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Mahr F, Waschbusch DA, Vgontzas A. A Pilot Study on the Effectiveness of Prazosin as a Treatment of Post-Traumatic Stress Disorder-Related Nightmares in Women with Bulimia Nervosa. Cureus 2023; 15:e42433. [PMID: 37637523 PMCID: PMC10448916 DOI: 10.7759/cureus.42433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Objectives Post-traumatic stress disorder (PTSD) symptoms are reported in over 36% of individuals with bulimia nervosa. To date, none of the clinical trials have examined nightmare reduction in this population. We evaluated the effectiveness of prazosin in bulimic females experiencing PTSD-related nightmares. We hypothesized that prazosin will decrease nightmares, normalize cortisol levels and secretory patterns, and improve sleep. Methods Our seven-week prospective, randomized, double-blind, placebo-controlled crossover pilot trial recruited eight adult women. Each participant received three weeks of prazosin and a placebo, separated by a one-week washout period. The order of treatment was counterbalanced across participants. Self-reports, clinician-administered scales, and salivary cortisol was collected to measure outcomes. Results A significant treatment effect was seen in nightmare intensity on the Clinician-Administered PTSD Scale (CAPS-I) (p=0.026) and a marginally significant effect on nightmare frequency (p=0.069). The only significant main effect of treatment on self-reported sleep parameters was on nightmares. Cortisol secretory patterns did not change, but on average, study participants had significantly higher cortisol levels compared to normative values. ANOVA showed a significant main effect of time for cortisol (F(4, 28) = 6.15, p=.001) but no within or between groups significant effects (ps>.179). Follow-up tests showed the effect of time was linear (F(1, 7) = 10.77, p=.013). Conclusion Prazosin significantly reduced intensity and marginally reduced the frequency of PTSD-related nightmares in bulimia nervosa but did not affect subjective sleep efficiency, quality, cortisol levels, or diurnal cortisol secretory pattern. Larger trials using objective sleep measures are warranted to replicate these findings.
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Affiliation(s)
- Fauzia Mahr
- Pediatrics and Eating Disorders, Penn State College of Medicine, Hershey, USA
| | - Daniel A Waschbusch
- Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, USA
| | - Alexandros Vgontzas
- Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, USA
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Porter C, Palmier-Claus J, Branitsky A, Mansell W, Warwick H, Varese F. Childhood adversity and borderline personality disorder: a meta-analysis. Acta Psychiatr Scand 2020; 141:6-20. [PMID: 31630389 DOI: 10.1111/acps.13118] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this meta-analysis was to better understand the magnitude and consistency of the association between childhood adversity and borderline personality disorder (BPD) across case-control, epidemiological and prospective cohort studies. METHOD Following the review protocol (reference: CRD42017075179), search terms pertaining to adversity and BPD were entered into three search engines. Random-effects meta-analysis synthesised the size and consistency of the effects. RESULTS A total of 97 studies compared BPD to non-clinical (k = 40) and clinical (k = 70) controls. Meta-analysis of case-control studies indicated that individuals with BPD are 13.91 (95% CI 11.11-17.43) times more likely to report childhood adversity than non-clinical controls. This effect was smaller when considering retrospective cohort (OR: 2.59; 95% CI 0.93-7.30) and epidemiological (OR: 2.56, 95% CI 1.24-5.30) studies. Findings were significant across adversity subtypes with emotional abuse (OR: 38.11, 95% CI: 25.99-55.88) and neglect (OR: 17.73, 95% CI = 13.01-24.17) demonstrating the largest effects. Individuals with BPD were 3.15 (95% CI 2.62-3.79) times more likely to report childhood adversity than other psychiatric groups. CONCLUSIONS This meta-analysis corroborates theoretical proposals that exposure to adverse life experiences is associated with BPD. It highlights the importance of considering childhood adversity when treating people diagnosed with BPD.
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Affiliation(s)
- C Porter
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - J Palmier-Claus
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK.,Lancashire Care NHS Foundation Trust, Lancashire, UK
| | - A Branitsky
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - W Mansell
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - H Warwick
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - F Varese
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Sjögren M, Nielsen ASM, Hasselbalch KC, Wøllo M, Hansen JS. A systematic review of blood-based serotonergic biomarkers in Bulimia Nervosa. Psychiatry Res 2019; 279:155-171. [PMID: 30878305 DOI: 10.1016/j.psychres.2018.12.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 12/20/2018] [Accepted: 12/30/2018] [Indexed: 01/12/2023]
Abstract
Bulimia Nervosa (BN) is a serious eating disorder, which affects 0.8-2.9% of the young population. The etiology is unknown and biomarkers would support in understanding the pathophysiology of BN, and in identifying BN patients that may benefit from medical treatment. This systematic review aims to answer whether (a) BN deviate from healthy controls in terms of serotonin (5-HT) biomarkers in blood, and whether (b) blood-based 5-HT biomarkers could be used to tailor psychopharmacological treatment in BN. A literature search using PubMed, PsycINFO and Embase was done using the following search terms: "Bulimia Nervosa" AND "serotonin" AND "blood" OR "plasma" OR "serum". 32 studies were included in this systematic review. Several biomarkers and challenge tests were identified and all studies described an association with BN and dysregulation of the 5-HT system compared to healthy controls. Several studies pointed to an association also to borderline symptoms in BN. BN deviate from healthy controls in terms of 5-HT biomarkers in blood supporting an abnormal 5-HT system in BN. 5-HT biomarkers and associated methods could be used to tailor treatment in BN although as yet, most tests described are unpractical for bedside use.
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Affiliation(s)
- Magnus Sjögren
- Mental Health Center Ballerup, Ballerup, Denmark; University of Copenhagen, Copenhagen, Denmark.
| | | | | | - Maria Wøllo
- Mental Health Center Ballerup, Ballerup, Denmark
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Utzinger LM, Haukebo JE, Simonich H, Wonderlich SA, Cao L, Lavender JM, Mitchell JE, Engel SG, Crosby RD. A latent profile analysis of childhood trauma in women with bulimia nervosa: Associations with borderline personality disorder psychopathology. Int J Eat Disord 2016; 49:689-94. [PMID: 27038436 PMCID: PMC5268761 DOI: 10.1002/eat.22532] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/10/2016] [Accepted: 02/13/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of this study was to empirically examine naturally occurring groups of individuals with bulimia nervosa (BN) based on their childhood trauma (CT) histories and to compare these groups on a clinically relevant external validator, borderline personality disorder (BPD) psychopathology. METHOD This study examined the relationship between CT and BPD psychopathology among 133 women with BN using latent profile analysis (LPA) to classify participants based on histories of CT. Participants completed the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I/P), the Diagnostic Interview for Borderlines-Revised (DIB-R), and the Childhood Trauma Questionnaire (CTQ). RESULTS The LPA revealed four trauma profiles: low/no trauma, emotional trauma, sexual trauma, and polytrauma. Results indicated that the sexual and polytrauma profiles displayed significantly elevated scores on the DIB-R and that the low/no and emotional trauma profiles did not differ significantly on the DIB-R. Secondary analyses revealed elevated levels of a composite CT score among those with both BN and BPD psychopathology compared to those with BN only. DISCUSSION These findings suggest that both childhood sexual abuse and the additive effects of childhood polytrauma may be linked to BPD psychopathology in BN. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:689-694).
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Affiliation(s)
- Linsey M. Utzinger
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Heath Sciences, Fargo, ND,Correspondence concerning this article should be addressed to Linsey M. Utzinger, Neuropsychiatric Research Institute, 120 South 8th Street, Fargo, ND 58103.
| | - Justine E. Haukebo
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND
| | - Heather Simonich
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND
| | - Stephen A. Wonderlich
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Heath Sciences, Fargo, ND
| | - Li Cao
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND
| | - Jason M. Lavender
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Heath Sciences, Fargo, ND
| | - James E. Mitchell
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Heath Sciences, Fargo, ND
| | - Scott G. Engel
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Heath Sciences, Fargo, ND
| | - Ross D. Crosby
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Heath Sciences, Fargo, ND
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Skrzypińska D, Szmigielska B. Dream-reality confusion in borderline personality disorder: a theoretical analysis. Front Psychol 2015; 6:1393. [PMID: 26441768 PMCID: PMC4569816 DOI: 10.3389/fpsyg.2015.01393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 09/01/2015] [Indexed: 11/30/2022] Open
Abstract
This paper presents an analysis of dream-reality confusion (DRC) in relation to the characteristics of borderline personality disorder (BPD), based on research findings and theoretical considerations. It is hypothesized that people with BPD are more likely to experience DRC compared to people in non-clinical population. Several variables related to this hypothesis were identified through a theoretical analysis of the scientific literature. Sleep disturbances: problems with sleep are found in 15–95.5% of people with BPD (Hafizi, 2013), and unstable sleep and wake cycles, which occur in BPD (Fleischer et al., 2012), are linked to DRC. Dissociation: nearly two-thirds of people with BPD experience dissociative symptoms (Korzekwa and Pain, 2009) and dissociative symptoms are correlated with a fantasy proneness; both dissociative symptoms and fantasy proneness are related to DRC (Giesbrecht and Merckelbach, 2006). Negative dream content: People with BPD have nightmares more often than other people (Semiz et al., 2008); dreams that are more likely to be confused with reality tend to be more realistic and unpleasant, and are reflected in waking behavior (Rassin et al., 2001). Cognitive disturbances: Many BPD patients experience various cognitive disturbances, including problems with reality testing (Fiqueierdo, 2006; Mosquera et al., 2011), which can foster DRC. Thin boundaries: People with thin boundaries are more prone to DRC than people with thick boundaries, and people with BPD tend to have thin boundaries (Hartmann, 2011). The theoretical analysis on the basis of these findings suggests that people who suffer from BPD may be more susceptible to confusing dream content with actual waking events.
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Affiliation(s)
- Dagna Skrzypińska
- Unit of Sleep Psychology, Institute of Psychology, Jagiellonian University Krakow, Poland
| | - Barbara Szmigielska
- Unit of Sleep Psychology, Institute of Psychology, Jagiellonian University Krakow, Poland
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Vaz-Leal FJ, Rodríguez-Santos L, García-Herráiz MA, Chimpén-López CA, Rojo-Moreno L, Beato-Fernández L, Ramos-Fuentes MI. The role of depression and impulsivity in the psychopathology of bulimia nervosa. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2013; 7:25-31. [PMID: 23972724 DOI: 10.1016/j.rpsm.2013.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 06/18/2013] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The study aimed to analyze the role of depression and impulsivity in the psychopathology of bulimia nervosa (BN). MATERIALS AND METHODS Seventy female patients with DSM-IV BN, purging subtype, were assessed for eating-related symptoms, body dissatisfaction, affective symptoms, impulsivity, and personality traits. Factor analysis and structural equation modeling methods were used for statistical analysis. RESULTS BN appeared as a condition which incorporated 5 general dimensions: a) binge eating and compensatory behaviours; b) restrictive eating; c) body dissatisfaction; d) dissocial personality traits; and e) a cluster of features which was called «emotional instability» The 5 obtained dimensions can be grouped into 2 basic factors: body dissatisfaction/eating behaviour and personality traits/psychopathology. The first one contains the clinical items used for the definition of BN as a clinical condition in the DSM-V and the International Classification of Diseases 10, and reflects the morphology and the severity of the eating-related symptoms. The second dimension includes a cluster of symptoms (depressive symptoms, impulsivity, and borderline, self-defeating and dissocial personality traits) which could be regarded as the «psychopathological core» of BN and may be able to condition the course and the prognosis of BN.
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Affiliation(s)
- Francisco J Vaz-Leal
- Facultad de Medicina, Universidad de Extremadura/Unidad de Trastornos de la Conducta Alimentaria, Complejo Hospitalario Universitario, Servicio Extremeño de Salud, Badajoz, España.
| | - Laura Rodríguez-Santos
- Facultad de Medicina, Universidad de Extremadura/Unidad de Trastornos de la Conducta Alimentaria, Complejo Hospitalario Universitario, Servicio Extremeño de Salud, Badajoz, España
| | - M Angustias García-Herráiz
- Facultad de Medicina, Universidad de Extremadura/Unidad de Trastornos de la Conducta Alimentaria, Complejo Hospitalario Universitario, Servicio Extremeño de Salud, Badajoz, España
| | - Carlos A Chimpén-López
- Facultad de Medicina, Universidad de Extremadura/Unidad de Trastornos de la Conducta Alimentaria, Complejo Hospitalario Universitario, Servicio Extremeño de Salud, Badajoz, España
| | - Luís Rojo-Moreno
- Facultad de Medicina, Universidad de Valencia/Unidad de Trastornos de la Conducta Alimentaria, Hospital La Fe, Valencia, España
| | - Luís Beato-Fernández
- Facultad de Medicina, Unidad de Trastornos de la Conducta Alimentaria, Hospital General de Ciudad Real, Universidad de Castilla-La Mancha, Ciudad Real, España
| | - María Isabel Ramos-Fuentes
- Facultad de Medicina, Universidad de Extremadura/Unidad de Trastornos de la Conducta Alimentaria, Complejo Hospitalario Universitario, Servicio Extremeño de Salud, Badajoz, España
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7
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Somer E, Ginzburg K, Kramer L. The role of impulsivity in the association between childhood trauma and dissociative psychopathology: mediation versus moderation. Psychiatry Res 2012; 196:133-7. [PMID: 22342121 DOI: 10.1016/j.psychres.2011.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 08/15/2011] [Accepted: 08/18/2011] [Indexed: 11/18/2022]
Abstract
Previous studies on survivors of childhood trauma documented associations between psychological dysregulation, impulsivity, and both behavioral and emotional manifestations of distress. Yet, the mechanism that links these variables remains unclear. The current study aims to examine the pattern of relations between a history of child abuse, impulsivity and dissociation. More specifically, it examines whether impulsivity serves as a moderator or mediator in the association between childhood trauma and dissociation. Eighty-one inpatients from the acute wards of two psychiatric hospitals participated in this study. Data were collected by clinician-administered questionnaires. A highly significant linear hierarchical regression analysis revealed that both psychiatric comorbidity and childhood trauma made unique contributions to the variance of dissociation. Yet, the significant association between childhood trauma and dissociation decreased when impulsivity was entered into the regression model. Our findings suggest that impulsivity mediates the association between childhood trauma and dissociative psychopathology and imply that the identification and treatment of impulsivity could be a potentially valuable clinical target in individuals with dissociative disorders.
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Affiliation(s)
- Eli Somer
- School of Social Work, University of Haifa, Mt. Carmel, Haifa, Israel.
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8
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Keeshin BR, Cronholm PF, Strawn JR. Physiologic changes associated with violence and abuse exposure: an examination of related medical conditions. TRAUMA, VIOLENCE & ABUSE 2012; 13:41-56. [PMID: 22186168 DOI: 10.1177/1524838011426152] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Although the extant evidence is replete with data supporting linkages between exposure to violence or abuse and the subsequent development of medical illnesses, the underlying mechanisms of these relationships are poorly defined and understood. Physiologic changes occurring in violence- or abuse-exposed individuals point to potentially common biological pathways connecting traumatic exposures with medical outcomes. Herein, the evidence describing the long-term physiologic changes in abuse- and violence-exposed populations and associated medical illnesses are reviewed. Current data support that (a) specific neurobiochemical changes are associated with exposure to violence and abuse; (b) several biological pathways have the potential to lead to the development of future illness; and (c) common physiologic mechanisms may moderate the severity, phenomenology, or clinical course of medical illnesses in individuals with histories of exposure to violence or abuse. Importantly, additional work is needed to advance our emerging understanding of the biological mechanisms connecting exposure to violence and abuse and negative health outcomes.
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Affiliation(s)
- Brooks R Keeshin
- Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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9
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Paris J, Laporte L, Russell J, Ng Ying Kin N, Guttman H. Platelet [³H] paroxetine binding in female patients with borderline personality disorder and their sisters. Psychiatry Res 2011; 186:76-9. [PMID: 20832123 DOI: 10.1016/j.psychres.2010.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 08/11/2010] [Accepted: 08/16/2010] [Indexed: 10/19/2022]
Abstract
Paroxetine binding could be a vulnerability marker for traits associated with borderline personality disorder (BPD). To study this relationship, we examined [³H] paroxetine binding in female patients with BPD and their sisters. The sample consisted of 54 sibling pairs in which a proband met criteria for BPD. All subjects were given the Diagnostic Interview for Borderlines, revised (DIB-R), the Diagnostic Assessment for Personality Pathology: Brief Questionnaire (DAPP-BQ), the Barratt Impulsivity Scale (BIS), the Affective Lability Scale (ALS), the Hamilton Rating Scale for Anxiety (HAM-A), the Hamilton Rating Scale for Depression (HAM-D), and the Symptom Checklist-90, revised (SCL-90-R). All subjects had platelets assayed for [³H] paroxetine binding. There were no significant differences between probands and sisters, but both groups scored significantly lower than a previously studied control group on B(max). There were no differences on Kd. Neither B(max) nor K(d) was related to most trait or symptomatic measures. Paroxetine binding could reflect endophenotypes common to BPD probands and their first-degree relatives.
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Affiliation(s)
- Joel Paris
- Institute of Community and Family Psychiatry, Canada.
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10
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Chen LP, Murad MH, Paras ML, Colbenson KM, Sattler AL, Goranson EN, Elamin MB, Seime RJ, Shinozaki G, Prokop LJ, Zirakzadeh A. Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clin Proc 2010; 85:618-29. [PMID: 20458101 PMCID: PMC2894717 DOI: 10.4065/mcp.2009.0583] [Citation(s) in RCA: 532] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To systematically assess the evidence for an association between sexual abuse and a lifetime diagnosis of psychiatric disorders. PATIENTS AND METHODS We performed a comprehensive search (from January 1980-December 2008, all age groups, any language, any population) of 9 databases: MEDLINE, EMBASE, CINAHL, Current Contents, PsycINFO, ACP Journal Club, CCTR, CDSR, and DARE. Controlled vocabulary supplemented with keywords was used to define the concept areas of sexual abuse and psychiatric disorders and was limited to epidemiological studies. Six independent reviewers extracted descriptive, quality, and outcome data from eligible longitudinal studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled across studies by using the random-effects model. The I(2) statistic was used to assess heterogeneity. RESULTS The search yielded 37 eligible studies, 17 case-control and 20 cohort, with 3,162,318 participants. There was a statistically significant association between sexual abuse and a lifetime diagnosis of anxiety disorder (OR, 3.09; 95% CI, 2.43-3.94), depression (OR, 2.66; 95% CI, 2.14-3.30), eating disorders (OR, 2.72; 95% CI, 2.04-3.63), posttraumatic stress disorder (OR, 2.34; 95% CI, 1.59-3.43), sleep disorders (OR, 16.17; 95% CI, 2.06-126.76), and suicide attempts (OR, 4.14; 95% CI, 2.98-5.76). Associations persisted regardless of the victim's sex or the age at which abuse occurred. There was no statistically significant association between sexual abuse and a diagnosis of schizophrenia or somatoform disorders. No longitudinal studies that assessed bipolar disorder or obsessive-compulsive disorder were found. Associations between sexual abuse and depression, eating disorders, and posttraumatic stress disorder were strengthened by a history of rape. CONCLUSION A history of sexual abuse is associated with an increased risk of a lifetime diagnosis of multiple psychiatric disorders.
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Affiliation(s)
- Laura P Chen
- Mayo Medical School, Mayo Clinic, Rochester, MN 55905, USA
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11
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Boynton-Jarrett R, Fargnoli J, Suglia SF, Zuckerman B, Wright RJ. Association between maternal intimate partner violence and incident obesity in preschool-aged children: results from the Fragile Families and Child Well-being Study. ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2010; 164:540-6. [PMID: 20530304 PMCID: PMC4586060 DOI: 10.1001/archpediatrics.2010.94] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine the impact of chronicity of maternal intimate partner violence (IPV) on obesity risk among preschool-aged children. DESIGN Prospective cohort study. SETTING Several large US cities. PARTICIPANTS A subsample of the Fragile Families and Child Well-being Study participants (n = 1595), who were children born between 1998 and 2000 and their parents interviewed at baseline and at 12, 36, and 60 months. MAIN EXPOSURE Maternal report of restrictive, sexual, and physical abuse from an intimate partner. Chronic IPV was defined as any maternal IPV exposure during both pregnancy or infancy (0-12 months) and early childhood (36-60 months). MAIN OUTCOME MEASURE Repeated measures of child body mass index. RESULTS Among the 1595 children, 16.5% were obese at age 5 years and 49.4% of the mothers reported some form of IPV. Compared with those who had no IPV exposure, children whose mothers reported chronic IPV had an elevated risk for obesity at age 5 years (adjusted odds ratio = 1.80; 95% confidence interval, 1.24-2.61). Stratified analyses indicated increased risk for obesity among girls with a maternal history of chronic IPV (adjusted odds ratio = 2.21; 95% confidence interval, 1.30-3.75) compared with boys (adjusted odds ratio = 1.66; 95% confidence interval, 0.94-2.93) and a larger effect of any maternal IPV on obesity among children living in less safe neighborhoods (adjusted odds ratio = 1.56; 95% confidence interval, 1.03-2.36). CONCLUSIONS Chronic maternal IPV is associated with increased risk of obesity among preschool-aged children. Preventing family violence and improving community safety may help reduce childhood obesity.
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Affiliation(s)
- Renée Boynton-Jarrett
- Department of General Pediatrics, Boston University School of Medicine, 88 E Newton St, Boston, MA 02118, USA.
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12
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Racine SE, Culbert KM, Larson CL, Klump KL. The possible influence of impulsivity and dietary restraint on associations between serotonin genes and binge eating. J Psychiatr Res 2009; 43:1278-86. [PMID: 19493540 PMCID: PMC2870529 DOI: 10.1016/j.jpsychires.2009.05.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 05/04/2009] [Accepted: 05/06/2009] [Indexed: 11/25/2022]
Abstract
Although serotonin (5-HT) genes are thought to be involved in the etiology of bulimia nervosa and binge eating, findings from molecular genetic studies are inconclusive. This may be due to limitations of past research, such as a failure to consider the influence of quantitative traits and gene-environment interactions. The current study investigated these issues by examining whether quantitative traits (i.e., impulsivity) and environmental exposure factors (i.e., dietary restraint) moderate 5-HT gene/binge eating associations in a sample of young women (N = 344). Binge eating was assessed using the Minnesota Eating Behavior Survey and the Dutch Eating Behavior Questionnaire (DEBQ). Impulsivity was assessed with the Barratt Impulsiveness Scale-Version 11. Dietary restraint was measured with a factor score derived from common restraint scales. Saliva samples were genotyped for the 5-HT2a receptor T102C polymorphism and 5-HT transporter promoter polymorphism. As expected, impulsivity and dietary restraint were associated with binge eating. Although the T allele of the 5-HT2a receptor gene and the s allele of the 5-HTT gene were associated with higher levels of impulsivity, there were no main effects of 5-HT genotypes on any binge eating measure, and interactions between genotypes, impulsivity, and dietary restraint were non-significant. In conclusion, we found no evidence to suggest that dietary restraint or impulsivity moderate associations between binge eating and these 5-HT genes. Future research should continue to explore interaction effects by examining larger samples, assessing dietary intake directly, and investigating other genes, traits, and environmental factors that may be related to binge eating and bulimia nervosa.
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Affiliation(s)
- Sarah E. Racine
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Kristen M. Culbert
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Christine L. Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Kelly L. Klump
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
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Fischer S, Smith GT, Cyders MA. Another look at impulsivity: a meta-analytic review comparing specific dispositions to rash action in their relationship to bulimic symptoms. Clin Psychol Rev 2008; 28:1413-25. [PMID: 18848741 DOI: 10.1016/j.cpr.2008.09.001] [Citation(s) in RCA: 219] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 08/12/2008] [Accepted: 09/02/2008] [Indexed: 10/21/2022]
Abstract
Recent advances in personality theory indicate that there are distinct constructs that dispose individuals to rash action and risky behavior, as opposed to one broad trait of impulsivity. Two are emotion based, two represent deficits in conscientiousness, and one is sensation seeking. Previous studies of impulsivity and its relationship to bulimia nervosa have yielded mixed findings. The authors applied this advance in personality theory to the study of bulimia nervosa (BN) to test the hypothesis that the emotion-based disposition of negative urgency (the tendency to act rashly when distressed) relates most strongly to BN symptoms. A meta-analysis of 50 articles indicated the following. Negative urgency had by far the largest effect size (weighted r=.38), followed by sensation seeking (weighted r=.16); lack of planning (weighted r=.16) and lack of persistence (weighted r=.08). Methodological moderators of the effect of distinct traits on BN symptoms were the use of scales that precisely measured one construct as opposed to general impulsivity scales that measured several constructs, clinical vs. non-clinical samples, and whether or not the personality scale was translated from its original language or not. Negative urgency appears especially important for BN; more broadly, researchers should consider the role of emotion-based dispositions to rash acts in their risk theories.
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Affiliation(s)
- Sarah Fischer
- Psychology Department, University of Georgia, United States.
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Gurguis GN. Psychiatric Disorders. Platelets 2007. [DOI: 10.1016/b978-012369367-9/50806-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Steiger H, Gauvin L, Joober R, Israel M, Ng Ying Kin NMK, Bruce KR, Richardson J, Young SN, Hakim J. Intrafamilial correspondences on platelet [3H-]paroxetine-binding indices in bulimic probands and their unaffected first-degree relatives. Neuropsychopharmacology 2006; 31:1785-92. [PMID: 16407896 DOI: 10.1038/sj.npp.1301011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Reduced brain serotonin (5-hydroxytryptamine: 5-HT) transporter activity has been associated with susceptibility to various forms of psychopathology, including bulimia nervosa (BN) and related syndromes characterized by appetitive or behavioural dysregulation. We applied density (Bmax) of platelet [3H-]paroxetine binding as a proxy for central 5-HT reuptake activity in two groups of women (33 with BN-spectrum disorders and 19 with no apparent eating or psychiatric disorders), most of these individuals' mothers (31 and 18, respectively), and a small sampling of their sisters (seven and eight, respectively). Hierarchical linear modeling techniques were used to account for nesting of individuals within families and diagnostic groupings. Bulimic probands, their mothers, and their sisters all displayed significantly lower density (Bmax) of platelet-paroxetine binding than did 'control' probands, mothers, or sisters-even when relatives showing apparent eating or psychiatric disturbances were excluded. In addition, in bulimic probands and mothers, significant within-family correlations were obtained on Bmax. These findings imply a heritable trait (or endophenotype), linked to 5-HT activity, and carried by BN sufferers and their first-degree relatives (even when asymptomatic). We propose that, under conducive circumstances, such a trait may increase risk of binge-eating behavior, or associated symptoms of affective or behavioral dysregulation.
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Affiliation(s)
- Howard Steiger
- Eating Disorders Program, Douglas Hospital, Montreal, QC, Canada.
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Ng Ying Kin NMK, Paris J, Schwartz G, Zweig-Frank H, Steiger H, Nair NPV. Impaired platelet [3H]paroxetine binding in female patients with borderline personality disorder. Psychopharmacology (Berl) 2005; 182:447-51. [PMID: 16052363 DOI: 10.1007/s00213-005-0097-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2005] [Accepted: 06/09/2005] [Indexed: 10/25/2022]
Abstract
RATIONALE There have been few studies of platelet paroxetine binding in borderline personality disorder (BPD). OBJECTIVE Our aim was to determine whether female BPD subjects show abnormalities in platelet paroxetine binding. METHODS Twenty-one female BPD subjects and 16 age- and gender-matched normal control subjects were assessed using the following: (1) Diagnostic Interview for Borderlines, Revised, (2) Diagnostic Assessment for Personality Pathology: Brief Questionnaire, and (3) Barratt Impulsivity Scale. Platelets were collected and assayed for platelet paroxetine binding. RESULTS Bmax was lower in the BPD group (p < 0.0001), but differences in Kd only reached a trend level. There were no associations with trait dimensions independent of diagnosis. CONCLUSIONS Reduced platelet paroxetine binding in female BPD patients may reflect presynaptic serotonin dysfunction.
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Affiliation(s)
- N M K Ng Ying Kin
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Steiger H, Richardson J, Israel M, Ng Ying Kin NMK, Bruce K, Mansour S, Marie Parent A. Reduced density of platelet-binding sites for [3H]paroxetine in remitted bulimic women. Neuropsychopharmacology 2005; 30:1028-32. [PMID: 15841087 DOI: 10.1038/sj.npp.1300693] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Findings show brain serotonin (5-hydroxytryptamine (5-HT)) activity to be altered in individuals who have had bulimia nervosa (BN), even after substantial remission of symptoms. Such findings could reflect persistent sequelae due to BN, or a vulnerability 'trait' that exists independently of active eating-disorder manifestations. We compared women with full-blown BN (BN; n=22), BN in remission (BN-R; n=11), and no eating or psychiatric disturbances (n=22) on measures of platelet [(3)H]paroxetine binding, eating symptoms and psychopathology. The BN-R group showed normal-range scores on eating and psychopathological symptoms, but reductions in density (B(max)) of binding sites for paroxetine similar to those obtained in the actively ill women. Both BN groups had substantially lower B(max) than did healthy controls. Our results corroborate other findings indicating recovered BN patients to have anomalous 5-HT functioning. While such effects could represent a lasting 'injury' to the system, reported covariations between personality traits and 5-HT indices in BN encourage us to favor the argument that some alterations of 5-HT activity (in this case, consistent with reduced transporter activity) represent a 'trait' associated with the risk of developing BN and/or associated psychopathology.
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Affiliation(s)
- Howard Steiger
- Eating Disorders Program, Douglas Hospital, Montreal, Quebec, Canada.
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Merckelbach H, à Campo J, Hardy S, Giesbrecht T. Dissociation and fantasy proneness in psychiatric patients: a preliminary study. Compr Psychiatry 2005; 46:181-5. [PMID: 16021587 DOI: 10.1016/j.comppsych.2004.08.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Nonclinical studies found that dissociative experiences are intimately linked to a trait known as fantasy proneness. We examined the links among dissociative symptoms, fantasy proneness, and impulsivity in psychiatric outpatients. Our sample consisted of 22 patients with schizophrenia, 20 patients with a diagnosis of borderline personality disorder, and 19 patients with a major depressive disorder. For the whole sample, levels of dissociation were found to be related to fantasy proneness and impulsivity. There were group differences in dissociative symptoms, with patients with borderline personality disorder reporting more such symptoms than patients with either schizophrenia or major depressive disorder. The overlap between dissociation and fantasy proneness may have important ramifications for studies addressing comorbid phenomena of dissociative symptoms.
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Affiliation(s)
- Harald Merckelbach
- Department of Experimental Psychology, University of Maastricht, The Netherlands.
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Jacobi C, Hayward C, de Zwaan M, Kraemer HC, Agras WS. Coming to Terms With Risk Factors for Eating Disorders: Application of Risk Terminology and Suggestions for a General Taxonomy. Psychol Bull 2004; 130:19-65. [PMID: 14717649 DOI: 10.1037/0033-2909.130.1.19] [Citation(s) in RCA: 808] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aims of the present review are to apply a recent risk factor approach (H. C. Kraemer et al., 1997) to putative risk factors for eating disorders, to order these along a timeline, and to deduce general taxonomic questions. Putative risk factors were classified according to risk factor type, outcome (anorexia nervosa, bulimia nervosa, binge-eating disorder, full vs. partial syndromes), and additional factor characteristics (specificity, potency, need for replication). Few of the putative risk factors were reported to precede the onset of the disorder. Many factors were general risk factors; only few differentiated between the 3 eating disorder syndromes. Common risk factors from longitudinal and cross-sectional studies were gender, ethnicity, early childhood eating and gastrointestinal problems, elevated weight and shape concerns, negative self-evaluation, sexual abuse and other adverse experiences, and general psychiatric morbidity. Suggestions are made for the conceptualization of future risk factor studies.
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Affiliation(s)
- Corinna Jacobi
- Department of Psychology, University of Trier, Trier, Germany.
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Steiger H, Israël M, Gauvin L, Ng Ying Kin NMK, Young SN. Implications of compulsive and impulsive traits for serotonin status in women with bulimia nervosa. Psychiatry Res 2003; 120:219-29. [PMID: 14561433 DOI: 10.1016/s0165-1781(03)00195-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Studies of bulimia nervosa (BN) often report decreased brain serotonin (5-hydroxytryptamine: 5-HT) activity. Across populations, impulsivity has been linked to reduced 5-HT activity, but compulsivity has been associated (at least inconsistently) with an increase. We therefore became interested in the association between behavioral-trait variations and 5-HT status in BN. In 56 bulimic and 29 non-bulimic women, we measured eating symptoms, personality traits, platelet paroxetine binding, and neuroendocrine responses following oral meta-chlorophenylpiperazine (m-CPP). Relative to normal eaters, bulimic women showed reduced density (Bmax) of platelet paroxetine-binding sites, blunted prolactin (PRL) responses following m-CPP, and (as a trend) lower basal PRL levels. However, after effects of binge-purge frequencies, body mass, and other extraneous factors were controlled, PRL levels at baseline and other moments in the serial sampling varied systematically with presence of impulsive and compulsive traits. PRL was generally low in BN, but 'high-compulsive'/'low-impulsive' traits were associated with higher (normal-range) PRL values. Comparable trait-related variations were not observed on paroxetine-binding indices. Our findings suggest that 5-HT status in BN may correspond to impulsive or compulsive traits, and they encourage multidimensional modeling of the pathophysiological role of 5-HT in BN.
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Affiliation(s)
- Howard Steiger
- Eating Disorders Program, Douglas Hospital, 6875 LaSalle Blvd, Verdun, Quebec H4H 1R3, Canada.
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Patkar AA, Gottheil E, Berrettini WH, Hill KP, Thornton CC, Weinstein SP. Relationship between Platelet Serotonin Uptake Sites and Measures of Impulsivity, Aggression, and Craving among African-American Cocaine Abusers. Am J Addict 2003. [DOI: 10.1111/j.1521-0391.2003.tb00486.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ramacciotti CE, Coli E, Paoli R, Marazziti D, Dell'Osso L. Serotonergic activity measured by platelet [3H]paroxetine binding in patients with eating disorders. Psychiatry Res 2003; 118:33-8. [PMID: 12759159 DOI: 10.1016/s0165-1781(03)00059-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Most of the evidence from pharmacological studies supports the hypothesis of a serotonergic (5-HT) dysregulation in eating disorders (ED), though a specific alteration related to the major ED subtypes, anorexia (AN) and bulimia nervosa (BN), has not been identified yet, possibly because of changes over time in ED nosology. The aim of the present study was to verify whether differences in serotonergic activity, measured by platelet [3H]paroxetine binding, would validate current ED classification. Platelet [3H]paroxetine binding was investigated in 26 patients with eating disorders diagnosed in accord with DSM-IV criteria (AN, n=11; BN, n=15) and 26 normal weight controls of comparable age; ED symptomatology was assessed by the Diagnostic Schedule for Eating Disorders. ED patients had significantly lower B(max) values than controls (288.5+/-109.2 vs. 1396.8+/-251.3 fmol/mg), whereas the K(d) was not significantly altered (0.12+/-0.13 and 0.12+/-0.05 nM, respectively). Among patients, differences in B(max) were related neither to DSM-IV subtypes nor to clinical variables such as presence of binge-eating, purging, impulsive behaviors, or symptoms of depression. Although ED patients share a dysregulation in serotonergic activity, DSM-IV subtype classification was not validated by [3H]paroxetine binding, and hence does not correspond to a specific 5-HT profile.
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Affiliation(s)
- Carla E Ramacciotti
- Department of Psychiatry, Pharmacology, Neurobiology and Biotechnologies, Section of Psychiatry, University of Pisa, Italy.
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Abstract
Although there have been many recent advances in research, much work remains to be done in the area of child and adolescent eating disorders. More data are needed regarding the normal development of eating behavior, resilience and risk factors for eating pathology, and treatment studies in children and adolescents. The best studied areas include epidemiology, short-term treatment for bulimia nervosa (BN), and outcome in anorexia nervosa. A case report of the single blind use of repetitive transcranial magnetic stimulation in a patient with BN has been reported, but its safe use in children and adolescents remains to be established.
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Steiger H, Koerner N, Engelberg MJ, Israël M, Ng Ying Kin NM, Young SN. Self-destructiveness and serotonin function in bulimia nervosa. Psychiatry Res 2001; 103:15-26. [PMID: 11472787 DOI: 10.1016/s0165-1781(01)00264-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Studies have linked bulimia nervosa (BN) to alterations in brain serotonin (5-hydroxytryptamine: 5-HT) activity and to heightened propensity for parasuicidality and self-injuriousness. The coincidence of self-destructiveness and 5-HT abnormality in BN is of interest, given documentation (in various populations) of an inverse association between 5-HT activity and potential for self-harm. The present study examined the connection between 5-HT status and self-destructiveness in BN. Structured interviews and self-report questionnaires were used to assess 40 bulimic and 21 normal-eater women for: (a) history of parasuicidal or self-injurious acts; and (b) mood and impulse-regulation problems. We then applied tests, presumed to reflect 5-HT function, of serial prolactin (PRL) and cortisol (CORT) responses after oral administration of the partial 5-HT agonist, meta-chlorophenylpiperazine (m-CPP). Relative to non-bulimic women, bulimic women (on average) showed blunting of PRL and CORT following m-CPP. The blunting of neuroendocrine responses was, however, most remarkable in bulimic women with a history of self-destructiveness. These findings suggest that some serotonergic anomalies reported in BN sufferers (i.e. reduced neuroendocrine response after m-CPP) may be most characteristic of individuals in the population showing clear-cut self-destructive potential.
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Affiliation(s)
- H Steiger
- Eating Disorders Program, Douglas Hospital, Quebec, Verdun, Canada.
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