Taste Responsiveness in Eating Disorders

Patients with anorexia or bulimia nervosa suffer from disturbances in body weight and nutritional status. Anorexia nervosa is characterized by extreme caloric restriction, avoidance of starches and fats, and a variety of metabolic and neuroendocrine dysfunctions associated with a severe loss of body Bulimia nervosa is characterized by uncontrollable eating binges that may be countered by fasting, purging, vomiting, or excessive physical e~ercise.~.~ Patients with a combined diagnosis of anorexia nervosa with bulimia alternate periods of near starvation with recurrent eating binges that are followed by purging or self-induced vomiting to lose Both anorexia and bulimia nervosa represent nutritional as well as psychiatric disorders.8-10 Characteristic patterns of food aversion and uncontrollable food cravings have been linked to the patients’ nutritional or metabolic Evidence is growing that uncontrollable binges are triggered by physiological events, and that food aversions may also have a psychobiological basis. Both physiological abnormalities and psychopathology can be reversed following weight regain and the resumption of normal eating habits.l4 Taste responsiveness may have a role in mediating food preferences and diet choices of eating disorder patient^.'^,^^ Some studies suggest that taste functioning of eating disorder patients is characterized by dysgeusia or hypoge~sia.’~,‘~ Prolonged calorie malnutrition and endocrine abnormalities in anorexia nervosa may lead to dysfunctions in taste and smell that depress appetite and contribute to food aversions. Chronic vomiting in bulimia nervosa reduces salivary flow, lowers oral pH, and may lead to a loss of taste sensitivity or sensory f u n ~ t i o n i n g . ~ ~ ~ ’ ~ Hedonic aspects of taste responsiveness may also underlie food cravings or food aversions. Anorectic patients profess to dislike sugars and starches and show a calculated avoidance of sweets and However, this phenomenon, sometimes known as “carbohydrate phobia,”z2 is by no means a stable trait of eating disorders. The same patients may consume vast quantities of sweets and desserts in the course of an eating binge. Recent clinical studies have further shown that both anorectic and bulimic women like the taste of intensely sweet solutions presented in the form of not-to-be-ingested taste stimuli.16 More recent reports based on analysis of cognitive structurez3 indicate