Women with eating disorder tendencies display altered cardiovascular, neuroendocrine, and psychosocial profiles

Disordered eating is associated with blunted blood pressure reactivity and poorer habituation to acute psychological stress

Psychological stress has been shown to influence the development and progression of disordered eating. Psychophysiological studies have reported that individuals with disordered eating behavior exhibit atypical cardiovascular reactions to acute psychological stress. However, prior studies have been limited by small sample sizes and have examined cardiovascular responses to a singular stress exposure. The current study examined the association between disordered eating and cardiovascular reactivity, as well as cardiovascular habituation to acute psychological stress. A mixed-sex sample (N = 450) of undergraduate students were categorized into a disordered eating or non-disordered eating group using a validated disordered eating screening questionnaire and attended a laboratory stress testing session. The testing session included two identical stress-testing protocols, each consisting of a 10-minute baseline and 4-minute stress task. Cardiovascular parameters including heart rate, systolic/diastolic blood pressure and mean arterial pressure (MAP) were recorded throughout the testing session. Post task measures of self-reported stress, as well as positive affect and negative affect (NA) reactivity were used to assess psychological reactions to stress. The disordered eating group exhibited greater increases in NA reactivity in response to both stress exposures. Additionally, in comparison to the control group, those in the disordered eating group exhibited blunted MAP reactivity to the initial stress exposure and less MAP habituation across both stress exposures. These findings indicate that disordered eating is characterized by dysregulated hemodynamic stress responsivity, which may constitute a physiological mechanism leading to poor physical health outcomes.

12-months of increased dietary intake does not exacerbate disordered eating-related attitudes, stress, or depressive symptoms in women with exercise-associated menstrual disturbances: The REFUEL randomized controlled trial

Disordered eating-related attitudes are a leading cause of energy deficiency and menstrual disturbances in exercising women. Although treatment recommendations include psychological counseling with increases in dietary intake, a key concern is whether increased dietary intake may exacerbate negative eating behaviors.

OBJECTIVE

To determine the effects of a 12-month nutritional intervention on eating-related attitudes and psychological characteristics in exercising women with oligomenorrhea/amenorrhea (Oligo/Amen).

METHODS

Intent-to-treat analysis of the REFUEL randomized controlled trial (#NCT00392873) in 113 exercising women (age [mean±SEM]:] 21.9 ± 0.4 yrs; BMI: 20.9 ± 0.2 kg/m²). Women were randomized to increase energy intake 20-40% above baseline energy needs (Oligo/Amen+Cal, n = 40) or maintain energy intake (Oligo/Amen Control, n = 36) while maintaining their exercise behaviors. A reference group of ovulatory women (OVref, n = 37) maintained diet and exercise behaviors. Body composition, eating attitudes, stress, and depressive symptoms were assessed at baseline and every 3 months.

RESULTS

At baseline, the Oligo/Amen groups had higher drive for thinness, cognitive restraint, and eating disorder risk than OVref group (p < 0.001). Increased energy intake led to increases in percent body fat and fat mass (p < 0.010), but not psychobehavioral outcomes, in the Oligo/Amen+Cal compared to Oligo/Amen Control group. Independent of group, cognitive restraint decreased (p < 0.001) and resilient coping increased (p < 0.007) over 12-months, while perceived stress (p = 0.143) and depressive symptoms (p = 0.344) were unchanged.

DISCUSSION

Long-term nutritional intervention consisting of modest increases in dietary intake with guidance from a registered dietician and a psychologist increases body and fat mass without increasing disordered eating-related attitudes, stress, or depressive symptoms in exercising women with Oligo/Amen.

Urinary free cortisol and childhood maltreatments in eating disorder patients: New evidence for an ecophenotype subgroup

Introduction

Increasing neurobiological evidence has suggested the presence of a specific ecophenotype in people with eating disorders (EDs) linked to early maltreatment. Urinary‐free cortisol could strengthen the data and show specific relationships between maltreated subtypes and the hormonal profiles of patients with EDs. This study aims to evaluate the presence of different urinary cortisol in drug‐free patients in the acute phase of the disorder and its relationship with childhood maltreatment.

Methods

A sample of 78 female patients with ED is included in the study. Childhood maltreatment history and 24‐h urinary free cortisol (24‐h UFC) are evaluated at a specialised ED ward admission.

Results

Patients with a maltreatment history show more blunted 24‐h UFC levels than peers without childhood maltreatment (p = 0.001). Regression analysis showed that child abuse is a predictor of the reduction of 24‐h UFC (p < 0.001), with physical abuse (p = 0.011) and sexual abuse (p = 0.050) that could have a more specific impact than other maltreatment subtypes.

Discussion

Childhood maltreatment should be evaluated in ED patients due to its biological impact on the hormonal stress axis, which could impair the ability of patients to respond to standardized ED treatment.

Eating disorder patients with history of maltreatment showed a reduced 24‐h urinary free cortisol.

New data support the evidence about the presence of an ecophenotype ED subgroup.

Reduced 24‐h urinary free cortisol is significantly correlated with child abuses.

A Systematic Review of Genetic Polymorphisms Associated with Binge Eating Disorder

The genetic polymorphisms involved in the physiopathology of binge eating disorder (BED) are currently unclear. This systematic review aims to highlight and summarize the research on polymorphisms that is conducted in the BED. We looked for observational studies where there was a genetic comparison between adults with BED, in some cases also with obesity or overweight, and healthy controls or obesity/overweight without BED. Our protocol was written using PRISMA. It is registered at PROSPERO (identification: CRD42020198645). To identify potentially relevant documents, the following bibliographic databases were searched without a time limit, but until September 2020: PubMed, PsycINFO, Scopus, and Web of Science. In total, 21 articles were included in the qualitative analysis of the systematic review, as they met the eligibility criteria. Within the selected studies, 41 polymorphisms of 17 genes were assessed. Overall, this systematic review provides a list of potentially useful genetic polymorphisms involved in BED: 5-HTTLPR (5-HTT), Taq1A (ANKK1/DRD2), A118G (OPRM1), C957T (DRD2), rs2283265 (DRD2), Val158Met (COMT), rs6198 (GR), Val103Ile (MC4R), Ile251Leu (MC4R), rs6265 (BNDF), and Leu72Met (GHRL). It is important to emphasize that Taq1A is the polymorphism that showed, in two different research groups, the most significant association with BED. The remaining polymorphisms need further evidence to be confirmed.

Eating behaviours related to psychological stress are associated with functional hypothalamic amenorrhoea in exercising women

Functional hypothalamic amenorrhoea (FHA) can occur due to the independent or combined effects of psychogenic and energetic stressors. In exercising women, research has primarily focused on energy deficiency as the cause of FHA while psychological stressors have been ignored. To assess both psychological and metabolic factors associated with FHA in exercising women, we performed across-sectional comparison of 61 exercising women (≥2 hours/week, age 18-35 years, BMI 16-25kg/m²), who were eumenorrheic or amenorrhoeic confirmed by daily urine samples assayed for reproductive hormone metabolites. Psychological factors and eating behaviours were assessed by self-report questionnaires. Exercising women with FHA had lower resting metabolic rate (p=0.023), T3 (p<0.001), T4 (p=0.013), leptin (p=0.002), higher peptide YY (p<0.001), greater drive for thinness (p=0.017), greater dietary cognitive restraint (p<0.001), and displayed dysfunctional attitudes, i.e., need for social approval (p=0.047) compared to eumenorrheic women. Amenorrhoeic women displayed asignificant positive correlation between the need for social approval and drive for thinness with indicators of stress, depression, and mood, which was not apparent in eumenorrheic women. In exercising women with FHA, eating behaviours are positively related to indicators of psychological stress and depression.

Treatment-Resistant Blunted HPA Activity, but Reversible Cardiovascular Stress Reactivity in Young Women With Eating Disorders

Previous research has provided evidence for a reduced neuroendocrine stress response in women with eating disorders (EDs). In the present study female in-patients with Anorexia and Bulimia nervosa were compared to female healthy controls (HC) before and after completing an in-patient treatment program. Salivary cortisol, alpha-amylase (sAA), heart rate response (HR), high-frequency heart rate variability (HF-HRV) and negative affective state were measured before, during and after exposure to the Trier Social Stress Test (TSST) at pre- and post-treatment. Patients with EDs (n = 13) showed significantly less ED symptoms at post-treatment. Compared to HC (n = 22), patients displayed a blunted cortisol stress response combined with overall attenuated sAA levels at pre-treatment. At post-treatment, the blunted cortisol stress response was still observable, while the differences in sAA responses disappeared. HR was attenuated at pre-treatment in patients, also indicated by a stronger HF-HRV throughout the TSST. These cardiovascular differences disappeared at post-treatment. Patients reported in general (pre- and post-treatment) more negative affect compared to HC. This study provides further evidences of a hypo-reactive hypothalamus-pituitary-adrenal axis (HPA) in patients with EDs which persists even after symptom recovery while initial low cardiovascular stress reactivity apparently can be restored by psychotherapy. Given the small sample size the findings have to be considered preliminary.

Toward Quantifying the Psychopathology of Eating Disorders From the Autonomic Nervous System Perspective: A Methodological Approach

The phenomenology of Eating Disorders (ED) relates with altered functioning of the Autonomic Nervous System (ANS). The lack of agreement in what comes to the direction and significance of such alterations is possibly due to the variability in the ED spectrum. As the stress response system is an integral part of the ANS, we propose to investigate ANS tonic variations and phasic activations in response to stressors. We hypothesize that, while using stress as a test probe, characteristic ANS dysregulations in ED may be found when considering several physiological signals measured over time, and weighted by the individual psychological profiles. In this article we describe a novel methodological approach to investigate this hypothesis with the aim of providing further clarification on the ED spectrum conceptualization. The proposed methodology has been designed to be easily integrated in clinical practice and, eventually, in daily life. The population under observation includes both patients in treatment for ED, and matched controls. The study session has the duration of 1 day, including: (1) the administration of a stress task in a controlled environment and (2) naturalistic data collection. The stress task is designed to elicit both mentally and physically driven ANS activation. The naturalistic component intends to illustrate the psychophysiology in everyday life. We use wearable devices to continuously and non-invasively measure bio-signals related to ANS functioning. This information is complemented with psychometric information from validated stress and ED scales and ecological momentary assessments. The protocol has received ethical approval and has been implemented in practice, currently accounting for 37 patients (out of 120) and 16 controls (out of 60). Ongoing work focus on the definition and implementation of a data processing pipeline to quantitatively test our hypothesis, both standard statistical methods and more exploratory machine learning approaches will be considered.

Insomnia and eating expectancies among college students: the role of emotion dysregulation

There is limited understanding of the relation between insomnia and aspects of eating among college students though available data suggest salient clinical relationships. The present study explored a potential transdiagnostic mechanism in the relation between insomnia symptoms and eating expectancies. Participants were a racially/ethnically diverse sample of 1589 college students (80.4% females; Mage = 22.2 years, SD = 5.27) from an urban university. Primary analysis included three regression-based models of eating expectancies. Insomnia symptoms served as the predictor, and emotion dysregulation served as the indirect (mediator) variable in all models. Results indicated that insomnia symptoms yielded a significant indirect effect through emotion dysregulation on expectancies of eating to help manage negative affect, alleviate boredom, and lead to feeling out of control. Students experiencing insomnia symptoms may be at higher risk for experiencing dysregulated emotions and consequently maladaptive eating expectancies compared to good sleepers.

Combined Patterns of Risk for Problem and Obesogenic Behaviors in Adolescents: A Latent Class Analysis Approach

BACKGROUND

Several studies have used latent class analyses to explore obesogenic behaviors and substance use in adolescents independently. We explored a variety of health risks jointly to identify distinct patterns of risk behaviors among adolescents.

METHODS

Latent class models were estimated using Youth Risk Behavior Surveillance System (YRBSS) 2011 data. Behaviors in the models included substance use, physical fights, physical activity (PA), sedentary activity, sleep, fruit and vegetables (F&V) consumption, and weight-related variables. Models were estimated separately by sex. Constrained and unconstrained models were computed for race. Age and perceived and calculated weight status were compared among emergent latent classes using latent multinomial logistic regressions.

RESULTS

Four and 5 latent class solutions emerged for boys and girls, respectively. Healthy, sedentary, and physically active (PA) groups were common in both boys and girls. The sample of boys also included a health risk behavior (HRB)/PA group and the sample of girls included HRB and HRB/F&V groups.

CONCLUSIONS

The results confirm that obesogenic and HRBs should be conceptualized as combined patterns of risk. Health education programming in schools should adopt a multiple health behavior approach to target the continuum of risks adolescents engage in simultaneously.

Does habituation really happen? Investigation of psycho-biological responses to body exposure in bulimia nervosa

BACKGROUND

Body exposure is a common and effective treatment for body image disturbance in bulimia nervosa (BN). However, little is known about treatment mechanisms. Based on models of emotional processing and neurovisceral integration, we expected to observe a) initial activation and b) habituation of cognitive-affective and autonomic responding within one and between two standardized body exposure sessions.

METHODS

A group of 13 women with BN and 13 healthy controls (HC) were repeatedly exposed to their bodies. Prior to and after treatment with three individualized mirror exposure sessions participants received a session of standardized exposure to videographic recordings of their body. Subjective ratings of body-related emotions and thoughts were assessed repeatedly throughout the standardized exposure sessions and autonomic responses were recorded continuously.

RESULTS

Subjective and sympathetic responses were activated initially in both groups. Cognitive-affective responses habituated within the standardized sessions in both groups, whereas between the standardized sessions habituation was only found in women with BN. Increasing sympathetic responses were found within the sessions in both groups.

CONCLUSIONS

The results support cognitive-affective habituation during body exposure in BN and to a lesser extent in HC. Autonomic responses however did not show a corresponding pattern and did not distinguish between groups. Implications for body exposure research and practice are discussed.

Behavioral and neurodevelopmental precursors to binge-type eating disorders: support for the role of negative valence systems

BACKGROUND

Pediatric loss-of-control (LOC) eating is a robust behavioral precursor to binge-type eating disorders. Elucidating precursors to LOC eating and binge-type eating disorders may refine developmental risk models of eating disorders and inform interventions.

METHOD

We review evidence within constructs of the Negative Valence Systems (NVS) domain, as specified by the Research Domain Criteria framework. Based on published studies, we propose an integrated NVS model of binge-type eating-disorder risk.

RESULTS

Data implicate altered corticolimbic functioning, neuroendocrine dysregulation, and self-reported negative affect as possible risk factors. However, neuroimaging and physiological data in children and adolescents are sparse, and most prospective studies are limited to self-report measures.

CONCLUSIONS

We discuss a broad NVS framework for conceptualizing early risk for binge-type eating disorders. Future neural and behavioral research on the developmental trajectory of LOC and binge-type eating disorders is required.

Examination of central body fat deposition as a risk factor for loss-of-control eating

BACKGROUND

Elevated body mass index (BMI), higher waist-to-hip ratio, and body dissatisfaction have been investigated as risk factors for the development of bulimic symptoms. Central fat deposition may be particularly relevant to eating disorders. To our knowledge, the longitudinal relations between fat distribution, body dissatisfaction, and loss-of-control (LOC) eating development and maintenance have not been studied.

OBJECTIVE

We examined body fat distribution, independent of BMI and depressive symptoms, as a unique correlate and predictor of body dissatisfaction and LOC eating cross-sectionally and over a 2-y follow-up.

DESIGN

Body composition was measured by using dual-energy X-ray absorptiometry in 294 adult women at risk of weight gain at baseline, 6 mo, and 24 mo. We assessed LOC eating, body dissatisfaction, and depressive symptoms at baseline, 6 wk, 6 mo, 12 mo, and 24 mo by using the Eating Disorder Diagnostic Interview, the Multidimensional Body-Self Relations Questionnaire-Appearance Scales Body Areas Satisfaction subscale, and the Center for Epidemiologic Studies-Depression Scale, respectively.

RESULTS

Independent of BMI, baseline total percentage body fat, percentage trunk fat, and percentage abdominal fat were related to greater body dissatisfaction. Total percentage body fat and trunk fat tended to be associated with greater body dissatisfaction at all subsequent time points. Women with a greater percentage trunk fat, specifically abdominal fat, were at highest risk of developing LOC eating. In the full sample, women with higher baseline percentage trunk and abdominal fat showed increases in LOC eating episode frequency over time, whereas LOC eating frequency remained stable among women with smaller percentages of fat in trunk and abdominal regions.

CONCLUSION

These findings lend further support to the premise that increased central body fat deposition is associated with body image dissatisfaction and suggest that it may represent a risk and maintenance factor for LOC eating. This trial was registered at clinicaltrials.gov as NCT00456131.

Anxiolytic efficacy of repeated oral capsaicin in rats with partial aberration of oral sensory relay to brain

OBJECTIVE

This study was conducted to examine if taste over load with oral capsaicin improves the adverse behavioural effects induced by partial aberration of oral sensory relays to brain with bilateral transections of the lingual and chorda tympani nerves.

DESIGN

Male Sprague-Dawley rats received daily 1 ml of 0.02% capsaicin or water drop by drop into the oral cavity following the bilateral transections of the lingual and chorda tympani nerves. Rats were subjected to ambulatory activity, elevated plus maze and forced swim tests after 11th, 14th and 17th daily administration of capsaicin or water, respectively. The basal and stress-induced plasma corticosterone levels were examined after the end of behavioural tests.

RESULTS

Ambulatory counts, distance travelled, centre zone activities and rearing were increased, and rostral grooming decreased, during the activity test in capsaicin treated rats. Behavioural scores of capsaicin rats during elevated plus maze test did not differ from control rats. Immobility during the swim test was decreased in capsaicin rats with near significance (P = 0.0547). Repeated oral capsaicin increased both the basal level and stress-induced elevation of plasma corticosterone in rats with bilateral transections of the lingual and chorda tympani nerves.

DISCUSSION

It is concluded that repeated oral administration of capsaicin reduces anxiety-like behaviours in rats that received bilateral transections of the lingual and chorda tympani nerves, and that the increased corticosterone response, possibly modulating the hippocampal neural plasticity, may be implicated in the anxiolytic efficacy of oral capsaicin.

Blunted neuroendocrine stress reactivity in young women with eating disorders

OBJECTIVE

Stress is known to influence risk and progression of eating disorders (EDs). However, studies investigating physiological and psychological stress responses under laboratory conditions in patients with Anorexia nervosa or Bulimia nervosa are scarce and often produce conflicting findings. We therefore aimed to compare the neuroendocrine and affective stress response in ED inpatients and healthy controls.

METHODS

Twenty-eight female inpatients with Anorexia or Bulimia nervosa and 26 healthy women were exposed to the Trier Social Stress Test (TSST). Salivary cortisol and alpha-amylase (sAA) levels were assessed before as well as repeatedly after stress exposure, while heart rate and heart rate variability were determined before and during the TSST. Negative affective state was assessed at baseline and post-TSST.

RESULTS

Compared to healthy controls, ED patients showed blunted cortisol stress responses combined with overall attenuated sAA levels. The latter was reflected in generally enhanced parasympathetic activity indicated by lower heart rate and stronger high-frequency heart rate variability throughout the TSST. Although patients reported more negative affect overall, they did not differ in their affective stress response.

CONCLUSIONS

In summary, patients suffering from eating disorders show a blunted HPA axis reactivity to stress exposure and a generally reduced sympathetic/exaggerated parasympathetic nervous system activity. This combination may contribute to elevated health risks seen in eating disorder patients, such as enhanced inflammatory activity, and thus provide insight into the underlying stress-related mechanisms.

Effects of maternal separation on the dietary preference and behavioral satiety sequence in rats

This study investigated the effects of maternal separation on the feeding behavior of rats. A maternal separation model was used on postnatal day 1 (PND1), forming the following groups: in the maternal separation (MS) group, pups were separated from their mothers each day from PND1 to PND14, whereas in the control (C) group pups were kept with their mothers. Subgroups were formed to study the effects of light and darkness: control with dark and light exposure, female and male (CF and CM), and maternal separation with dark and light exposure, female and male (SDF, SDM, SLF and SLM). Female rats had higher caloric intake relative to body weight compared with male controls in the dark period only (CF=23.3±0.5 v. CM=18.2±0.7, P<0.001). Macronutrient feeding preferences were observed, with male rats exhibiting higher caloric intake from a protein diet as compared with female rats (CF=4.1±0.7, n=8 v. CM=7.0±0.5, n=8, P<0.05) and satiety development was not interrupted. Female rats had a higher adrenal weight as compared with male rats independently of experimental groups and exhibited a higher concentration of serum triglycerides (n=8, P<0.001). The study indicates possible phenotypic adjustments in the structure of feeding behavior promoted by maternal separation, especially in the dark cycle. The dissociation between the mother's presence and milk intake probably induces adjustments in feeding behavior during adulthood.

Evidence for a compulsive-like behavior in rats exposed to alternate access to highly preferred palatable food

Converging evidence suggests that recurrent excessive calorie restriction causes binge eating by promoting behavioral disinhibition and overeating. This interpretation suggests that cognitive adaptations may surpass physiological regulations of metabolic needs after recurrent cycles of dieting and binging. Intermittent access to palatable food has long been studied in rats, but the consequences of such diet cycling procedures on the cognitive control of food seeking remain unclear. Female Wistar rats were divided in two groups matched for food intake and body weight. One group received standard chow pellets 7 days/week, whereas the second group was given chow pellets for 5 days and palatable food for 2 days over seven consecutive weeks. Rats were also trained for operant conditioning. Intermittent access to palatable food elicited binging behavior and reduced intake of normal food. Rats with intermittent access to palatable food failed to exhibit anxiety-like behaviors in the elevated plus maze, but displayed reduced locomotor activity in the open field and developed a blunted corticosterone response following an acute stress across the diet procedure. Trained under a progressive ratio schedule, both groups exhibited the same motivation for sweetened food pellets. However, in contrast to controls, rats with a history of dieting and binging exhibited a persistent compulsive-like behavior when access to preferred pellets was paired with mild electrical foot shock punishments. These results highlight the intricate development of anxiety-like disorders and cognitive deficits leading to a loss of control over preferred food intake after repetitive cycles of intermittent access to palatable food.

Effect of paroxetine on physiological response to stress and smoking

OBJECTIVE

Smokers often smoke during stressful events, which leads to large increases in cardiovascular measures such as blood pressure (BP) and heart rate (HR). Because exaggerated cardiovascular response to stress is associated with cardiovascular disease risk, this study examined paroxetine's effect on the physiological response to combining stress and smoking.

METHODS

Sixty-two participants completed this randomized, double-blind, crossover study in which BP, HR, plasma epinephrine, norepinephrine, and cortisol concentrations were measured at rest, while smoking, and during a speech and math task. Laboratory sessions occurred after 1 month of paroxetine and after 1 month of placebo.

RESULTS

Significant increases occurred for all measures (except cortisol) during smoking, with further increases occurring during the speech task (time effect, p < .001). After 1 month of paroxetine, norepinephrine and HR values were lower and cortisol values were higher (versus placebo) throughout the laboratory session (treatment effect, p < .001). Treatment × time effects were observed for BP and HR (all, p < .01). For systolic and diastolic BP, a smaller increase (from baseline to measures during speech) was observed after paroxetine compared with placebo (both, p < .006). In both measures, the increase in response to smoking was similar for both treatments; however, the further increase during the speech was smaller when taking paroxetine (versus placebo).

CONCLUSIONS

This study suggests that paroxetine affects physiological response to stress in smokers. Further research is needed to determine the impact of these results on cardiovascular health. Trial Registration clinicaltrials.gov Identifier: NCT00218439.

Cortisol and ghrelin concentrations following a cold pressor stress test in overweight individuals with and without night eating

OBJECTIVE

To explore appetite-related hormones following stress in overweight individuals, and their relationship with night eating (NE) status.

METHOD

We measured plasma cortisol and ghrelin concentrations, and recorded ratings of stress and hunger in response to a physiological laboratory stressor (cold pressor test, CPT), in overweight women with (n=11; NE) and without (n=17; non-NE) NE.

RESULTS

Following the CPT, cortisol (P<0.001) and ghrelin (P<0.05) levels increased, as did stress and hunger ratings (all P<0.001), across all subjects (NE and non-NE). NE exhibited higher baseline cortisol (P<0.05) levels than non-NE. NE also had greater cortisol area under the curve (AUC) than non-NE (P=0.019), but not when controlling for baseline cortisol levels. Ghrelin baseline and AUC did not differ between groups. NE showed higher AUC stress (P<0.05), even when controlling for baseline stress.

DISCUSSION

Overweight individuals showed increased cortisol, ghrelin, stress and hunger following a laboratory stressor, and there was some evidence for greater increases in cortisol and subjective stress among NE. The greater AUC cortisol level in NE was due to higher baseline levels, but the group difference in stress was in direct response to the stressor. Our results support a role for cortisol and stress in NE.

Adrenocortical regulation, eating in the absence of hunger and BMI in young children

The purpose of this study was to examine relations among adrenocortical regulation, eating in the absence of hunger, and body mass index (BMI) in children ages 5-9years (N=43). Saliva was collected before and after the Trier Social Stress Test for Children (TSST-C), and was later assayed for cortisol. Area under the curve with respect to increase (AUCi) was used as a measure of changes in cortisol release from baseline to 60min post-TSST-C. Age- and sex-specific BMI scores were calculated from measured height and weight, and eating in the absence of hunger was assessed using weighed food intake during a behavioral procedure. We also included a measure of parents' report of child impulsivity, as well as family demographic information. Participants were stratified by age into younger (5-7years) and older (8-9years) groups. In younger children, parents' reports of child impulsivity were significantly and positively associated with BMI; cortisol AUCi was not associated with BMI or eating in the absence of hunger. In older children, however, greater stress-related cortisol AUCi was related to higher BMI scores and greater energy intake in the absence of hunger. The results suggest that cortisol AUCi in response to psychosocial stress may be linked to problems with energy balance in children, with some variation by age.

Electrophysiologic evidence for multilevel deficits in emotional face processing in patients with bulimia nervosa

BACKGROUND

Empirical evidence suggests substantial deficits regarding emotion recognition in bulimia nervosa (BN). The aim of the current study was to investigate electrophysiologic evidence for deficits in emotional face processing in patients with BN.

METHODS

Event-related potentials were recorded from 13 women with BN and 13 matched healthy controls while viewing neutral, happy, fearful, and angry facial expressions. Participants' recognition performance for emotional faces was tested in a subsequent categorization task. In addition, the degree of alexithymia, depression, and anxiety were assessed via questionnaires.

RESULTS

Categorization of emotional faces was hampered in BN (p = .01). Amplitudes of event-related potentials differed during emotional face processing: face-specific N170 amplitudes were less pronounced for angry faces in patients with BN (mean [M] [standard deviation {SD}] = 1.46 [0.56] µV versus M [SD] = -1.23 [0.61] µV, p = .02). In contrast, P3 amplitudes were more pronounced in patients with BN as compared with controls (M [SD] = 2.64 [0.46] µV versus M [SD] = 1.25 [0.39] µV, p = .04), independent of emotional expression.

CONCLUSIONS

The study provides novel electrophysiologic data showing that emotional faces are processed differently in patients with BN as compared with healthy controls. We suggest that deficits in early automatic emotion classification in BN are followed by an increased allocation of attentional resources to compensate for those deficits. These findings might contribute to a better understanding of the impaired social functioning in BN.

Disordered eating behaviour is associated with blunted cortisol and cardiovascular reactions to acute psychological stress

Research suggests a potential dysregulation of the stress response in individuals with bulimia nervosa. This study measured both cardiovascular and cortisol reactions to a standardised laboratory stress task in individuals identified as showing disordered eating behaviour to determine whether dysregulation of the stress response is characteristic of the two branches of the stress response system. Female students (N=455) were screened using two validated eating disorder questionnaires. Twelve women with disordered eating, including self-induced vomiting, and 12 healthy controls were selected for laboratory stress testing. Salivary cortisol and cardiovascular activity, via Doppler imaging and semi-automatic blood pressure monitoring, were measured at resting baseline and during and after exposure to a 10-min mental arithmetic stress task. Compared to controls the disordered eating group showed blunted cortisol, cardiac output, heart rate, and stroke volume reactions to the acute stress, as well as an attenuated vasodilatory reaction. These effects could not be accounted for in terms of group differences in stress task performance, subjective task impact/engagement, age, BMI, neuroticism, cardio-respiratory fitness, or co-morbid exercise dependence. Our findings suggest that disordered eating is characterised by a dysregulation of the autonomic stress-response system. As such, they add further weight to the general contention that blunted stress reactivity is characteristic of a number of maladaptive behaviours and states.

Acute stress potentiates brain response to milkshake as a function of body weight and chronic stress

Objective

Stress is associated with increased intake of palatable foods and with weight gain, particularly in overweight women. Stress, food, and body mass index (BMI) have been separately shown to impact amygdala activity. However, it is not known whether stress influences amygdala responses to palatable foods, and whether this response is associated with chronic stress or BMI.

Design

Fourteen overweight and obese women participated in a functional magnetic resonance imaging (fMRI) scan as they consumed a palatable milkshake during script-driven autobiographical guided imagery of stressful and neutral-relaxing scenarios.

Results

We report that a network including insula, somatomotor mouth area, ventral striatum, and thalamus responds to milkshake receipt, but none of these areas are impacted by stress. In contrast, while the left amygdala responds to milkshake irrespective of condition, the right amygdala responds to milkshake only under stressful conditions. Moreover, this right amygdala response is positively associated with basal cortisol levels, an objective measure of chronic stress. We also found a positive relationship between BMI and stress related increased response to milkshake in the orbitofrontal cortex.

Conclusions

These results demonstrate that acute stress potentiates response to food in the right amygdala and orbitofrontal cortex as a function of chronic stress and body weight, respectively. This suggests that the influence of acute stress in potentiating amygdala and OFC responses to food is dependent upon individual factors like BMI and chronic stress. We conclude that BMI and chronic stress play a significant role in brain response to food and in stress-related eating.

Increased mesohippocampal dopaminergic activity and improved depression-like behaviors in maternally separated rats following repeated fasting/refeeding cycles

We have previously reported that rats that experienced 3 h of daily maternal separation during the first 2 weeks of birth (MS) showed binge-like eating behaviors with increased activity of the hypothalamic-pituitary-adrenal axis when they were subjected to fasting/refeeding cycles repeatedly. In this study, we have examined the psychoemotional behaviors of MS rats on the fasting/refeeding cycles, together with their brain dopamine levels. Fasting/refeeding cycles normalized the ambulatory activity of MS rats, which was decreased by MS experience. Depression-like behaviors, but not anxiety, by MS experience were improved after fasting/refeeding cycles. Fasting/refeeding cycles did not significantly affect the behavioral scores of nonhandled (NH) control rats. Fasting/refeeding cycles increased dopamine levels not only in the hippocampus but also in the midbrain dopaminergic neurons in MS rats, but not in NH controls. Results demonstrate that fasting/refeeding cycles increase the mesohippocampal dopaminergic activity and improve depression-like behaviors in rats that experienced MS. Together with our previous paper, it is suggested that increased dopamine neurotransmission in the hippocampus may be implicated in the underlying mechanisms by which the fasting/refeeding cycles induce binge-like eating and improve depression-like behaviors in MS rats.

The arcuate NPY, POMC, and CART expressions responding to food deprivation are exaggerated in young female rats that experienced neonatal maternal separation

This study was conducted to examine the effect of neonatal maternal separation on the hypothalamic feeding peptides expression in young female offspring. Sprague-Dawley pups were separated from dam for 3h daily during PND 1-14 (MS), or left undisturbed except routine cage cleaning (NH). Weanling female pups were housed in group and the arcuate mRNA levels of neuropeptide Y (NPY), proopiomelanocortin (POMC), and cocaine-amphetamine regulated transcript (CART) were examined at two months of age with or without food deprivation. The basal arcuate expression levels of these peptides did not differ between NH and MS group. However, a 48 h of food deprivation significantly increased NPY mRNA level, and decreased POMC and CART, in the arcuate nucleus of MS females, but not in NH females. Fasting-induced elevation of the plasma corticosterone tended to be greater in MS group than in NH, but the basal levels did not differ between the groups. Plasma leptin levels were decreased in MS females compared with NH, and food deprivation significantly suppressed the leptin levels both in NH and MS groups. Results suggest that MS experience may increase stress vulnerability in female rats and exaggerate the feeding peptides expression in the arcuate nucleus responding to metabolic stress food deprivation.

Repetitive transcranial magnetic stimulation reduces cortisol concentrations in bulimic disorders

BACKGROUND

In people with bulimic eating disorders, exposure to high-calorie foods can result in increases in food craving, raised subjective stress and salivary cortisol concentrations. This cue-induced food craving can be reduced by repetitive transcranial magnetic stimulation (rTMS). We investigated whether rTMS has a similar effect on salivary cortisol concentrations, a measure of hypothalamic-pituitary-adrenal axis (HPAA) activity.

METHOD

We enrolled twenty-two female participants who took part in a double-blind randomized sham-controlled trial on the effects of rTMS on food craving. Per group, eleven participants were randomized to the real or sham rTMS condition. The intervention consisted of one session of high-frequency rTMS delivered to the left dorsolateral prefrontal cortex (DLPFC). Salivary cortisol concentrations were assessed at four time points throughout the 90-min trial. To investigate differences in post-rTMS concentrations between the real and sham rTMS groups, a random-effects model including the pre-rTMS cortisol concentrations as covariates was used.

RESULTS

Salivary cortisol concentrations following real rTMS were significantly lower compared with those following sham rTMS. In this sample, there was also a trend for real rTMS to reduce food craving more than sham rTMS.

CONCLUSIONS

These results suggest that rTMS applied to the left DLPFC alters HPAA activity in people with a bulimic disorder.

An animal model of eating disorders associated with stressful experience in early life

Experience of childhood abuse is prevalent among patients with eating disorders, and dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis is implicated in its pathophysiology. Neonatal maternal separation is considered as an animal model of stressful experience early in life. Many of studies have demonstrated its impact both on the activity of HPA axis and the development of psycho-emotional disorders later in life. In this paper, a series of our researches on developing an animal model of eating disorders is reviewed. An animal model of neonatal maternal separation was used; Sprague-Dawley pups were separated from dam daily for 180 min during the first 2 weeks of life (MS) or undisturbed. Anxiety-/depression-like behaviors were observed in MS rats at the age of two months with decreased serotonergic activity in the hippocampus and the raphe. Post-weaning social isolation promoted food intake and weight gain of adolescent MS pups, with impacts on anxiety-like behaviors. Sustained hyperphagia was observed in the MS pups subjected to a fasting/refeeding cycle repeatedly during adolescence, with increased plasma corticosterone levels. Anhedonia, major symptom of depression, to palatable food was observed in adolescent MS pups with blunted response of the mesolimbic dopaminergic activity to stress. Results suggest that neonatal maternal separation lead to the development of eating disorders when it is challenged with social or metabolic stressors later in life, in which dysfunctions in the HPA axis and the brain monoaminergic systems may play important roles.

Couple dissatisfaction and eating profile: a mediation effect of coping style

Individuals' ways of coping with psychological stress have often been associated with body weight regulation through their impact on eating behaviours. In particular, emotion-oriented and distraction-oriented coping styles have been steadily related to disordered eating. Couple dissatisfaction may be experienced as an important psychological stressor and could therefore affect eating behaviours through the use of inadequate coping strategies. The study proposes 1) to compare women reporting a low vs a high level of couple satisfaction, and 2) to test mediational models including couple satisfaction, coping styles, and eating variables. Analyses were performed among 65 overweight/obese premenopausal women who reported being weight-preoccupied. Women exhibiting couple dissatisfaction (34.8%) showed a higher level of EDE-Q restraint, more intense concerns about eating and shape, a higher level of disinhibition and susceptibility to hunger and endorsed more often a distraction-oriented coping style, independently of their body weight. Furthermore, distraction- oriented coping style seemed to be a valid mediator of the relation between couple dissatisfaction and eating behaviours. Since non-normative eating behaviours, namely disinhibition and susceptibility to hunger, have been particularly linked to a higher body weight status, it is relevant to extend the scope of interest to more distal contributing factors, such as couple dissatisfaction.

Altered cardiovascular adaptability in depressed patients without heart disease

OBJECTIVES

Despite its clinical importance and relevance for health care policy, the pathways between depression and stress regulation remain poorly understood. The objective of our study was to compare cardiovascular and autonomic responses to brief psychosocial stress in a group of severely depressed subjects without heart disease and a non-depressed control-group.

METHODS

We recorded cardiovascular and autonomic reactions to two different stress tasks including anger recall and mental arithmetic in a sample of 25 severely depressed and 25 non-depressed subjects. Aggregated data were compared with repeated-measures MANOVA. We used contrasts to evaluate different response patterns concerning cardiovascular and autonomic reactivity vs. recovery.

RESULTS

Depressed subjects showed overall reduced high-frequency heart rate variability and an altered cardiovascular adaptability concerning heart rate, blood pressure, cardiac output, and, on a trend level, peripheral resistance. With few exceptions, we found no differences between reactivity vs. recovery response patterns.

CONCLUSIONS

Our results provide further evidence for altered cardiovascular reactivity and impaired cardiac autonomic functioning in depression. Further research is needed on psychophysiological response to either more disease-oriented or more personality-oriented stressors.

Changes of body composition in bulimia nervosa: increased visceral fat and adrenal gland size

OBJECTIVE

To study the hypothesis that young women suffering from active bulimia nervosa (BN) have more visceral fat and increased adrenal gland volumes (AGV) than healthy controls (HC).

METHODS

Thirteen patients with BN of purging type and 11 healthy age and weight matched women (HC), aged between 19 and 36 years (mean 24 +/- 3 years), with a BMI of 19 to 29 (mean 24 +/- SD 3) were examined. BN was diagnosed by DSM-IV criteria and the severity of illness by the Eating Disorder Inventory (EDI-2). Whole body fat distribution and AGV were determined using a whole body magnetic resonance (MR) scan (T1w) and a 3D-sequence (T1w) at 1.5 Tesla. Salivary cortisol was determined at 9 AM and 4 PM.

RESULTS

BN patients had significantly more visceral adipose tissue (VAT) (HC, 1589.3 +/- 967.6 ml versus 927.2 +/- 428.4 ml, p < .05) and an increased relative AGV (0.068% of body volume versus 0.048% of body volume, p < .05) compared with HC, although waist circumference and BMI did not differ. Although the VAT part in the upper abdomen was increased, especially the VAT of lower abdomen along with the pelvis or any subcutaneous fat compartment was not increased.

CONCLUSIONS

The increase of the VAT volume and the increased AGV in BN women with purging point to chronic high stress levels associated with a hyperactivity of the hypothalamic-pituitary-adrenal axis in these patients. This is the first MR study showing morphological changes in stress associated endocrine organs of young BN patients.

Personal mastery is associated with reduced sympathetic arousal in stressed Alzheimer caregivers

OBJECTIVES

Spousal caregivers of Alzheimer's disease patients are at increased risk for cardiovascular disease, possibly via sympathetic response to stressors and subsequent catecholamine surge. Personal mastery (i.e., belief that one can manage life's obstacles) may decrease psychological and physiological response to stressors. This study examines the relationship between mastery and sympathetic arousal in elderly caregivers, as measured by norepinephrine (NE) reactivity to an acute psychological stressor.

DESIGN

Cross-sectional.

SETTING

Data were collected by a research nurse in each caregiver's home.

PARTICIPANTS

Sixty-nine elderly spousal Alzheimer caregivers (mean age: 72.8 years) who were not taking beta-blocking medication.

INTERVENTION

After assessment for mastery and objective caregiving stressors, caregivers underwent an experimental speech task designed to induce sympathetic arousal.

MEASUREMENTS

Mastery was assessed using Pearlin's Personal Mastery scale and Alzheimer patient functioning was assessed using the Clinical Dementia Rating Scale, Problem Behaviors Scale, and Activities of Daily Living Scale. Plasma NE assays were conducted using pre- and postspeech blood draws.

RESULTS

Multiple regression analyses revealed that mastery was significantly and negatively associated with NE reactivity (B = -9.86, t (61) = -2.03, p = 0.046) independent of factors theoretically and empirically linked to NE reactivity.

CONCLUSIONS

Caregivers with higher mastery had less NE reactivity to the stressor task. Mastery may exert a protective influence that mitigates the physiological effects of acute stress, and may be an important target for psychosocial interventions in order to reduce sympathetic arousal and cardiovascular stress among dementia caregivers.

Body composition and endocrine status of long-term stress-induced binge-eating rats

Clinical binge eating runs a protracted course. The etiology of binge eating remains perplexing in part because, in humans, it is difficult to isolate and assess the independent and aggregate impact of various contributing variables. Using rats, we found that footshock stress and a history of caloric restriction (S+R), combine synergistically to induce binge eating. Stress and dieting are also strong antecedents and relapse factors in human eating disorders. Here we report further behavioral and physiological parallels to human binge eating. Like the protracted course of human binge eating, young female Sprague-Dawley rats continued to binge eat after 23 restriction/stress cycles (7 months) and this despite experiencing no significant weight loss during the restriction phases. Stress alone reduced adiposity by 35% (p<0.001) but S+R rats had no significant fat loss. An endocrine profile of normal plasma leptin and insulin levels but marked elevation of plasma corticosterone levels was found only in the binge-eating (S+R) rats (p<0.01), also paralleling endocrine profiles reported in clinical binge-eating studies. These behavioral and physiological similarities between this animal model and clinical binge eating increase its utility in understanding binge eating. Importantly, our findings also highlight the stubborn nature of binge eating: once a critical experience with dieting and stress is experienced, little if any further weight loss or food restriction is necessary to sustain it.

Altered coordination of the neuroendocrine response during psychosocial stress in subjects with high trait anxiety

Contradicting data are available on stress responsiveness in subjects with high anxiety. In the present study we tested the hypothesis that high trait anxiety is associated with impaired coordination of the stress response, rather than global hypo- or hyper-responsiveness. The sample consisted of subjects with high (n=15) and with low (n=12) trait anxiety. Subjects with middle-range levels of anxiety were excluded from the study. After psychological characterization, the volunteers were exposed to a public speech procedure. A spectrum of neuroendocrine parameters was measured before, during and after the procedure and the results were analyzed by exploratory statistics. Psychological characterization of subjects revealed a lower preference for task-oriented but a higher one for emotion-oriented coping strategies as well as lower scores on hardiness in subjects with high trait anxiety. After the speech procedure, differences in selected mood and personality characteristics were observed, with the anxious group scoring significantly higher in scales for stress, tiredness, arousal, anxiety and depression. Factor analysis revealed that one common factor grouped blood pressure, catecholamine concentrations in blood and heart rate in non-anxious subjects, while three distinct factors separated these parameters in anxious subjects. Correlation analysis in anxious subjects showed that lower adrenocorticotropin (ACTH) and cortisol responses during stress were associated with exaggerated perception of stress and worse mental performance. Our findings indicate that subjects with high anxiety have different relationships between specific neuroendocrine parameters, subjective perception of stress and Stroop test performance.

Cognitive dietary restraint and cortisol: importance of pervasive concerns with appearance

The purpose of this study was to elucidate the nature of the relationship between dietary restraint and physiological stress, by investigating which eating and body-related constructs are related to salivary cortisol and to perceived stress. Female undergraduates (N = 170) completed self-report measures on dietary restraint, appearance beliefs, body satisfaction variables, perceived stress, and eating self-efficacy. Participants also provided two saliva samples. The first sample was collected after awakening, and the second was collected 6-8 h later. A factor analysis was performed in order to reduce redundancy in the set of measures surrounding eating and body attitudes, which yielded three factors. The findings indicated that women with stronger beliefs about the importance of their appearance, as well as negative emotions and cognitions surrounding their body image, had higher levels of cortisol in the afternoon. These appearance and body-related constructs were also associated with higher levels of perceived stress. However, perceived stress was not associated with salivary cortisol. There were no significant relationships between any of the eating or psychological variables and morning cortisol levels. These results suggest that dysfunctional cognitions surrounding appearance and body image significantly contribute to the relationship between dietary restraint and elevations in cortisol excretion. Implications for interventions and women's health are discussed.

Cardiac parasympathetic regulation in obese women with binge eating disorder

OBJECTIVE

Obese individuals with a binge eating disorder (BED) differ from obese non-binge eaters (NBED) with respect to (a) eating behaviour, (b) psychiatric comorbidity and (c) level of psychosocial distress. The aim of the study was to explore whether these three factors have an influence on cardiac parasympathetic function, that is independent of obesity: as alterations in cardiac parasympathetic function may have a role in the higher cardiovascular mortality that is present in obese individuals.

METHODS

In total, 38 obese women (BMI>30 kg/m(2)), with a BED and 34 age and BMI matched healthy controls (NBED) completed a laboratory stress protocol that incorporated a baseline resting period, Head-up Tilt Testing (HUT) and two challenging mental tasks. Heart rate and blood pressure were measured continuously during the protocol. Parasympathetic cardiac regulation was assessed as the high frequency component of heart rate variability (HRV-HF).

RESULTS

Mental challenge led to an augmented reduction of HRV-HF in obese binge eaters, which was linked to the binge eating frequency and hunger perception, but not to psychiatric comorbidity. During baseline conditions and HUT, no significant differences in parasympathetic measures were observed between the two subject groups.

CONCLUSION

Subjects with a BED showed greater reduction in parasympathetic cardiac control (HRV-HF) during mental stress, suggesting higher stress vulnerability in women with a BED. Longitudinal investigations are necessary to evaluate whether this is associated with an increased cardiovascular mortality.

Bulimia nervosa—a primary defect in the hypthalamic–pituitary–adrenal axis?

Bulimia nervosa has been associated with impaired satiety, decreased resting metabolic rate and abnormal neuroendocrine regulation. The aim of this study was to investigate the diurnal cortisol secretion and the pituitary-adrenal response to corticotropin-releasing hormone (CRH) in subjects suffering from bulimia nervosa. Eight female subjects with remitted bulimia nervosa, ages 24-56, and 8 sex- and weight-matched controls volunteered to participate. After an overnight fast they were admitted to the Clinical Research Center for 24 hour recording of plasma cortisol secretion. Blood were drawn every 2nd hour from 8 AM. After another overnight fast, the subjects performed a 120-min CRH test (100 microg i.v.), drawn for measurements of adrenocorticotropin releasing hormone (ACTH) and cortisol. Compared to the control group (CG), the diurnal cortisol secretions in the bulimic group (BG) decreased at time points 6 AM to 2 PM. In the CRH test, the ACTH response was significantly stronger in the BG than in the CG. Similar observations were found for cortisol, although not at significant levels. Remitted bulimic patients exhibit a neuroendocrine pattern of decreased HPA axis activity with a hyperreactivity to CRH. This may indicate a complex and so far poorly understood neuroendocrine dysregulation of HPA axis associated with the disease.

Stress response and binge eating disorder

In clinical practice, obese patients report stress as a primary trigger for binge eating. However, the biological mechanism underlying this relationship is poorly understood. This paper presents, a theoretical overview of how cortisol secretion, a major component of the stress response, could play a role in binge eating, given that exogenous glucocorticoids can lead to obesity by increasing food intake. I will discuss findings from recent studies demonstrating links between laboratory stress, cortisol, food intake and abdominal fat in humans. Cortisol is elevated following laboratory stressors in women with anorexia nervosa (AN), bulimia nervosa (BN), and obesity, but has not been widely studied in women with binge eating disorder (BED). Additionally, I will review recent findings demonstrating a greater cortisol response to stress in obese women with BED compared to non-BED.

Fasting-induced increases of arcuate NPY mRNA and plasma corticosterone are blunted in the rat experienced neonatal maternal separation

This study was conducted to examine the effects of neonatal maternal separation on the hypothalamic expression of feeding peptides in later life. Pups in maternal separation (MS) groups were separated from their dam for 3 h daily from postnatal day (PND) 1-14, while pups in non-handled (NH) groups were left undisturbed. Rats were sacrificed on PND 60 to examine the gene expression of neuropeptide Y (NPY) and pro-opiomelanocortin (POMC) in the hypothalamic arcuate nucleus by mRNA in situ hybridization. Half of the rats from each group were food-deprived for 48 h before sacrifice. POMC mRNA expression increased in the free fed MS group compared with the free fed NH group. Food deprivation significantly decreased the arcuate POMC mRNA level in both groups. Body weight gain, basal levels of plasma corticosterone, leptin, and arcuate NPY mRNA were not modulated by experience of neonatal maternal separation. However, fasting-induced increases of plasma corticosterone and arcuate NPY expression were blunted in MS rats. These results suggest that neonatal maternal separation may increase the basal expression level of arcuate POMC mRNA, while inhibit the fasting-induced expression of arcuate NPY mRNA, later in life. Lastly, the altered expression of arcuate NPY mRNA, but not of arcuate POMC mRNA, appeared to be related with altered activity of the hypothalamic-pituitary-adrenal gland axis in offspring by neonatal maternal separation.

Cortisol Stress Response Is Positively Correlated with Central Obesity in Obese Women with Binge Eating Disorder (BED) before and after Cognitive-Behavioral Treatment

Stress is the most commonly reported trigger of binge eating, and high cortisol levels are positively related to both central body fat and food intake after laboratory stress. We therefore examined waist circumference (WHR) and cortisol stress responsivity after a cold pressor stress test (CPT) in 22 obese (BMI > 27) women (11 BED, 11 non-BED). BMI and WHR did not differ between groups. The BED group had higher morning basal cortisol than the non-BED group (P = .03) and greater AUC cortisol after CPT, after controlling for AUC insulin (P = .04). In the BED group, WHR was related to AUC cortisol (P = .002) and peak cortisol stress responsivity (P = .003). Twenty (10 non-BED, 10 BED) were randomized to a 6-week treatment program (CBT + Diet) or Wait-List (WL) control group. There were no BED group or treatment-group differences in WHR, morning basal cortisol, or AUC cortisol after CPT. The relationship between WHR and both AUC cortisol (P = .002) and peak cortisol stress responsivity after CPT (P = .008) remained significant in the BED group. In BED, there is a hyperactive HPA axis related to abdominal obesity that persists even after treatment, suggesting that cortisol might be a primary factor in the disorder.

High trait anxiety in healthy subjects is associated with low neuroendocrine activity during psychosocial stress

Altered stress responsiveness has been repeatedly related to mood and anxiety disorders. In a traditional view, a reduction of the stress response has been thought favorable. The goal of the present study was to verify the hypothesis that high anxiety is accompanied by enhanced hormone release during stress. Healthy subjects at the upper (anxious, n = 15) and lower (non-anxious, n = 12) limits of the normal range of a trait anxiety scale (State trait anxiety inventory) were exposed to psychosocial stress procedure based on public speech. Hormone levels, cardiovascular activation and skin conductance were measured. Exposure to psychosocial stress was associated with significant increases of all parameters measured. During the stress procedure, subjects with high trait anxiety exhibited lower levels of hormones of the hypothalamo-pituitary-adrenocortical axis, namely ACTH and cortisol in plasma, as well as cortisol in saliva. Similarly, the stress-induced activation of epinephrine, norepinephrine and prolactin secretion was significantly lower in anxious subjects in comparison with that in non-anxious subjects. Thus, in contrast to the traditional view, high anxiousness was not associated with exaggerated stress response. Our findings suggest that high trait anxiety may be associated with an inability to respond with adequate hormone release to acute stress stimuli.

Cortisol, hunger, and desire to binge eat following a cold stress test in obese women with binge eating disorder

OBJECTIVE

Increased basal cortisol levels have been found in bulimia nervosa. After stress, increased cortisol levels have been associated with increased food intake in healthy women. Therefore, we assessed cortisol, hunger, and desire to binge eat after a cold pressor test (CPT) among women with binge eating disorder (BED).

METHODS

Twenty-two obese (body mass index [BMI] = 36.7 +/- 6.5 SD) females (11 non-BED, 11 BED) completed the Zung depression scale and underwent the CPT, hand submerged in ice water for 2 minutes. Over 60 minutes, periodic ratings of hunger and desire to binge eat were obtained, just before blood draws for cortisol, as well as insulin. On a separate day, participants had a 1-mg oral dexamethasone suppression test (DST).

RESULTS

The BED group had higher depression scores than the non-BED (p = .04), but depression was not a significant covariate for the cortisol response or to DST. After controlling for contraceptive use (n = 3), the BED group had higher basal cortisol than the non-BED group (p = .03), but cortisol did not differ after DST (p = .40). The BED group had nearly significant greater cortisol AUC after the CPT (p = .057) after controlling for insulin AUC and contraceptive use (p = .057). The BED group also had greater AUC for hunger (p = .03) and desire to binge eat (p = .02) after the CPT.

CONCLUSION

These findings support our hypothesis of a hyperactive HPA-axis in BED, which may contribute to greater hunger and binge eating.

Deficits in plasma oxytocin responses and increased negative affect, stress, and blood pressure in mothers with cocaine exposure during pregnancy

In animals, oxytocin enhances maternal behavior and lowers blood pressure (BP) and negative affect, while parturitional cocaine disrupts oxytocin activity and increases maternal neglect and aggression. Thus, we compared oxytocin, BP, maternal behavior, and affect in mothers of infants who used cocaine (cocaine, n = 10) or did not (no drug, n = 25) during pregnancy. Laboratory BP and circulating oxytocin, catecholamines, and cortisol were examined before and during a speech stressor on 2 days, with vs. without prestress baby holding. Ambulatory monitoring assessed BP, urinary norepinephrine, and cortisol for 24 h at home. The cocaine group had lower oxytocin levels, greater hostility and depressed mood, less support from others and mastery over life events, higher BP during all events of testing without the baby, and higher ambulatory BP and urinary norepinephrine at home, while cortisol and epinephrine responses were blunted. Although they tended to hold their babies less often at home, baby holding in the laboratory led to decreased BP in cocaine mothers who then did not differ from no-drug mothers in BP or observed affect.

Daily stress, coping, and dietary restraint in binge eating

OBJECTIVE

The current study evaluated whether psychological stress, use of specific coping strategies, and trait dietary restraint would prospectively predict binge eating episodes.

METHOD

After completing a baseline measure of restraint, 46 binge eating college women kept daily diaries assessing depressed affect, stress, coping, and binge eating for 30 days.

RESULTS

Regardless of level of depressed mood, higher stress was associated with increased risk of same-day binge eating; distraction coping was associated with increased risk of future binge eating; social support was associated with decreased risk of same-day binge eating; and women with high versus low dietary restraint showed different patterns of relationship for stress, coping, and binge eating.

DISCUSSION

Vulnerability to binge eating in women who differ in terms of dietary restraint level may vary as a function of their coping responses to stress. Results highlight the complexities of stress and coping in binge eating.

Comparison of HPA axis hormonal responses to naloxone vs psychologically-induced stress

Although the naloxone challenge has been used to draw inferences about the dynamics of the stress response, this procedure has never actually been compared "head to head" with a psychological stressor. In the present study, we asked 14 healthy volunteers to complete the naloxone challenge and the Trier Social Stress Test in an outpatient GCRC laboratory setting so that the degree of correspondence between the two procedures could be examined. Findings indicated that subjects who had greater ACTH responses to naloxone also had greater ACTH responses to the psychologically-induced stressor. This was true for both ACTH peak (r=0.57; p<0.04) and ACTH AUC response (r=0.64; p<0.02) measures; none of the cortisol summary score measures correlated significantly across the two challenges. Associations were also found between subjects' baseline personality characteristics and their ACTH responses to each of the challenges. Furthermore, the kinds of characteristics that predicted greater ACTH response to the pharmacological challenge were similar to the kinds of characteristics that predicted ACTH response to the psychological challenge. In general, higher scores on the NEO dimensions of Extraversion and Openness predicted greater ACTH responses. These findings give preliminary evidence that novelty-seeking behavior may be associated with HPA axis lability. The commonalities in personality predictors between the two challenges further support the notion that a common biological substrate may be, at least partially, responsible for the similarities in responses. However, caution should be used in assuming that responses to naloxone directly parallel responses to physiological stress.