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It is not known with certainty what causes eating disorders. It can be due to a combination of biological, psychological or environmental causes.

Contents 1 Biological 2 Psychological 2.1 Personality traits 2.2 Environmental 2.2.1 Child maltreatment 2.2.2 Social isolation 2.2.3 Parental influence 2.2.4 Peer pressure 2.2.5 Cultural pressure 2.3 Eating disorders in men 3 References

BiologicalEdit

File:DNA Repair.jpg

• Genetic: Numerous studies have been undertaken that show a possible genetic predisposition toward eating disorders.^[1][2][3]
• Biochemical:Eating behavior is a complex process controlled by the neuroendocrine system of which the Hypothalamus-pituitary-adrenal-axis (HPA axis) is a major component. Dysregulation of the HPA-axis has been associated with eating disorders,^[4][5] such as irregularities in the manufacture, amount or transmission of certain neurotransmitters, hormones^[6] or neuropeptides^[7].
  • serotonin: a neurotransmitter involved in depression also has an inhibitory affect on eating behavior^{[8][9][10][11][12]}
  • norepinephrine is both a neurotransmitter and a hormone; abnormalities in either capacity may affect eating behavior^[13][14]
  • dopamine:which in addition to being a precursor of norepinephrine and epinephrine is also a neurotransmitter which regulates the rewarding property of food^[15][16]
• leptin and ghrelin; leptin is a hormone produced primarily by the fat cells in the body it has an inhibitory effect on appetite by inducing a feeling of saiety. Ghrelin is an appetite inducing hormone produced in the stomach and the upper portion of the small intestine. Circulating levels of both hormones are an important factor in weight control. While often associated with obesity both hormones and their respective effects have been implicated in the pathophysiology of anorexia nervosa and bulimia nervosa.^[17]
• immune system:studies have shown that a majority of patients with anorexia and bulimia nervosa have elevated levels of autoantibodies that affect hormones and neuropeptides that regulate appetite control and the stress response. There may be a direct correlation between autoantibody levels and associated psychological traits.^[18][19]

File:BrainLobesLabelled.jpg

• infection:PANDAS, is an abbreviation for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. Children with PANDAS "have Obsessive Compulsive Disorder (OCD) and/or tic disorders such as Tourette's Syndrome, and in whom symptoms worsen following infections such as "Strep throat" and Scarlet Fever." (NIMH) There is a possibility that PANDAS may be a precipitating factor in the development of Anorexia nervosa in some cases, (PANDAS AN).^[20]
• lesions:studies have shown that lesions to the right frontal lobe or temporal lobe can cause the pathological symptoms of an eating disorder^[21][22][23]
• tumors:tumors in various regions of the brain have been implicated in the development of abnormal eating patterns.^{[24][25][26][27][28]}
• brain calcification: a study highlights a case in which prior calcification of the right thalumus may have contributed to development of anorexia nervosa.^[29]

• somatosensory homunculus; is the representation of the body located in the somatosensory cortex, first described by renowned neurosurgeon Wilder Penfield. The illustration was originally termed "Penfield's Homunculus", homunculus meaning little man. "In normal development this representation should adapt as the body goes through its pubertal growth spurt. However, in AN it is hypothesized that there is a lack of plasticity in this area, which may result in impairments of sensory processing and distortion of body image". (Bryan Lask, also proposed by VS Ramachandran)
• Obstetric complications. There have been studies done which show maternal smoking, obstetric and perinatal complications such as maternal anemia, very pre-term birth (32<wks.), being born small for gestational age, neonatal cardiac problems, preeclampsia, placental infarction and sustaining a cephalhematoma at birth increase the risk factor for developing either anorexia nervosa or bulimia nervosa. Some of this developmental risk as in the case of placental infarction, maternal anemia and cardiac problems may cause intrauterine hypoxia, umbilical cord occlusion or cord prolapse may cause ischemia, resulting in cerebral injury, the prefrontal cortex in the fetus and neonate is highly susceptible to damage as a result of oxygen deprivation this has been shown to contribute to executive dysfunction, ADHD, and may affect personality traits associated with both eating disorders and comorbid disorders such as impulsivity, mental rigidity and obsessionality. The problem of perinatal brain injury, in terms of the costs to society and to the affected individuals and their families, is extraordinary." (Yafeng Dong, PhD) ^{[30][31][32][33][34][35][36][37][38][39][40]}

PsychologicalEdit

Eating disorders are classified as Axis I^[41] disorders in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV). Published by The American Psychiatric Association. There are various other psychological issues that may factor into eating disorders, some fulfill the criteria for a separate Axis I diagnosis or a personality disorder which is coded Axis II and thus are considered comorbid to the diagnosed eating disorder. Axis II disorders are subtyped into 3 "clusters", A, B and C.The causality between personality disorders and eating disorders has yet to be fully established.^[42] Some people have a previous disorder which may increase their vulnerability to developing an eating disorder.^[43][44][45] Some develop them afterwards.^[46] The severity and type of eating disorder symptoms have been shown to affect comorbidity.^[47] The DSM-IV should not be used by laypersons to diagnose themselves, even when used by professionals there has been considerable controversy over the diagnostic criteria used for various diagnoses, including eating disorders. There has been controversy over various editions of the DSM including the latest edition DSM-V due in May 2013.^{[48][49][50][51][52]}

Comorbid Disorders
Axis I	Axis II
depression[53]	obsessive compulsive personality disorder[54]
substance abuse, alcoholism[55]	borderline personality disorder[56]
anxiety disorders[57]	narcissistic personality disorder[58]
obsessive compulsive disorder[59][60]	histrionic personality disorder[61]
Attention-Deficit-Hyperactivity-Disorder[62][63][64][65]	avoidant personality disorder[66]

Personality traitsEdit

There are various childhood personality traits associated with the development of eating disorders.^[67] During adolescence these traits may become intensified due to a variety of physiological and cultural influences such as the hormonal changes associated with puberty, stress related to the approaching demands of maturity and socio-cultural influences and perceived expectations, especially in areas that concern body image. Many personality traits have a genetic component and are highly heritable. Maladaptive levels of certain traits may be acquired as a result of anoxic or traumatic brain injury, neurodegenerative diseases such as Parkinson's disease, neurotoxicity such as lead exposure, bacterial infection such as Lyme disease or viral infection such as Toxoplasma gondii as well as hormonal influences. While studies are still continuing via the use of various imaging techniques such as fMRI; these traits have been shown to originate in various regions of the brain^[68] such as the amygdala^[69][70] and the prefrontal cortex^[71] Disorders in the prefrontal cortex and the executive functioning system have have been shown to affect eating behavior.^[72][73]

Personality Traits
The Big Five personality traits	The "Big Five" also referred to as the "Five-Factor Model" are five broad factors (dimensions) of personality, that are based upon empirical research. A mnemonic device to remember them is the acronym "OCEAN". Two of the tests to measure the Big Five are the "Big Five Inventory" and the IPIP (International Personality Item Pool ) an abbreviated form is the "IPIP-NEO". The BFI and the IPIP-NEO are available free online for noncommercial purposes. see; external links [74]
1.Openness to Experience/Intellect	Composed of two related but seperable traits, Openness to Experience and Intellect. Behavioral aspects include having wide interests, and being imaginative and insightful, correlated with activity in the dorsolateral prefrontal cortex. Considered primarily a cognitive trait.[75]
2.conscientiousness	Scrupulous, meticulous, principaled behavior guided or conforming to one's own conscience. Associated with the dorsolateral prefrontal cortex. Anorexics are noted to have higher levels of conscientiousness.[76][77][78]
3.extroversion amygdala</br>	Gregarious, outgoing, sociable, projecting one's personality outward. The opposite of extroversion is introversion. Extroversion has shown to share certain genetic markers with substance abuse. Extroversion is associated with various regions of the prefrontal cortex and the amygdala.[79][80][81]
4.agreeableness	Refers to a compliant, trusting, empathic, sympathetic, friendly and cooperative nature.[82][83][84]
5.neuroticism thalamus	"Refers to an individual’s tendency to become upset or emotional" (Hans Eysenck) "Neuroticism is the major factor of personality pathology" (Eysenck & Eysenck, 1969). Neuroticism has a been linked to serotonin transporter (5-HTT) binding sites in the thalamus: as well as activity in the insular cortex.[85][86][87]
self esteem (low)</br>	A "favorable or unfavorable attitude toward the self (Rosenberg, 1965)."An individual's sense of his or her value or worth, or the extent to which a person values, approves of, appreciates, prizes, or likes him or herself" (Blascovich & Tomaka, 1991).[88][89][90]
harm avoidance	A tendency towards shyness, being fearful and uncertain, tendency to worry. Neonatal complications such as preterm birth have been shown to affect harm avoidance. Those with BED, AN, and BN exhibit high levels of harm avoidance. The volume of the left amygdala in girls was correlated to levels of HA, in separate studies HA was correlated with reduced grey matter volume in the orbito-frontal, occipital and parietal regions.[91][92][93][94]
novelty seeking	Impulsive, exploratory, fickle, excitable, quick-tempered, and extravagant. Associated with addictive behavior.
perfectionism Human brain in the coronal orientation. Amygdalae are shown in dark red.	"I don't think needing to be perfect is in any way adaptive" (Paul Hewitt, PhD) Socially prescribed perfectionism-"believing that others will value you only if you are perfect." Self-oriented perfectionism-"an internally motivated desire to be perfect. Perfectionism is one of the traits associated with obsessional behavior and like obsessionality is also believed to be regulated by the basal ganglia.[95][96][97].
Alexithymia insular cortex</br>	The inability to express emotions."To have no words for one's inner experience"(Rený J. Muller Ph. D).In studies done with stroke patients, alekithymia was found to be more prevalent in those who developed lesions in the right hemisphere following a cerebral infarction. There is a positive association with Post Traumatic Stress Disorder (PTSD), childhood abuse and neglect and alekithymia. Utilizing psychometric testing and fMRI, studies showed positive response in the insula, posterior cingulate cortex (PCC), and thalamus.[98][99][100]
rigidity Animation. Frontal lobe(red) of left cerebral hemisphere. frontal lobe	Inflexibility, difficulty making transitions, adherence to set patterns. Mental rigidity arises out of a deficit of the executive functions. Originally termed frontal lobe syndrome it is also referred to as dysexecutive syndrome and usually occurs as a result of damage to the frontal lobe. This may be due to physical damage as in the famous case of Phineas Gage, or due to the effects of a disease such as Huntington's disease or an hypoxic or anoxic insult[101][102] [103][104]
impulsivity inferior frontal gyrus</br>	Risk taking, lack of planning, and making up one’s mind quickly (Eysenck and Eysenck). A component of disinhibition. Abnormal patterns of impulsivity have been linked to lesions in the right inferior frontal gyrus and in studies done by Antonio Damasio author of Descartes Error, damage to the ventromedial prefrontal cortex has been shown to cause a defect in real-life decision making in individuals with otherwise normal intellect. Those who sustain this type of damage are oblivious to the future consequences of their actions and live in the here and now.[105][106].[107][108]:[109][110]
disinhibition orbitofrontal cortex</br>	Behavioral disinhibition is an inability or unwillingness to constrain impulses, it is key component of executive functioning. Researchers have emphasized poor behavioural inhibition as the central impairment of ADHD. May symptomatic of orbitofrontal lobe syndrome a subtype of frontal lobe syndrome which may be an acquired disorder as a result of traumatic brain injury, Hypoxic Ischaemic Encephalopathy (HIE), anoxic encephalopathy, degenerative diseases such as Parkinson's, bacterial or viral infection such as Lyme disease and neurosyphilis. Disinhibition has been consistently associated with substance abuse disorders, obesity, higher BMI, excessive eating, an increased rate of eating, and perceived hunger.[111][112][113][114][115][116][117][118]
obsessionality 120px basal ganglia	Persistent often unwelcome and frequently disturbing ideas, thoughts, images or emotions, rumination, often inducing an anxious state. Obsessionality may result as a dysfunction of the basal ganglia [119][120][121]

EnvironmentalEdit

Child maltreatmentEdit

Child abuse which encompasses physical, psychological and sexual abuse, as well as neglect has been shown by innumerable studies to be a precipitating factor in a wide variety of psychiatric disorders including eating disorders. Children who are subjugated to abuse may develop a disordered eating pattern in an effort to gain some sense of control or for a sense of comfort. Or they may be in an environment where the diet is unhealthful or insufficient.

Child abuse and neglect can cause profound changes in both the physiological structure and the neurochemistry of the developing brain. Children who as wards of the state were placed in orphanages or foster homes are especially susceptible to developing a disordered eating pattern. In a study done in New Zealand 25% of the study subjects in foster care exhibited an eating disorder. (Tarren-Sweeney M. 2006) An unstable home environment is detrimental to the emotional well-being of children, even in the absence of blatant abuse or neglect the stress of an unstable home can contribute to the development of an eating disorder.^{[122][123][124] [125][126][127][128][129][130]}

Social isolationEdit

Social isolation has been shown to have a deleterious effect on an individuals' physical and emotional well-being. Those that are socially isolated have a higher mortality rate in general as compared to individuals that have established social relationships. This effect on mortality is markedly increased in those with pre-existing medical or psychiatric conditions, this has been especially noted in cases of coronary heart disease. "The magnitude of risk associated with social isolation is comparable with that of cigarette smoking and other major biomedical and psychosocial risk factors." ( Brummett et al.)

Social isolation can be inherently stressful, depressing and anxiety provoking. In an attempt to ameliorate these distressful feelings an individual may engage in emotional eating in which food serves as a source of comfort. The loneliness of social isolation and the inherent stressors thus associated have been implicated as triggering factors in binge eating as well.^{[131][132][133][134]}

Parental influenceEdit

Parental influence has been shown to be an intrinsic component in developing the eating behaviors of children. This influence is manifested and shaped by a variety of diverse factors such as familial genetic predisposition, dietary choices as dictated by cultural or ethnic preferences, the parents' own body shape and eating patterns, the degree of involvement and expectations of their children's eating behavior as well as the interpersonal relationship of parent and child. This is in addition to the general psychosocial climate of the home and the presence or absence of a nurturing stable environment. It has been shown that maladaptive parental behavior has an important role in the development of eating disorders. As to the more subtle aspects of parental influence it has been shown that eating patterns are established in early childhood and that children should be allowed to decide when their appetite is satisfied as early as the age of two. A direct link has been proven between obesity and parental pressure to eat more.

Coercive tactics in regard to diet have not been proven to be efficacious in controlling a child's eating behavior. Affection and attention have been shown to affect the degree of a childs' finickiness and their acceptance of a more varied diet.^{[135] [136] [137][138][139][140]}

Peer pressureEdit

In various studies such as one conducted by The McKnight Investigators, peer pressure was shown to be a significant contributor to body image concerns and attitudes toward eating among subjects in their teens and early twenties.

Eleanor Mackey and co-author, Annette M. La Greca of the University of Miami, studied 236 teen girls from public high schools in southeast Florida. "Teen girls' concerns about their own weight, about how they appear to others and their perceptions that their peers want them to be thin are significantly related to weight-control behavior," says psychologist Eleanor Mackey of the Children's National Medical Center in Washington and lead author of the study. "Those are really important."

Dieting among adolescents was also reported to being influenced by peer behavior. With many of those individuals on a diet reporting that their friends also were dieting. The number of friends dieting and the number of friends who pressured them to diet also played a significant role in their own choices.^{[141] [142] [143][144]}

Cultural pressureEdit

There is a cultural emphasis on thinness which is especially pervasive in western society. There is an unrealistic stereotype of what constitutes beauty and the ideal body type as portrayed by the media, fashion and entertainment industries."The cultural pressure on women to be thin is an important predisposing factor for the development of eating disorders" (Bryan Lask, PhD) ^{[145] [146]}

Eating disorders in menEdit

There has been an increasing rate of males suffering from various eating disorders including anorexia nervosa. There is a perceived stigma attached, as eating disorders are generally viewed as primarily affecting women. Among men the rates of eating disorders are higher in the gay and bi-sexual communities (Feldman & Meyer, 2007), yet it also affects heterosexual men. Despite the perceived stigma, some high profile male celebrities have publicised their struggles with eating disorders such as actor Dennis Quaid, who struggled with what he called "manorexia" for which he sought treatment. Quaid said his problems began when he went on a diet to lose forty pounds to play Doc Holliday in the movie "Wyatt Earp" in 1994. Billy Bob Thornton has also struggled with anorexia, once losing 59 lbs.Thomas Holbrook, M.D., is Clinical Director of the Eating Disorders Program at Rogers Memorial Hospital in Oconomowoc, Wisconsin despite being a psychiatrist specializing in eating disorders, he suffered from anorexia nervosa with compulsive exercising. At one time the 6-ft.-tall psychiatrist weighed just 135 lbs. "I was terrified," he says, "of being fat." His story has been chronicled in various publications including USA Today and People Magazine.

ReferencesEdit

1. ↑ The evolving genetics of eating disorders Psychiatric Clinics of North America 2001 Jun;24 (2):215-225 PMID 11416922
2. ↑ Genetics in eating disorders:state of the science CNS Spectrum.2004 Jul;9(7):215-225 PMID 11416922
3. ↑ Environmental and genetic factors for eating disorders: what the clinician needs to know Child and Adolescent Psychiatric Clinics of North America Jan;18(1):67-82 PMID 19014858
4. ↑ Gross MJ Corticotropin-releasing factor and anorexia nervosa: reactions of the hypothalamus-pituitary-adrenal axis to neurotropic stressAnn Endocrinol (Paris). 1994;55(6):221-8. PMID 7864577
5. ↑ Licinio J, Wong ML,The hypothalamic-pituitary-adrenal axis in anorexia nervosa. Gold PW.Psychiatry Res. 1996 Apr 16;62(1):75-83.PMID 8739117
6. ↑ Chaudhri O, Small C, Bloom S. Gastrointestinal hormones regulating appetite. Philos Trans R Soc Lond B Biol Sci. 2006 Jul 29;361(1471):1187-209. PMID 16815798
7. ↑ Gendall KA.Leptin, neuropeptide Y, and peptide YY in long-term recovered eating disorder patients. Biol Psychiatry. 1999 Jul 15;46(2):292-9. PMID 10418705
8. ↑ Jimerson DC, et.al.,Eating disorders and depression: is there a serotonin connection? Biol Psychiatry. 1990 Sep 1;28(5):443-54. PMID 2207221
9. ↑ Leibowitz, The role of serotonin in eating disorders. Drugs 1990;39Suppl 3:33-44 PMID 2197074
10. ↑ Blundell et al.serotonin, eating behavior, fat intake Obes Res 1995 Nov;3 Suppl4:471s-476s PMID 8697045
11. ↑ Kaye WH, Anorexia, obsessional behavior and serotonin, Psycopharmacology Bulletin 1997;33(3)335-44 PMID 9550876
12. ↑ Bailer UF et al.Altered 5-HT(2A) receptor binding after recovery from bulimia-type anorexia nervosa: relationships to harm avoidance and drive for thinness. Neuropsychopharmacology. 2004 Jun;29(6):1143-55. PMID 15054474
13. ↑ Hainer V et al.,Serotonin and norepinephrine reuptake inhibition and eating behavior. Annals of The New York Academy of Sciences 2006 Nov;1083:252-69 PMID 17148744
14. ↑ Altered norepinephrine in bulimia: effects of pharmacological challenge with isoproternol Psychiatric Residency 1990 Jul;33 (1):1PMID 2171006
15. ↑ Wang et, al. Brain dopamine and obesity Lancet 2001 Feb. 3;357(9253):354-357 PMID 11210998
16. ↑ Volknow et al. Brain dopamine is associated with eating behavior in humans International Journal of Eating Disorder 2003 Mar:33 (2)136-42 PMID 1216579
17. ↑ Frederich R, Hu S, Raymond N, Pomeroy C. Leptin in anorexia nervosa and bulimia nervosa: importance of assay technique and method of interpretation. PMID 11919545
18. ↑ Fetissov SO et al.Autoantibodies against neuropeptides are associated with psychological traits in eating disorders. Proc Natl Acad Sci U S A. 2005 Oct 11;102(41):14865-70. Epub 2005 Sep 29.PMID 16195379
19. ↑ Sinno MH.et al. Regulation of feeding and anxiety by alpha-MSH reactive autoantibodies. Psychoneuroendocrinology. 2009 Jan;34(1):140-9. Epub 2008 Oct 8.PMID 18842346
20. ↑ Sokol MS. Child Adolesc Psychopharmacol. 2000 Summer;10(2):133-45.Infection-triggered anorexia nervosa in children: clinical description of four cases. PMID 10933123
21. ↑ Uher R, Treasure J. Brain lesions and eating disorders. J Neurol Neurosurg Psychiatry. 2005 Jun;76(6):852-7. PMID 15897510
22. ↑ Houy E et al.Anorexia nervosa associated with right frontal brain lesion. Int J Eat Disord. 2007 Dec;40(8):758-61. PMID 17683096
23. ↑ Trummer M et al.,Right hemispheric frontal lesions as a cause for anorexia nervosa report of three cases Acta Neurochir (Wien). 2002 Aug;144(8):797-801; discussion 801. PMID 12181689
24. ↑ Winston AP Pineal germinoma presenting as anorexia nervosa: Case report and review of the literature. Int J Eat Disord. 2006 Nov;39(7):606-8. PMID 17041920
25. ↑ Chipkevitch E, Fernandes AC. Hypothalamic tumor associated with atypical forms of anorexia nervosa and diencephalic syndrome. Arq Neuropsiquiatr. 1993 Jun;51(2):270-4. PMID 8274094
26. ↑ Rohrer TR et al.Craniopharyngioma in a female adolescent presenting with symptoms of anorexia nervosa. Klin Padiatr. 2006 Mar-Apr;218(2):67-71. PMID 16506105
27. ↑ Chipkevitch E. Brain tumors and anorexia nervosa syndrome. Brain Dev. 1994 May-Jun;16(3):175-9, discussion 180-2.PMID 7943600
28. ↑ Lin L et al. Brain tumor presenting as anorexia nervosa in a 19-year-old man. J Formos Med Assoc. 2003 Oct;102(10):737-40. PMID 14691602
29. ↑ Conrad R et al. Nature against nurture, calcification in the right thalamus in a young man with anorexia nervosa and obsessive compulsive personality-disorder CNS Spectrum 2008 Oct;13(10)906-10 PMID 18955946
30. ↑ Burke CJ, Tannenberg AE, Payton DJ Ischaemic cerebral injury, intrauterine growth retardation, and placental infarction. Dev Med Child Neurol. 1997 Nov;39(11):726-30.PMID 9393885
31. ↑ Cnattinghuis S et.al. Very pre-term birth, birth trauma and the risk of anorexia nervosa among girls. Arch Gen Psychiatry 1999 Jul;56(7):634-8PMID 10401509
32. ↑ Favoro A et al. Perinatal factors and the risk of developing anorexia nervosa and bulimia nervosa Arch Gen Psychiatry 2006 Jan;63(1)82-8. PMID 16389201
33. ↑ Favoro A The relationship between obstetric complications and temperament in eating disorders:a mediation hypothesis Psychosom Med 2008 Apr.70(3):372-7 PMID 18256341
34. ↑ Decker MJ et al.Episodic neonatal hypoxia evokes executive dysfunction and regionally specific alterations in markers of dopamine signaling. Neuroscience. 2003;117(2):417-25. PMID 12614682
35. ↑ Decker MJ, Rye DB.Neonatal intermittent hypoxia impairs dopamine signaling and executive functioning. Sleep Breath. 2002 Dec;6(4):205-10. PMID 12524574
36. ↑ Scher MS.Fetal and neonatal neurologic case histories: assessment of brain disorders in the context of fetal-maternal-placental disease. Part 1: Fetal neurologic consultations in the context of antepartum events and prenatal brain development. J Child Neurol. 2003 Feb;18(2):85-92. PMID 12693773
37. ↑ Scher MS, Wiznitzer M, Bangert BA.Cerebral infarctions in the fetus and neonate: maternal-placental-fetal considerations. Clin Perinatol. 2002 Dec;29(4):693-724, vi-vii. PMID 12516742
38. ↑ Burke CJ, Tannenberg AEDev Med Child Neurol. 1995 Jun;37(6):555-62. Prenatal brain damage and placental infarction--an autopsy study. PMID 7789664
39. ↑ Squier M, Keeling JW.The incidence of prenatal brain injury. Neuropathol Appl Neurobiol. 1991 Feb;17(1):29-38. PMID 2057048
40. ↑ Al Mamun A et.al. Does maternal smoking during pregnancy have a direct effect on future offspring obesity? Evidence from a prospective birth cohort study. Am J Epidemiol. 2006 Aug 15;164(4):317-25. PMID 16775040
41. ↑ Westen D, Harnden-Fischer J. Personality profiles in eating disorders: rethinking the distinction between axis I and axis II. Am J Psychiatry. 2001 Apr;158(4):547-62. PMID 11282688
42. ↑ Rosenvinge et al. The comorbidity of eating disorders and personality disorders: a metanalytic review of studies between 1983 and 1998 Eating and Weight Disorders 2000 June;5(2):52-61 PMID 10941603
43. ↑ Kaye WH Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American journal of Psychiatry 2004 Dec;161(12)2215-21 PMID 15569892
44. ↑ Thornton C, Russell J.Obsessive compulsive comorbidity in the dieting disorders Int J Eat Disord. 1997 Jan;21(1):83-7. PMID 8986521
45. ↑ Vitousek K, Manke F. Personality variables and disorders in anorexia nervosa and bulimia nervosa. J Abnorm Psychol. 1994 Feb;103(1):137-47. PMID 8040475
46. ↑ Braun Dl Psychiatric comorbidity in patients with eating disorders. Psychological Medicine 1994;24:854-67 PMID 7892354
47. ↑ Spindler A, Milos G. Eat Behav. 2007 Aug;8(3):364-73. Links between eating disorder symptom severity and psychiatric comorbidity. PMID 17606234
48. ↑ Collier R. DSM revision surrounded by controversy. Media has become part of the cause for disorders such as anorexia and bulimia. Psychologists say since the media plays such a powerful role in US culture that it's escalating impressions on youth, beauty and weight have started to have negative effects on women that watch TV and are more exposed to the media. There is no direct evidence given that this is a new study, however, it has increasingly become part of popular media debate. CMAJ. 2009 Nov 17. PMID 19920166
49. ↑ Kutchins H, Kirk SA.DSM-III-R: the conflict over new psychiatric diagnosesHealth Soc Work. 1989 May;14(2):91-101.PMID 2714710
50. ↑ DSM-IV Diagnostic Criteria for Eating Disorders May Be Too Stringent Marlene Busko/ Article
51. ↑ The Politics of Disease Definition: A Summer of DSM-V Controversy in Review. Stanford Center for Law and the BiosciencesArticle
52. ↑ Psychiatry manual's secrecy criticized. Los Angeles Times Article
53. ↑ RC Casper Depression and Anxiety 1998;Suppl 1;96-104 PMID 9809221
54. ↑ Serpell L, Livingstone A, Neiderman M, Lask B.Anorexia nervosa: obsessive-compulsive disorder, obsessive-compulsive personality disorder, or neither? Clin Psychol Rev. 2002 Jun;22(5):647-69. PMID: 12113200
55. ↑ Bulik Et. Al.Alcohol use disorder comorbidity in eating disorders: a multicenter study. Journal of Clinical Psychiatry 2004 July;65(7):1000-6 PMID 15291691
56. ↑ Larsson JO,Hellzen MPatterns of personality disorders in women with chronic eating disorders; Eating and Weight Disorders 2004 Sep;9(3):200-5 PMID 15656014
57. ↑ JN Swinburne Touz Sm The co-morbidity of eating disorders and anxiety: a review Eur Eat Disord Rev 2007 Jul;15(4):253-74 PMID 17676696
58. ↑ Ronningstam E.Pathological narcissism and narcissistic personality disorder in Axis I disorders. Harv Rev Psychiatry. 1996 Mar-Apr;3(6):326-40. PMID 9384963
59. ↑ Anderlich MB American Journal of Psychiatry 2003 Feb;160(2)242-7 PMID 12562569
60. ↑ Pinto A, Mancebo MC, Eisen JL, Pagano ME, Rasmussen SA. The Brown Longitudinal Obsessive Compulsive Study: clinical features and symptoms of the sample at intake. Clin Psychiatry. 2006 May;67(5):703-11.PMID 16841619
61. ↑ Lucka I, Cebella A. Characteristics of the forming personality in children suffering from anorexia nervosa Psychiatr Pol. 2004 Nov-Dec;38(6):1011-8.PMID 15779665
62. ↑ Bulimia nervosa and attention deficit hyperactivity disorder: a possible role for stimulant medication. Dukarm CP. J Women's Health (Larchmt). 2005 May;14(4):345-50. PMID 15916509
63. ↑ Mikami AY et, el.Bulimia nervosa symptoms in the Multimodal Treatment Study of Children with ADHD. Int J Eat Disord. 2009 Apr 17 PMID 19378318
64. ↑ Biederman J. et al.Are girls with ADHD at risk for eating disorders? Results from a controlled, five-year prospective study. J Dev Behav Pediatr. 2007 Aug;28(4):302-7. PMID 17700082
65. ↑ Cortese S. et al.Attention-deficit/hyperactivity disorder (ADHD) and binge eating Nutr Rev. 2007 Sep;65(9):404-11. Nutr Rev. 2008 Jun;66(6):357. PMID 17958207
66. ↑ Bruce KR et, al.Bulimia nervosa with co-morbid avoidant personality disorder: behavioural characteristics and serotonergic function. Psychol Med. 2004 Jan;34(1):113-24.PMID 14971632
67. ↑ Podar I, Hannus A, et.al.Personality and affectivity characteristics associated with eating disorders: a comparison of eating disordered, weight-preoccupied, and normal samples .J Pers Assess. 1999 Aug;73(1):133-47.PMID 10497805
68. ↑ Gardini S et al.Individual differences in personality traits reflect structural variance in specific brain regions. Brain Res Bull. 2009 Jun 30;79(5):265-70. Epub 2009 Mar 28. PMID 19480986
69. ↑ Marsh AA et al. Reduced amygdala response to fearful expressions in children and adolescents with callous-unemotional traits and disruptive behavior disorders. Am J Psychiatry. 2008 Jun;165(6):712-20. Epub 2008 Feb 15. PMID 18281412
70. ↑ Iidaka T et al. Volume of left amygdala subregion predicted temperamental trait of harm avoidance in female young subjects. A voxel-based morphometry study. Brain Res. 2006 Dec 13;1125(1):85-93. Epub 2006 Nov 17. PMID 17113049
71. ↑ Rubino V et al.Activity in medial prefrontal cortex during cognitive evaluation of threatening stimuli as a function of personality style.
72. ↑ Spinella M, Lyke J. Executive personality traits and eating behavior. Int J Neurosci. 2004 Jan;114(1):83-93. PMID 14660070
73. ↑ Sinai C. et.al.Thyroid hormones and personality traits in attempted suicide. Psychoneuroendocrinology. 2009 Nov;34(10):1526-32. Epub 2009 Jun 13.PMID 19525070
74. ↑ Thompson RL, Brossart DF, Carlozzi AF, Miville ML. Five-factor model (Big Five) personality traits and universal-diverse orientation in counselor trainees. J Psychol. 2002 Sep;136(5):561-72.PMID 12431039
75. ↑ DeYoung CG, Peterson JB, Higgins DM.J Pers. Sources of openness/intellect: cognitive and neuropsychological correlates of the fifth factor of personality.2005 Aug;73(4):825-58.PMID 15958136
76. ↑ MacLaren VV, Best LA.Female students' disordered eating and the big five personality facets. Eat Behav. 2009 Aug;10(3):192-5. Epub 2009 Apr 17.PMID 19665103
77. ↑ Heaven PC, Mulligan K, Merrilees R, Woods T, Fairooz Y. Neuroticism and conscientiousness as predictors of emotional, external, and restrained eating behaviors. Int J Eat Disord. 2001 Sep;30(2):161-6.PMID 11449449
78. ↑ Casper RC, Hedeker D, McClough JF. Personality dimensions in eating disorders and their relevance for subtyping. J Am Acad Child Adolesc Psychiatry. 1992 Sep;31(5):830-40.PMID 1400113
79. ↑ Luo X, Kranzler HR, Zuo L, Wang S, Gelernter J. Personality Traits of Agreeableness and Extraversion are Associated with ADH4 VariationBiol Psychiatry. 2007 Mar 1;61(5):599-608. Epub 2006 Oct 25.PMID 17069770
80. ↑ Wright CI. et. al.Neuroanatomical correlates of extraversion and neuroticism. Cereb Cortex. 2006 Dec;16(12):1809-19. Epub 2006 Jan 18.PMID 16421327
81. ↑ Mendez MF, Chen AK, Shapira JS, Lu PH, Miller BL.Acquired extroversion associated with bitemporal variant of frontotemporal dementia. J Neuropsychiatry Clin Neurosci. 2006 Winter;18(1):100-7.PMID 16525077
82. ↑ Rankin KP. et.al.Right and left medial orbitofrontal volumes show an opposite relationship to agreeableness in FTD. Dement Geriatr Cogn Disord. 2004;17(4):328-32.PMID 15178947
83. ↑ Graziano WG, Tobin RM.Agreeableness: dimension of personality or social desirability artifact? Bergeman CS et.al. Genetic and environmental effects on openness to experience, agreeableness, and conscientiousness: an adoption/twin study. J Pers. 1993 Jun;61(2):159-79.PMID 8345444
84. ↑ J Pers. 2002 Oct;70(5):695-727. PMID 12322857
85. ↑ Miller JL et.al.Neuroticism and introversion: a risky combination for disordered eating among a non-clinical sample of undergraduate women. Eat Behav. 2006 Jan;7(1):69-78. Epub 2005 Aug 1. PMID 16360625
86. ↑ Takano A,et.al. Relationship between neuroticism personality trait and serotonin transporter binding. Biol Psychiatry. 2007 Sep 15;62(6):588-92. Epub 2007 Mar 6. PMID 17336939
87. ↑ Deckersbach T, 'et al..Regional cerebral brain metabolism correlates of neuroticism and extraversion. Depress Anxiety. 2006;23(3):133-8. PMID 16470804
88. ↑ Button EJ Self esteem, eating problems and psychological wellbeing in a cohort of school age 15-16: question and interview PMID 8986516Int J Eat Disord 1997 Jan;21(1):39-41
89. ↑ Strober M.,Personality factors in anorexia nervosa.,Pediatrician. 1983-1985;12(2-3):134-8. PMID 6400211
90. ↑ Eiber R et al..Self-esteem: a comparison study between eating disorders and social phobia. Encephale. 2003 Jan-Feb;29(1):35-41. PMID 12640325
91. ↑ Favaro A, Tenconi E, Santonastaso P.The relationship between obstetric complications and temperament in eating disorders: a mediation hypothesis. Psychosom Med. 2008 Apr;70(3):372-7. Epub 2008 Feb 6.PMID 18256341
92. ↑ Iidaka T. et.al. Volume of left amygdala subregion predicted temperamental trait of harm avoidance in female young subjects. A voxel-based morphometry study. Brain Res. 2006 Dec 13;1125(1):85-93. Epub 2006 Nov 17.PMID 17113049
93. ↑ Peterson CB.Personality dimensions in bulimia nervosa, binge eating disorder, and obesity. Compr Psychiatry. 2010 Jan-Feb;51(1):31-6. Epub 2009 May 2. PMID 19932823
94. ↑ Gardini S, Cloninger CR, Venneri A.Individual differences in personality traits reflect structural variance in specific brain regions. Brain Res Bull. 2009 Jun 30;79(5):265-70. Epub 2009 Mar 28.PMID 19480986
95. ↑ Halmi KA et al.Perfectionism in anorexia nervosa: variation by clinical subtype, obsessionality, and pathological eating behavior. Am J Psychiatry. 2000 Nov;157(11):1799-805. PMID 11058477
96. ↑ Ruggiero GM ..et al.Stress situation reveals an association between perfectionism and drive for thinness. Int J Eat Disord. 2003 Sep;34(2):220-6. PMID 12898558
97. ↑ Hewitt PL et.al."The impact of perfectionistic self-presentation on the cognitive, affective, and physiological experience of a clinical interview Psychiatry. 2008 Summer;71(2):93-122. PMID 18573033
98. ↑ Frewen PA, Pain C, Dozois DJ, Lanius RA. Alexithymia in PTSD: psychometric and FMRI studies. Ann N Y Acad Sci. 2006 Jul;1071:397-400.PMID 16891585
99. ↑ O Guilbaud et, al. Alexithymia and depression in eating disorders Encephale. 2000 Sep-Oct(5);1-6 PMID 11192799
100. ↑ Smith GJ.et, al.Alexithymia in patients with eating disorders: an investigation using a new projective technique. Percept Mot Skills. 1997 Aug;85(1):247-56. PMID 9293583
101. ↑ Peskine A, Picq C, Pradat-Diehl P.Brain Inj. Cerebral anoxia and disability. 2004 Dec;18(12):1243-54.PMID 15666568
102. ↑ Ho AK, Robbins AO, Barker RAHuntington's disease patients have selective problems with insightMov Disord. 2006 Mar;21(3):385-9. PMID 16211608
103. ↑ Tchanturia K et al.Perceptual illusions in eating disorders: rigid and fluctuating styles Behav Ther Exp Psychiatry. 2001 Sep;32(3):107-15. PMID 11934124
104. ↑ Cserjési R.Affect, cognition, awareness and behavior in eating disorders. Comparison between obesity and anorexia nervosa. Orv Hetil. 2009 Jun 1;150(24):1135-43. PMID 19482720
105. ↑ Bechara A, Damasio AR, Damasio H, Anderson SW. Insensitivity to future consequences following damage to human prefrontal cortex. Cognition. 1994 Apr-Jun;50(1-3):7-15.PMID 8039375
106. ↑ Eysenck SB, Eysenck HJ.The place of impulsiveness in a dimensional system of personality description Br J Soc Clin Psychol. 1977 Feb;16(1):57-68. PMID 843784
107. ↑ Welch SL, Fairburn CG. Impulsivity or comorbidity in bulimia nervosa. A controlled study of deliberate self-harm and alcohol and drug misuse in a community sample. Br J Psychiatry. 1996 Oct;169(4):451-8. PMID 8894196
108. ↑ Corstorphine E et al. Trauma and multi-impulsivity in the eating disorders. Eat Behav. 2007 Jan;8(1):23-30. Epub 2004 Sep 22. PMID 17174848
109. ↑ Patton JH, Stanford MS, Barratt ES. J Clin Psychol. 1995 Nov;51(6):768-74. Factor structure of the Barratt impulsiveness scale. PMID 8778124
110. ↑ Chamberlain SR, Sahakian BJ. The neuropsychiatry of impulsivity Curr Opin Psychiatry. 2007 May;20(3):255-61. PMID 17415079
111. ↑ Smith CF.Association of dietary restraint and disinhibition with eating behavior, body mass, and hunger. Eat Weight Disord. 1998 Mar;3(1):7-15.PMID 11234257
112. ↑ Bryant EJ, King NA, Blundell JE. Disinhibition: its effects on appetite and weight regulation. Obes Rev. 2008 Sep;9(5):409-19. Epub 2007 Dec 26.PMID 18179615
113. ↑ Personality and substance dependence symptoms: modeling substance-specific traits. Grekin ER, Sher KJ, Wood PK. Psychol Addict Behav. 2006 Dec;20(4):415-24.PMID 17176176
114. ↑ Young SE et. al.Genetic and environmental influences on behavioral disinhibition Am J Med Genet. 2000 Oct 9;96(5):684-95.PMID 11054778
115. ↑ Young SE et.al.Behavioral disinhibition: liability for externalizing spectrum disorders and its genetic and environmental relation to response inhibition across adolescence. J Abnorm Psychol. 2009 Feb;118(1):117-30.PMID 19222319
116. ↑ Emond V, Joyal C, Poissant H.Structural and functional neuroanatomy of attention-deficit hyperactivity disorder (ADHD) Encephale. 2009 Apr;35(2):107-14. Epub 2008 Jul 7.PMID 19393378
117. ↑ Spiegel DR.,Qureshi N., The successful treatment of disinhibition due to a possible case of non-human immunodeficiency virus neurosyphilis: a proposed pathophysiological explanation of the symptoms and treatment.doi:10.1016/j.genhosppsych.2009.01.002
118. ↑ Aarsland D, Litvan I, Larsen JP Neuropsychiatric symptoms of patients with progressive supranuclear palsy and Parkinson's disease. J Neuropsychiatry Clin Neurosci. 2001 Winter;13(1):42-9.PMID 11207328
119. ↑ Zubieta JK. Obsessionality in eating-disorder patients: relationship to clinical presentation and two-year outcome. J Psychiatr Res. 1995 Jul-Aug;29(4):333-42.PMID 8847659
120. ↑ Salkovskis PM, Forrester E, Richards C. Cognitive-behavioural approach to understanding obsessional thinking. Br J Psychiatry Suppl. 1998;(35):53-63. PMID 9829027
121. ↑ Corcoran KM, Woody SR. Appraisals of obsessional thoughts in normal samples. Behav Res Ther. 2008 Jan;46(1):71-83. PMID 18093572
122. ↑ Horish N et al. Abnormal, psychosocial situations and eating disorders in adolescence. J.Am. Acad. Child Adolesc Psychiatry 1996 July;35(7) 921-7 PMID 8768353
123. ↑ Kopp et al.The fatal outcome of an individual with anorexia nervosa...OBJECTIVES:: To illustrate the close association between a disturbed psychosocial up-bringing, frequent physical illness, and medical interventions Int J Eat Disord. 2009 Feb 26;43(1):93-96. PMID 19247986
124. ↑ Rayworth BB, Wise LA, Harlow BL. Childhood abuse and risk of eating disorders in women. Epidemiology. 2004 May;15(3):271-8. PMID 15097006
125. ↑ Wonderlich SA,et, al., Relationship of childhood sexual abuse to eating disorders J. Am Acad Child Adolesc. Psychiatry Aug;36(8):110715 PMID 9256590
126. ↑ Feldman MB, Meyer IH.Childhood abuse and eating disorders in gay and bisexual men. Int J Eat Disord. 2007 Jul;40(5):418-23. PMID 17506080
127. ↑ Rohde P.et.al.Associations of child sexual and physical abuse with obesity and depression in middle-aged women. Child Abuse Negl. 2008 Sep;32(9):878-87. Epub 2008 Oct 22. PMID 18945487
128. ↑ Williamson DF.Body weight and obesity in adults and self-reported abuse in childhood. Int J Obes Relat Metab Disord. 2002 Aug;26(8):1075-82.PMID 12119573
129. ↑ Waller G. Sexual abuse and the severity of bulimic symptoms. Br J Psychiatry. 1992 Jul;161:90-3. PMID 1638336
130. ↑ Waller G, Halek C, Crisp AH. Sexual abuse as a factor in anorexia nervosa: evidence from two separate case series. J Psychosom Res. 1993 Dec;37(8):873-9. PMID 8301627
131. ↑ Troop NA, Bifulco A. Childhood social arena and cognitive sets in eating disorders. Br J Clin Psychol. 2002 Jun;41 (Pt 2):205-11. PMID 12034006
132. ↑ Nonogaki K, Nozue K, Oka Y. Social isolation affects the development of obesity and type 2 diabetes in mice. Endocrinology. 2007 Oct;148(10):4658-66. Epub 2007 Jul 19. PMID 17640995
133. ↑ Esplen MJ et al..Relationship between self-soothing, aloneness, and evocative memory in bulimia nervosa. Int J Eat Disord. 2000 Jan;27(1):96-100. PMID 10590454
134. ↑ Larson R, Johnson C. Bulimia: disturbed patterns of solitude. Addict Behav. 1985;10(3):281-90. PMID 3866486
135. ↑ Johnson JG,et al.Childhood adversities associated with risk for eating disorders or weight problems during adolescence or early adulthood. Am J Psychiatry. 2002 Mar;159(3):394-400. PMID 11870002
136. ↑ Klesges RCJ Parental influences on children's eating behavior and relative weight. Appl Behav Anal. 1983 Winter;16(4):371-8.PMID 6654769
137. ↑ Galloway AT et al.Parental pressure, dietary patterns, and weight status among girls who are "picky eaters".J Am Diet Assoc. 2005 Apr;105(4):541-8. PMID 15800554
138. ↑ Jones C, Harris G, Leung N.Parental rearing behaviours and eating disorders: the moderating role of core beliefs. Eat Behav. 2005 Dec;6(4):355-64. Epub 2005 Jun 13. PMID 16257809
139. ↑ Children's eating attitudes and behaviour: a study of the modelling and control theories of parental influence. Brown R, Ogden J. Health Educ Res. 2004 Jun;19(3):261-71. PMID 15140846
140. ↑ Savage JS, Fisher JO, Birch LL. Parental influence on eating behavior: conception to adolescence. J Law Med Ethics. 2007 Spring;35(1):22-34. PMID 17341215
141. ↑ Page RM, Suwanteerangkul J.Dieting among Thai adolescents: having friends who diet and pressure to diet. Eat Weight Disord. 2007 Sep;12(3):114-24. PMID 17984635
142. ↑ The McKnight Investigators. Risk factors for the onset of eating disorders in adolescent girls: results of the McKnight longitudinal risk factor study. Am J Psychiatry. 2003 Feb;160(2):248-54.PMID 12562570
143. ↑ Paxton SJ et, al. Friendship clique and peer influences on body image concerns, dietary restraint, extreme weight-loss behaviors, and binge eating in adolescent girls. J Abnorm Psychol. 1999 May;108(2):255-66. PMID 10369035
144. ↑ Rukavina T, Pokrajac-Bulian A. Eat Weight Disord. 2006 Mar;11(1):31-7. Thin-ideal internalization, body dissatisfaction and symptoms of eating disorders in Croatian adolescent girls. PMID 16801743
145. ↑ Garner DM, Garfinkel PE.Socio-cultural factors in the development of anorexia nervosa. Psychol Med. 1980 Nov;10(4):647-56. PMID 7208724
146. ↑ Eisenberg ME, Neumark-Sztainer D, Story M, Perry C.The role of social norms and friends' influences on unhealthy weight-control behaviors among adolescent girls. Soc Sci Med. 2005 Mar;60(6):1165-73. PMID 15626514