[Kleine-Levin syndrome]

The Kleine-Levin syndrome is generally considered to be a benign functional disorder of hypothalamic structures. Its onset is usually in adolescence. The most characteristic symptoms are periodic hypersomnia, excessive eating, hypersexuality, irritability and apathy. Associated features are depressive and schizophrenic symptoms. A biological relationship between the Klein-Levin syndrome and endogenous psychoses is discussed.

A behavioral taxonomy of obese female participants in a weight-loss program

To create a behavioral classification of obesity, 2-wk baseline food diaries were obtained from 236 obese women entering weight-loss programs. Subjects monitored food intake along with the social, environmental, and emotional context in which each meal occurred. Variables representing situation-specific eating behaviors were statistically extracted from greater than 11,000 eating episodes. Hierarchical cluster analysis identified five distinct groups of subjects on the basis of similarity of eating patterns. The five groups were (1) moderately healthy eating habits, (2) chronic food restrictors, (3) alternating diet-binge eaters, (4) emotional overeaters, (5) unrestricted meal overeaters. The five groups differed on questionnaire measures of emotional adjustment and eating behavior but did not differ on dropout rates, amount of weight lost, or exercise compliance. The chronic food restrictors had significantly less lean body mass, lower resting metabolic rates, and higher waist-to-hip ratios than did the unrestricted meal overeaters.

Dysfunctional family systems: relationships to disordered eating behaviors among university women

Clinicians have speculated that the appearance and maintainance of eating-disordered behavior may be attributed to certain familial characteristics which predispose vulnerable individuals to the development of these behaviors. However, few empirical studies exist to substantiate these speculations. This study compared the responses of 190 female university students on three self-report instruments: the Disordered Eating and Weight Control Instrument (DEWCI), the Eating Disorders Instrument (EDI), and the Family Adaptability and Cohesion Evaluation Scale (FACES III) to identify potential relationships between eating-disordered behavior and family types. Subjects were classified, on the basis of their scores on the FACES III, into one of three family types: balanced, midrange, or extreme. A one-way analysis of variance with main effect for family type was applied to the eating-behavior subscales. A Turkey multiple comparison test was applied to the significant main effects. Women classified in the extreme family type scored significantly higher (p less than .05) on several measures of eating-disordered behavior. A Distance From Center (DFC) linear score also was computed and correlated with the eating-disordered subscales. All but 4 of the 18 measures correlated significantly (p less than .05). These findings support speculation, particularly that of family theorists, that eating-disordered behavior may be a symptom response and/or coping strategy for women in dysfunctional families.

Hyperendorphinemia in obesity is not related to the affective state

In seventy-two patients affected by hyperphagic obesity and forty age-matched, normal weight volunteers we performed a psychological assessment, through various mental tests, and evaluated the beta-endorphin (B-Ep), ACTH and cortisol circulating levels, in basal condition and following an overnight short dexamethasone suppression test (DST). The hormones were measured by radioimmunoassay either directly in the serum (cortisol) and the plasma (ACTH), or after affinity gel column chromatography (B-Ep). In obese subjects B-Ep levels in basal conditions were four times greater than in normal weight controls and showed significantly less reduction after DST. ACTH and cortisol levels, in contrast, were in the normal range and were suppressed following dexamethasone as was also true in the control group. Psychological evaluation on M.M.P.I. (Minnesota Multiphasic Personality Inventory) revealed a trend toward hypochondria, depression, hysterias, psychoasthenia and schizophrenia. However, no significant correlation has been found between M.M.P.I. clinical scale scores and circulating levels of B-Ep and cortisol either in basal conditions or after DST. In conclusion, these data do not support the hypothesis that abnormalities of the hypothalamus-pituitary-adrenal axis in hyperphagic obesity are related to affective disorders.

From dietary restraint to binge eating: some theoretical considerations

A correlation between dietary restraint and the occurrence of binge eating has been convincingly shown in several investigations. However, the mediating mechanisms have not yet been elaborated in detail nor linked to empirical evidence. This theoretical gap is addressed in the following. After a short review of behavioral and metabolic correlates of dietary restraint, potential effects of restrained eating on the psychophysiological regulation of food intake are described. These effects may lead to the disruption of intake regulation and therefore can be regarded as direct causes of binge eating.

[Neuroendocrine changes and affective disorders in patients with hyperphagic obesity]

Circulating levels of cortisol and beta-endorphin were evaluated in basal condition and following dexamethasone administration in 20 healthy subjects and in 60 subjects suffering from hyperphagic obesity. Moreover, mental tests were administered to these subjects in order to evaluate the affective state. Our data showed that in obese patients B-Ep plasma levels were significantly higher than those of the control group, while cortisol plasma levels were similar in the two groups. Dexamethasone administration decreased cortisol plasma levels in normal and obese subjects, while did not modify B-Ep plasma levels in obese subjects. However, after dexamethasone administration 16.6% of the obese subjects did not show a complete decrease of cortisol level. This group of subjects obtained the highest scores for depression and hypochondria to MMPI.

Eating behavior in bulimia

Despite our strong belief in the utility of laboratory studies of eating behavior, we also note several caveats on the data thereby obtained. First, it must be assumed that subjects' behavior is influenced by the laboratory environment and is not identical to eating behavior in a "normal" setting. Second, not all bulimic subjects who were screened for these studies actually participated, so that it is possible that the sample of patients from whom we obtained data differed in some ways from a general clinical population of women with bulimia. Nonetheless, we believe that our data provide compelling evidence that the disturbed eating behavior characteristic of bulimia nervosa can be profitably studied in the laboratory. Even under structured laboratory conditions, most bulimic patients rated one of their multicourse meals as typical of a binge, and, during that meal, consumed a much larger amount of food and ate more rapidly than did controls who were asked to overeat. The significant correlations between the sizes of the multicourse and single-course binge meals and between the size of laboratory binge meals and the size of the "naturally occurring" binge meals reported to the dietician suggest that a reproducible phenomenon is being examined. The results of our studies suggest that the abnormalities of eating behavior in bulimia nervosa cannot be viewed simply as a disturbance of carbohydrate consumption or even as the episodic consumption of a certain type of food. Rather, eating behavior in this syndrome appears more generally disturbed. The most striking difference between the binge and the nonbinge meals of bulimic patients and between the binge eating of patients and the overeating of normal persons is the amount of food consumed, not the macronutrient composition of the meals. In addition, for all four meal types, the patients were hungrier after the end of the meal than were the controls, even though the patients' average caloric intakes were generally larger and their average hunger ratings before the meals did not differ from those of the controls. Certainly, self-induced vomiting may contribute to this abnormality, but it was also observed after nonbinge meals when vomiting did not occur. Together, these data are consistent with the notion that the essential appetitive abnormality in bulimia nervosa lies in the control of the amount of food consumed, not in the consumption of a particular macronutrient or type of food. Patients with bulimia nervosa appear less responsive than normal to the signals that lead to the termination of a meal.(ABSTRACT TRUNCATED AT 400 WORDS)

Kleine-Levin syndrome 15 years later

A Chinese man with Kleine-Levin syndrome showed evidence of hypothalamic disturbance and damage to the limbic system. He has been free from symptoms of hypersomnia and hyperphagia for 15 years, but now suffers from ejaculatory impotence which is discussed in the light of aetiological theories of this puzzling disorder.

Negative oedipal transference of a male patient to his female analyst during the termination phase

There has been some debate in the literature concerning the ability of the male patient to experience his paternal, and particularly negative oedipal, transference feelings directly toward his female analyst. In this context, the author describes paternal transference manifestations evident throughout her male patient's analysis, and presents detailed process material from the termination phase. At this time the patient's obsessional neurosis was revived in the context of setting a termination date, and transference to the negative oedipal father could be clearly demonstrated. The paper illustrates that even the negative oedipal component of the paternal transference can be experienced directly in the male patient/female analyst, dyad, and interpretation of this material can bring it into clearer focus. The author discusses some possible influences of her sex on the timing and intensity of the material.

Abnormal food-seeking behavior after surgery for craniopharyngioma

Three patients are described in whom surgical removal of a craniopharyngioma was followed by extreme hyperphagia resulting in obesity and abnormal food-seeking behavior, including foraging for food, stealing food or stealing money for food. These behaviors resemble those seen in the Prader-Willi syndrome but contrast with those noted in bulimia. This deviant behavior was a major factor in the poor outcome of surgery. Attempts at rehabilitation were unsuccessful.

Emotional and somatic consequences of binge episodes

The present study investigated emotional and somatic consequences of the daily eating episodes of 19 bulimics, 15 bingers, and 20 normal control subjects. For 1 week, subjects rated 21 emotional and somatic states immediately following all eating episodes and 1 h later. Results indicated that bulimics and bingers reported significantly greater negative and somatic consequences immediately following their binge episodes than normal eaters following all of their eating episodes. For both groups, these negative emotional consequences persisted over time. Following nonbinge episodes, only bulimics reported experiencing significantly greater negative emotions than normal controls. Comparisons of the binge and nonbinge episodes of the bulimics and bingers indicated that binge episodes are followed by greater immediate and delayed negative and somatic consequences than nonbinge episodes. Furthermore, the positive emotions that occur immediately after a binge significantly decrease in intensity within 90 min after the episode. Theoretical and clinical implications of these findings are discussed.

[Clinical evaluation of food motivation in borderline arterial hypertension]

Alimentary motivation (AM) disorders, varying in nature, markedness and duration, were found in 102 individuals with marginal arterial hypertension (64 of those showing obesity). Enhanced AM with an undulating recurrence pattern was established in 71.6%. Normal AM was noted in 24.5%, and reduced AM, in 3.9% of the patients. A relationship between elevated BP and AM changes was recorded in 70.5% of cases. Unstable or altogether lacking effect of the will effort to suppress alimentary discomfort (in 31 of 73 patients) suggests that anorexic agents should be added to combined treatment schemes for patients with marginal arterial hypertension and enhanced AM.

An animal model of excessive eating: schedule-induced hyperphagia in food-satiated rats

Nineteen rats were maintained throughout the experiment on ad libitum wet mash and water and were trained to press a lever on fixed-interval or fixed-ratio schedules of reinforcement with electrical brain stimulation. Fourteen rats ate at least 150% more mash during intermittent reinforcement sessions than during baseline, massed reinforcement control, and/or extinction sessions. In a 3-hr session, 11 of those 14 consumed more than 22 g of wet mash (13 g dry weight), the equivalent of nearly half an animal's daily food intake. In subsequent control sessions, the electrodes did not support stimulus-bound eating despite attempts to make stimulation parameters optimal. These results indicate that the eating was schedule induced or adjunctive, and suggest that the procedure may provide an animal model of excessive nonregulatory eating that contributes to obesity in humans.

Eating style: a validation study of the Dutch Eating Behaviour Questionnaire in normal subjects and women with eating disorders

This study is a validation of the Dutch Eating Behaviour Questionnaire (DEBQ). Results from normal men and women confirmed the presence of three robust factors of restraint, emotional eating and external eating. Data from women attending 'weightwatchers', and patients with diagnoses of anorexia nervosa and bulimia indicated that the DEBQ was largely successful in identifying the eating styles which are thought to characterise these three client groups. The results were also evaluated in the light of predictions from restraint theory which suggest that chronic restraint is causally related to higher levels of externality and emotional eating.

[Clinical characteristics of food motivation in patients with alimentary obesity]

Characteristics of food behavioral reactions were studied in 159 patients with alimentary obesity, basing on the analysis of a specially developed questionnaire which helped elucidating the features of food motivation (FM) during 8-12 months. Three groups of patients were distinguished (with high, low and normal FM) in relation to the character, degree and duration of changes in the patients' behavioral reactions. The main manifestations of high (109 patients, 68.7% cases) and low (18 patients, 11.2% cases) FM were specified. Thirty two (20.1%) patients with normal FM in their catamnesis showed distinct hyperphagic behavior that, together with other features of FM, was considered as the state of a stable remission of high FM. Two types of high FM were differentiated which should be taken into account in the administration of effective therapy to patients with alimentary obesity.

The prevalence of bulimia among college students

A survey was conducted to determine the prevalence of bulimia and bulimic symptoms in a nonclinical sample of 907 college freshmen and seniors. Using criteria based on the Diagnostic and Statistical Manual of Mental Disorders, 4 per cent of the women and 0.4 per cent of the men were classified as bulimic. Symptoms of bulimia, such as binge eating, purging behaviors, and extreme fear of gaining weight, were much more prevalent.

Death due to chronic syrup of ipecac use in a patient with bulimia

A 17-year-old girl presented with malaise, weakness, palpitations, dysphagia, myalgias, and weight loss of 1 month's duration. Within 24 hours of admission to the hospital, she had hypotension unresponsive to medical management, intractable congestive heart failure, and arrhythmias; she died. Several empty bottles of syrup of ipecac were later found among her belongings. Syrup of ipecac is commonly used to induce emesis in patients who had ingested toxic substances. The chief pharmacologic property of this agent is due to its alkaloid component, emetine. There have been many previous reports of death due to emetine poisoning in patients receiving ipecac fluid extract and in those treated for amoebic dysentery. However, the literature cites only three case reports of fatalities secondary to chronic ipecac use as a means of losing weight. This is the first report of a death due to chronic ipecac use in an adolescent patient with bulimia. Emetine persists in the body for long periods, and in patients who have ingested it chronically, emetine is extremely toxic, specifically to cardiac smooth and skeletal muscles. With an increased awareness of the importance of weight control in the adolescent age group, the physician must carefully evaluate these patients for the use of emetics.

Neuropsychological test performance of bulimic patients

Thirty subjects with DSM-III diagnoses of bulimia were compared to 30 matched controls on the Luria-Nebraska Neuropsychological Battery. The bulimics showed poorer performance on tasks associated with functioning of the right frontal cortical area, primarily tasks involving speed of drawing geometric figures. The similarities of the findings to previous findings with anorexic samples and patients with affective disorders are discussed.

Bulimia: primary care approach and intervention

Bulimia is a serious and increasingly prevalent eating disorder involving both the ingestion of large quantities of food and the subsequent purging of the ingested calories. Nurse practitioners can effectively intervene in cases of bulimia because of their ability to assess the bulimic's potential medical problems and provide the health education and counseling necessary to stop the dangerous binge/purge cycle. Clues aiding in the diagnosis of bulimia include frequent weight fluctuations, enlargement of the patient's parotid glands, dental erosion, menstrual irregularity, electrolyte imbalance and depression. Interventions should address the patient's medical problems, disrupt the binge/purge cycle, help the patient to establish normal eating patterns, raise the bulimic's self-esteem and help resolve underlying depression.