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Researchers Dig Deeper Into Neuropsychology of Anorexia

Recent findings from a team of Norwegian and British researchers indicate that girls and women with anorexia may compulsively check their bodies because they have unusual difficulty switching between mental tasks, although the evidence is far from conclusive. Women affected by the eating disorder anorexia nervosa commonly display a compulsive need to examine their bodies and pass (generally negative) judgment on their physical appearance. In a study published in April 2015 in the Journal of Eating Disorders, researchers from two Norwegian institutions and two British institutions explored a possible explanation for this compulsive behavior: an unusual inability to shift fluidly between various mental tasks. The researchers concluded that such an inability may help explain anorexia-related compulsive body checking, although they could not identify a consistent pattern in the study participants.

Anorexia Nervosa and Body Checking

Anorexia nervosa is defined by the American Psychiatric Association as a mental health condition belonging to a larger group of conditions known officially as feeding and eating disorders. All people with diagnosable cases of the disorder have ongoing problems keeping their weight within at least 15 percent of the generally accepted norm for their age, height and gender. Underlying these problems are symptoms that include a profound desire to avoid gaining weight, an inability to accurately judge one’s body weight or body image relative to others and lack of understanding of the potentially severe physical and mental repercussions of maintaining a seriously low body weight. Women with anorexia also commonly develop a condition called amenorrhea, characterized by a persistent lack of a monthly menstruation.  Most people affected by the disorder are teenage girls or women in the early stages of adulthood. People with anorexia typically repeatedly check their bodies to look for signs of weight gain and keep track of their appearance. Specific examples of anorexia-related body-checking behaviors include such things as pinching skin and fat in various body areas, monitoring the contours of protruding bones and repeatedly looking for any upward fluctuations in body weight. Broadly speaking, these behaviors are consciously or unconsciously intended to reduce anxiety levels in affected individuals. However, in reality, they commonly have the opposite effect and make people with anorexia more susceptible to the disorder’s damaging impact.

Mental Flexibility

In order to remain alert to shifting circumstances, all human beings must appropriately move between various mental states and focus on key features in their ever-changing internal and external environments. Psychologists and psychiatrists sometimes refer to this ability as set-shifting; it develops gradually during childhood, adolescence and early adulthood as part of a larger grouping of higher-level mental skills known collectively as executive function. People who demonstrate poor set-shifting may develop unusually rigid, obsessive or compulsive behavior.

Anorexia, Set-Shifting and Body Checking

Problems with set-shifting are common in people with anorexia. In the study published in the Journal of Eating Disorders, researchers from Norway’s Oslo University Hospital and Clinical Neuroscience Research Group and the United Kingdom’s Care UK and Great Ormond Street Hospital for Children used a project involving 75 teenagers and young women to explore the connection between set-shifting difficulties and classic anorexia-related body-checking behaviors. Thirty of the study participants had diagnosed cases of anorexia nervosa, while the remaining 45 participants were unaffected by the disorder and acted as a generally healthy comparison group. The researchers used a screening tool called the Body Checking Questionnaire to gauge the extent of body-checking behavior in the teens and women in both groups. In addition, they used a screening tool called the Wisconsin Card Sorting Test to gauge set-shifting abilities in all of the participants. The researchers confirmed the relative lack of set-shifting ability in the girls and women affected by anorexia; they characterized the degree of this lack as medium-to-large in comparison to the girls and women unaffected by the disorder. However, when the researchers compared the level of body-checking behavior in the two groups, they could find no consistent link between poor set-shifting skills and increased involvement in such behavior. The study’s authors note that their findings may point to a lack of a connection between poor mental flexibility and compulsive body checking in girls and women with anorexia. However, they also note that several explanations may account for an apparent (but not actual) disconnection, including a relatively narrow range of anorexia-related problems in their small participant group and an insufficient understanding of the ways in which poor set-shifting influences anorexia-related body-checking behaviors.

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