Hypothalamic-pituitary-adrenal-axis hyperactivity in bulimia

The TRH test in bulimia and anorexia nervosa: a controlled study

TSH responsiveness to 500 micrograms TRH given intravenously was examined in ten bulimic outpatients, nine anorexic in-patients and a group of age matched healthy subjects. Serum TSH levels were measured by means of a sensitive radioimmune assay. There were no group differences between bulimic subjects and the healthy comparison group. Anorexic subjects at low weight showed a delayed response to TRH, which tended to normalize with weight gain. Bulimic subjects showed varied patterns of response and it remains possible that a sub-group of bulimic patients may have an abnormality of response to TRH.

Affective disorder and substance abuse in women with bulimia

One hundred and eight women with bulimia were evaluated for affective disorder and alcohol or drug abuse, by means of the DSM-III diagnostic criteria. In this sample, 43.5% had a history of affective disorder and 18.5% had a history of alcohol or drug abuse. Approximately 56% of the bulimia patients scored within the moderate to severe range of depression on the Beck Depression Inventory.

Phenomenologic relationship of eating disorders to major affective disorder

We administered the National Institute of Mental Health Diagnostic Interview Schedule to 41 patients with a lifetime history of anorexia nervosa (25 with and 16 without bulimia) and to 49 patients with bulimia alone. Results showed that 77% of the patients with eating disorders had a lifetime diagnosis of DSM-III major affective disorder, a rate significantly higher than that found in comparison groups composed of the first-degree relatives of probands with schizophrenia and bipolar disorder. High lifetime rates of anxiety disorders, substance use disorders, and kleptomania were also observed. By contrast, few cases of personality disorders and no cases of schizophrenia were found. These findings combine with the results of studies of family history, long-term outcome, response to biological tests, and treatment response to suggest that anorexia nervosa and bulimia may be closely related to major affective disorder.