 126
4.2.5 Associations between the brain activity as a response to a taste and psychological factors 128
4.3 A critical reflection of the current study 130
4.4 Strengths and limitations 132
4.5 Implications and conclusions 134
5 References 136
6 Appendix 169
Publications and presentations resulting from this dissertation 173