EM has a very active research programme,linked to his research programmes at Gt. Ormond St. Hospital for Children, London and previously the Regional Eating Disorders Service, Univ. of Oslo, Norway
The programme covers most aspects of early onset eating disorders but with a particular emphasis on neuroscience.
1) The neuropsychology of eating disorders.
This project uses the Ravello Profile (www.ravelloprofile.org) to investigate the neuropsychological profiles of patients with eating disorders. The Ravello Profile is a standardised neuropsychological test battery, devised by Prof Lask’s team and now used worldwide. The findings suggest three different clusters of neuropsychological performance indicating the possibility of neurobiological-based subsets of anorexia nervosa.
2) PANDAS (paediatric auto-immune neurodevelopmental disorder associated with streptococcus).
This study, in liaison with a number of centres in the USA, is investigating the possible role of auto-immune reactions, similar to those found in rheumatic fever and Sydenham’s chorea, that affect specific brain regions and contribute to the development of anorexia nervosa. Similar processes have been noted in OCD and tics/Tourette’s Syndrome.
3) Season of Birth (SoB)
Numerous studies have identified a bias toward spring births in anorexia nervosa and a couple of studies have identified a bias toward autumn births in bulimia nervosa. This study is part of a worldwide project, involving 25 centres in 9 countries. The aim of the study is to overcome previous methodological problems and to ascertain whether or not there is any bias in season of birth. It will test four hypotheses to account for such biases.
4) Obstetric complications (OCs).
Previous studies have suggested that obstetric complications are a risk factor for the development of a number of psychiatric disorders including anorexia nervosa. This study is part of a collaboration with various centres in the USA aimed at assessing the prevalence of OCs in anorexia nervosa compared with normative data and identifying any specific complications or patterns of complications that may be relevant
There have been numerous reports of raised levels of alexythymia in anorexia nervosa. However it is not known whether this is a trait common to anorexia nervosa or a state secondary to the illness. This study is exploring whether there is change in alexythymic features, as measured by a specific scale, between commencement and end of treatment.
6) Parental constructions of anorexia nervosa and the treatment process
Very few studies have researched parents’ perceptions of the illness and its treatment process. This study aims to explore how parents experience and understand the process using qualitative methods.
There is an obligation upon all clinical services to assess outcomes. This study investigates change in a number of domains between admission and discharge. The domains include physical status, eating disorder psychopathology, depression, anxiety and obsessive compulsive features.
Anxiety around eating is a major feature of eating disorders and can be a considerable obstacle to effective treatment. Hydroxyzine, originally marketed as an anti-histamine, has proved to be an effective anxiolytic. A centre in the USA has been using it for pre-meal anxiety with seemingly good response. We are joining with that centre to conduct a formal evaluation.
9) Cognitive remediation therapy (CRT).
CRT is a relatively new treatment for anorexia nervosa that shows promise, even in those who have been ill for many years. The essence of CRT is its focus on cognitive styles – the how of thinking and perceiving, rather than the what, the process rather than the content. It uses games and puzzles aiming to remedy unhelpful cognitive styles. In conjunction with a number of other centres we are conducting phase 1 and 2 trials of its applicability for early onset anorexia nervosa.