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Evaluation ViewAttendees 5

Eating Disorders
Symposia

Symposium 49 - Unraveling complexity: Novel mechanistic insights into "atypical" anorexia nervosa

Saturday, November 16, 2024
8:30 AM – 10:00 AM EST
Location: Congress C, 4th Floor, Loews
CE: 1.5

Keywords: Anorexia, Eating, Diagnosis
Level of Familiarity: Basic to moderate
Recommended Readings: Walsh, B. T., Hagan, K. E., & Lockwood, C. (2023). A systematic review comparing atypical anorexia nervosa and anorexia nervosa. The International journal of eating disorders, 56(4), 798–820. https://doi.org/10.1002/eat.23856,   Biçaker, E., Trolio, V., Miller, A. E., Zhu, L. Y., White, C., & Racine, S. E. Affective processes underlying restrictive eating in atypical anorexia nervosa: Comparisons to anorexia nervosa and bulimia nervosa using ecological momentary assessment. International Journal of Eating Disorders. https://doi.org/10.1002/eat.24134,   Sandoval-Araujo, L. E., Cusack, C. E., Ralph-Nearman, C., Glatt, S., Han, Y., Bryan, J., Hooper, M. A., Karem, A., & Levinson, C. A. Differentiation between atypical anorexia nervosa and anorexia nervosa using machine learning. International Journal of Eating Disorders. https://doi.org/10.1002/eat.24160,   Wong, V. Z., & Lowe, M. R. Is there a basis for a weight cut-off point? A large-scale investigation of atypical anorexia and anorexia nervosa subtypes among patients at a residential treatment centre. European Eating Disorders Review. https://doi.org/10.1002/erv.3077,   Eddy, K. T., Plessow, F., Breithaupt, L., Becker, K. R., Slattery, M., Mancuso, C. J., Izquierdo, A. M., Van De Water, A. L., Kahn, D. L., Dreier, M. J., Ebrahimi, S., Deckersbach, T., Thomas, J. J., Holsen, L. M., Misra, M., & Lawson, E. A. (2023). Neural activation of regions involved in food reward and cognitive control in young females with anorexia nervosa and atypical anorexia nervosa versus healthy controls. Translational Psychiatry, 13(1), 220. https://doi.org/10.1038/s41398-023-02494-3

Anorexia nervosa (AAN) is an eating disorder diagnosis describing individuals who meet all criteria for AN, including significant weight loss, yet have a BMI > 18.5 kg/m2. Although this disorder was only recently recognized as a distinct diagnosis, the sparse research available suggests that AAN presents as frequently to treatment (Harrop et al., 2021) and is associated with similarly severe eating disorder symptoms and medical and psychological sequelae (Johnson-Munguia et al., 2023; Walsh et al., 2023) as low-weight AN. These findings underscore that AAN is a serious condition that has been neglected within eating disorders research, which is especially alarming in light of studies suggesting that AAN disproportionally affects underrepresented groups within eating disorders research (e.g., people of color, men). Thus, the lack of research on AAN demonstrates both a knowledge gap and an equity concern within the field.
Despite the severity of AAN, little is known regarding the mechanisms promoting and maintaining this disorder. Although there has been increasing evidence that AAN and AN share many clinical characteristics, few studies have investigated the similarities and differences in mechanisms between these disorders. As a result, there is a poor understanding of what processes are important to target in treating AAN; thus, interventions for this disorder currently lack the necessary evidence base. Clarifying mechanistic processes (e.g., affective, neurobiological, personality traits) in AAN is essential for developing theoretical models, increasing diagnostic clarity, and informing intervention targets for this severe disorder. Therefore, this symposium aims to share emerging studies of mechanisms associated with AAN with the hope of launching research that is critical to improving understanding and treatment of this serious yet under-researched and under-served disorder.
Ege Bıçaker will present ecological momentary assessment results to compare affective processes associated with restrictive eating in AAN, AN, and BN. Kira Venables will examine associations between empirically-derived personality profiles, eating disorder symptoms, and affective symptoms in a sample of undergraduates with a history of AAN, AN, BN, or no eating disorder. Dr. Ralph-Nearman will highlight outcomes of a study examining the relationships among hallmark eating disorder symptoms, cognitions, emotions, and behaviors in AN and AAN across multiple time lags. Valerie Wong will provide data using path analysis to test the effect of weight suppression on eating disorder symptoms through avoidance and negative affect in inpatients with AAN. Dr. Eddy will present data examining the neurobiological underpinnings of AN and AAN to inform diagnostic thresholds. Finally, Dr. Walsh will provide expert commentary on key takeaways from the presentations and future directions for mechanistic research in AAN.

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Describe the state of existing research on mechanisms in atypical AN.
  2. Detail findings from novel research about mechanisms that distinguish atypical AN from other eating disorders.
  3. Critically examine the state of the literature and further research that is needed.
  4. Present emerging research investigating mechanisms implicated in the development and maintenance of eating disorder behaviors in atypical AN
  5. Encourage innovation in researchers' and clinicians' understanding of atypical AN to inform future studies and treatment approaches.

Presentations:

  • 8:30 AM – 10:00 AM EST
    (SYM 49) The Role of Affect in the Maintenance of Restrictive Eating Behaviors in Atypical Anorexia Nervosa: Comparisons to Anorexia Nervosa and Bulimia Nervosa

    Speaker: Ege Bicaker, B.S. (she/her/hers) – McGill University

    Co-author: Vittoria Trolio, B.S. (she/her/hers) – McGill University

    Co-author: Alexia E. Miller, B.A. (she/her/hers) – McGill University

    Co-author: Lisa Zhu, B.S. (she/her/hers) – Western University

    Co-author: Chloe White, N/A, B.A. – Simon Fraser University

    Co-author: Sarah E. Racine, PhD (she/her/hers) – McGill University

  • 8:30 AM – 10:00 AM EST
    (SYM 49) Personality Subtypes and Clinical Symptoms in U.S. Undergraduates with Atypical Anorexia Nervosa, Anorexia Nervosa, and Bulimia Nervosa

    Speaker: Kira Venables, B.A. (she/her/hers) – Virginia Commonwealth University

    Co-author: Hannah Heintz, B.A. (she/her/hers) – Virginia Commonwealth University

    Co-author: Ariana Bazzi, B.S. (she/her/hers) – Virginia Commonwealth University

    Co-author: Amanda Makara, B.S. (she/her/hers) – Virginia Commonwealth University

    Co-author: Adanya D. Johnson, B.S. – Virginia Commonwealth University

    Co-author: Kelsey Hagan, Ph.D. – Virginia Commonwealth University

    Co-author: Ann F. Haynos, Ph.D. (she/her/hers) – Virginia Commonwealth University

  • 8:30 AM – 10:00 AM EST
    (SYM 49) Comparing Predictive Relationships and Duration of Effects Among Key Eating Disorder Cognitions, Emotions, and Behaviors in Anorexia Nervosa and Atypical Anorexia Nervosa

    Speaker: Christina Ralph-Nearman, M.S., Ph.D. – University of Louisville

    Co-author: Christina Ralph-Nearman, M.S., Ph.D. – University of Louisville

    Co-author: Madison Hooper, MS – Vanderbilt University

    Co-author: Cheri Levinson, Ph.D. (she/her/hers) – University of Louisville

  • 8:30 AM – 10:00 AM EST
    (SYM 49) Examining Affective Consequences of Weight Suppression in Atypical Anorexia Nervosa

    Speaker: Valerie Wong, B.S. (she/her/hers) – Rutgers, The State University of New Jersey

    Co-author: Valerie Wong, B.S. (she/her/hers) – Rutgers, The State University of New Jersey

    Co-author: Edward A. Selby, Ph.D. (he/him/his) – Rutgers University

  • 8:30 AM – 10:00 AM EST
    (SYM 49) Neurobiological Mechanisms of Atypical Anorexia Nervosa

    Speaker: Kamryn Eddy, Ph.D. – Harvard Medical School / Massachusetts General Hospital

    Co-author: Lauren Breithaupt, PHD – MGH/HMS

    Co-author: Jennifer J. Thomas, Ph.D. – Massachusetts General Hospital

    Co-author: Kendra R. Becker, Ph.D. – Massachusetts General Hospital/Harvard Medical School

    Co-author: Rachel Kim, MD, PHD – MGH/HMS

    Co-author: Franziska Plessow, PHD – MGH/HMS

    Co-author: Meghan Slattery, NP – MGH

    Co-author: Amanda Lyall, PHD – MGH/HMS

    Co-author: Marek Kubicki, MD, PHD – BWH/HMS

    Co-author: Laura Holsen, PhD – Brigham and Women's Hospital

    Co-author: Madhusmita Misra, MD, MPH – Massachusetts General Hospital/Harvard Medical School

    Co-author: Elizabeth Lawson, MD – MGH/HMS