Not the Function of Eating, but Spontaneous Activity and Energy Expenditure, Reflected in "Restlessness" and a "Drive for Activity" Appear to Be Dysregulated in Anorexia Nervosa: Treatment Implications
Not the Function of Eating, but Spontaneous Activity and Energy Expenditure, Reflected in "Restlessness" and a "Drive for Activity" Appear to Be Dysregulated in Anorexia Nervosa: Treatment Implications
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DOI：
10.3389/fpsyg.2018.02303
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发表时间：
2018-11-23
影响因子：
3.8
通讯作者：
Casper, Regina C.
中科院分区：
文献类型：
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作者：
Casper, Regina C.
神经性厌食症(AN)作为一种综合征并不常见，尽管广泛的节食或自愿的食物限制，特别是在女性青少年中。这表明，限制卡路里摄入量可能不是推动减肥的唯一因素。本文回顾的能量消耗研究的历史观察和实验证据以及运动传感器的记录表明，AN与运动活动水平有关，其能量输出与正常体重、年龄匹配的健康对照组没有显着差异。相比之下，其他长期营养不良的情况通常与能量损失、运动减慢以及自我发起的活动和幸福感下降有关。从研究结果可以推断出几个假设：(A)长期严格的卡路里限制未能降低运动和能量消耗。(B)临床和主观上可观察到的精神和身体上的躁动和持续的运动活动，这种躁动的能量强度不同，似乎是运动和多动的允许因素，并可能推动运动和多动。(C)在减肥过程中的某个时候产生的这种躁动的能量和增加的觉醒似乎可以增强人的自我知觉和幸福感，增强本体感觉，加强身体意识和自尊。(D)躁动和持续的运动活动可能构成AN的一种表型。能量调节系统异常这一概念的治疗价值主要在于它的启发性和解释性，以及它对疾病预防的潜力，这可能是AN中大量遗传和表观遗传变化的结果。作为AN发展和维持的一个允许的和重要的组成部分，躁动的能量不会从根本上改变治疗，因为长期的食物剥夺是AN发展的主要原因。在有组织的治疗计划中重新营养，包括个人和家庭治疗，如果有指示，热应用，仍然是对AN最有效的对症治疗。证实躁动的概念将需要患者的合作和投入，以更准确地识别和捕捉允许消瘦患者保持活动和活跃的经历、感觉和变化。
Anorexia nervosa (AN) is uncommon as a syndrome, despite widespread dieting or voluntary food restriction, especially among female adolescents. This suggests that restriction of caloric intake might not be the only component driving weight loss in AN. Historical observations and experimental evidence from energy expenditure studies and recordings from movement sensors reviewed in this paper reveal that AN is associated with motor activity levels and with an energy output not significantly different from that in normal-weight healthy age-matched controls. By contrast, other conditions of prolonged caloric under-nutrition are typically associated with loss of energy, slowing of movements and a decrease in self-initiated activity and well-being. Several hypotheses can be inferred from the findings: (a) that long term severe caloric restriction fails in downregulating movements and energy expenditure in AN. (b) Clinically and subjectively observable as mental and physical restlessness and continued motor activity, this restless energy, differing in intensity, seems to serve as the permissive factor for and possibly to drive exercise and hyperactivity in AN. (c) Such restless energy and increased arousal, generated sometime in the course of the weight loss process, appear to enhance the person's self-perception and wellbeing, to heighten proprioception, to intensify body awareness and to improve self-esteem. (d) Restlessness and continued motor activity may constitute a phenotype of AN. The therapeutic value of the concept of an abnormality in the energy regulatory system, likely the result of a host of genetic and epigenetic changes in AN, lies primarily in its heuristic and explanatory power and its potential for disease prevention. Restless energy as a permissive and important component for the development and in the maintenance of AN, does not fundamentally alter treatment, since prolonged food deprivation is the principal causal factor for the development of AN. Re-nutrition within a structured treatment plan, to include individual and family therapy and, if indicated, heat application, remains the most effective symptomatic treatment for AN. Corroboration of the concept of restless activation will require the patient's cooperation and input to identify and capture more precisely the experiences, sensations, and changes that allow the emaciated patient to remain mobile and active.