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Eating Disorders

Anorexia nervosa and autoimmune comorbidities: A bidirectional route?
Sirufo MM, Magnanimi LM, Ginaldi L, De Martinis M. Anorexia nervosa and autoimmune comorbidities: A bidirectional route? CNS Neurosci Ther. 2022 Dec;28(12):1921-1929. doi: 10.1111/cns.13953. Epub 2022 Sep 16. PMID: 36114699; PMCID: PMC9627382.
In this review, in addition to reporting the numerous cases described in which autoimmune disorders are associated with anorexia or vice versa, we summarize the many aspects of this relationship between the immune system (IS) and AN. We describe how the microbiota affects the IS, disrupts gut-brain communication, and possibly triggers eating disorders. We also describe the shared immunological pathways of autoimmune and eating disorders and in particular the occurrence of disrupted T cell tolerance and autoantibodies in AN. The described observations represent the starting point for possible, future research directions.
Prevalence of PANS in Child Prevalence of pediatric acute-onset neuropsychiatric syndrome (PANS) in children and adolescents with eating disorders Adolescent Eating Disorders
Prevalence of PANS in Child and Adolescent Eating Disorders
Marya Aman, Jennifer Coelho, BoyeeLin, Cynthia Lu, Shannon Zaitsoff, John Best and S. Evelyn StewartBC Children’s Hospital Research Institute, University of British Columbia
“Conclusion
  •  The surprisingly high lifetime PANS rate of 52% within pediatric ED were higher than that previously reported for OCD populations. The large majority had abrupt onset of parent- reported OC symptoms as well as abrupt food restriction.
  • Those in the PANS group were more likely to be female, be prescribed an SSRI, and have parent reported abrupt OC symptom onset, abrupt food refusal, relapsing and remitting course, and concurrent anxiety, depression, irritability or aggression, behavioural regression, school deterioration, and sleep problems, enuresis, and/or frequent urination.
  • This appears to be a distinct subgroup that requires further characterization with respect to functional impacts and management approaches.”
Bidirectional relationship between eating disorders and autoimmune diseases
Hedman A, Breithaupt L, Hübel C, Thornton LM, Tillander A, Norring C, Birgegård A, Larsson H, Ludvigsson JF, Sävendahl L, Almqvist C, Bulik CM. Bidirectional relationship between eating disorders and autoimmune diseases. J Child Psychol Psychiatry. 2019 Jul;60(7):803-812. doi: 10.1111/jcpp.12958. Epub 2018 Sep 3. PMID: 30178543.

Conclusions: The interactions between EDs and autoimmune diseases support the previously reported associations. The bidirectional risk pattern observed in women suggests either a shared mechanism or a third mediating variable contributing to the association of these illnesses.

Association of Exposure to Infections in Childhood With Risk of Eating Disorders in Adolescent Girls
Breithaupt L, Köhler-Forsberg O, Larsen JT, Benros ME, Thornton LM, Bulik CM, Petersen L. Association of Exposure to Infections in Childhood With Risk of Eating Disorders in Adolescent Girls. JAMA Psychiatry. 2019 Aug 1;76(8):800-809. doi: 10.1001/jamapsychiatry.2019.0297. Erratum in: JAMA Psychiatry. 2019 May 8;: PMID: 31017632; PMCID: PMC6487907.

In a Danish population-based cohort study of 525 643 adolescent girls, a prior infection in childhood was associated with an increased risk of later anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified.

The findings suggest that hospital-treated infections and less severe infections treated with anti-infective agents are associated with increased risk of subsequent anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified and that future studies should investigate whether these associations are causal and identify the exact mechanisms between infections and subsequent inflammatory processes with eating disorders.

PANDAS and anorexia nervosa-a spotters’ guide: Suggestions for medical assessment
Vincenzi B, O’Toole J, Lask B. PANDAS and anorexia nervosa–a spotters’ guide: suggestions for medical assessment. Eur Eat Disord Rev. 2010 Mar;18(2):116-23. doi: 10.1002/erv.977. PMID: 20148396.
Conclusion: Given the current state of knowledge, diagnosingPANDAS is extraordinarily difficult. However, extrapolating from knowledge aboutSydenham’s choreaandPANDAS–OCD and PANDAS–tics/TS, a heightened index of suspicion for the existence of an auto-immune reaction in the brain response to environmental infectious agents culminating in ‘anorexia nervosa’ should be maintained.