Unna N Danner

Altrecht GGZ · Altrecht Eating Disorders Rintveld

Background Inherent to anorexia nervosa are repetitive thoughts about weight and shape. Growing research suggests the relevance of intolerance of uncertainty and worry in maintaining these types of repetitive thoughts. The relation between these cognitive processes and weight and shape concerns in adolescent girls with anorexia nervosa is understud...

Genome-wide association studies have discovered hundreds of loci associated with complex brain disorders, but it remains unclear in which cell types these loci are active. Here we integrate genome-wide association study results with single-cell transcriptomic data from the entire mouse nervous system to systematically identify cell types underlying...

Introduction Inefficient problem solving in the social domain may be one of the difficulties underlying the interpersonal challenges thought to maintain anorexia nervosa (AN). However, past studies have neglected to control for depression, anxiety, and intolerance of uncertainty (IU), which are known to contribute to social problem solving. Method...

Background: Guideline-recommended therapies are moderately successful in the treatment of obsessive-compulsive disorder (OCD) and anorexia nervosa (AN), leaving room for improvement. Cognitive inflexibility, a common trait in both disorders, is likely to prevent patients from engaging in treatment and from fully benefiting from existing therapies....

Eating disorders and substance use disorders frequently co‐occur. Twin studies reveal shared genetic variance between liabilities to eating disorders and substance use, with the strongest associations between symptoms of bulimia nervosa and problem alcohol use (genetic correlation [rg], twin‐based = 0.23‐0.53). We estimated the genetic correlation...

Objective: Enhanced cognitive behavior therapy (CBT-E) is a transdiagnostic treatment suitable for the full range of eating disorders (EDs). Although the effectiveness of CBT(-E) is clear, it is not being used as widely in clinical practice as guidelines recommend. The aim of the present study was to compare the effectiveness of CBT-E with treatme...

Eating disorders and substance use disorders frequently co-occur. Twin studies reveal shared genetic variance between liabilities to eating disorders and substance use, with the strongest associations between symptoms of bulimia nervosa (BN) and problem alcohol use (genetic correlation [rg], twin-based=0.23-0.53). We estimated the genetic correlati...

Characterized primarily by a low body-mass index, anorexia nervosa is a complex and serious illness¹, affecting 0.9–4% of women and 0.3% of men2–4, with twin-based heritability estimates of 50–60%⁵. Mortality rates are higher than those in other psychiatric disorders⁶, and outcomes are unacceptably poor⁷. Here we combine data from the Anorexia Nerv...

In this study we aimed to determine whether decision-making ability, cognitive inflexibility and emotion-driven impulsiveness are associated with weight status as expressed by body mass index (BMI), percentage body fat, waist circumference and skinfold thickness in adults from eight different European countries taking part in the I.Family study. Th...

In MRI scans of patients with anorexia nervosa (AN), reductions in brain volume are often apparent. However, it is unknown whether such brain abnormalities are influenced by genetic determinants that partially overlap with those underlying AN. Here, we used a battery of methods (LD score regression, genetic risk scores, sign test, SNP effect concor...

Background: Patients with anorexia nervosa (AN) demonstrate aberrations in choice behavior, including impairments in laboratory measures of decision making. Although a wealth of studies suggest that these aberrations arise from alterations in value processing, it remains unclear by which core component of value processing this is mediated. Method...

Disorders of the brain can exhibit considerable epidemiological comorbidity and often share symptoms, provoking debate about their etiologic overlap. We quantified the genetic sharing of 25 brain disorders from genome-wide association studies of 265,218 patients and 784,643 control participants and assessed their relationship to 17 phenotypes from...

Objective: The objective of this study was to evaluate disordered eating behaviours (DEBs) in different age groups in a Cypriot non-clinical population sample. Study design: Comparative cross-sectional study. Method: A total of 1716 participants from the Cyprus component of the I.Family study completed the Eating Attitudes Test-26 (EAT-26). Th...

Brainstorming diseases Consistent classification of neuropsychiatric diseases is problematic because it can lead to misunderstanding of etiology. The Brainstorm Consortium examined multiple genome-wide association studies drawn from more than 200,000 patients for 25 brain-associated disorders and 17 phenotypes. Broadly, it appears that psychiatric...

The Risk factors for Binge Eating Disorder in Overweight (REO) questionnaire is a screening tool for nutritionists to discriminate between individuals with obesity with and without Binge Eating Disorder (BED). The first study tested the discriminative ability of the REO and identified an optimal cut-off value. In the second study this cut-off value...

Anorexia nervosa (AN) is a complex and serious eating disorder, occurring in ~1% of individuals. Despite having the highest mortality rate of any psychiatric disorder, little is known about the aetiology of AN, and few effective treatments exist. Global efforts to collect large sample sizes of individuals with AN have been highly successful, and a...

We aimed to investigate the association between emotion-driven impulsiveness and snack food consumption in 1039 European adolescents aged 12-18 years. During the cross-sectional examination in 2013/2014, complete information was collected on: emotion-driven impulsiveness (using the negative urgency subscale from the Urgency, Premeditation, Persever...

The purpose of the present review is to provide a summary of the research findings on emotion regulation in Binge Eating Disorder (BED). Negative emotions and maladaptive emotion regulation strategies play a role in the onset and maintenance of binge eating in BED. Anger and sadness, along with negative emotions related to interpersonal experiences...

Objective: To explore the association between emotion-driven impulsiveness, cognitive inflexibility, decision-making and weight status as reflected in body mass index (BMI) z-score (zBMI) in European adolescents. Methods: In total, 3354 adolescents aged between 12 and 18 years from the I.Family cohort completed the questionnaire-based negative urg...

Anorexia nervosa (AN) is a complex neuropsychiatric disorder presenting with dangerously low body weight, and a deep and persistent fear of gaining weight. To date, only one genome-wide significant locus associated with AN has been identified. We performed an exome-chip based genome-wide association studies (GWAS) in 2158 cases from nine population...

Patients with complex and severe eating disorders often receive a number of ineffective or/and insufficient treatments. Direct referral of these patients to highly specialized tertiary treatment facilities in an earlier stage of the disorder is likely to be more (cost)-effective. The aim of the study was to develop a decision tool that aids clinici...

Background Relevance of diminished mental capacity in anorexia nervosa (AN) to course of disorder is unknown. Aims To examine prognostic relevance of diminished mental capacity in AN. Method A longitudinal study was conducted in 70 adult female patients with severe AN. At baseline, mental capacity was assessed by psychiatrists, and clinical and n...

Achtergrond en doel van het onderzoek Normaliseren van eetpatroon en gewicht is een primair doel van de behandeling van anorexia nervosa. Gewichtstoename kan verbetering van de overige eetstoornissymptomen bevorderen. 1 Er zijn aanwijzingen dat gewichtstoename vroeg in de behandeling een grotere positieve invloed op de eetstoornis symptomen dan gew...

Background Anorexia nervosa (AN) and Obsessive Compulsive Disorder (OCD) are among the most incapacitating and costly of mental disorders. Cognitive Behaviour Therapy (CBT), medication, and combination regimens, to which in AN personalised guidance on weight control is added, are moderately successful, leaving room for more effective treatment algo...

Background Relapse is common among recovered anorexia nervosa (AN) patients. Studies on relapse prevention with an average follow-up period of 18 months found relapse rates between 35 and 41 %. In leading guidelines there is general consensus that relapse prevention in patients treated for AN is a matter of essence. However, lack of methodological...

Objective: Intelligence is a known vulnerability marker in various psychiatric disorders. In eating disorders (ED) intelligence has not been studied thoroughly. Small-scale studies indicate that intelligence levels might be above general population norms, but larger scale studies are lacking. The aim of this study was to determine intellectual fun...

Women ill with anorexia nervosa (AN) have been shown to exhibit altered cognitive functioning, particularly poor set-shifting (SS). In this study, we investigated whether brain activation in frontal and parietal regions during visual stimulus processing correlates with SS ability. Women currently ill with AN (AN; N=14), recovered women (REC; N=14)...

The maintenance of normal body weight is disrupted in patients with anorexia nervosa (AN) for prolonged periods of time. Prior to the onset of AN, premorbid body mass index (BMI) spans the entire range from underweight to obese. After recovery, patients have reduced rates of overweight and obesity. As such, loci involved in body weight regulation m...

Background Mental capacity to consent to treatment in anorexia nervosa is a neglected area in clinical decision-making. Aims To examine clinical and neuropsychological parameters associated with diminished mental capacity in anorexia nervosa. Method An explorative study was conducted in 70 adult female patients with severe anorexia nervosa. Menta...

The present study aims to examine the influence of negative affect on decision making in women with anorexia nervosa (AN) compared to healthy control women and, secondly, to assess differences between the restrictive (ANR) and binge-purge (ANBP) subtypes. One hundred four women (32 with ANR, 32 with ANBP, and 40 healthy controls) participated. All...

Background: Anorexia nervosa (AN), which is the most serious of the eating disorders, starts earlier in life and often continues into adulthood. Aim: To discuss the typical features of AN in adolescents. Method: We present an overview based on the literature about AN in adolescents and on analysis performed by experts. Results: Youngsters wi...

Purpose of review: This review compares the literature on cognitive remediation therapy (CRT) for eating disorders with findings in the field of schizophrenia, and discusses future directions for CRT for eating disorders. Recent findings: First studies using a randomized controlled trial design show the added value of CRT for eating disorders. P...

Anorexia Nervosa (AN) is a severe mental disorder characterized by food restriction and weight loss. This study aimed to test the model posed by Brooks et al. (2012), that women suffering from chronic AN show decreased food cue processing activity in brain regions associated with energy balance and food reward (bottom-up; BU) and increased activity...

Hyperactivity and elevated physical activity are both considered symptom characteristics of anorexia nervosa (AN). It has been suggested that a drive for activity (DFA) may underlie these expressions, yet research into DFA in AN remains scant. This study investigated DFA levels in patients with AN and its relation to AN severity. Furthermore, as ph...

Objective: Compulsory in-patient refeeding of patients with severe anorexia nervosa (AN) has caused considerable controversy. The effects of such treatment on longer-term outcome are not well known. The objective of this article is to review the evidence on the outcome of compulsory treatment for AN. Method: Three large databases were searched f...

This study examined the underlying processes of decision-making impairments in individuals with anorexia nervosa (AN) and bulimia nervosa (BN). We deconstructed their performance on the widely used decision task, the Iowa Gambling Task (IGT) into cognitive, motivational, and response processes using cognitive modeling analysis. We hypothesized that...

The Wellcome Trust Case Control Consortium 3 anorexia nervosa genome-wide association scan includes 2907 cases from 15 different populations of European origin genotyped on the Illumina 670K chip. We compared methods for identifying population stratification, and suggest list of markers that may help to counter this problem. It is usual to identify...

Anorexia nervosa (AN) is a complex and heritable eating disorder characterized by dangerously low body weight. Neither candidate gene studies nor an initial genome-wide association study (GWAS) have yielded significant and replicated results. We performed a GWAS in 2907 cases with AN from 14 countries (15 sites) and 14 860 ancestrally matched contr...

Background: Individuals with eating disorders show deficits in neuropsychological functioning which might preexist and underlie the etiology of the eating disorders and influence relapse. Deficits in cognitive flexibility, i.e., set-shifting and central coherence, might perpetuate the symptoms. Cognitive remediation therapy (CRT) was developed to...

The psychometric properties of the Dutch version of the Eating Disorder Inventory–3 (EDI-3) were tested in eating disordered patients (N = 514) using confirmatory factor analyses, variance decomposition, reliabilities, and receiver operating characteristic (ROC) curve analyses. Factorial validity results supported the 12 subscales, but model fit wa...

As people are relatively incompetent in assessing the impact of visceral states on their behavior, two studies tested the hypothesis that hunger affects the extent to which people assess themselves as external eaters. In Study 1 participants' current self-reported hunger states were linked to their scores on an external eating scale. Hungrier parti...

Research suggests that individuals with binge eating pathology (e.g., bulimia nervosa (BN) and binge eating disorders (BED)) have decision making impairments and particularly act impulsively in response to negative affect. The aim of this study was to examine the influence of negative affect on choice behavior in women with BN and BED. Ninety women...

To examine the influence of emotional eating and lack of cognitive reappraisal on eating pathology in women with binge-purge and restricting type eating disorders. Women with a diagnosis of anorexia or bulimia nervosa according to the DSM-IV-tr (n = 50) and non-clinical women without eating disorders (n = 52) were asked about emotional eating tende...

Neuropsychological studies are increasingly popular in eating disorders (ED). 1 However, there are few studies that look specifically into intelligence levels of ED patients. 2-3 We have studied intelligence data of a large sample of ED patients. Objectives 1. To compare the IQ's of patients with anorexia nervosa (AN), bulimia nervosa (BN) and ED n...

Excessive physical activity is a common feature in Anorexia Nervosa (AN) that interferes with the recovery process. Animal models have demonstrated that ambient temperature modulates physical activity in semi-starved animals. The aim of the present study was to assess the effect of ambient temperature on physical activity in AN patients in the acut...

The purpose of this study is to examine set-shifting, central coherence, and decision making in women currently ill with anorexia nervosa (AN), women recovered from AN, and healthy control women. We aim to test whether these neuropsychological weaknesses persist after recovery, and explore relations between the impairments Compared to control women...

The Eating Disorder Diagnostic Scale (EDDS) is a brief self-report measure for diagnosing anorexia nervosa, bulimia nervosa and binge eating disorder. Research has provided evidence of the reliability and validity of this scale in non-clinical populations. Our study is the first to examine the psychometric features of the EDDS in a clinical populat...

The purpose of the current study was to examine decision making in female patients with binge eating disorder (BED) in comparison with obese and normal weight women. In the study, 20 patients with BED, 21 obese women without BED and 34 healthy women participated. Decision making was assessed using the Iowa Gambling Task (IGT). Several questionnaire...

As people are relatively incompetent in assessing the impact of visceral states on their behavior, two studies tested the hypothesis that hunger affects the extent to which people assess themselves as external eaters. In Study 1 participants' current self-reported hunger states were linked to their scores on an external eating scale. Hungrier parti...

The objective of the current study was to examine the cognitive processes that make it possible to use intentions to change one's habitual health-related behaviour. The study used an idiosyncratic approach to investigate personal existing habits and non-habitual behaviours in a within-participants experiment. Participants first generated habitual a...

Hyperactivity in anorexia nervosa is difficult to control and negatively impacts outcome. Hyperactivity is a key driving force to starvation in an animal model named activity-based anorexia (ABA). Recent research has started unraveling what mechanisms underlie this hyperactivity. Besides a general increase in locomotor activity that may be an expre...

This research examined the role of habit and intention in the prediction of future behaviour by analysing that past behaviour frequency moderates the intention-behaviour relationship to the extent that the context in which the behaviour was performed is stable. In two correlational studies, it was found that habit interacted with intention when con...

Three studies examined the cognitive processes underlying the formation of goal-directed habits in a multiple means context. Repeated retrieval of target means upon goal activation was expected to result in inhibition of competing means for the same goal. In all studies, participants studied goal-means combinations and subsequently practiced the re...

Our repertoire of social behavior may include the ability to grasp and take on the goals of others automatically - that is, without conscious intent. Two experiments tested and confirmed the hypothesis that priming social groups causes individuals to pursue the goals stereotypical for members of those groups. Study 1 found that participants provide...

Processing strategies in risk assessment were studied in an Internet experiment. Women (N = 399) who were either low or high in rape myth acceptance (RMA) were asked to recall either two or six behaviors that either increase or decrease the risk of being sexually assaulted. Later they judged their personal vulnerability to sexual assault under eith...