MedicalResearch.com Interview with:
Lauren Breithaupt, PhD
Department of Psychology
George Mason University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Our study provides novel insight into the relationship between the immune system and eating disorders characterized by chronic restriction (e.g., anorexia nervosa) and binge eating and/or purging (e.g., binge eating disorder, bulimia nervosa). These findings also add to the growing body of literature linking the immune systems broadly and mental disorders.
We found that infections in early childhood were associated with an increased risk of anorexia nervosa, bulimia nervosa, and other eating disorders such as binge eating disorder in adolescence. These relationships appear to be both time and dose-dependent, meaning that the onset of eating disorder diagnosis is greatest in the first three months following the infection, and the more infections, the greater the risk.
MedicalResearch.com: What should readers take away from your report?
Response: Both neuroinflammation and pathogens may be at play.
Commonly reported symptoms of both infections and inflammation include loss of appetite and decreased food intake. In vulnerable populations, these changes may increase the risk of eating disorder development.
In addition, contracting an infection and taking anti-infective agents can alter the stability of the microbes that inhabit our gut. A large nerve, called the vagus nerve, runs from the brain all the way to the abdomen. This connection between the gut and the brain is called the gut-brain axis. Changes in microbiota from infections or ingestion of anti-infective agents could affect behaviors via communication from the gut-brain axis.
Rapid onset of restrictive eating has been reported in patients after a variety of infections such as rheumatic fever, streptococcal infection (i.e., strep throat), viral meningitis, mycoplasma pneumonia, coccidioidomycosis, and influenza and rapid reduced and restricted food intake following an infection is a core symptoms of the pediatric acute-onset neuropsychoatric syndrome known as PANS.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We are looking forward to continuing to explore the complex interplay between the immune system and eating disorders. For example, my team and I at the Massachusetts General Hospital Eating Disorder and Clinical Research Program (MGH EDCR) are currently exploring the gut-brain axis in a study of low-weight adolescents with a spectrum of eating disorders. We are also hoping to study the response to Cognitive Behavioral Treatment for Avoidant Restrictive Food Intake Disorder (CBT-AR; developed at the MGH EDCRP by my colleague Drs. Jennifer J. Thomas & Kamryn T. Eddy) in kids with PANS/PANDAS selective eating subtypes given the paucity of treatments available for these kids.
Most of the infections that we studied are common infections, such as respiratory and gastrointestinal infections. It is important to note that the majority of kids with a common infection will not go on to develop an eating disorder and infections themselves are necessary for adolescents for the normal development of the immune system.
MedicalResearch.com: Is there anything else you would like to add?
Response: As a clinician and a scientist, I hope that this study encourages the vigilance of detection of eating disorder symptoms from both providers and parents of children. If you notice symptoms of an eating disorder in your child, seeking a diagnostic evaluation from a professional and beginning evidence-based treatment early will lead to restored health.
Breithaupt L, Köhler-Forsberg O, Larsen JT, et al. Association of Exposure to Infections in Childhood With Risk of Eating Disorders in Adolescent Girls. JAMA Psychiatry. Publishe https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2731310
April 24, 2019. doi:10.1001/jamapsychiatry.2019.0297
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