Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-27T08:51:48.281Z Has data issue: false hasContentIssue false
  • English
  • Français

Bulimia and major affective disorder: experience with 105 patients

Published online by Cambridge University Press:  28 April 2020

J.I. Hudson ,
H.G. Pope Jr.  and
D. Yurgelun-todd
J.I. Hudson
Affiliation:
Laboratories for Psychiatric Research, Mailman Research Center, McLean Hospital, 115 Mill Street Belmont, MA02178, USA
H.G. Pope Jr.
Affiliation:
Laboratories for Psychiatric Research, Mailman Research Center, McLean Hospital, 115 Mill Street Belmont, MA02178, USA
D. Yurgelun-todd
Affiliation:
Laboratories for Psychiatric Research, Mailman Research Center, McLean Hospital, 115 Mill Street Belmont, MA02178, USA
Get access

Summary

Several lines of evidence suggest that bulimia - the syndrome of compulsive binge-eating - may be related to major affective disorder. First, high rates of major affective disorder have been found both among bulimic patients and their relatives. Second, neuroendocrine abnormalities, similar to those found in major affective disorder, have been reported in bulimia. Finally, several antidepressant medications have been shown to be effective in the treatment of bulimia.

To investigate further the relationship between bulimia and major affective disorder, we evaluated 105 consecutive patients (101 women, 4 men), meeting DSM III criteria for bulimia, referred to our center, for the following: (1) rates of current or past major affective disorder and other psychiatric disorders, by DSM III criteria, using the NIMH Diagnostic Interview Schedule (n = 105); (2) family history of psychiatric disorders among first-degree relatives, by DSM III criteria (n = 101); (3) response to the 1 mg oral overnight dexamethasone suppression test (DST) with postdexamethasone plasma cortisol level measured at 16 00 h (n = 43); and (4) response to open trials of antidepressant medications, front several different classes - particularly tricyclic antidepressants, monoamine oxidase (MAO) inhibitors, and trazodone (n = 50).

The results of these studies were as follows: (1) the bulimic patients displayed a 77% lifetime prevalence rate of major affective disorder by DSM III criteria; (2) the morbid risk for major affective disorder among the firstdegree relatives of the bulimic probands was 0.29, similar to the 0.19 morbid risk found among the first-degree relatives of 40 probands with bipolar disorder, but significantly higher than the 0.03 morbid risk found among the first-degree relatives of 46 schizophrenic probands (P<0.001); (3) the bulimic patients showed a 40% rate of nonsuppression to the DST (16 00 h postdexamethasone plasma cortisol Level≥5.0 mcg/dl), significantly higher than the 9% rate of nonsuppression found among 22 normal control subjects (P<0.02); and (4) after one or more trials of antidepressant medications, 38% of the bulimic patients achieved a remission of symptoms (cessation of bingeeating episodes), 34% achieved a marked response (75-99% reduction in the frequency of binge-eating episodes), 16% achieved a moderate response (50-74% reduction in the frequency of binge-eating episodes), and 12% had no response (less than a 50% reduction in the frequency of binge-eating episodes).

Thus, on each of the four indices evaluated, patients with bulimia were similar to patients with major affective disorder, but were distinguishable from patients with other psychiatric disorders and from normal Controls. These results are consistent with the hypothesis that bulimia may be closely related to major affective disorder.

Résumé

Résumé

De nombreux arguments laissent penser que les conduites boulimiques - prises compulsives de nourriture - pourraient être liées au trouble affectif majeur. Tout d'abord, une proportion élevée de troubles affectifs majeurs est retrouvée chez tes patients boulimiques et dans leurs familles. Ensuite, des anomalies endocriniennes identiques á celles identifiées dans les troubles affectifs majeurs ont pu être rapportées dans les boulimies. Enfin, plusieurs traitements antidépresseurs se sont montrés efficaces dans les troubles boulimiques.

Afin de poursuivre l'exploration des relations entre boulimie et trouble affectif majeur, nous avons évalué consécutivement 105 patients (101 femmes, 4 hommes) réunissant les critéres de boulimie du DSM III et qui ont été étudiés dans notre Centre de la façon suivante: (1) établissement du diagnostic de trouble affectif majeur passé ou actuel, ou d‘autres diagnostics psychiatriques à l'aide du manuel d‘entretien standardisé du NIMH (105 patients); (2) recherche de troubles psychiatriques chez les parents de ler degré à l'aide des critères du DSM III (101 patients); (3) étude du test de freinage par la dexaméthasone (1 mg per os) chez 43 patients (cortisol plasmatique mesuré à 16 h): (4) étude de la réponse à différentes classes de médicaments antidépresseurs administré per os, en particulier antidépresseurs tricycliques, IMAO, trazodone (56 patients).

Les résultats de ces études sont tes suivants: (1) le taux de prévalence sur la vie des patients boulimiques pour le trouble affectif majeur est de 77% en utilisant les critères du DSM III; (2) le risque morbide de trouble affectif majeur pour les parents de ler degré des patients boulimiques est à 0,29, comparable au risque à 0,19 retrouvé chez les parents de ler degré des 40 patients bipolaires, et significativement beaucoup plus élevé que le risque à 0,03 retrouvé chez les parents de ler degre des 46 patients schizophrènes ; (3) le taux d‘échappement au test de freinage à la dexaméthasone est de 40% (cortisol plasmatique à 16 h supérieur à 5.0 mcg/dl); ce taux est significativement supérieur de celui de 9% retrouvé chez les 22 sujets témoins normaux (P<0,02); (4) aprés un ou plusieurs essais de traitements antidépresseurs, une rémission symptomatique (disparition des conduites boulimiques) est observée chez 38% des patients. Chez 34% la réponse thérapeutique est nette (75 à 99% de réduction de la fréquence des accès boulimiques). Chez 16% la réponse est modérée (50 à 74% de réduction de la fréquence des accès). Chez 12% il n’y a pas de réponse (moins de 50% de réduction de la fréquence des accès).

Ainsi, pour chacun des 4 indices évalués, les patients boulimiques sont comparables à ceux présentant un trouble affectif majeur et se distinguent à la fois des sujets présentant un autre trouble psychiatrique et des sujets témoins. Ces résultats renforcent l’hypothése d’une relation étroite entre les conduites boulimiques et te trouble affectif majeur.

Keywords

bulimiamajor affective disorderschizophreniadexamethasone suppression testantidepressantsboulimietrouble affectif majeurschizophrénietest de freinage à la dexaméthasoneantidépresseurs
Type
Original article
Information
Psychiatry and Psychobiology , Volume 3 , Issue 1 , 1988 , pp. 37 - 47
Copyright
Copyright © European Psychiatric Association 1988

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1980) DSM III: Diagnostic and Statistical Manual of Mental Disorders(3rd edn) Washington, D.C.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders(3rd edn) Washington, D.C.Google Scholar
Behar, D. & Winokur, G. (1979) Research in alcoholism and depression: A two-way Street under construction. In: Psychiatric Factors in Drug Abuse(Pickens, R.W. & Heston, L.L., eds.) Grune & Stratton, New York, pp. 125–151Google Scholar
Braithwaite, R.A.Goulding, R.Theano, G.Bailey, J. & Coppen, A. (1972) Plasma concentration of amitripytline and clinical response. Lancet, 1, 1297–1300CrossRefGoogle Scholar
Breier, A.Charney, D.S. & Heninger, G.R. (1985) The diagnostic validity of anxiety disorders and their relationship to depressive illness. Am. J. Psychiatry, 142, 787–797Google ScholarPubMed
Carroll, B.J.Feinberg, M.Greden, J.F.Tarika, J.Albala, A.A.Haskett, R.F.James, N.M.Kronfol, Z.Lohr, N.Steiner, M.de Vigne, J.P. & Young, E. (1981) A specifie laboratory test for the diagnosis of melancholia: Standardization, validation, and clinical utility. Arch. Gen. Psychiatry. 38, 15–22CrossRefGoogle Scholar
Crowe, R.R.Noyes, R.Pauls, D.L. & Slymen, D. (1983) A family study of panic disorder. Arch. Gen. Psychiatry. 40, 1065–1069CrossRefGoogle ScholarPubMed
Fairburn, C.G. & Cooper, P.J. (1982) Self-induced vomiting and bulimia nervosa: An undetected problem. Br. Med. J. 284, 1153–1155CrossRefGoogle Scholar
Fairburn, C.G. & Cooper, P.J. (1984) The clinical features of bulimia nervosa. Br. J. Psychiatry. 144, 238–246CrossRefGoogle ScholarPubMed
Fichter, M.M.Pirke, K.M. & Holsboer, F. (1986) Weight loss causes neuroendocrine disturbances: Experimental study in healthy starving subjects. Psychiatry Res. 17, 61–72CrossRefGoogle ScholarPubMed
Garner, D.M.Garfinkel, P.E. & O’Shaughnessy, M. (1985) The validity of the distinction between bulimia with and without anorexia nervosa. Am. J. Psychiatry. 142, 581–587Google ScholarPubMed
Gershon, E.S.Hamovit, J.R.Guroff, J.J.Dibble, E.Leckman, J.F.Sceery, W.Targum, S.D.Nurnberger, J.I. Jr.Goldin, L.T. & Bunney, W.E. (1982) A family study of schizoaffective, bipolar I, bipolar II, unipolar, and normal control probands. Arch. Gen. Psychiatry. 39, 1157–1167CrossRefGoogle ScholarPubMed
Goodwin, D.F. (1979) Genetics of alcoholism. In: Psychiatric Factors in Drug Abuse(Pickens, R.W.Heston, L.L., eds.), Grune & Stratton, New York, pp. 199–217Google Scholar
Gwirtsman, H.E.Roy-Byrne, P.Yager, J. & Gerner, R.H. (1983) Neuroendocrine abnormalities in bulimia. Am. J. Psychiatry. 140, 559–563Google ScholarPubMed
Halmi, K.A.Falk, J.R. & Schwartz, E. (1981) Bingeeating and vomiting: A survey of a college population. Psychol. Med. 22, 697–706CrossRefGoogle Scholar
Hatsukami, E.Eckert, E.D.Mitchell, J.E. & Pyle, R.L. (1984) Affective disorder and substance abuse in women with bulimia. Psychol. Med. 14, 701–714CrossRefGoogle ScholarPubMed
Herzog, D.B. (1982) Bulimia: The secretive syndrome. Psychosomatics 5, 481–487CrossRefGoogle Scholar
Herzog, D.B. (1984) Are anorexic and bulimic patients depressed. Am. J. Psychiatry. 141, 1594–1597Google ScholarPubMed
Hirschfeld, R.M.Koslow, S.H. & Kupfer, D.J. (1983) The clinical utility of the dexamethasone suppression test in psychiatry. J. Am. Med. Assoc. 250, 2172–2174CrossRefGoogle Scholar
Horne, R.L.Ferguson, J.M.Pope, H.G. Jr.Hudson, J.J.Lineberry, C.G.Ascher, J. & Cato, A. (1988) Treatment of bulimia with bupropion: a multicenter controlled trial. J. Clin. Psychiatry(in press)Google Scholar
Hudson, J.I. & Hudson, M.S. (1984) Endocrine dysfunction in anorexia nervosa and bulimia: Comparison with abnormalities in other psychiatrie disorders and disturbances due to metabolic factors. Psychiatr. Devel 4, 237–272Google Scholar
Hudson, J.I. & Pope, H.G. Jr. (1987) Depression and eating disorders. In: Presentations of Depression(Cameron, O.G., ed.), John Wiley & Sons, New York, pp. 33–66Google Scholar
Hudson, J.I.Pope, H.G. Jr. & Jonas, J.M. (1985) Antidepressant treatment of bulimia. Adv. Behav. Res. Ther. 7, 173–179CrossRefGoogle Scholar
Hudson, J.I.Pope, H.G. Jr.Jonas, J.M.Laffer, P.S.Hudson, M.S. & Melby, J.C. (1983a) Hypothalamicpituitary- adrenal axis hyperactivity in bulimia. Psychiatr. Res. 8, 111–118CrossRefGoogle Scholar
Hudson, J.I.Pope, H.G. Jr.Jonas, J.M. & Yurgelun-Todd, D. (1983b) Family history study of anorexia nervosa and bulimia. Br. J. Psychiatry. 142, 133–138CrossRefGoogle Scholar
Hudson, J.IPope, H.G. Jr.Jonas, J.M. & Yurgelun-Todd, D. (1983c) Phenomenologic relationship of eating disorders to major affective disorder. Psychiatr. Res. 9, 345–354CrossRefGoogle Scholar
Hudson, J.IPope, H.G. Jr.Yurgelun-Todd, D.Jonas, J.M. & Frankenburg, F.R. (1987) A controlled study of lifetime prevalence of affective and other psychiatric disorders in bulimic outpatients. Am. J. Psychiatry. 144, 1283–1287Google ScholarPubMed
Hughes, P.L.Wells, L.A. & Cunningham, C.J. (1986) The dexamethasone suppression test in bulimia before and after successful treatment with desipramine. J. Clin. Psychiatry 47, 515–517Google ScholarPubMed
Hughes, P.L.Wells, L.A.Cunningham, C.J. & Ilstrup, D.M. (1986) Treating bulimia with desipramine: A double-blind placebo-controlled study. Arch. Gen. Psychiatry. 43, 182–186CrossRefGoogle ScholarPubMed
Insel, T.R.Gillin, J.Moore, A.Mendelson, W.B.Loewenstein, R.J. & Murphy, D.L. (1982) The sleep of patients with obsessive-compulsive disorder. Arch. Gen. Psychiatry. 39, 1372–1377CrossRefGoogle ScholarPubMed
Insel, T.R. & Murphy, D.L. (1981) The psychopharmacological treatment of obsessive compulsive disorder: A review. J. Clin. Psychopharmacol. 2, 304–311CrossRefGoogle Scholar
Johnson, C.Lewis, C.Love, S.Lewis, L. & Stuckey, M. (1984) Incidence and correlates of bulimic behavior in a female high school population. J. Youth Adolesc. 13, 15–26CrossRefGoogle Scholar
Kaplan, A.S. (1987) Thyroid function in bulimia. In: The Psychobiology of Bulimia (Hudson, J.I & Pope, H.G. Jr., eds.) American Psychiatric Press, Washington, D.C, pp. 55–71Google Scholar
Kiriike, N.Nishiwaki, S.Izumiya, Y. & Kawakita, Y. (1986) Dexamethasone suppression test in bulimia. Biol. Psychiatry. 21, 325–328CrossRefGoogle ScholarPubMed
Klein, D.F.Gittelman, R.Quitkin, F. & Rifkin, A. (1980) Diagnosis and Drug Treatment of Psychiatric Disorders: Adults and Children,2nd edn, William and Wilkins, BaltimoreGoogle Scholar
Kupfer, D.J.Hanin, I.Spiker, D.G.Grau, T. & Coble, P. (1977) Amitriptyline plasma levels and clinical response in primary depression. Clin. Pharmacol. Ther. 22, 904–911CrossRefGoogle ScholarPubMed
Leckman, J.F.Merikangas, K.R.Pauls, D.L.Prusoff, B.A. & Weissman, M.M. (1983a) Anxiety disorders and depression: Contradictions between family study data and DSM III conventions. Am. J. Psychiatry. 140, 880–882Google Scholar
Leckman, J.F.Weissman, M.M.Merikangas, K.R.Pauls, D.L. & Prusoff, B.A. (1983b) Panic disorder and major depression: Increased risk of depression, alcoholism, panic and phobic disorders in families of depressed probands with panic disorber. Arch. Gen. Psychiatry. 40, 1055–1060CrossRefGoogle Scholar
Lee, N.F.Rush, A.J. & Mitchell, J.E. (1985) Depression and bulimia. J. Affective Disord. 9, 231–238CrossRefGoogle ScholarPubMed
Lindy, D.C.Walsh, B.T.Roose, S.P.Gladis, M. & Glassman, A.H. (1985) The dexamethasone suppression test in bulimia. Am. J. Psychiatry. 142, 1375–1376Google ScholarPubMed
Loosen, P.T. & Prange, A.J. (1982) Serum thyrotropin response to thyrotropin-releasing hormone in psychiatric patients: A review. Am. J. Psychiatry. 139, 405–416Google ScholarPubMed
McGrath, P.J.Quitkin, F.M.Stewart, J.W.Liebowitz, M.Fyer, A. & Davies, S. (1981) An open clinical trial of mianserin. Am. J. Psychiatry. 138, 530–532Google ScholarPubMed
Metropolitan Life Insurance Company (1959) New weight standards for men and women. Stat. Bull. Metrop. Life Insur. Co. 40, 1–40Google Scholar
Mitchell, J.E. & Groat, R. (1984) A placebo-controlled, double-blind trial of amitriptyline in bulimia. J. Clin. Psychopharmacol. 4, 186–193CrossRefGoogle ScholarPubMed
Mitchell, J.E.Hatsukami, D.Pyle, R.L. & Eckert, E.D. (1986) Bulimia with and without a family history of depressive illness. Compr. Psychiatry 27, 215–219CrossRefGoogle ScholarPubMed
Mitchell, J.E.Pyle, R.L.Hatsukami, D. & Boutacoff, L.I. (1984) The dexamethasone suppression test in patients with bulimia. J. Clin. Psychiatry 45, 508–5)1Google ScholarPubMed
Pirke, K.M.Schweiger, U.Laessle, R.Fichter, M.M. & Wolfram, G. (1987) Metabolic and endocrine consequences of eating behavior and food composition in bulimia. In: The Psychobiology of Bulimia (Hudson, J.I & Pope, H.G. Jr., eds.), American Psychiatric Press, Washington, D.C., pp. 129–143Google Scholar
Pope, H.G. Jr. & Hudson, J.I. (1984) New Hope for Binge Eaters: Advances in the Understanding and Treatment of Bulimia. Harper & Row, New YorkGoogle Scholar
Pope, H.G. Jr. & Hudson, J.I. (1986) Antidepressant drug treatment of bulimia: current status. J. Clin. Psychiatry 47, 339–345Google ScholarPubMed
Pope, H.G. Jr.Hudson, J.I. & Jonas, J.M. (1983a) Antidepressant treatment of bulimia: Preliminary experience and practical recommendations. J. Clin. Psychopharmacol. 3, 274–281CrossRefGoogle Scholar
Pope, H.G. Jr.Hudson, J.I.Jonas, J.M. & Yurgelun-Todd, D. (1983b) Bulimia treated with imipramine: A placebo-controlled double-blind study. Am. J. Psychiatry. 140, 554–558Google Scholar
Pope, H.G. Jr.Hudson, J.I. & Yurgelun-Todd, D. (1984a) Anorexia nervosa and bulimia among 300 suburban women shoppers. Am. J. Psychiatry. 141, 292–294Google Scholar
Pope, H.G. Jr.Hudson, J.I.Yurgelun-Todd, D. & Hudson, M.S. (1984b) Prevalence of anorexia nervosa and bulimia in three student populations. Int. J. Eating Disord. 3, 45–513.0.CO;2-G>CrossRefGoogle Scholar
Pyle, R.L.Halvorson, P.A.Neuman, P.A. & Mitchell, J.E. (1986) The increasing prevalence of bulimia in freshman college students. Int. J. Eating Disord. 5, 631–6473.0.CO;2-E>CrossRefGoogle Scholar
Pyle, R.L.Mitchell, J.E. & Eckert, E.D. (1981) Bulimia: A report of 34 cases. J. Clin. Psychiatry 42, 60–64Google ScholarPubMed
Pyle, R.L.Mitchell, J.E.Eckert, E.D.Halvorson, P.A.Neuman, P.A. & Goff, G. (1983) The incidence of bulimia in freshman college students. Int. J. Eating Disord. 2, 75–853.0.CO;2-7>CrossRefGoogle Scholar
Robins, L.N.Helzer, J.E.Croughan, J.Williams, J. & Spitzer, R.L. (1980) NIMH Diagnostic Interview Schedule (2nd edn) Rockville, Md., National Institute of Mental HealthGoogle Scholar
Robins, L.N.Helzer, J.E.Weissman, M.M.Orvaschel, H.Gruenberg, E.Burke, J.D. & Regier, D.A. (1985) Lifetime prevalence of specifie psychiatric disorders in three sites. Arch. Gen. Psychiatry. 41, 949–958CrossRefGoogle Scholar
Sabine, E.J.Yonace, A.Farrington, A.J.Barratt, K.H. & Wakeling, A. (1983) Bulimia nervosa: A placebo-controlled double-blind therapeutic trial of mianserin. Br. J. Clin. Pharmacol. 15, 195S–202SCrossRefGoogle ScholarPubMed
Schuckit, M.A. (1986) Genetic and clinical implications of alcoholism and affective disorder. Am. J. Psychiatry. 143, 140–147Google ScholarPubMed
Slater, E. & Cowie, V. (1971) The Genetics of Mental Illness. Oxford University Press, LondonGoogle Scholar
Stern, S.L.Dixon, K.N.Nemzer, E.Lake, M.D.Sansone, R.A.Smeltzer, D.J.Lantz, S. & Schrier, S.S. (1984) Affective disorder in the families of women with normal weight bulimia. Am. J. Psychiatry. 141, 1224–1227Google ScholarPubMed
Stokes, P.E.Stoll, P.M.Koslow, S.H.Maas, J.W.Davis, J.M.Swann, A.C. & Robins, E. (1984) Pretreatment DST and hypothalamic-pituitary-adrenocortical function in depressed patients and comparison groups: A multicenter study. Arch. Gen Psychiatry 141, 257–267CrossRefGoogle Scholar
Task Force on the Use of Laboratory Tests in Psychiatry (1985) Tricyclic antidepressants-blood level measurements and clinical outcome: An APA task force report. Am. J. Psychiatry. 142, 155–162CrossRefGoogle Scholar
Tsuang, M.T.Winokur, G. & Crowe, R.R. (1980) Morbidity risks of schizophrenia and affective disorders among first-degree relatives of patients with schizophrenia, mania, depression, and surgical conditions. Br. J. Psychiatry. 137, 497–504CrossRefGoogle ScholarPubMed
Uhde, T.W.Boulenger, J.P.Roy-Byrne, P.P.Geraci, M.F.Vittone, B.J. & Post, R.M. (1985) Longitudinal course of panic disorder: Clinical and biological considerations. Prog. Neuro-Psychopharmacol. 9, 39–51CrossRefGoogle ScholarPubMed
Viesselman, J.O. & Roig, M. (1985) Depression and suicidality in eating disorders. J. Clin. Psychiatry 46, 118–124Google ScholarPubMed
Walsh, B.T.Roose, S.P.Glassman, A.H.Gladis, M. & Sadik, C. (1985) Bulimia and depression. Psychosom. Med. 47, 123–131CrossRefGoogle ScholarPubMed
Walsh, B.T.Roose, S.P.Lindy, D.C.Gladis, M. & Glassman, A.H. (1987) Hypothalamic-pituitaryadrenal axis function in bulimia. In: The Psychobiology of Bulimia(Hudson, J.I. & Pope, H.G. Jr., eds.), American Psychiatric Press, Washington, D.C., pp. l–llGoogle Scholar
Walsh, B.T.Stewart, J.W.Roose, S.P.Gladis, M. & Glassman, A.H. (1984) Treatment of bulimia with phenelzine: A double-blind, placebo-controlled study. Arch. Gen. Psychiatry. 41, 1105–1109CrossRefGoogle ScholarPubMed
Ziegler, V.E.Clayton, P.J. & Biggs, J.T. (1977) A comparison study of amitriptyline and nortriptyline with plasma levels. Arch. Gen. Psychiatry. 34, 607–612CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.