Anorexia nervosa (AN)

Question 1

What are the main DSM-V criteria for AN?

Answer 1

A) Restriction of energy intake relative to requirements, leading to low body weight
B) Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain
C) Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

Question 2

In which cases is tube feeding necessary?

Answer 2

• If people stay for too long on very low weight, the brain can be impaired (frontal cortex is working less good). Tube feeding stabilizes the patient, thus, enables them to be treated with psychotherapy (CBT, Schema,…)
• if the patient is in danger to die due to the low body weight

Question 3

Is AN a common disorder?

Answer 3

No, only 0.6% of young females.

Question 4

Why is AN one of the psychiatric disorder with the highest mortality rate?

Answer 4

AN is very difficult to treat.

Question 5

What different types of body estimation exist?

Answer 5

A) visual experiences of body estimation -> “I see that I am fat.”
B) Cognitive experiences of body estimation -> “I think that I am fat.”
C) Tactile experiences of body estimation -> “I feel that I am fat.”

Question 6

How is the internal model of our body called?

Answer 6

Blueprint

Question 7

What are bodily cognitions?

Answer 7

emotions, attitudes, semantics

Question 8

What is bodily perception?

Answer 8

visual, and tactile perception

Question 9

What is bodily action?

Answer 9

planning/execution of motor action

Question 10

What forms the blueprint of our body?

Answer 10

The input from multiple senses contributes to building the blueprint of our body and its size in the brain.

Question 11

Does the Homunculus show our body representation?

Answer 11

No, the homunculus is used as a presentation of our body in the brain, but it has nothing to do with our body representation.

Question 12

Can body representation be seen as one image?

Answer 12

No, body representation does not depend only on visual perception, it is also formed by semantic perceptions.

Question 13

Why is our body representation crucial for our daily life?

Answer 13

We need it to survive (evolutionary aspect). It prevents us from bumping into objects, hitting the mosquito on our arm without even seeing it (the tactile stimulus is enough)….

Question 14

What is body representation?

Answer 14

Body representation is:
- the internal model of our body (blueprint)
- constructed from multi-sensory information
- formed by abstract information, not only an ‘image’!
- crucial in daily life for: bodily cognition/affect, bodily perception and motor action

Question 15

How is body image disturbance (BID) defined?

Answer 15

the incorrect notion of one’s own body size or shape

Question 16

How does the body scaled action differ in an AN patient compared to healthy controls?

Answer 16

the AN patient moves as if they are bigger than they are
-> Study example:
- AN patients and healthy controls were asked to go through a space between two walls
- Results: HC rotated their shoulders significantly at a later time point (smaller space) than AN participants,
-> AN participants overestimated the width of their shoulders

Question 17

What is the rubber hand illusion?

Answer 17

The illusion comes on when the real and fake hands are stroked at the same time (synchronous). In combining the visual information with the touch sensations, the brain mistakenly concludes that the rubber hand must be part of the person’s body (feeling of embodiment).

Question 18

What showed the rubber hand illusion in AN patients?

Answer 18

Before the illusion AN patients estimated their hands bigger than they were. After the rubber hand illusion, the estimation of their hand decreased in both conditions (synchronous and asynchronous -> feeling of embodiment was not necessarily needed)

Question 19

What showed the Virtual reality full body illusion on body image disturbance in AN patients?

Answer 19

Body size perceptions in AN is flexible even more for emotional body parts (eg.: belly, hips, thighs) and improved body size estimation remains over time

Question 20

Is it possible to update the body representation of a person?

Answer 20

Yes. Example: Pregnant woman: in the beginning they bump into objects, but brain can update their body representation and then they don’t bump into objects anymore

Question 21

Explain the hoop intervention and the underlying aspects and factors.

Answer 21

Hoops in different sizes are on the floor. The AN patient has to decide which hoop fits for his/her body to go through it (repeated over 8 weeks). While choosing the hoops it’s suggested to talk about the emotional body parts and the reasoning why the patient chooses this hoop. Most important aspect is that the patient has to experience on their own that they fit easily through the chosen hoop (overestimation of body size) -> just by telling an AN patient its not gonna work, he/she needs to experience it -> no chance for excuses why this can’t be true

Question 22

Why is it difficult (probably impossible) to update their body representation automatically/on their own?

Answer 22

AN patients always overestimate their body size, thus, they don’t bump into objects for example -> brain can not learn