51
|
Rothschild R, Quitkin HM, Quitkin FM, Stewart JW, Ocepek-Welikson K, McGrath PJ, Tricamo E. A double-blind placebo-controlled comparison of phenelzine and imipramine in the treatment of bulimia in atypical depressives. Int J Eat Disord 1994; 15:1-9. [PMID: 8124322 DOI: 10.1002/1098-108x(199401)15:1<1::aid-eat2260150102>3.0.co;2-e] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Although antidepressants have been found to be superior to placebo in 12 of 14 studies, the relationship between improvement in the depressive diathesis and bulimia is unclear. In this study, the efficacy of placebo, imipramine, and phenelzine is examined in patients comorbid for atypical depression and bulimia. Greater improvement was observed for both depressive and bulimic symptoms with phenelzine than with either imipramine or placebo. Consistent with its poor antidepressant effects in atypical depression, imipramine seemed to have minimal efficacy for the bulimic symptoms of atypical depressives. These data suggest that the presence of bulimia does not alter the treatment response of atypically depressed patients. Furthermore, the data may suggest a link between depression and bulimia in atypical depressives. Demonstrating a statistical difference with a small sample suggests the effect size is robust, however conclusions are limited by a small sample size.
Collapse
Affiliation(s)
- R Rothschild
- College of Physicians and Surgeons, Columbia University, New York, NY
| | | | | | | | | | | | | |
Collapse
|
52
|
Abstract
Following a brief introduction to the concept of addiction, the definition of and diagnostic criteria for sexual addiction are presented. A theoretical framework for treatment of sexual addiction is then outlined, based on an understanding of the underlying addictive process: the compulsive dependence on external actions as a means of regulating one's internal states. Effective treatment addresses both addictive behavior and the addictive process. Addictive sexual behavior is addressed through behavioral symptom management, which includes relapse prevention and other cognitive-behavioral techniques. The addictive process is addressed by enhancing self-regulatory functions through individual psychotherapy, therapeutic group experience, and pharmacotherapy (medication treatment, when indicated). An integrated system for treatment of sexual addiction, which brings together these therapeutic methods in one theoretically coherent, clinically unified approach, is outlined.
Collapse
Affiliation(s)
- A Goodman
- Minnesota Institute of Psychiatry, St. Paul 55105
| |
Collapse
|
53
|
Abstract
In contrast to the West, bulimic disorders are rarer than anorexia nervosa in Hong Kong. Four female normal-weight bulimic patients with mostly typical clinical features and conspicuous morbidity are reported. The case histories support the hypothesis that binge-eating is used to regulate unpleasant effect.
Collapse
Affiliation(s)
- S Lee
- Department of Psychiatry, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin
| | | | | |
Collapse
|
54
|
Kanter RA, Williams BE, Cummings C. Personal and parental alcohol abuse, and victimization in obese binge eaters and nonbingeing obese. Addict Behav 1992; 17:439-45. [PMID: 1442237 DOI: 10.1016/0306-4603(92)90004-f] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Current obesity research has begun to emphasize the importance of pretreatment assessment and more individually tailored treatment protocols. Obese binge eaters have been identified as a subgroup of the obese who do not respond well to standard behavioral treatment programs. We were interested in identifying variables that are important to consider when assessing and treating obese binge eaters. The present study assessed the prevalence of personal alcohol abuse, parental alcohol abuse, and victimization in 62 males and 274 females seeking treatment for obesity. Obese binge eaters (OBE) had significantly greater rates of personal alcohol abuse, parental alcohol abuse, and victimization than the nonbingeing obese (NBO) in our sample. Further studies of the OBE population are recommended.
Collapse
Affiliation(s)
- R A Kanter
- Northwest Clinical Nutrition Center, Seattle, WA 98133
| | | | | |
Collapse
|
55
|
Walters EE, Neale MC, Eaves LJ, Heath AC, Kessler RC, Kendler KS. Bulimia nervosa and major depression: a study of common genetic and environmental factors. Psychol Med 1992; 22:617-622. [PMID: 1410087 DOI: 10.1017/s0033291700038071] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A genetic analysis of the co-occurrence of bulimia and major depression (MD) was performed on 1033 female twin pairs obtained from a population based register. Personal interviews were conducted and clinical diagnoses made according to DSM-III-R criteria. Additive genes, but not family environment, are found to play an important aetiological role in both bulimia and MD. The genetic liabilities of the two disorders are correlated 0.456. While unique environmental factors account for around half of the variation in liability to both bulimia and MD, these risk factors appear to be unrelated, i.e., each disorder has its own set of unique environmental risk factors. Thus, the genetic liability of bulimia and MD is neither highly specific nor entirely non-specific. There is some genetic correlation between the two disorders as well as some genetic and environmental risk factors unique to each disorder. Limitations and directions for future research are discussed.
Collapse
Affiliation(s)
- E E Walters
- Department of Psychiatry, Medical College of Virginia/Virginia Commonwealth University, Richmond
| | | | | | | | | | | |
Collapse
|
56
|
Goldbloom DS, Naranjo CA, Bremner KE, Hicks LK. Eating disorders and alcohol abuse in women. BRITISH JOURNAL OF ADDICTION 1992; 87:913-9. [PMID: 1525533 DOI: 10.1111/j.1360-0443.1992.tb01986.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Theory and empirical evidence support a relationship between the eating disorders (anorexia nervosa and bulimia nervosa) and alcoholism. This study examines the co-prevalence and characteristics of these disorders among two populations of adult women: those presenting for treatment of alcoholism and those referred to a specialized eating disorders programme. Twenty-two of 73 females (30.1%) with alcohol problems met psychometric cut-off scores for eating disorder, while 25 of the 96 eating disorder females (26.9%) gave psychometric evidence of alcohol dependence. These rates exceed general population norms. While certain clinical and psychometric features distinguish subgroups with both disorders, the basis for co-prevalence and the implications for treatment are unknown.
Collapse
|
57
|
Hudson JI, Weiss RD, Pope HG, McElroy SK, Mirin SM. Eating disorders in hospitalized substance abusers. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 1992; 18:75-85. [PMID: 1562008 DOI: 10.3109/00952999209001613] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Among 386 consecutive patients hospitalized for substance abuse, 15% of 143 women had a lifetime diagnosis of anorexia or bulimia nervosa, compared to only 1% of 243 men. Women with eating disorders had significantly higher rates of stimulant abuse and lower rates of opioid abuse than women without eating disorders.
Collapse
Affiliation(s)
- J I Hudson
- Clinical Neurophysiology Laboratory, McLean Hospital, Belmont, Massachusetts 02178
| | | | | | | | | |
Collapse
|
58
|
|
59
|
Goldbloom DS, Garfinkel PE. The serotonin hypothesis of bulimia nervosa: theory and evidence. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1990; 35:741-4. [PMID: 2282627 DOI: 10.1177/070674379003500904] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Bulimia nervosa is an eating disorder with multiple causes that has been the object of extensive research since it was first described in 1979. This review evaluates both the theoretical rationale and empirical evidence for a model which suggests that disturbed serotonin activity is involved in the development of this disorder. Limitations of the hypothesis and prospects for the future are considered.
Collapse
|
60
|
Abstract
The onset and progression of symptomatology in patients with anorexia nervosa and bulimia nervosa is complex. It is unlikely that dysregulation of a single neurotransmitter system would be sufficient to explain the pathophysiology of these disorders. The studies reviewed above provide preliminary evidence that decreased central serotonin function may contribute to the onset or persistence of binge eating episodes in patients with bulimia nervosa, including low weight anorexic patients with bulimic symptoms. Future clinical studies will benefit from the availability of selective serotonin receptor agonists and antagonists. Longitudinal studies through progressive phases of treatment and clinical remission will be important to clarify the contribution of dietary and body weight changes to results of neurotransmitter studies with eating disorder patients.
Collapse
Affiliation(s)
- D C Jimerson
- Department of Psychiatry, Beth Israel Hospital, Boston, Massachusetts 02215
| | | | | | | |
Collapse
|
61
|
Jimerson DC, Lesem MD, Kaye WH, Hegg AP, Brewerton TD. Eating disorders and depression: is there a serotonin connection? Biol Psychiatry 1990; 28:443-54. [PMID: 2207221 DOI: 10.1016/0006-3223(90)90412-u] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Central serotonin pathways modulate eating patterns, and may also participate in the regulation of behavioral impulsivity and mood. Recent studies lend support to the hypothesis that impaired postingestive satiety in bulimia nervosa is associated with reduced hypothalamic serotonergic responsiveness. Serotonin dysregulation has been implicated in major depression, and may play a role in the increased prevalence of depressive episodes in patients with eating disorders. This review compares evidence for alterations in central serotonin regulation in patients with anorexia nervosa, bulimia nervosa, and depression. It is proposed that impaired synaptic transmission in functionally distinct serotonin pathways may result in concurrent or sequential periods of binge eating, behavioral impulsivity, and depression in patients with eating disorders.
Collapse
Affiliation(s)
- D C Jimerson
- Department of Psychiatry, Beth Israel Hospital, Boston, MA 02215
| | | | | | | | | |
Collapse
|
62
|
Keck PE, Pope HG, Hudson JI, McElroy SL, Yurgelun-Todd D, Hundert EM. A controlled study of phenomenology and family history in outpatients with bulimia nervosa. Compr Psychiatry 1990; 31:275-83. [PMID: 2387143 DOI: 10.1016/0010-440x(90)90034-p] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We administered structured diagnostic interviews and family history evaluations to 69 outpatient women meeting the new DSM-III-R criteria for bulimia nervosa. This group was compared with 50 women with DSM-III bulimia, 24 women with major depression, and 28 nonpsychiatric control women, all recruited during previous studies. On both phenomenologic and family history assessments, the women with DSM-III-R bulimia nervosa closely resembled the women with DSM-III bulimia, and both groups differed significantly from controls in their prevalence of personal and familial major mood disorders. These data support a relationship between bulimia nervosa and major mood disorders, consistent with that suggested by studies of bulimia assessed by earlier diagnostic criteria.
Collapse
Affiliation(s)
- P E Keck
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, MA 02178
| | | | | | | | | | | |
Collapse
|
63
|
Zanarini MC, Frankenburg FR, Pope HG, Hudson JI, Yurgelun-Todd D, Cicchetti CJ. Axis II comorbidity of normal-weight bulimia. Compr Psychiatry 1990; 31:20-4. [PMID: 2297983 DOI: 10.1016/0010-440x(90)90050-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The axis II comorbidity of 34 women with active bulimia, 18 women with remitted bulimia, and 20 women with a history of major depression was assessed blind to axis I diagnosis using the Diagnostic Interview for Personality Disorders (DIPD), a semistructured interview of demonstrated reliability. Fifty percent of the active bulimic subjects, 44% of the remitted bulimic subjects, and 35% of the depressed controls met DSM-III criteria for at least one axis II disorder. Despite the generally higher prevalence of axis II pathology in both bulimic groups than depressed controls, these between-group differences did not reach significance. The clinical implications of these findings are discussed.
Collapse
Affiliation(s)
- M C Zanarini
- Psychosocial Research Program, McLean Hospital, Belmont, MA 02178
| | | | | | | | | | | |
Collapse
|
64
|
Rutter M, Macdonald H, Le Couteur A, Harrington R, Bolton P, Bailey A. Genetic factors in child psychiatric disorders--II. Empirical findings. J Child Psychol Psychiatry 1990; 31:39-83. [PMID: 2179248 DOI: 10.1111/j.1469-7610.1990.tb02273.x] [Citation(s) in RCA: 171] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- M Rutter
- MRC Child Psychiatry Unit, Institute of Psychiatry, London, U.K
| | | | | | | | | | | |
Collapse
|
65
|
Mitchell JE, Pyle R, Eckert ED, Hatsukami D. The influence of prior alcohol and drug abuse problems on bulimia nervosa treatment outcome. Addict Behav 1990; 15:169-73. [PMID: 2343791 DOI: 10.1016/0306-4603(90)90021-o] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study examined the impact of prior alcohol/drug abuse problems on long-term outcome for a series of women with bulimia nervosa. The patients with a history of alcohol/drug abuse problems were not more likely to demonstrate a pattern drug use following bulimia treatment, and overall their outcome was comparable to the outcome of those patients who had not had alcohol/drug abuse problems.
Collapse
Affiliation(s)
- J E Mitchell
- University of Minnesota Medical School, Minneapolis
| | | | | | | |
Collapse
|
66
|
|