Thinking Outside the Box in Anorexia Nervosa Research

By Laura Mackew, Research Assistant, Clinical Research

Anorexia Nervosa is a serious and often life threatening psychiatric condition, with a broad spectrum of impact, affecting those diagnosed as well as their family members and friends. It is a very complex disorder, characterized by behavioral and psychological disturbances. Behaviourally there is disturbed eating behavior such as severe caloric restriction, and in some cases, binge eating and purging and compulsive exercising. Psychological disturbances include high levels of obsessionality, perfectionism. and body image disturbance as well as depression and anxiety.

Current treatment approaches for anorexia nervosa may include psychotherapy, medication or a combination of approaches; however, no single treatment has empirical evidence-based support. It has become clear to many in the field that in order to identify evidenced-based treatments for anorexia nervosa, researchers need to be innovative and think outside the box.

In fact, there are three important studies currently underway – two that are investigating new treatment approaches and one aimed at uncovering potential underlying neurobiological disturbances in the disorder:

• In one study, CAMH, in collaboration with Columbia University in New York and three other sites in the US, is conducting a randomized clinical trial looking at a new outpatient medication treatment option that may be helpful for people with anorexia nervosa, particularly with unstable mood states and high levels of anxiety.Importantly, participants in this study are able to continue to receive their standard medications and/or psychotherapeutic interventions while in the trial.
• The second study employs a new mode of treatment called repetitive transamagnetic stimulation (rTMS). rTMS is an outpatient very well tolerated intervention that has been shown to be helpful in the treatment of depression and related conditions.For the first time anywhere, researchers at CAMH are able to offer an rTMS treatment specific for anorexia nervosa. This involves a customized form of rTMS that targets deeper areas of the brain thought to play a role in the disorder but was unattainable with previously available technology.
• Our third important study aims to further our understanding about the brain of people with anorexia nervosa by comparing the structural integrity of brain fibers within several neural circuits and the functional impairments that result from these abnormalities in circuitry. It is thought that such abnormalities may be important in the development and/ or chronicity of the disorder.

Researchers hope this study will lead to the identification of biomarkers which may assist with future diagnosis and treatment. The study involves Magnetic Resonance Imaging (MRI), a painless procedure that produces a scan of the brain using magnetic fields (not x-rays or radiation). During the scan, a diffusion tensor protocol will be implemented, allowing for 3D reconstruction of functional circuits.

Through these studies, investigators at CAMH are utilizing cutting edge techniques and technology in order to further our understanding of anorexia nervosa as well as to uncover effective pharmacological and non-pharmacologically based treatment approaches.

To find out more about any of these study please visit “Find a CAMH Study” (use keyword anorexia nervosa).