Relation of clinical variables to dissociative phenomena in eating disorders

Article Abstract:

Dissociation in psychology is the ability to block something from consciousness, such as memories or aspects of personality. Mild dissociation includes daydreaming and transient attention lapses; extreme dissociation includes multiple personality disorder and amnesia. Pierre Janet was the first investigator to demonstrate that dissociation is an important defense mechanism used to cope with traumatic experiences. Current interest in dissociation is sparked, in part, by the observation that dissociation is often a consequence of child abuse. The authors of this report became interested in dissociation when two of their patients concurrently met the criteria for anorexia nervosa, an eating disorder in which food intake is severely restricted, and multiple personality disorder. A review of the literature has also reported this association. Patients with dissociative disorders are often treatable with hypnosis, as are patients with eating disorders. There is increasing evidence of a history of trauma, especially sexual abuse, among eating disorder patients. There is also a high incidence of eating disorders in patients with dissociative disorders. Dissociation in anorexia nervosa may also account for the body image distortions that are characteristic symptoms of these patients. Twelve anorexic and 18 bulimic women, aged 16 to 39 years, comprised this study group. The anorexics were all underweight, and the bulimics had average body weights. Thirty normal women comprised the control study group. The Dissociative Experiences Scale was used to assess dissociative capacity, and was administered along with test to measure anxiety, depression, and impulsivity. The average scores for the eating disorder patients were significantly higher than those for the matched controls. The anorexics had higher scores than the bulimic patients, except on the amnesia subscale, but the differences were not considered statistically significant. A score of 30 or greater on the Dissociative Experiences Scale reflects significant levels of dissociative psychopathology. All of the normal control subjects scored below 30, and 24 had a score of less than 10. Five of the anorexics, and four of the bulimics scored above 30, and almost all of the eating disorder patients scored higher than their matched control (25 out of 30). The patients with dissociation scores of over 30 had a significantly higher frequency of suicide attempts and self-mutilation (7 out of 9, compared with 7 out of 21). This greater incidence of self-harm was not found to be correlated with a higher level of impulsivity, but may have a specific relationship with the dissociative symptoms. This data agrees with other current research indicating that dissociative psychopathology and eating disorders both result from severe childhood abuse, and that understanding the dissociative factor occurring in eating disorders may help in selecting the best treatment strategies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Dissociation (Psychology), Dissociative disorders

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CSF oxytocin in anorexia nervosa and bulimia nervosa: clinical and pathophysiologic considerations

Article Abstract:

Oxytocin is a pituitary hormone which promotes uterine contraction during labor and lactation after delivery. The results of previous studies indicate that oxytocin also interacts with vasopressin. Vasopressin has been found in abnormally high levels in underweight patients with anorexia nervosa. Also, experiments have shown that oxytocin interferes with the action of vasopressin in promoting the consolidation of learning acquired during aversive conditioning. It was hypothesized that low levels of oxytocin accompany high levels of vasopressin in these patients to impair aversively conditioned learning, and that this mechanism is involved in a neurobiologic disturbance in patients with eating disorders. The cerebral spinal fluid (CSF) oxytocin was measured in 20 women with anorexia nervosa, 35 normal-weight women with bulimia nervosa, and 11 normal control subjects. All of the subjects fasted overnight and a lumbar puncture was performed to withdraw CSF so oxytocin levels could be measured. The average CSF oxytocin level in five of the underweight women with anorexia nervosa who restricted their diets was lower than that of 12 underweight anorexics who were also bulimic, or that of the 35 bulimic patients. Levels of CSF oxytocin in these patients were significantly lower than the normal controls. The average oxytocin levels of the underweight bulimic anorexic patients were comparable with the normal-weight bulimic women and the control subjects. This implies the lower CSF oxytocin is not totally dependent on weight loss. A specific subgroup of anorexic patients may exist who restrict their food intake, which may contribute to the low CSF oxytocin levels seen in these patients. This may exacerbate the anorexic's tendency to be preoccupied with adverse consequences of eating, and thus perpetuate her restriction of food intake. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Physiological aspects, Anorexia nervosa, Oxytocin

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Psychiatric disorders in the first-degree relatives of probands with bulimia nervosa

Article Abstract:

Bulimia nervosa is an eating disorder characterized by binge-purge behavior; patients typically eat large quantities of food and then purge themselves by vomiting and using diuretics and laxatives. Bulimics are often of normal body weight because they absorb some food before purging or between episodes. Studies of patients' families have noted an elevated rate of affective disorders (such as depression and manic depression), substance abuse, and eating disorders in relatives of bulimics. This study, conducted at the National Institute of Mental Health, involved interviewing the first-degree relatives of 40 bulimic patients and 24 normal volunteers. Relatives of bulimics had a significantly greater prevalence of major affective disorders, alcoholism and eating disorders than relatives of controls. Approximately half of the bulimics themselves had major affective disorders and half had substance abuse disorders. The most important result was that bulimics who did not have affective disorders had close relatives who did, which suggests that genetic predispositions for bulimia and major affective disorders may be linked. The presence of these psychiatric conditions in bulimics and their relatives may have implications for understanding the cause and treatment of bulimia.

Statistics, Depression, Mental, Depression (Mood disorder), Genetic aspects, Affective disorders, Mood disorders

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