Metabolic and endocrine indices of starvation in Bulimia: A comparison with anorexia nervosa

Pirke, Karl M.; Pahl, Jörg J.; Schweiger, Ulrich; Warnhoff, Michael

doi:10.1016/0165-1781(85)90037-x

Cited by 158 publications

(50 citation statements)

References 16 publications

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“…Free thyroxine levels for the BN remitted were significantly lower than control levels. The finding of significantly reduced free thyroxine and baseline prolactin levels in the BN active group is consistent with previous reports (Pirke et al 1985;Levy et al 1988;Obarzanek et al 1991; Figure 1. Placebo-adjusted serum prolactin response following administration of d,l-fenfluramine in 21 individuals recovered from bulimia nervosa (BN-R), 21 healthy controls (CNTRL), and 19 subjects with current bulimia nervosa (BN-A).…”

Section: Discussionsupporting

confidence: 82%

Serotonin Function Following Remission from Bulimia Nervosa

Wolfe

Metzger

Levine

et al. 2000

Neuropsychopharmacology

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Section: Discussionsupporting

confidence: 82%

Serotonin Function Following Remission from Bulimia Nervosa

Wolfe

Metzger

Levine

et al. 2000

Neuropsychopharmacology

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“…In ad di tion, el e vated cho les terol, triglyceride, and low-density li po pro tein cho les terol (LDL-C) lev els and re duced high-density li po pro tein cho lesterol (HDL-C) lev els were found in Viet nam vet er ans with chronic posttraumatic stress dis or der (PTSD) (16). The excess lipid mo bi li za tion re sult ing from ca lo ric mal nu tri tion in bulimia nervosa (BN) (17) and an orexia nervosa (AN) patients (18) has been dem on strated to in crease the plasma levels of free fatty ac ids.…”

mentioning

confidence: 99%

Serum Lipid Concentrations in Patients with Comorbid Generalized Anxiety Disorder and Major Depressive Disorder

2001

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Ob jec tive:To ex am ine the lipid lev els in a sam ple of pa tients with comorbid gen er al ized anx i ety dis or der (GAD) and ma jor depres sive dis or der (MDD).Methods: Se rum lipid con cen tra tions were ex am ined in 40 pa tients with both GAD and MDD, in 27 pa tients with MDD only, in 26 pa tients with GAD only, and in 24 healthy con trol sub jects.Re sults: All mean se rum cho les terol con cen tra tions are pre sented in Ta ble 1. The mean se rum to tal cho les terol con cen tra tion in pa tients with both GAD and MDD was sig nif i cantly higher than in MDD-only pa tients, GAD-only pa tients, and con trol sub jects. The triglyceride con cen tra tion was also sig nif i cantly higher in pa tients with both GAD and MDD than in MDD-only pa tients, GAD-only pa tients, and con trol sub jects. Pa tients with both GAD and MDD had a lower mean high-density li po pro tein cho lesterol (HDL-C) con cen tra tion than did pa tients with GAD only and con trol sub jects. The se rum con cen tra tion of low-density li popro tein cho les terol (LDL-C) was higher in pa tients with both GAD and MDD than in pa tients with MDD only and GAD only and healthy con trol sub jects. Con clu sions: Our find ings in di cate that the pa tients with both GAD and MDD have in creased se rum cho les t erol, triglyceride, and LDL-C and re duced HDL-C lev els. These pa tients may have a greater risk of mor tal ity from cor o nary ar tery dis ease (CAD) than do pa tients with ei ther de pres sion or anx i ety dis or der. H igh se rum lipid con cen tra tions are closely as so ci ated with stress and anx i ety (1,2). Sev eral in ves ti ga tions have dem on strated that both nat u ral and ex per i men tally induced stress re sult in a sig nif i cant in crease in cho les terol (3,4). There fore, the pres ence of anx i ety may in crease the risk for cor o nary heart dis ease. Sym pa thetic ac ti va tion in gen er alized anx i ety dis or der (GAD) (5) and in panic dis or der (PD) (4,6) causes an in crease in the ac tiv ity of li po pro tein lipase through the re lease of epi neph rine and corticosteroids. This hy per ac tiv ity in li po pro tein lipase re sults in an in crease in free fatty ac ids which may be con verted into cho les terol. Previ ous stud ies also re ported an as so ci a tion be tween low choles terol lev els and ma jor de pres sive dis or der (MDD) (7-11). Maes and oth ers sug gested that MDD was ac com pa nied by re duced for ma tion of cholesteryl es ters and by im paired reverse cho les terol trans port (9). Hay ward and oth ers (12) and Bajwa and oth ers (13) found that PD pa tients had sig nif icantly higher cho les terol lev els com pared with MDD pa tients and healthy con trol sub jects. Bajwa and oth ers also re ported that among MDD pa tients, a his tory of anx i ety dis or ders (GAD, sim ple pho bia, PD) was as so ci ated with a sig nif i cant el e va tion of se rum cho les terol lev els (13). Agargun and others found that PD pa tients had higher se rum cho les terol than did PD pa tients with comorbid MDD and nor mal c...

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“…Other research provides suggestive evidence of a starvation pathway linking purging and menstrual cycle disruption. Previous studies have identified two indicators of starvation, high serum beta-hydroxybutyrate and low total triodothyronine (T3), in women with bulimia nervosa and anorexia nervosa [12,33,34]. Importantly women with bulimia nervosa who are of normal weight can nonetheless manifest hormonal alterations characteristic of emaciated women with anorexia nervosa [35].…”

Section: Discussionmentioning

confidence: 99%

“…Amenorrhea is a diagnostic criterion of anorexia nervosa in females and is thought to result from malnutrition-induced alterations in gonadotropin secretion, particularly luteinizing hormone (LH) [11]. Amenorrhea can also occur in healthy-weight females with bulimia nervosa [12], but oligomenorrhea is more common. Oligomenorrhea occurs within the range of 37-64% of women diagnosed with bulimia nervosa [13,14] and has been linked to extremely low [15] or high [1] body mass index (BMI), excessive exercise [10], and other eating disorder psychopathology [10].…”

mentioning

confidence: 99%

Irregular Menses Linked to Vomiting in a Nonclinical Sample: Findings from the National Eating Disorders Screening Program in High Schools

Austin

Ziyadeh

Vohra

et al. 2008

Journal of Adolescent Health

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Purpose-Using data from an eating disorders screening initiative conducted in high schools across the United States, we examined the relationship between vomiting frequency and irregular menses in a nonclinical sample of adolescent females.Methods-A self-report questionnaire was administered to students from U.S. high schools participating in the National Eating Disorders Screening Program in 2000. The questionnaire included items on frequency of vomiting for weight control in the past 3 months, other eating disorder symptoms, frequency of menses, height, and weight. Multivariable regression analyses were conducted using data from 2791 girls to estimate the risk of irregular menses (defined as menses less often than monthly) associated with vomiting frequency, adjusting for other eating disorder symptoms, weight status, age, race/ethnicity, and school clusters.Results-Girls who vomited to control their weight one to three times per month were one and a half times more likely (risk ratio [RR] = 1.6; 95% confidence interval [CI] = 1.2-2.2), and girls who vomited once per week or more often were more than three times more likely (RR = 3.2; 95% CI = 2.3-4.4), to experience irregular menses than were girls who did not report vomiting for weight control. Vomiting for weight control remained a strong predictor of irregular menses even when overweight and underweight participants were excluded.Conclusions-Our study adds to the evidence that vomiting may have a direct effect on hormonal function in adolescent girls, and that vomiting for weight control may be a particularly deleterious component of eating disorders. Little is known about the relationship between vomiting for weight control and disruption of menses in females who do not meet diagnostic criteria for an eating disorder. Most research on the topic has been carried out with clinical samples of females with known anorexia or bulimia nervosa [14,16,17]. In one community-based study of high school students, Johnson and Whitaker examined the behavioral correlates of secondary amenorrhea in 2544 girls aged 13-18 years and found a positive association between secondary amenorrhea and multiple binge-eating behaviors in combination with laxative use or self-induced vomiting [18]. KeywordsWe carried out the present analyses using data from the National Eating Disorders Screening Program (NEDSP) [19], conducted in high schools nationwide, to examine the relationship between vomiting frequency and irregular menses in a nonclinical sample of adolescent females. In addition we sought to estimate the unique association of vomiting frequency with menstrual irregularity independent of the effects of other eating disorder symptoms, underweight, and overweight on menstrual function. MethodsThe national nonprofit organization, Screening for Mental Health, that led the initiative sent notices to high schools across the country inviting them to participate in the one-time screening program in 2000. Of the 270 public, private, and parochial schools that enrolled in NEDSP, ...

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Metabolic and endocrine indices of starvation in Bulimia: A comparison with anorexia nervosa

Cited by 158 publications

References 16 publications

Serotonin Function Following Remission from Bulimia Nervosa

Serotonin Function Following Remission from Bulimia Nervosa

Serum Lipid Concentrations in Patients with Comorbid Generalized Anxiety Disorder and Major Depressive Disorder

Irregular Menses Linked to Vomiting in a Nonclinical Sample: Findings from the National Eating Disorders Screening Program in High Schools

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