Skip to main content
SpringerLink
Log in

Surgical Treatments for Anorexia Nervosa

  • Chapter
  • First Online:
Neurosurgical Treatments for Psychiatric Disorders

Abstract

Anorexia nervosa (AN) is a severe psychiatric disorder with high rates of morbidity and mortality. An estimated 21 % of patients experience a chronic course despite treatment with the best available medications and behavioral therapies. Existing data suggest that lesioning and deep brain stimulation can benefit a large proportion (ranging from 60 to 80 %) of patients with medically intractable AN. Long-term serious adverse events are very infrequent. Functional neuroimaging studies have increased our understanding of the mechanisms of disease development and therapeutic action. At our institution, we grade AN on a four-point scale based on patient clinical characteristics and our surgical experience over the past 8 years. This scale is particularly useful for guiding the selection of surgical procedures. Such treatment options include deep brain stimulation or lesioning of the nucleus accumbens , anterior capsulotomy, and anterior cingulotomy. Data suggest that surgical treatment is a viable option for intractable AN, and can alleviate suffering and improve the quality of life of patients with these disabling disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Steiner H, et al. Risk and protective factors for juvenile eating disorders. Eur Child Adolesc Psychiatry. 2003;12(Suppl 1):i38–46.

    PubMed  Google Scholar 

  2. Yager J, Andersen AE. Clinical practice. Anorexia nervosa. N Engl J Med. 2005;353(14):1481–8.

    Article  CAS  PubMed  Google Scholar 

  3. Keski-Rahkonen A, et al. Epidemiology and course of anorexia nervosa in the community. Am J Psychiatry. 2007;164(8):1259–65.

    Article  PubMed  Google Scholar 

  4. Hoek HW, van Hoeken D. Review of the prevalence and incidence of eating disorders. Int J Eat Disord. 2003;34(4):383–96.

    Article  PubMed  Google Scholar 

  5. Berkman ND, Lohr KN, Bulik CM. Outcomes of eating disorders: a systematic review of the literature. Int J Eat Disord. 2007;40(4):293–309.

    Article  PubMed  Google Scholar 

  6. Forcano L, et al. Suicide attempts in anorexia nervosa subtypes. Compr Psychiatry. 2011;52(4):352–8.

    Article  PubMed  Google Scholar 

  7. Norrington A, et al. Medical management of acute severe anorexia nervosa. Arch Dis Child Educ Pract Ed. 2012;97(2):48–54.

    Article  PubMed  Google Scholar 

  8. Herpertz-Dahlmann B. Adolescent eating disorders: definitions, symptomatology, epidemiology and comorbidity. Child Adolesc Psychiatr Clin North Am. 2009;18(1):31–47.

    Article  Google Scholar 

  9. Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010;375(9714):583–93.

    Article  PubMed  Google Scholar 

  10. Bulik CM, et al. Alcohol use disorder comorbidity in eating disorders: a multicenter study. J Clin Psychiatry. 2004;65(7):1000–6.

    Article  PubMed  Google Scholar 

  11. Strober M, Freeman R, Morrell W. The long-term course of severe anorexia nervosa in adolescents: Survival analysis of recovery, relapse, and outcome predictors over 10–15 years in a prospective study. Int J Eat Disord. 1997;22(4):339–60.

    Article  CAS  PubMed  Google Scholar 

  12. Steinhausen HC. The outcome of anorexia nervosa in the 20th century. Am J Psychiatry. 2002;159(8):1284–93.

    Article  PubMed  Google Scholar 

  13. Herzog DB, et al. Recovery and relapse in anorexia and bulimia nervosa: a 7.5-year follow-up study. J Am Acad Child Adolesc Psychiatry. 1999;38(7):829–37.

    Article  CAS  PubMed  Google Scholar 

  14. Connan F, et al. A neurodevelopmental model for anorexia nervosa. Physiol Behav. 2003;79(1):13–24.

    Article  CAS  PubMed  Google Scholar 

  15. Clarke TK, Weiss AR, Berrettini WH. The genetics of anorexia nervosa. Clin Pharmacol Ther. 2012;91(2):181–8.

    Article  CAS  PubMed  Google Scholar 

  16. Noordenbos G, Seubring A. Criteria for recovery from eating disorders according to patients and therapists. Eat Disord. 2006;14(1):41–54.

    Article  PubMed  Google Scholar 

  17. Kaye WH, et al. Neurocircuity of eating disorders. Curr Top Behav Neurosci. 2011;6:37–57.

    Article  PubMed  Google Scholar 

  18. Kaye WH, Fudge JL, Paulus M. New insights into symptoms and neurocircuit function of anorexia nervosa. Nat Rev Neurosci. 2009;10(8):573–84.

    Article  CAS  PubMed  Google Scholar 

  19. Frank GK, et al. Increased dopamine D2/D3 receptor binding after recovery from anorexia nervosa measured by Positron emission tomography and [11C] raclopride. Biol Psychiatry. 2005;58(11):908–12.

    Article  CAS  PubMed  Google Scholar 

  20. Kaye WH, et al. Nothing tastes as good as skinny feels: the neurobiology of anorexia nervosa. Trends Neurosci. 2013;36(2):110–20.

    Article  CAS  PubMed  Google Scholar 

  21. Friederich HC, et al. Neurocircuit function in eating disorders. Int J Eat Disord. 2013;46(5):425–32.

    Article  PubMed  Google Scholar 

  22. Kaye WH, et al. Abnormalities in CNS monoamine metabolism in anorexia nervosa. Arch Gen Psychiatry. 1984;41(4):350–5.

    Article  CAS  PubMed  Google Scholar 

  23. Bergen AW, et al. Association of multiple DRD2 polymorphisms with anorexia nervosa. Neuropsychopharmacology. 2005;30(9):1703–10.

    Article  CAS  PubMed  Google Scholar 

  24. Friederich HC, et al. Differential motivational responses to food and pleasurable cues in anorexia and bulimia nervosa: a startle reflex paradigm. Psychol Med. 2006;36(9):1327–35.

    Article  PubMed  Google Scholar 

  25. Halford JC, Cooper GD, Dovey TM. The pharmacology of human appetite expression. Curr Drug Targets. 2004;5(3):221–40.

    Article  CAS  PubMed  Google Scholar 

  26. Nunn K, et al. The fault is not in her parents but in her insula–a neurobiological hypothesis of anorexia nervosa. Eur Eat Disord Rev. 2008;16(5):355–60.

    Article  PubMed  Google Scholar 

  27. Phillips ML, et al. Neurobiology of emotion perception II: Implications for major psychiatric disorders. Biol Psychiatry. 2003;54(5):515–28.

    Article  PubMed  Google Scholar 

  28. Phillips ML, et al. Neurobiology of emotion perception I: the neural basis of normal emotion perception. Biol Psychiatry. 2003;54(5):504–14.

    Article  PubMed  Google Scholar 

  29. Shin LM, Liberzon I. The neurocircuitry of fear, stress, and anxiety disorders. Neuropsychopharmacology. 2010;35(1):169–91.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Giel KE, et al. Attentional processing of food pictures in individuals with anorexia nervosa–an eye-tracking study. Biol Psychiatry. 2011;69(7):661–7.

    Article  PubMed  Google Scholar 

  31. Zhang H-W, et al. Metabolic imaging of deep brain stimulation in anorexia nervosa: a 18F-FDG PET/CT study. Clin Nucl Med. 2013;38(12):943–8.

    PubMed  Google Scholar 

  32. Lipsman N, et al. Subcallosal cingulate deep brain stimulation for treatment-refractory anorexia nervosa: a phase 1 pilot trial. Lancet. 2013;381(9875):1361–70.

    Article  PubMed  Google Scholar 

  33. Frank GK. Altered brain reward circuits in eating disorders: chicken or egg? Curr Psychiatry Rep. 2013;15(10):396.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Focker M, Knoll S, Hebebrand J. Anorexia nervosa. Eur Child Adolesc Psychiatry. 2013;22:S29–35.

    Article  PubMed  Google Scholar 

  35. Guarda AS. Treatment of anorexia nervosa: insights and obstacles. Physiol Behav. 2008;94(1):113–20.

    Article  CAS  PubMed  Google Scholar 

  36. Wade TD, Treasure J, Schmidt U. A case series evaluation of the Maudsley model for treatment of adults with anorexia nervosa. Eur Eat Disord Rev. 2011;19(5):382–9.

    PubMed  Google Scholar 

  37. Bulik CM, et al. Anorexia nervosa treatment: a systematic review of randomized controlled trials. Int J Eat Disord. 2007;40(4):310–20.

    Article  PubMed  Google Scholar 

  38. Brewerton TD. Antipsychotic agents in the treatment of anorexia nervosa: neuropsychopharmacologic rationale and evidence from controlled trials. Curr Psychiatry Rep. 2012;14(4):398–405.

    Article  PubMed  Google Scholar 

  39. McKnight RF, Park RJ. Atypical antipsychotics and anorexia nervosa: a review. Eur Eat Disord Rev. 2010;18(1):10–21.

    Article  PubMed  Google Scholar 

  40. Wilson GT, Shafran R. Eating disorders guidelines from NICE. Lancet. 2005;365(9453):79–81.

    Article  PubMed  Google Scholar 

  41. Couturier J, Lock J. What is recovery in adolescent anorexia nervosa? Int J Eat Disord. 2006;39(7):550–5.

    Article  PubMed  Google Scholar 

  42. Drury MO. An emergency leucotomy. Br Med J. 1950;2(4679):609.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  43. Crisp AH, Kalucy RS. The effect of leucotomy in intractable adolescent weight phobia (primary anorexia nervosa). Postgrad Med J. 1973;49(578):883–93.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  44. Morgan JF, Crisp AH. Use of leucotomy for intractable anorexia nervosa: a long-term follow-up study. Int J Eat Disord. 2000;27(3):249–58.

    Article  CAS  PubMed  Google Scholar 

  45. Birley JL. Modified frontal leucotomy: a review of 106 cases. Br J Psychiatry. 1964;110:211–21.

    Article  CAS  PubMed  Google Scholar 

  46. Carmody JT, Vibber FL. Anorexia nervosa treated by prefrontal lobotomy. Ann Intern Med. 1952;36(2:2):647–52.

    CAS  PubMed  Google Scholar 

  47. Kay DW. Anorexia nervosa: a study in prognosis. Proc R Soc Med. 1953;46(8):669–74.

    CAS  PubMed Central  PubMed  Google Scholar 

  48. Sargant W. Leucotomy in psychosomatic disorders. Lancet. 1951;2(6673):87–91.

    Article  CAS  PubMed  Google Scholar 

  49. Sifneos PE. A case of anorexia nervosa treated successfully by leucotomy. Am J Psychiatry. 1952;109(5):356–60.

    CAS  PubMed  Google Scholar 

  50. Zamboni R, et al. Dorsomedial thalamotomy as a treatment for terminal anorexia: a report of 2 cases. Acta Neurochirurgica. 1993;34–35.

    Google Scholar 

  51. Kelly D, Mitchell-Heggs N. Stereotactic limbic leucotomy—a follow-up study of thirty patients. Postgrad Med J. 1973;49(578):865–82.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  52. Mitchell-Heggs N, Kelly D, Richardson A. Stereotactic limbic leucotomy–a follow-up at 16 months. Br J Psychiatry. 1976;128:226–40.

    Article  CAS  PubMed  Google Scholar 

  53. Barbier J, et al. Successful anterior capsulotomy in comorbid anorexia nervosa and obsessive-compulsive disorder: case report. Neurosurgery. 2011;69(3):E745–51; discussion E751.

    Google Scholar 

  54. Bomin S, Li D, Zhan S (2007) DBS for anorexia nervosa. The eighth world congress of International Neuromodulation Society. Acapulco, Mexico.

    Google Scholar 

  55. Wu H, et al. Deep-brain stimulation for anorexia nervosa. World Neurosurg. 2012;80(3-4):S29 e1–10.

    Google Scholar 

  56. Deuschl G, et al. A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med. 2006;355(9):896–908.

    Article  CAS  PubMed  Google Scholar 

  57. Mueller J, et al. Pallidal deep brain stimulation improves quality of life in segmental and generalized dystonia: results from a prospective, randomized sham-controlled trial. Mov Disord. 2008;23(1):131–4.

    Article  PubMed  Google Scholar 

  58. O’Sullivan D, Pell M. Long-term follow-up of DBS of thalamus for tremor and STN for Parkinson’s disease. Brain Res Bull. 2009;78(2–3):119–21.

    Article  PubMed  Google Scholar 

  59. Goodman WK, Alterman RL. Deep brain stimulation for intractable psychiatric disorders. Annu Rev Med. 2011;63:511–24.

    Article  PubMed  Google Scholar 

  60. Wang J, et al. Treatment of intractable anorexia nervosa with inactivation of the nucleus accumbens using stereotactic surgery. Stereotact Funct Neurosurg. 2013;91(6):364–72.

    Article  PubMed  Google Scholar 

  61. Zhan S, et al. Long-term follow-up of bilateral anterior capsulotomy in patients with refractory obsessive-compulsive disorder. Clin Neurol Neurosurg. 2014;119:91–5.

    Article  PubMed  Google Scholar 

  62. Zuo C, et al. Metabolic imaging of bilateral anterior capsulotomy in refractory obsessive compulsive disorder: an FDG PET study. J Cereb Blood Flow Metab. 2013;33(6):880–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  63. Christmas D, et al. Long term outcome of thermal anterior capsulotomy for chronic, treatment refractory depression. J Neurol Neurosurg Psychiatry. 2011;82(6):594–600.

    Article  PubMed  Google Scholar 

  64. Hurwitz TA, et al. Bilateral anterior capsulotomy for intractable depression. J Neuropsychiatry Clin Neurosci. 2012;24(2):176–82.

    Article  PubMed  Google Scholar 

  65. Cosgrove GR, Rauch SL. Stereotactic cingulotomy. Neurosurg Clin N Am. 2003;14(2):225–35.

    Article  PubMed  Google Scholar 

  66. Dougherty DD, et al. Prospective long-term follow-up of 44 patients who received cingulotomy for treatment-refractory obsessive-compulsive disorder. Am J Psychiatry. 2002;159(2):269–75.

    Article  PubMed  Google Scholar 

  67. Baer L, et al. Cingulotomy for intractable obsessive-compulsive disorder. Prospective long-term follow-up of 18 patients. Arch Gen Psychiatry. 1995;52(5):384–92.

    Article  CAS  PubMed  Google Scholar 

  68. van der Plasse G, et al. Deep brain stimulation reveals a dissociation of consummatory and motivated behaviour in the medial and lateral nucleus accumbens shell of the rat. PLoS One. 2012;7(3):e33455.

    Article  PubMed Central  PubMed  Google Scholar 

  69. Bhatia S, et al. Surgical complications of deep brain stimulation. Stereotact Funct Neurosurg. 2008;86(6):367–72.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest Statement

The authors declare that there are no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China

    Bomin Sun, Dianyou Li, Wei Liu, Shikun Zhan, Yixin Pan & Xiaoxiao Zhang

Authors
  1. Bomin Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dianyou Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wei Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shikun Zhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yixin Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiaoxiao Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bomin Sun .

Editor information

Editors and Affiliations

  1. Center for Functional Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University, Shanghai, China

    Bomin Sun

  2. Neurosurgery, University of California, Los Angeles, California, USA

    Antonio De Salles

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Shanghai Jiao Tong University Press, Shanghai and Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Sun, B., Li, D., Liu, W., Zhan, S., Pan, Y., Zhang, X. (2015). Surgical Treatments for Anorexia Nervosa. In: Sun, B., Salles, A. (eds) Neurosurgical Treatments for Psychiatric Disorders. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-9576-0_15

Download citation

  • DOI: https://doi.org/10.1007/978-94-017-9576-0_15

  • Published:

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-017-9575-3

  • Online ISBN: 978-94-017-9576-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation