Neurobiological and Psychopathological Variables Related to Emotional Instability: A Study of Their Capability to Discriminate Patients with Bulimia Nervosa from Healthy Controls

Abstract

Objective: To analyze the capability of a set of neurobiological and psychopathological variables to discriminate bulimia nervosa (BN) patients from healthy controls. Method: Seventy-five female patients with purging BN and 30 healthy controls were compared for psychopathology (impulsivity, borderline personality traits, depressive symptoms and self-defeating personality traits) and neurobiological parameters reflecting hypothalamic-pituitary-adrenal axis activity (morning serum cortisol before and after dexamethasone) and monoamine activity (24-hour urinary excretion of norepinephrine, serotonin, dopamine, and their main metabolites: 3-methoxy-4-hydroxyphenylglycol, 5-hydroxyindoleacetic acid, and homovanillic acid). Furthermore, the relationships between the 2 sets of variables were compared in the 2 samples. Results: BN patients displayed higher impulsivity, more severe depressive features, and more borderline and self-defeating personality traits than controls. The 4 psychopathological variables were strongly interrelated in patients, whereas only depressive features correlated with self-defeating personality traits in controls. Patients had lower 24-hour excretion of serotonin and dopamine than controls, as well as lower ability to suppress cortisol. The relations between the biochemical and the psychopathological variables were only significant in the BN patients, but not in the control group. When discriminant analysis methods were applied, patients and controls differed for psychopathology (impulsive behaviors and borderline personality traits) and biological parameters (baseline cortisol and dopamine excretion), but when the variables were analyzed together, the differences in neurobiological parameters appeared as mediated by the psychopathological status. Discussion: Our results suggest that hypothalamic-pituitary-adrenal axis activity, dopamine activity and other biological parameters are worthy of further study as potential dimensional markers of BN, although they seem to depend on the psychopathological status of the patients, in such a way that the psychopathological items associated with emotional instability (impulsivity and borderline personality traits) seem to be more reliable as clinical markers at the time being.

Blunted cortisol response to stress in patients with eating disorders: Its association to bulimic features

“…Our ED patients had a lower capability to suppress cortisol after DXT administration than the HC. This finding has been already reported in literature, including previous papers from our group . According to the existing data, it seems that approximately half of AN patients and one third of patients with BN are non‐suppressors .…”

“…We consider that the finding in our patients of plasma and saliva basal cortisol levels lower to those of the HC group can be justified by the fact that the basal assessment was made in a laboratory setting; so, and even including a rest period before the collection of blood samples, the probands could be in a high degree of activation due to the anxiety caused by the tests to be done. In addition, and according to the results from some studies, hypercortisolism can be associated with specific clinical manifestations and can be mediated by other factors which have not been assessed in our study, as for example alcohol use …”

“…Once again, these findings confirm the idea that we have studied 3 very selected and highly differentiated populations. In addition, the scales used to measure the severity of ED symptoms and affective/anxiety symptoms showed a strong reciprocal correlation (see Table ), revealing a fact that we have already reported in previous studies: the relevance of depression and anxiety in the psychopathology and neurobiology of ED and their association with other clinical factors …”

Mesocorticolimbic dopamine functioning in primary psychopathy: A source of within-group heterogeneity

“…Contrary to primary psychopathic subjects, traits such as hostility, aggression, suicidal behavior, and impulsivity in both healthy controls and groups of neurotic, violent, and/or suicidal personality disordered patients have been mainly related to lower HVA levels (r ≈ -0.32) (Coccaro and Lee, 2010;Engström et al, 1999;Limson et al, 1991;Sher et al, 2006;Vaz-Leal et al, 2011), or to higher HVA levels in the context of serotonergic deficiency (Nilsson et al, 2010). Therefore, higher DA functioning could specifically relate to antisocial traits in primary psychopathic individuals, whereas in non-psychopathic (or secondary psychopathic) individuals characterized by emotional dysregulation and serotonergic deficiency, it may be a deregulation of DA activity (both lower and higher HVA levels) which is associated with aggression and impulsivity.…”

Coping strategies and stress‐induced natural killer cell redistribution in women with eating disorders

“…Our ED patients also responded in a similar way, but with specific patterns of response: While in AN patients the decrease in the number of lymphocytes was similar to that in the HC, the process was three to four times more intense in the BN patients. We consider this discordance perhaps to be due to the existence of differences in the reactivity to stress of the HPA and SAM axes in AN and BN (Garaci et al, 2019; A. M. Monteleone et al, 2015, 2017; P. Monteleone et al, 2011, 2012, 2014; Nagata, Yamada, Iketani, & Kiriike, 2006; Paszynska et al, 2016; Pirke et al, 1992; Vaz‐Leal, Rodríguez‐Santos, García‐Herráiz, & Ramos‐Fuentes, 2011; Vaz‐Leal et al, 2007, 2010; Vaz‐Leal, Rodríguez‐Santos, García‐Herráiz, Monge‐Bautista, & López‐Vinuesa, 2011). In a recent study, we reported that AN‐restricting type patients display a pattern of stress‐induced cortisol release similar to that of healthy individuals, whereas a blunted cortisol response is observed in BN patients (Vaz‐Leal et al, 2018).…”