Successful control of affect partly depends on the capacity to modulate negative emotional responses through the use of cognitive strategies (i.e., reappraisal). Recent studies suggest the involvement of frontal cortical regions in the modulation of amygdala reactivity and the mediation of effective emotion regulation. However, within-subject inter-regional connectivity between amygdala and prefrontal cortex in the context of affect regulation is unknown. Here, using psychophysiological interaction analyses of functional magnetic resonance imaging data, we show that activity in specific areas of the frontal cortex (dorsolateral, dorsal medial, anterior cingulate, orbital) covaries with amygdala activity and that this functional connectivity is dependent on the reappraisal task. Moreover, strength of amygdala coupling with orbitofrontal cortex and dorsal medial prefrontal cortex predicts the extent of attenuation of negative affect following reappraisal. These findings highlight the importance of functional connectivity within limbic-frontal circuitry during emotion regulation.

Objective-The Diagnostic and Statistical Manual of Mental Disorders (DSM) is designed primarily as a clinical tool. Yet high rates of diagnostic "crossover" among the anorexia nervosa subtypes and bulimia nervosa may reflect problems with the validity of the current diagnostic schema, thereby limiting its clinical utility. This study was designed to examine diagnostic crossover longitudinally in anorexia nervosa and bulimia nervosa to inform the validity of the DSM-IV-TR eating disorders classification system.Method-A total of 216 women with a diagnosis of anorexia nervosa or bulimia nervosa were followed for 7 years; weekly eating disorder symptom data collected using the Eating Disorder Longitudinal Interval Follow-Up Examination allowed for diagnoses to be made throughout the follow-up period.Results-Over 7 years, the majority of women with anorexia nervosa experienced diagnostic crossover: more than half crossed between the restricting and binge eating/purging anorexia nervosa subtypes over time; one-third crossed over to bulimia nervosa but were likely to relapse into anorexia nervosa. Women with bulimia nervosa were unlikely to cross over to anorexia nervosa.Conclusions-These findings support the longitudinal distinction of anorexia nervosa and bulimia nervosa but do not support the anorexia nervosa subtyping schema.With the preparation for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders under way, the validity of the DSM-IV-TR classification system for eating disorders has been called into question (1). In the current diagnostic system, anorexia nervosa and bulimia nervosa are recognized as full syndrome eating disorders with specific criteria sets. DSM is designed to serve primarily as a clinical tool, providing "clear descriptions of diagnostic categories in order to enable clinicians and investigators to diagnose, communicate about, study, and treat people with various mental disorders" (DSM-IV-TR, p. xxxvii). Yet the high rates of diagnostic "crossover," such as movement from anorexia nervosa to bulimia nervosa, may reflect problems with the validity of the current diagnostic schema for eating disorders, thereby limiting its utility.

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Physicians treating patients with anorexia nervosa should carefully assess patterns of alcohol use during the course of care because one third of women who had alcoholism and died had no history of alcohol use disorder at intake.

At 22 years, approximately two-thirds of females with anorexia nervosa and bulimia nervosa were recovered. Recovery from bulimia nervosa happened earlier, but recovery from anorexia nervosa continued over the long term, arguing against the implementation of palliative care for most individuals with eating disorders.

Objective To investigate whether anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding and eating disorders (OSFED), including purging disorder (PD), subthreshold BN, and BED at ages 14 and 16, are prospectively associated with later depression, anxiety disorders, alcohol and substance use, and self-harm. Method Eating disorders were ascertained at 14 and 16 years of age in 6,140 youth at age 14 (58% of those eligible) and 5,069 at age 16 (52% of those eligible) as part of the prospective Avon Longitudinal Study of Parents and Children (ALSPAC). Outcomes (depression, anxiety disorders, binge drinking, drug use, deliberate self-harm, weight status) were measured using interviews and questionnaires about 2 years following predictors. Generalized estimating equation models adjusting for gender, socio-demographic variables, and prior outcome were used to examine prospective associations between eating disorders and each outcome. Results All eating disorders were predictive of later anxiety disorders. AN, BN, BED, PD, and OSFED were prospectively associated with depression (respectively AN: odds ratio [OR]=1.39 [95% CIs: 1.00-1.94]; BN: OR=3.39[1.25-9.20]; BED: OR=2.00 [1.06-3.75]; PD: OR=2.56 [1.38-4.74]). All eating disorders but AN predicted drug use and deliberate self-harm (BN: OR=5.72[2.22-14.72], PD: OR=4.88[2.78-8.57], subthreshold BN: OR=3.97[1.44-10.98], subthreshold BED: OR=2.32[1.43-3.75]). Whilst BED and BN predicted obesity (respectively OR=3.58 [1.06-12.14] and OR=6.42 [1.69-24.30]), AN was prospectively associated with underweight. Conclusions Adolescent eating disorders, including subthreshold presentations, predict negative outcomes, including mental health disorders, substance use, deliberate self-harm, and weight outcomes. This study highlights the high public health and clinical burden of eating disorders among adolescents.

Overweight, treatment-seeking adolescents with BED are clearly distinguishable from teens without the disorder on measures of eating-related psychopathology, mood, and anxiety. RECENT-BINGE, but not PAST-LOC, is also associated with significantly greater eating-related and general psychopathology.

The phenomenology of childhood and adolescent loss of control (LOC) eating is unknown. The authors interviewed 445 youths to assess aspects of aberrant eating. LOC was associated with eating NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript forbidden food before the episode; eating when not hungry; eating alone; and experiencing secrecy, negative emotions, and a sense of "numbing" while eating (ps < .01). Hierarchical cluster analysis revealed a subgroup, most of whom reported LOC eating. Cluster members reported having a trigger initiate episodes, eating while watching television, and having decreased awareness regarding the amount consumed. The authors conclude that aspects of LOC eating during youth are similar to aspects of adult episodes, but a youth-specific presentation may exist. Findings may provide an intervening point to prevent excessive weight gain and eating disorders.Keywords binge eating; loss of control eating; children; adolescentsThe prevalence of pediatric overweight has nearly tripled in recent years (Ogden et al., 2006). Overweight during youth puts individuals at high risk for becoming obese adults (Field, Cook, & Gillman, 2005;Freedman, Khan, Dietz, Srinivasan, & Berenson, 2001;Guo, Wu, Chumlea, & Roche, 2002;Whitaker, Wright, Pepe, Seidel, & Dietz, 1997;Williams, 2001). Given the serious untoward medical (Adams et al., 2006;Freedman et al., 2001) and psychosocial (Puhl & Brownell, 2002;Strauss & Pollack, 2003) consequences of excess weight, overweight during childhood and adolescence is a major public health problem. Prevention and early intervention are critical to reduce the current epidemically high prevalence of pediatric overweight (Styne, 2003). Targeting behavioral factors that promote excessive weight gain may be a potential point of intervention. However, clarification of relevant behavioral factors is required before prevention efforts may be designed and implemented.Binge eating is defined as eating a large amount of food given the context, during which a sense of lack of control over eating is experienced (American Psychiatric Association [APA], 2000). Recurrent binge eating is the hallmark behavior of binge eating disorder BED; (APA, 2000). Compared to obese adults without an eating disorder, adults with BED suffer from poorer physical health (J. G. Johnson, Spitzer, & Williams, 2001) and higher levels of eating disorder psychopathology (e.g., Masheb & Grilo, 2000;Wilfley et al., 2000) and are more likely to be diagnosed with a comorbid psychiatric disorder (e.g., Marcus, 1995;Wilfley et al., 2000;Yanovski, Nelson, Dubbert, & Spitzer, 1993). BED and subthreshold binge eating are often associated with excess body weight and obesity (de Zwaan, 2001;Yanovski et al., 1993). Not only is BED a disorder of clinical significance (Wilfley, Wilson, & Agras. 2003), but some (Sherwood, Jeffery, & Wing, 1999;Yanovski, Gormally, Leser, Gwirtsman, & Yanovski, 1994), although not all (Wadden, Foster, & Letizia, 1992), data suggest that the presence of the ...