Academic Appointments

  • Professor Emeritus-Hourly, Psychiatry and Behavioral Sciences

Current Research and Scholarly Interests

Eating disorders ; anorexia nervosa: endocrinology and subtypes; risk factors for restricting anorexia nervosa: personality traits and starvation-induced mental and behavioral activation. Women’s health: depression with atypical physical symptoms; depression during pregnancy and postnatal depression: effects on the offspring.

All Publications

  • Greater male variability in daily energy expenditure develops through puberty. Biology letters Halsey, L. G., Careau, V., Ainslie, P. N., Alemán-Mateo, H., Andersen, L. F., Anderson, L. J., Arab, L., Baddou, I., Bandini, L., Bedu-Addo, K., Blaak, E. E., Blanc, S., Bonomi, A. G., Bouten, C. V., Bovet, P., Brage, S., Buchowski, M. S., Butte, N., Camps, S. G., Casper, R., Close, G. L., Colbert, L. H., Cooper, J. A., Cooper, R., Dabare, P., Das, S. K., Davies, P. S., Deb, S., Nyström, C. D., Dietz, W., Dugas, L. R., Eaton, S., Ekelund, U., Hamdouchi, A. E., Entringer, S., Forrester, T., Fudge, B. W., Gillingham, M., Goris, A. H., Gurven, M., Haisma, H., Hambly, C., Hoffman, D., Hoos, M. B., Hu, S., Joonas, N., Joosen, A., Katzmarzyk, P., Kempen, K. P., Kimura, M., Kraus, W. E., Kriengsinyos, W., Kuriyan, R., Kushner, R. F., Lambert, E. V., Lanerolle, P., Larsson, C. L., Lessan, N., Löf, M., Martin, C., Matsiko, E., Meijer, G. A., Morehen, J. C., Morton, J. P., Must, A., Neuheuser, M., Nicklas, T. A., Ojiambo, R. M., Pietilainen, K. H., Pitsiladis, Y. P., Plange-Rhule, J., Plasqui, G., Prentice, R. L., Rabinovich, R., Racette, S. B., Raichen, D. A., Ravussin, E., Redman, L., Reilly, J. J., Reynolds, R., Roberts, S., Rood, J. C., Samaranayake, D., Sardinha, L. B., Scuitt, A. J., Silva, A. M., Sinha, S., Sjödin, A. M., Stice, E., Stunkard, A., Urlacher, S. S., Valencia, M. E., Valenti, G., van Etten, L. M., Van Mil, E. A., Verbunt, J. A., Wells, J. C., Wilson, G., Wood, B., Yoshida, T., Zhang, X., Murphy-Alford, A., Loechl, C., Luke, A., Pontzer, H., Rood, J., Sagayama, H., Westerterp, K. R., Wong, W. W., Yamada, Y., Speakman, J. R. 2023; 19 (9): 20230152


    There is considerably greater variation in metabolic rates between men than between women, in terms of basal, activity and total (daily) energy expenditure (EE). One possible explanation is that EE is associated with male sexual characteristics (which are known to vary more than other traits) such as musculature and athletic capacity. Such traits might be predicted to be most prominent during periods of adolescence and young adulthood, when sexual behaviour develops and peaks. We tested this hypothesis on a large dataset by comparing the amount of male variation and female variation in total EE, activity EE and basal EE, at different life stages, along with several morphological traits: height, fat free mass and fat mass. Total EE, and to some degree also activity EE, exhibit considerable greater male variation (GMV) in young adults, and then a decreasing GMV in progressively older individuals. Arguably, basal EE, and also morphometrics, do not exhibit this pattern. These findings suggest that single male sexual characteristics may not exhibit peak GMV in young adulthood, however total and perhaps also activity EE, associated with many morphological and physiological traits combined, do exhibit GMV most prominently during the reproductive life stages.

    View details for DOI 10.1098/rsbl.2023.0152

    View details for PubMedID 37727077

  • Restlessness and an Increased Urge to Move (Drive for Activity) in Anorexia Nervosa May Strengthen Personal Motivation to Maintain Caloric Restriction and May Augment Body Awareness and Proprioception: A Lesson From Leptin Administration in Anorexia Nervosa. Frontiers in psychology Casper, R. C. 2022; 13: 885274


    Anorexia nervosa (AN), a disorder of voluntary food restriction leading to severe weight loss in female adolescents, remains an enigma. In particular, the appropriation of the starved thin body into the self-concept in AN is a process insufficiently researched and still poorly understood. Healthy humans undergoing starvation experience a slowing of movements and avoid voluntary exercise. By contrast, AN tends to be not infrequently associated with voluntary, sometimes excessive and/or compulsive exercise. Such deliberate exercise, not reported in starvation, seems to be facilitated by an increased urge for movement and physical restlessness, particular to AN. The increased urge to move would reflect spontaneous daily activity, the energy expended for everything that is not sleeping, eating, or voluntary exercise. Our hypothesis is that the starvation-induced increased urge to move and restlessness may promote the development of AN. Reversal of the fasting state, by either high caloric food or by leptin administration, would be expected to reduce restlessness and the increased urge to move along with improvement in other symptoms in AN. This review explores the idea that such restless activation in AN, in itself and through accelerating body weight loss, might foster the integration of the starving body into the self-concept by (1) enhancing the person's sense of self-control and sense of achievement and (2) through invigorating proprioception and through intensifying the perception of the changing body shape. (3) Tentative evidence from studies piloting leptin administration in chronic AN patients which support this hypothesis is reviewed. The findings show that short term administration of high doses of leptin indeed mitigated depressive feelings, inner tension, intrusive thoughts of food, and the increased urge to be physically active, easing the way to recovery, yet had little influence on the patients' personal commitment to remain at a low weight. Full recovery then requires resolution of the individuals' personal unresolved psychological conflicts through psychotherapy and frequently needs specialized treatment approaches to address psychiatric co-morbidities. AN might be conceptualized as a hereditary form of starvation resistance, facilitated by the effects of starvation on fitness allowing for an exceptionally intense personal commitment to perpetuate food restriction.

    View details for DOI 10.3389/fpsyg.2022.885274

    View details for PubMedID 35959022

    View details for PubMedCentralID PMC9359127

  • Urges to Move and Other Motivation States for Physical Activity in Clinical and Healthy Populations: A Scoping Review Protocol. Frontiers in psychology Stults-Kolehmainen, M. A., Blacutt, M., Bartholomew, J. B., Boullosa, D., Janata, P., Koo, B. B., McKee, P. C., Casper, R., Budnick, C. J., Gilson, T. A., Blakemore, R. L., Filgueiras, A., Williamson, S. L., SantaBarbara, N., Barker, J. L., Bueno, F. A., Heldring, J., Ash, G. I. 2022; 13: 901272


    Motivation for bodily movement, physical activity and exercise varies from moment to moment. These motivation states may be "affectively-charged," ranging from instances of lower tension (e.g., desires, wants) to higher tension (e.g., cravings and urges). Currently, it is not known how often these states have been investigated in clinical populations (e.g., eating disorders, exercise dependence/addiction, Restless Legs Syndrome, diabetes, obesity) vs. healthy populations (e.g., in studies of motor control; groove in music psychology). The objective of this scoping review protocol is to quantify the literature on motivation states, to determine what topical areas are represented in investigations of clinical and healthy populations, and to discover pertinent details, such as instrumentation, terminology, theories, and conceptual models, correlates and mechanisms of action. Iterative searches of scholarly databases will take place to determine which combination of search terms (e.g., "motivation states" and "physical activity"; "desire to be physically active," etc.) captures the greatest number of relevant results. Studies will be included if motivation states for movement (e.g., desires, urges) are specifically measured or addressed. Studies will be excluded if referring to motivation as a trait. A charting data form was developed to scan all relevant documents for later data extraction. The primary outcome is simply the extent of the literature on the topic. Results will be stratified by population/condition. This scoping review will unify a diverse literature, which may result in the creation of unique models or paradigms that can be utilized to better understand motivation for bodily movement and exercise.

    View details for DOI 10.3389/fpsyg.2022.901272

    View details for PubMedID 35898999

    View details for PubMedCentralID PMC9311496

  • Might Starvation-Induced Adaptations in Muscle Mass, Muscle Morphology and Muscle Function Contribute to the Increased Urge for Movement and to Spontaneous Physical Activity in Anorexia Nervosa? Nutrients Casper, R. C. 2020; 12 (7)


    Severely undernourished and underweight anorexia nervosa (AN) patients typically remain active and mobile. Might such persistent physical activity in AN be supported by specific adaptations in muscle tissue during long term undernutrition? To identify potential differences, studies examining the effects of undernutrition on skeletal muscle mass, muscle morphology and muscle function in healthy humans and in AN patients were reviewed. Adjustments in muscle morphology and function in AN did not differ in substance from those in healthy humans, undernourished people, or undergoing semi-starvation. Loss of muscle mass, changes in muscle contractility and atrophy of muscle fibers (predominantly type II fibers) characterized both groups. Muscle innervation was unaffected. Work capacity in men in semi-starvation experiments and in females with AN declined by about 70% and 50%, respectively. Perceptions of fatigue and effort distinguished the groups: signs of general weakness, tiring quickly and avoidance of physical activity that were recorded in semi-starvation were not reported for AN patients. The absence of distinctive starvation-related adjustments in skeletal muscle in AN suggests that new methods, such as muscle gene expression profiles in response to deficient nutrient intake, and better knowledge of the central regulatory circuitries contributing to motor urgency will be required to shed light on the persistent mobility in AN patients.

    View details for DOI 10.3390/nu12072060

    View details for PubMedID 32664448

  • Increased urge for movement, physical and mental restlessness, fundamental symptoms of restricting anorexia nervosa? Brain and behavior Casper, R. C., Voderholzer, U. n., Naab, S. n., Schlegl, S. n. 2020: e01556


    Continued mobility in the presence of severe weight loss is a well known, yet insufficiently researched characteristic of anorexia nervosa (AN). This study was designed to assess the prevalence of the drive for activity, here operationalized as an increased urge for movement, physical restlessness, and mental restlessness.Participants were 83 female consecutively admitted adolescent patients qualifying for a diagnosis of AN (ICD-10), restricting subtype. Information collected included responses to a questionnaire inquiring retrospectively about physical and psychological reactions after significant weight loss (on average 12.5 kg) and to measures of psychiatric and eating disorder pathology and exercise behaviors at hospital admission.Over 80% of AN patients reported experiencing, at least partly, either, an increased urge for movement, physical or mental restlessness after significant weight loss. Altogether 95.1% reported, at least partly, one or a combination of two or all three symptoms. The sensations coexisted with equally high levels of fatigue and loss of energy, typically observed in starvation. The increased urge for movement and physical restlessness were foremost associated with reported actual physical activity and with weight loss. By contrast, mental restlessness was strongly linked to the degree of eating disorder pathology and to the severity of psychiatric symptoms.This is the first investigation of the presence of an increased urge for movement, physical restlessness, and mental restlessness after significant weight loss in patients with acute AN. The symptoms, given their high frequency and specificity, are likely pathogenic for AN and, if replicated, deserve to be considered for inclusion as diagnostic criteria for AN.

    View details for DOI 10.1002/brb3.1556

    View details for PubMedID 32017454

  • 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. Frontiers in psychology Casper, R. C. 2018; 9: 2303


    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.

    View details for DOI 10.3389/fpsyg.2018.02303

    View details for PubMedID 30532724

    View details for PubMedCentralID PMC6265370

  • The "Strikingly Disproportionate Degree of Physical and Mental Energy" in Anorexia Nervosa (AN) Manifested as Restlessness and a Drive for Activity may Reflect a Disorder of Energy Homeostasis Casper, R. NATURE PUBLISHING GROUP. 2016: S469–S470
  • Restless activation and drive for activity in anorexia nervosa may reflect a disorder of energy homeostasis. International journal of eating disorders Casper, R. C. 2016; 49 (8): 750-752

    View details for DOI 10.1002/eat.22575

    View details for PubMedID 27315579

  • Use of selective serotonin reuptake inhibitor antidepressants in pregnancy does carry risks, but the risks are small. journal of nervous and mental disease Casper, R. C. 2015; 203 (3): 167-169


    The paper by Robinson posits that risks from prenatal exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants are not different from the risks encountered in the general population and that untoward effects of SSRIs are difficult to distinguish from those of the mood disorder. Indeed, maternal depression and anxiety can have negative consequences for fetal and postnatal development. Fortunately, experimental evidence suggests that mood and anxiety disorder symptoms often respond to psychosocial interventions. If pharmacotherapy becomes necessary, it is, however, important to know that even if SSRI drugs have been shown to be safe overall, research has shown that fetal development can be adversely affected by in utero exposure to SSRIs in a subgroup of neonates. Examples would be the transient neonatal adaptation syndrome, an increased risk of persistent pulmonary hypertension of the newborn, and small, albeit measurable, changes in motor and social adaptability in infancy and childhood.

    View details for DOI 10.1097/NMD.0000000000000258

    View details for PubMedID 25714254

  • Selective Serotonin Reuptake Inhibitors (ssri) in Pregnancy: The Effects on the Offspring Casper, R. ELSEVIER SCIENCE INC. 2012: 101S
  • Length of prenatal exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants: effects on neonatal adaptation and psychomotor development PSYCHOPHARMACOLOGY Casper, R. C., Gilles, A. A., Fleisher, B. E., Baran, J., Enns, G., Lazzeroni, L. C. 2011; 217 (2): 211-219


    This study evaluated the question whether length of in utero exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants might affect neonatal outcome and psychomotor development in infancy.Birth outcome was determined in the offspring of 55 women with major depressive disorder who used SSRI medication for different durations during their pregnancies. At an average age of 14 months, children underwent a pediatric examination and an evaluation with the Bayley Scales of Infant Development (BSID-II).Duration of in utero exposure to SSRIs was negatively associated with total Apgar scores, specifically the activity subscale. Odds ratios for a low score (<2) on this scale were 3.8 and 6.0 at 1 and 5 min, respectively. Newborns with longer exposure were more often admitted to the Neonatal Intensive Care Unit (p < .03). Mental Development Index scores of the infants were not associated with the length of gestational exposure to SSRIs. A longer duration of exposure increased the risk for lower Psychomotor Developmental Index and Behavioral Rating Scale scores in infancy (p = 0.012 and p = 0.007, respectively) on the BSID-II.The findings provide evidence that the length of prenatal SSRI antidepressant use can affect neonatal adjustment and can have an effect on psychomotor test scores in infancy. Importantly, the children's mental development and motor function by neurological examination were within the normal range. Timing of exposure to SSRIs during susceptible periods of fetal development and variations in the severity of maternal depression may have contributed to the associations.

    View details for DOI 10.1007/s00213-011-2270-z

    View details for PubMedID 21499702

  • Diet and Mental Health: An Up-to-Date Analysis Inaugural Conference of the World-Council-on-Genetic-Nutrition-and-Fitness-for-Health Casper, R. C. KARGER. 2011: 98–113

    View details for Web of Science ID 000294441100013

    View details for PubMedID 21865824

  • Relevance of animal models to human eating disorders and obesity PSYCHOPHARMACOLOGY Casper, R. C., Sullivan, E. L., Tecott, L. 2008; 199 (3): 313-329


    This review addresses the role animal models play in contributing to our knowledge about the eating disorders anorexia nervosa (AN) and bulimia nervosa (BN) and obesity.Explore the usefulness of animal models in complex biobehavioral familial conditions, such as AN, BN, and obesity, that involve interactions among genetic, physiologic, psychological, and cultural factors.The most promising animal model to mimic AN is the activity-based anorexia rodent model leading to pathological weight loss. The paradigm incorporates reward elements of the drive for activity in the presence of an appetite and allows the use of genetically modified animals. For BN, the sham-feeding preparation in rodents equipped with a gastric fistula appears to be best suited to reproduce the postprandial emesis and the defects in satiety. Animal models that incorporate genes linked to behavior and mood may clarify biobehavioral processes underlying AN and BN. By contrast, a relative abundance of animal models has contributed to our understanding of human obesity. Both environmental and genetic determinants of obesity have been modeled in rodents. Here, we consider single gene mutant obesity models, along with models of obesigenic environmental conditions. The contributions of animal models to obesity research are illustrated by their utility for identifying genes linked to human obesity, for elucidating the pathways that regulate body weight and for the identification of potential therapeutic targets. The utility of these models may be further improved by exploring the impact of experimental manipulations on the behavioral determinants of energy balance.

    View details for DOI 10.1007/s00213-008-1102-2

    View details for Web of Science ID 000257383200003

    View details for PubMedID 18317734

  • The 'drive for activity' and "restlessness" in anorexia nervosa: Potential pathways JOURNAL OF AFFECTIVE DISORDERS Casper, R. C. 2006; 92 (1): 99-107


    This paper discusses the hypothesis that a 'drive for activity" in the presence of physiological and endocrine changes consistent with starvation is a characteristic symptom of acute anorexia nervosa (AN). This 'drive for movement', along with alertness and lack of fatigue, so unlike the motor slowing and loss of energy observed in simple starvation has been recognized in AN throughout history, but has received little attention in the past fifty years. Clinical reports and experimental evidence suggest that 'restlessness' and a 'drive for activity' vary in intensity, they appears to be starvation-dependent and to wane with food intake. Central nervous system (CNS) systems known to be involved in mediating activity and arousal levels that are altered by the negative energy expenditure in AN are reviewed. Among these, the corticotropin-releasing hormone (CRH) system, the melanocyte stimulating hormone/agouti-related protein (MSH/AGRP) system and the norepinephrine/epinephrine (NE/EPI) and dopamine (DA) system may contribute to the 'drive for activity' and alertness in AN. AN appears to represent a disorder of gene/environment interaction. Future research will reveal whether in individuals predisposed to AN, the 'drive for activity' reflects the reactivation of mechanisms important in food scarcity, controlled by one or more evolutionary conserved genes including those regulating foraging behavior. Recognition of the 'drive for activity' as a diagnostic symptom of AN and its assessment prior to re-nutrition would permit clarification of its role in the etiology of AN.

    View details for DOI 10.1016/j.jad.2005.12.039

    View details for Web of Science ID 000238136800013

    View details for PubMedID 16448703

  • Psychiatric disorders, mood and cognitive function: The influence of nutrients and physical activity 5th International Conference on Nutrition and Fitness Casper, R. C. KARGER. 2005: 1–16

    View details for Web of Science ID 000233859400003

    View details for PubMedID 16151266

  • Nutrients, neurodevelopment, and mood. Current psychiatry reports Casper, R. C. 2004; 6 (6): 425-429


    Human neurodevelopment is the result of genetic and environmental interactions. This paper examines the role of prenatal nutrition relative to psychiatric disorders and explores the relationship among nutrients, mood changes, and mood disorders. Epidemiologic studies have found that adults who were born with a normal, yet low birth weight have an increased susceptibility to diseases such as coronary heart disease, diabetes, and stroke in adulthood. Prenatal caloric malnutrition, low birth weight, and prematurity also increase the risk for neurodevelopmental disorders, schizophrenia, affective disorders, and schizoid and antisocial personality disorders. Placebo-controlled studies in medicated patients suggest that add-on treatment with omega-3 fatty acids, particularly eicosapentaenoic acid, may ameliorate symptoms of major depressive disorder. Additional studies are necessary to confirm any benefits for bipolar disorders.

    View details for PubMedID 15538990

  • Late pregnancy exposure to Serotonin Reuptake Inhibitors (SSRIs) is associated with neonatal adjustment problems and subtle motor changes in infancy compared to early pregnancy exposure to SSRIs or no drug exposure Casper, R. C., Fleischer, B. E., Lee-Ancajas, J. C., Gaylor, E., Hoyme, E. H., Gilles, A., DeBattista, A. NATURE PUBLISHING GROUP. 2004: S139
  • The need to revise the diagnostic criteria for anorexia nervosa JOURNAL OF NEURAL TRANSMISSION Hebebrand, J., Casper, R., Treasure, J., Schweiger, U. 2004; 111 (7): 827-840


    Anorexia nervosa (AN) is a complex disorder of unclear etiology. We argue that the current DSM-IV criteria do not adequately describe the cardinal symptoms of this "eating disorder". Our reasoning is based on the lack of empirical evidence supporting the terminology of some of the criteria, which underlie the core of our current conceptualisation of AN. We propose alternative criteria which allow a better integration of biologically derived hypotheses addressing the nosology and the symptomatology of AN.

    View details for DOI 10.1007/s00702-004-0136-9

    View details for Web of Science ID 000222514400006

    View details for PubMedID 15206001

  • Hyperactivity in patients with anorexia nervosa and in semistarved rats: evidence for a pivotal role of hypoleptinemia Annual Meeting of the Society-for-the-Study-of-Ingestive-Behavior Hebebrand, J., Exner, C., Hebebrand, K., Holtkamp, C., Casper, R. C., Remschmidt, H., Herpertz-Dahlmann, B., Klingenspor, M. PERGAMON-ELSEVIER SCIENCE LTD. 2003: 25–37


    Patients with anorexia nervosa (AN) often show normal to elevated physical activity levels despite severe weight loss and emaciation. This is seemingly in contrast to the loss of energy and fatigue characteristic of other starvation states associated with weight loss. Despite the fact that historical accounts and clinical case studies of AN have regularly commented on the elevated activity levels, the behavior has become only recently the subject of systematic study. Because rodents and other species increase their activity upon food restriction leading to weight loss when given access to an activity wheel--a phenomenon referred to as activity-based anorexia or semi-starvation-induced hyperactivity (SIH)-it has been proposed that the hyperactivity in AN patients may reflect the mobilization of phylogenetically old pathways in individuals predisposed to AN. Exogeneous application of leptin in this animal model of AN has recently been shown to suppress completely the development of SIH. Hypoleptinemia, as a result of the food restriction, may represent the initial trigger for the increased activity levels in AN patients and in food-restricted rats. In the first and second parts of our review, we will summarize the relevant findings pertaining to hyperactivity in AN patients and in the rat model, respectively. We conclude with a synopsis and implications for future research.

    View details for DOI 10.1016/S0031-9384(03)00102-1

    View details for Web of Science ID 000183846800004

    View details for PubMedID 12818707

  • Follow-up of children of depressed mothers exposed or not exposed to antidepressant drugs during pregnancy 1st International Conference on Womens Mental Health Casper, R. C., Fleisher, B. E., Lee-Ancajas, J. C., Gilles, A., Gaylor, E., DeBattista, A., Hoyme, H. E. MOSBY-ELSEVIER. 2003: 402–8


    To compare the structural growth and developmental outcome of children born to mothers diagnosed with major depressive disorder during pregnancy who were exposed or not exposed to selective serotonin reuptake inhibitors (SSRIs) in utero.Children whose mothers were diagnosed with major depressive disorder in pregnancy and elected not to take medication (n = 13) were compared with children of depressed mothers treated with SSRIs (n = 31) on birth outcomes and postnatal neurodevelopmental functioning between ages 6 and 40 months. Children underwent blinded standardized pediatric and dysmorphology examinations and evaluations of their mental and psychomotor development with the use of the Bayley Scales of Infant Development (BSID II).The Bayley mental developmental indexes were similar in both groups. Children exposed to SSRIs during pregnancy had lower APGAR scores and scored lower on the Bayley psychomotor development indexes and the motor quality factor of the Bayley Behavioral Rating Scale than unexposed children.The findings that SSRIs during fetal development might have subtle effects on motor development and motor control are consistent with the pharmacologic properties of the drugs.

    View details for DOI 10.1067/mpd.203.139

    View details for Web of Science ID 000182733800011

    View details for PubMedID 12712058

  • How useful are pharmacological treatments in eating disorders? Psychopharmacology bulletin Casper, R. C. 2002; 36 (2): 88-104


    The eating disorders anorexia nervosa (AN) and bulimia nervosa (BN) are multifactorial syndromes of unknown origin which occur typically in female adolescents or young women. Nowadays, AN and BN are most often triggered by dietary restriction. Both are treatable conditions. As in other psychiatric disorders, a lower comorbidity, a shorter duration of illness, less familial psychopathology, and, in AN, a higher minimal weight have been shown to be associated with a better outcome. So far, no abnormalities specific to AN or BN that would shed light on their etiology have been identified. Controlled and uncontrolled studies testing antipsychotic, antidepressant, weight-promoting, and prokinetic drugs have demonstrated that the core symptoms of AN are refractory to currently available psychotropic medication. For relapse prevention, however, antidepressant medication may be useful. Renutrition, psychotherapy, and family therapy remain the cornerstones of treatment for AN. Placebo-controlled studies with antidepressant drugs have been far more promising for treating BN in the short term. Recent studies have found that lasting symptomatic improvement and remission require the addition of psychological treatments in the form of cognitive and interpersonal psychotherapy. The steady stream of newly identified peptides and other molecules involved in appetite and body weight control may ultimately provide cues to better targeted treatments of eating disorders.

    View details for PubMedID 12397843

  • Family functioning in anorexia nervosa differs by subtype INTERNATIONAL JOURNAL OF EATING DISORDERS Casper, R. C., Troiani, M. 2001; 30 (3): 338-342


    This study investigated family functioning in adolescents with the restricting and bulimic type of anorexia nervosa (AN) and in healthy controls.Fifty-one parents and their children (17 with AN and 34 healthy adolescents) completed the Family Assessment Measure, a self-report instrument that provides information about the functional strengths and weaknesses of the family and each family member.AN patients with the bulimic subtype and their mothers were significantly more likely to perceive family functioning as impaired than were healthy adolescents or restricting AN patients. Restricting AN patients and their families did not differ from healthy control families.The results suggest that the problems faced by bulimic patients color their and their parents' view of each other and the family. Symptomatic and personality differences between the subtypes of AN with better control, fewer symptoms, and denial of conflict characterizing restricting AN families may be reflected in family interaction styles.

    View details for Web of Science ID 000170823400014

    View details for PubMedID 11767716

  • What triggers abnormal eating in bulimic and nonbulimic women? The role of dissociative experiences, negative affect, and psychopathology PSYCHOLOGY OF WOMEN QUARTERLY Lyubomirsky, S., Casper, R. C., Sousa, L. 2001; 25 (3): 223-232
  • No gender differences in placebo responses of patients with major depressive disorder BIOLOGICAL PSYCHIATRY Casper, R. C., Tollefson, G. D., Nilsson, M. E. 2001; 49 (2): 158-160


    This study was designed to compare placebo responses in men and women.Data for 501 women and 375 men with major depressive disorder treated with placebo from seven investigational randomized double-blind trials comparing fluoxetine with placebo were analyzed. Changes in major depressive disorder symptoms with placebo administration were measured as changes in total Hamilton Depression Rating Scale scores and adverse (nocebo) effects were measured by comparing treatment-emergent signs and symptoms.Both women and men with major depressive disorder showed significant symptomatic improvement following placebo administration, similar in magnitude and time course of response. Women on placebo reported slightly more nocebo effects than men.The finding that women and men with major depressive disorder demonstrated a similar therapeutic outcome after placebo administration suggests that gender is not a predictor of placebo response.

    View details for Web of Science ID 000166675000008

    View details for PubMedID 11164762

  • Mood, its relationship to physical activity and nutrition 4th International Conference on Nutrition and Fitness Casper, R. C., Reed, E., Gilles, A., Chiang, L. KARGER. 2001: 73–88

    View details for Web of Science ID 000172512700008

    View details for PubMedID 11545047

  • Behavioral activation and lack of concern, core symptoms of anorexia nervosa? 14th World Congress on Psychosomatic Medicine Casper, R. C. JOHN WILEY & SONS INC. 1998: 381–93


    The core symptoms of anorexia nervosa have remained points of debate. The goal of this paper is a close study of unexpected and paradoxical symptoms in anorexia nervosa which are described in the literature but which, for the most part, have escaped the attention of investigator.Following a brief examination of psychological influences: developmental psychodynamics issues, psychiatric comorbidity and personality features, as well as the physical consequences of starvation, all of which are considered probable contributors to the pathological process, the symptoms of denial, lack of concern, contentment, liveliness, and overactivity in anorexia nervosa are discussed.If these symptoms are accepted as specific for anorexia nervosa, their presence suggests that starvation might generate in individuals with a vulnerability for anorexia nervosa a condition of mental and physical activation.Areas of research to test this hypothesis, positing starvation-induced arousal or activation as a physiological dysregulation in anorexia nervosa which would powerfully support food avoidance, are discussed.

    View details for Web of Science ID 000076770900005

    View details for PubMedID 9813763

  • Serotonin, a major player in the regulation of feeding and affect BIOLOGICAL PSYCHIATRY Casper, R. C. 1998; 44 (9): 795-797

    View details for Web of Science ID 000076692700001

    View details for PubMedID 9807635

  • Women?s Health Cambridge University Press Casper 1998
  • Recognizing eating disorders in women PSYCHOPHARMACOLOGY BULLETIN Casper, R. C. 1998; 34 (3): 267-269


    Anorexia nervosa (AN) and bulimia nervosa (BN) are currently classified as eating disorders. Both disorders are the product of a complex interaction between psychological and physiological processes and both show considerable comorbidity with other psychiatric disorders. Physiological and endocrine abnormalities, including primary or secondary amenorrhea and menstrual dysfunction, are common and for the most part a function of the severity of weight loss, malnutrition and/or abnormal eating habits. Therefore, assessment needs to include several steps: (1) Clinical evaluation to ascertain the diagnosis, including weight and height measurements; (2) Determination of co-existing psychiatric illnesses; and (3) Physical examination and evaluation of the physiological and endocrine status. Eating disorders interfere with reproductive function. In view of the fact that dieting has reached epidemic proportions among the young female population, and given the high association between eating disorders and endocrine abnormalities as well as menstrual disturbances, all women participating in research studies should be screened for the presence of eating disorders, disordered eating, and excessive exercise.

    View details for Web of Science ID 000078297300008

    View details for PubMedID 9803752

  • Depression and eating disorders. Depression and anxiety Casper, R. C. 1998; 8: 96-104


    Both depressive disorders and eating disorders are multidimensional and heterogeneous disorders. This paper examines the nature of their relationship by reviewing clinical descriptive, family-genetic, treatment, and biological studies that relate to the issue. The studies confirm the prominence of depressive symptoms and depressive disorders in eating disorders. Other psychiatric syndromes which occur with less frequency, such as anxiety disorders and obsessive-compulsive disorders in anorexia nervosa, or personality disorders, anxiety disorders, and substance abuse in bulimia nervosa, also play an important role in the development and maintenance of eating disorders. Since few studies have controlled for starvation-induced physical, endocrine, or psychological changes which mimic the symptoms considered diagnostic for depression, further research will be needed. The evidence for a shared etiology is not compelling for anorexia nervosa and is at most suggestive for bulimia nervosa. Since in contemporary cases dieting-induced weight loss is the principal trigger, women with self-critical or depressive features will be disproportionately recruited into eating disorders. The model that fits the data best would accommodate a relationship between eating disorders and the full spectrum of depressive disorders from no depression to severe depression, with somewhat higher rates of depression in bulimic anorectic and bulimia nervosa patients than in restricting anorexia nervosa patients, but the model would admit a specific pathophysiology and psychopathology in each eating disorder.

    View details for PubMedID 9809221

  • Individual psychopathology relative to reports of unwanted sexual experiences as predictor of a bulimic eating pattern INTERNATIONAL JOURNAL OF EATING DISORDERS Casper, R. C., Lyubomirsky, S. 1997; 21 (3): 229-236


    The goal of this study was to determine whether family and individual psychopathology mediate the relationship between unwanted sexual experiences and bulimic eating behavior.Sixty-one women diagnosed with bulimia nervosa and 92 women students and university staff who had never met critia for an eating disorder completed standardized questionnaires on eating behavior, sexual abuse, individual psychopathology, and family psychopathology.Linear regression showed bulimic eating behavior to be significantly related to sexual abuse (beta = .40; p < .0001; R2 = 8.9%). However, multiple regression analyses with family and individual psychopathology as independent variables in addition to sexual abuse showed only individual psychopathology to predict significantly abnormal eating behavior (beta = .53, p < .0001; overall R2 = 49.6%). Specifically, depressive symptoms, suicidality, and impulsive behavior, but not substance abuse, were the components of individual psychopathology most directly associated with bulimia.The findings suggest that the primary focus in treatment should not be the traumatic events themselves, but their long-term consequences for the individual.

    View details for Web of Science ID A1997WQ64500003

    View details for PubMedID 9097196

  • Body perception and emotional health in athletes: A study of female adolescents involved in aesthetic sports 3rd International Conference on Nutrition and Fitness Casper, R. C., Michaels, J., Simon, K. KARGER. 1997: 134–147

    View details for Web of Science ID A1997BJ41E00008

    View details for PubMedID 9270317

  • Truly late onset of eating disorders: A study of 11 cases averaging 60 years of age at presentation INTERNATIONAL JOURNAL OF EATING DISORDERS Beck, D., Casper, R., Andersen, A. 1996; 20 (4): 389-395


    To study late-onset cases of eating disorders in order to (1) document the occurrence of these cases as truly new onset, even if postmenopausal; (2) to alert clinicians to the category of late-onset eating disorders, especially clinical features and treatment response; (3) to challenge some prevailing assumptions of etiology.Selection of cases of eating disorders with first onset after age 40 that met DSM-IV criteria, by review of eating disorders admissions to three university hospital programs.Eleven patients, approximately 1% of all cases of eating disorders, had first onset of an eating disorder after age 40 and as late as 77, with an average onset of 56 and clinical presentation at 60 years. They met DSM-IV criteria for all subtypes of eating disorders. In general, concurrent medical and comorbid psychiatric symptoms made recognition and treatment more complex.Truly late-onset cases do occur, challenging etiological theories requiring adolescent age of onset, premenopausal endocrine functioning, or adolescent psychodynamic conflicts. Late-occurring cases, after accurate diagnosis, require an appreciation of psychological themes pertinent to this age group, such as bereavement or unresolved body image issues. Age by itself is no barrier to onset of eating disorders, which may occur whenever self-starvation and/or binge-purge behaviors become entrenched as sustaining behaviors for amelioration of psychodynamic conflicts, mood disorders, or interpersonal distress.

    View details for Web of Science ID A1996VV63600006

    View details for PubMedID 8953326

  • An eight-year follow-up: Outcome from adolescent compared to adult onset anorexia nervosa JOURNAL OF YOUTH AND ADOLESCENCE Casper, R. C., Jabine, L. N. 1996; 25 (4): 499-517
  • Carbohydrate metabolism and its regulatory hormones in anorexia nervosa WHO Study Group on Anorexia Nervosa (AN) Meeting - Basic Mechanisms, Clinical Approaches and Treatment Casper, R. C. ELSEVIER IRELAND LTD. 1996: 85–96


    Findings of studies of carbohydrate metabolism in anorexia nervosa are reviewed. Topics covered included fasting blood sugar concentrations; serum insulin concentrations, insulin receptor binding activity, insulin sensitivity, and insulin resistance; plasma ketone bodies and free fatty acids; glucose tolerance tests; growth hormone, cortisol, intestinal hormones, and norepinephrine. Metabolic changes reported in anorexia nervosa are similar to those found in human and animal studies of states of caloric and carbohydrate restriction. Restoration of normal body weight is associated with normalization of virtually all measures. It is concluded that published studies offer no conclusive evidence for a syndrome-specific impairment in carbohydrate metabolism in anorexia nervosa.

    View details for Web of Science ID A1996UL14200011

    View details for PubMedID 8739118

  • Gender differences, but no racial group differences, in self-reported psychiatric symptoms in adolescents JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Casper, R. C., Belanoff, J., Offer, D. 1996; 35 (4): 500-508


    To study gender differences in psychiatric symptoms and their relationship to minor delinquent behavior in high school seniors.This was a cross-sectional study of symptoms experienced during the past 2 weeks and the past year. Male (n = 249) and female (n = 248) high school seniors attending an inner-city and two suburban high schools rated themselves on a 46-item Hopkins Symptom Checklist and a 19-item Delinquency questionnaire.Female adolescents, regardless of race, reported significantly higher levels of emotional distress, in particular depressed mood and anxiety, than did male adolescents. A separate factor analysis of male and female students generated anger-tension, school problems, and sadness-irritation, lethargy, respectively, as the first two factors. Trouble paying attention in school and marijuana, alcohol, and other drug use were associated with significantly higher levels of psychiatric symptoms. Black and white adolescents were similar in psychological adjustment.This survey confirms sex differences in the level of psychiatric symptoms for 16- to 18-year-old adolescents, suggests gender-related qualitative differences in negative emotions, and emphasizes the importance of controlling for education when studying adolescents from different ethnic or racial backgrounds.

    View details for Web of Science ID A1996UB75900016

    View details for PubMedID 8919712

  • Appetite and nutrition with aging PSYCHIATRIC ANNALS Casper, R. C. 1996; 26 (2): 56-?
  • NUTRITION AND ITS RELATIONSHIP TO AGING Symposium on the Neurobiology and Neuroendocrinology of Aging Casper, R. C. PERGAMON-ELSEVIER SCIENCE LTD. 1995: 299–314


    The aging process alone has no significant adverse consequences for the caloric intake and the nutritional status of healthy elderly individuals. Epidemiological data suggest that in humans, in contrast to rodents, undernutrition reduces the life span. In the Western World, malnutrition in old age has become uncommon and is, for the most part, the result of physical illness and/or of psychological and socio-economic factors, such as depressive disorders, social isolation, smoking, alcohol abuse, and poverty. Body weight shows a U- or J-shaped relationship to mortality risk with the highest survival rates found at normal to moderate overweight. However, studies that have controlled for disease already present, smoking status, serum cholesterol level, or hypertension, suggest an increased mortality risk for lower and upper extremes of body weight, only. Populations with healthy lifestyles have significantly greater life expectancy that the average normal population. Even in the very old, exercise has been shown to improve muscle strength and function. The studies suggest that nutritional intake and nutritional status in old age is multifactorial and dependent not only on appetite and availability of diverse food, but also on physical activity, body mass, education, and an involved social lifestyle.

    View details for Web of Science ID A1995RA38100009

    View details for PubMedID 7556509



    The study describes a sequential analysis of depression-related physical symptoms and their relationship to imipramine and amitriptyline plasma levels over 4 weeks of treatment in 79 unipolar and bipolar patients hospitalized for major depressive disorder. Insomnia diminished in all patients after 2 weeks of drug administration. After 4 weeks, the sleep of patients whose depressive disorder has significantly improved was nearly normal, whereas patients who remained depressed showed continued sleep impairment. Reductions in loss of appetite, weight and sexual interest paralleled mood improvement. Tricyclic plasma levels significantly correlated with improved sleep. The findings suggest a close link between depressed mood and physical symptoms during recovery from major depressive disorder.

    View details for Web of Science ID A1994NX89100001

    View details for PubMedID 7963067


    View details for Web of Science ID A1993BY22C00009

    View details for PubMedID 8503221



    Attitudes toward body weight and dieting and the relations of these attitudes to psychological adjustment were investigated in 497 randomly selected adolescents who were in their senior year in one urban and two suburban midwestern high schools. Most students reported feeling physically healthy. Two thirds of female adolescents were preoccupied with weight and dieting compared with only a small number (approximately 15%) of male adolescents. Black female adolescents were found to be less weight- and diet-conscious than white female adolescents. Increased weight and dieting concerns were associated with greater body and self-image dissatisfaction, with a depressed mood, and greater overall symptomatic distress in both male and female adolescents. The fairly common fear of being overweight and thoughts about dieting experienced by contemporary female adolescents, in part, seem to reflect the greater aesthetic value that contemporary society places on thinness for women. Overall, the findings suggest that preoccupation with weight and/or dieting concerns in either male or female adolescents are likely to indicate psychological problems.

    View details for Web of Science ID A1990DW64600011

    View details for PubMedID 2388787



    Personality characteristics were assessed in women who had physically and, in the majority, psychologically recovered from restricting anorexia nervosa at an 8- to 10-year follow-up. Personality dimensions were evaluated using the Multidimensional Personality Questionnaire, the California Personality Inventory, and the Reid-Ware Scale. Women who had recovered from anorexia nervosa rated higher on risk avoidance, displayed greater restraint in emotional expression and initiative, and showed greater conformance to authority than age-matched normal women. On comparison with their sisters, the recovered women reported a greater degree of self- and impulse control and less enterprise and spontaneity; sisters, however, endorsed equally high moral standards. The differences in personality characteristics remained significant after statistically controlling for depressive symptoms and eating behavior. The results suggest that a temperamental disposition toward emotional and behavioral restraint combined with a strong sense for traditional values may be psychological risk factors for the development of the restricting type of anorexia nervosa.

    View details for Web of Science ID A1990CY40600004

    View details for PubMedID 2330389

  • Cortisol measures in primary major depressive disorder with hypersomnia or appetite increase. J. Affect. Disorders Casper, et al 1988: 131-140
  • Bulimia, its incidence and clinical significance in patients with anorexia nervosa. Arch.Gen Psych. Casper, et el. 1980: 1030-1035