Changes in oral cavity during period of intensive vomiting in patient with somatoform autonomic dysfunction - description of the case. / Zmiany w jamie ustnej w przebiegu intensywnych wymiotów u pacjentki z zaburzeniem wegetatywnym wystepujacym pod postacia somatyczna - opis przypadku.

INTRODUCTION: The most important endogenous causes of erosion are eating disorders, gastro-oesophageal reflux (GERD), alcoholism and syndromes involving lowered saliva secretion. AIM: The aim of this work is to study a patient with symptoms of somatoform autonomic dysfunction, in which significant erosive loss occurred through chemical influence of gastric acid on oral cavity. METHODS: Seventeen years old girl was sent to Department of Child and Adolescent Psychiatry due to persistent nausea and vomiting, which occurred over a period of about 10 months. Because of this she was repeatedly admitted to a paediatric hospital. Nausea and vomiting led to fear of going out of the house and of being in public places. In addition dental clinical examination was performed. RESULTS: Somatoform Disorders, during which there has been intense vomiting, can be seen as an unusual example of purging-type eating disorders. Erosion of enamel was the most common. In examination of oral mucosa, keratinisation, tongue covered with removable coating and exfoliative cheilitis associated with drying and cracking of lips, were detected. CONCLUSIONS: Observed erosion of teeth and changes in macroscopic construction of oral mucosa seem to be symptoms caused mainly by induced intense and prolonged vomiting. Those changes may be a serious problem not only for the patient's health but also their aesthetics. The described case of patient with intense and long-term vomiting indicates the need of multidisciplinary medical care, including systematic dental assessment.

The assessment of the impact of anorexia nervosa on the vocal apparatus in adolescent girls - A preliminary report.

BACKGROUND: Chronic undernourishment in the course of anorexia nervosa leads to various metabolic and hormonal changes, which translates to the impaired functioning of the majority of systems and internal organs. The impact of eating disorders on the condition of the vocal apparatus has been described in the literature; nevertheless, it concerns mainly bulimia nervosa. OBJECTIVES: assessment of the vocal apparatus in adolescent girls diagnosed with anorexia nervosa from the point of view of possible influence on the function and structure of the larynx, low body mass accompanying anorexia, as well as energy deficiency, hormonal and emotional disturbances. MATERIALS AND METHODS: The research included 41 girls aged 12-19 years, diagnosed with anorexia, who were assessed for the condition of the vocal apparatus, using the perceptual assessment of voice according to GRBAS scale, videolarynostroboscopy, acoustic assessment, and voice self-assessment in Jacobson's VHI scale (voice handicap index). RESULTS: The perceptual assessment of voice using the GRBAS scale revealed that changes in voice were mainly weak, asthenic in nature (70.73%) and there was also the feature of puffing perceived in voice (41.46%). In voice self-assessment with the use of VHI, most subjects seemed to point to changes of voice self-perception in emotional subscale (68%). Videolaryngostroboscopy revealed some features of functional disturbances of voice in more than half of subjects, mainly in the form of hyperfunctional dysphonia (31.78%). The maximal phonation time was significantly shorter, in proportion to duration of the primary disease. In the acoustic analysis, the decrease in the basic frequency F0 and narrowing of the voice scale were observed. 55% of older, post-adolescent patients presented with the structure of the larynx that was inappropriate for their age. CONCLUSIONS: These results might indicate that anorexia nervosa could have led to the structural and functional changes in the vocal apparatus. Such disturbances may be explained by the hormonal dysfunctions as well as starvation. Hormonal substitution at the appropriate time might be beneficial for the structure and phonation function of the larynx in girls with AN.

Salivary and serum insulin-like growth factor (IGF-1) assays in anorexic patients.

OBJECTIVES: The purpose of this study was to measure the salivary and serum free IGF-1 concentration of patients with anorexia nervosa (AN) in comparison to an average population. METHODS: A controlled clinical trial was designed for an age- and gender-matched group of 121 AN patients and 77 healthy individuals. A clinical examination was made and blood and salivary samples were taken during the acute stage of AN (BMI < 15 kg/m2) in the first week of hospitalization. An enzyme immunoassay (ELISA) suitable for measuring free IGF-1 was used. RESULTS: Anorexic patients had significant reductions in salivary unstimulated flow rate (UFR), pH and free IGF-1 levels in their saliva and serum. Significant correlations between serum IGF-1 and BMI; salivary IGF-1 and UFR and pH were detected. CONCLUSIONS: Salivary and serum IGF-1 analyses appear to be a reliable biochemical indicator of malnutrition in AN patients. Measurement of salivary IGF-1 levels would allow new perspectives in monitoring AN in its early stages.

[Macroscopic evaluation of the oral mucosa and analysis of salivary pH in patients with anorexia nervosa]. / Ocena makroskopowa blony sluzowej jamy ustnej i analiza pH sliny u pacjentów z jadlowstretem psychicznym.

UNLABELLED: The aim of the study was to evaluate the status of the oral mucosa, to assess the prevalence of Candida in the oral cavity and to analyze the pH values of total saliva in patients with anorexia nervosa (AN) in comparison to the general population. METHOD: A controlled clinical trial was designed for two, age-matched, female groups: patients with AN (Group A, n=31) and healthy women (Group 0, n = 40). Total saliva was collected at rest and after stimulation by chewing paraffin wax. Salivary pH was measured and macroscopic evaluation of the oral mucosa was performed with a qualitative and quantitative mycological analysis. The smear layer was collected from three different areas in the oral cavity. Selected Candida broths were used for incubation. RESULTS: Changes in the macroscopic structure of the oral mucosa due to multifactorial etiologies were observed. The prevalence of Candida in patients with AN was comparable to that in the general population. Salivary pH values were significantly lower in the AN patients than in the control group. CONCLUSIONS: The incidence of pathological changes in the oral mucosa is associated with the loss of the salivary protective barrier. This is shown by the significant reduction in the pH values of stimulated and non-stimulated saliva of the AN patients. In these patients, the monitoring of salivary parameters such as salivary flow rate and pH is indicated, and a regular dental checkup, together with soft tissue evaluation, is advised.

Parotid gland flow activity and inorganic composition in purging bulimic patients treated with fluoxetine.

OBJECTIVES: The purpose of this study was to establish whether vomiting bulimic and/or non-bulimic depressive patients, both treated with the serotonin reuptake inhibitor SI-5-HT (fluoxetine), have differing proportions of inorganic components (specifically, sodium, potassium and calcium) in their parotid salivary gland secretions, than in the average population. METHODS: A controlled clinical trial was designed for three age-matched female groups: bulimic patients receiving fluoxetine 40 mg/day (n = 33), non-bulimic patients diagnosed with bipolar affective disorder (fluoxetine 20 mg/day, n = 25) and healthy controls (n = 51). Parotid saliva was collected using a Lashley cap while the subjects were at rest. Stimulation was obtained chemically using a 3% citric acid solution, and physically by instructing the subjects to chew on wax pellets. The concentrations of sodium, potassium and calcium ions were measured using the colorimetric photometry method. RESULTS: The bulimic patients had a reduction in flow and sodium and potassium ions in the parotid saliva and non-bulimic patients had a reduction in flow. Deficits in certain components of saliva were shown to be directly related to salivary flow rate. CONCLUSIONS: The data suggest that detection of inorganic deficits in parotid saliva might serve as a reliable confirmation of reduction in flow amongst purging bulimic patients treated with fluoxetine.

The study of candidate genes related to the neurodevelopmental hypothesis of anorexia nervosa: classical association study versus decision tree.

In this research, we conducted a study of genes connected with the neurodevelopmental hypothesis of anorexia nervosa, using classical statistical and data-mining methods to establish a relationship with disease risk and algorithms to identify the best genetic predictors of anorexia nervosa.

Serum neurotrophin concentrations in polish adolescent girls with anorexia nervosa.

OBJECTIVES: Several lines of evidence suggest that brain-derived neurotrophic factor (BDNF) plays an important role in weight regulation and eating behaviors as well as in the activity-dependent neuroplasticity underlying learning and memory behaviors involving the hippocampus. In anorexia nervosa (AN) patients, abnormal serum BDNF concentrations, cognitive impairments and specific personality traits have been traditionally observed. This study explores the levels of four serum neurotrophins [BDNF, neurotrophin 3 (NTF3), neurotrophin 4 (NTF4) and glial cell line-derived neurotrophic factor (GDNF)] with respect to their use as potential biomarkers for AN. This study also investigates any associations that might exist between serum neurotrophin levels and neurocognitive impairment or personality traits. METHODS: Serum neurotrophin concentrations were measured in 60 AN patients (AN group) and 45 healthy controls (HC group). We correlated the serum levels of the four neurotrophins BDNF, NTF3, NTF4 and GDNF and the clinical type of anorexia. We also analyzed the relationship between serum neurotrophin levels and the Beck Depression Inventory, body mass index, executive functions by the Wisconsin Card Sorting test (WCST) and personality dimensions by the Temperament and Character Inventory (TCI) test. RESULTS: Serum NTF4 concentrations were significantly lower when comparing all AN patients (34.7 ± 72.5 pg/ml) or restriction type AN patients (29.1 ± 62.5 pg/ml) with the HC group (58.4 ± 135.8 pg/ml; p = 0.004 and p = 0.005, respectively). A significant correlation (p < 0.005) between BDNF serum levels and patient personality dimensions as measured by the TCI test was observed. Furthermore, significant correlations were observed between NTF4 and GDNF serum levels and executive function as measured by the WCST. CONCLUSIONS: These data suggest that NTF4 might serve as a biomarker for AN. Furthermore, BDNF and GDNF serum levels appear to be associated with personality traits and executive function.

[Searching for Tourette's syndrome gene. Part 1. Heterogeneity of clinical phenotypes]. / W poszukiwaniu genu zespolu Gilles de la Tourette'a. Czesc 1. Róznorodnosc fenotypów klinicznych.

The French neuropsychiatrist Georges Gilles de la Tourette described in 1885 the "Maladie des Tics" which later was named after him, as Gilles de la Tourette syndrome (GTS). Gilles de la Tourette syndrome is a neurodevelopmental disorder characterized by simple and complex motor and vocal tics with multiple neuropsychiatric comorbidities. GTS is often concurrent with obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD). There are several clinical GTS subtypes: GTS only, GTS+OCD, and GTS+OCD+ADHD. Additional clinical aspects of the disorder include occurrence of anger episodes, anxiety and mood disorders, and learning and sleeping disturbances. The genetics of GTS is complex and remains unclear. So far, no causative candidate genes have been identified. However, segregation studies in families and twins with GTS provide strong evidence for the existence of a genetic background associated with a multifactorial mode of inheritance. Progress in studies on genome variability among patients with GTS is necessary to improve pharmacotherapeutic strategies of the disorder.

[Searching for Tourette's syndrome gene. Part 2. Patient's genome variability]. / W poszukiwaniu genu zespolu Tourette'a. Czesc 2. Zmiennosc genomu chorych.

Gilles de la Tourette syndrome (GTS) is a complex, heterozygous genetic disorder. Twenty chromosomal rearrangements (7q22-q31, 8q13-q22, and 18q22) indicating genomic regions which may be involved in the etiology of the disorder have been reported in families with GTS. Moreover, pathogenic mutations responsible for GTS were found in the SLITRK1 and the L-histidine decarboxylase (HDC) genes. The W317X mutation in the HDC gene points to a possible role for histaminergic neurotransmission in the mechanism and modulation of tic disorder. The distribution of single nucleotide polymorphisms (SNPs) was examined in at least 14 candidate genes (DRD1, DRD2, DRD3, DRD4, DAT1, MAOA, 5HTR2A, 5HTR3A, TDO2, CNR1, HLA-DRB, IL1RA, MOG, and SGCE) using a case-control genetic association analysis. Still, a lack of replicated and consistent results was observed. Recently, rare structural variants of different genes involved in neurodevelopment determined by recurrent exonic copy number variations (CNVs) have been found in a subset of patients suffering from GTS.

Flow rates and inorganic composition of whole saliva in purging bulimic patients treated with a fluoxetine.

OBJECTIVES: The current study established whether vomiting bulimic and/or non-bulimic depressive patients, both treated with a serotonin reuptake inhibitor (fluoxetine), have changes in their whole salivary secretion and inorganic components: Na(+), K(+), Ca(2+). METHODS: From 108 female subjects, namely bulimics (Group B) (fluoxetine: 40 mg/day) (n=33), non-bulimic depressives (Group D) (fluoxetine: 20 mg/day) (n=25) and a Group C of 50 healthy controls, unstimulated and stimulated saliva was collected. The concentrations of Na(+), K(+), Ca(2+) were determined by colorimetric photometry method (Effox 5053, Eppendorf, Germany). RESULTS: The bulimic group reported significant lower output in salivary flow and sodium concentration. In the group (D) only flow was lower than in healthy controls but not significant. CONCLUSION: This study supports the hypothesis that salivary flow is an unreliable indicator of bulimia, the lack of increase in sodium level in stimulated saliva in bulimic subjects could be a more reliable confirmation of the eating disorder.

[Visual-spatial functions and organisation of grapho-motor actions in ADHD children]. / Funkcje wzrokowo-przestrzenne i organizacja czynnosci ci grafomotorycznych u dzieci z ADHD.

AIM: The aim of the study was to test whether children with a diagnosis of ADHD at the age of 7-16 years have deficits in visual-spatial, visual memory, planning, and organisation of the visual-motor functions. METHODS: The study included 186 unrelated patients aged 7-16 years diagnosed with ADHD. The control group consisted of 156 healthy individuals aged 7-16 years. The methods applied were the Rey-Osterrieth Complex Figure Test (ROCF) and Matching (MFFT). RESULTS: The number of errors in the MFFT was significantly different between healthy combined subtype. There were no differences between inattentive and healthy children. In the Rey-Osterieth Complex Figure test, statistically significant differences were found between the control group and a group of combined ADHD in the number of points obtained when drawing back and reproduction from memory. In the latter index were also differences between ADHD inattentive children and the combined subtype. Children with ADHD obtained statistically significant different results than healthy children in the drawing category (which were treated as an indicator of the executive functions of planning) but only in reproduction from memory. Quality of the copy does not differentiate the groups. CONCLUSIONS: ROCF and MFFT are useful measures of visual-spatial function and visual memory of children with ADHD. They have less relevance in the assessment of executive functions. Visual-spatial disorders were found only in children with ADHD combined subtype.

Brain derived neurotrophic factor gene Val66Met and -270C/T polymorphisms and personality traits predisposing to anorexia nervosa.

OBJECTIVES: Polymorphisms in BDNF gene has been proposed, as susceptibility loci for stress-related psychiatric disorders. Several lines of molecular and biochemical evidence point to the role of BDNF in anorexia nervosa (AN). Personality traits may constitute the intermediate phenotypes between genes and vulnerability to AN. METHODS: BDNF Val66Met and -270C/T polymorphisms were genotyped in 149 patients with AN and 100 healthy control females. Temperamental traits in all subjects were measured with Temperament and Character Inventory. First in case-control analysis, we assessed, if analyzed genotypes confer risk for AN. Next, the association of BDNF gene variants with personality dimensions in patients and control subjects was analyzed. RESULTS: No significant differences between patients with anorexia nervosa and controls in frequency of genotypes and alleles were observed. AN patients with Met allele showed higher Harm avoidance (Anova F=4.70; p=0.03) than Val/Val homozygotes. AN patients, who carried the T allele of BDNF -270C/T polymorphism showed higher Persistence (Anova F=4.04; p<0.05) and Harm avoidance (Anova F=7.93; p=0.006) than C/C homozygotes, however after correction for multiple testing only the latter association remained statistically significant. No significant relationship between Val/Met 66 genotype and -270C/T genotype with personality was observed in healthy females. CONCLUSIONS: These results may suggest, that BDNF -270 C/T polymorphism may influence the personality trait associated with higher risk of AN.

[Is the developmental model accurate for all psychiatric disorders?]. / Czy we wszystkich zaburzeniach psychicznych obowiazuje model rozwojowy?

In the 1980's a neurodevelopmental hypothesis of schizophrenia was proposed. Since that time, the role of early developmental age as a risk period for action of etiological factors in psychosis was confirmed. Additionally, many disturbances of pre-schizophrenic persons in the developmental age were demonstrated. Recently published longitudinal cohort studies indicate that majority of the psychiatric disorders other than schizophrenia are preceded by occurrence of psychiatric disorders in childhood and early adolescence. Moreover, in numerous studies of adult anxiety and mood disorders, the role of early risk factors was observed and temperament, neurophysiological and psychopathological disturbances in early age were reported. The resulting developmental model of psychiatric disorders may help in the understanding of their pathogenesis. Subsequently, detection and treatment of early life disturbances may hypothetically prevent severe psychopathological symptoms in adulthood.

[Genetic background of ADHD: population studies, genes of the catecholamine system]. / Udzial czynników genetycznych w etiologii ADHD. Badania populacyjne, geny ukladu amin katecholowych.

Attention-deficit hyperactivity disorder (ADHD) begins in early childhood. In this article we review the studies supporting a genetic background of this disorder. ADHD occurs in 3-10% of the general population. Family studies reveal a 5 times more likely frequency of ADHD among first-degree relatives than in the general population. Monozygotic twin concordance rate for ADHD is 81%, whereas for dizygotic twins it is 29%. One of the ADHD predisposing factors is dopaminergic neurotransmission abnormality. According to other studies there is a relationship between polymorphism of dopamine transporter gene (DAT), dopamine receptors genes: DRD2, DRD3, DRD4, DRD5, dopamine-beta-hydroxylase gene (DBH) and catechol-O-methyltransferase gene (COMT) and ADHD. In other articles authors describe abnormalities of the serotonergic system, such as the polymorphism of the serotonin transporter gene (5HTT/SERT), serotonin receptors genes 5HT2A and 5HT1B in the development ofADHD. Another possible factor in ADHD background is the dysregulation of the adrenergic system. The most frequently studied is the connection between polymorphism of norepinephrine transporter gene (NET), adrenergic receptors genes: alpha 2A (ADRA2A), alpha 1C (ADRA1C), alpha 2C and monoamine oxidase A gene (MAO-A).

[Genetic background of ADHD: genes of the serotonergic system, other candidate genes, endophenotype]. / Udzial czynników genetycznych w etiologii ADHD. Geny ukladu serotoninergicznego, pozostale geny kandydujace, endofenotyp.

Recent studies have shown that in the aetiology of attention-deficit hyperactivity disorder (ADHD) genetic factors may be of importance. Biochemical and pharmacological studies reveal a connection between abnormalities of dopaminergic, adrenergic and serotonergic system and ADHD. Therefore genes for enzymes synthesizing or degrading proper neurotransmitters, genes for adequate transporters and receptors and genes for other substances, which altered the level of neurotransmitters, are studied. Many authors describe the connection between ADHD development and the synaptosomal-associated protein 25 (SNAP-25) gene. This protein plays a role in catecholamine secretion. Its higher expression is specific for neurones. SNAP-25 gene mutation may change this protein level, function of synapse and neurotransmitters storage. Acetylcholine receptor alpha4 subunit gene stimulation increases the dopamine level. Therefore this receptor gene may be important in the aetiology of ADHD studies. Other possible factors in ADHD background are substance influence on brain maturation, including N-methyl-D aspartate glutamate receptor 2A gene polymorphism (GRIN2A) and brain derived neurotrophic factor (BDNF) gene. One of the greatest challenges in studying the genetic basis of psychiatric disorders is to find appropriate ways to define the relevant endophenotype. ADHD often coexists with other psychiatric disorders, including specific developmental disorders, conduct disorders, obsessive-compulsive disorder and early onset of bipolar disorder.

[Efficacy of buspirone and fluoxetine in short-term treatment of bulimia nervosa]. / Ocena skutecznosci krótkotrwalego leczenia bulimii buspironem i fluoksetyna.

UNLABELLED: Bulimia nervosa (BN) is a common and disabling psychiatric disorder, which affects mainly young females. The basic therapeutic modalities include pharmacotherapy with selective serotonin reuptake inhibitors, cognitive behavioural therapy and combined treatment. AIM: This 12-week open label study was performed to assess the efficacy of buspirone-5-HT1A receptor agonist in the treatment of bulimia, and to compare it with the efficacy of fluoxetine --the standard treatment of BN. METHOD: We recruited 57 patients, who were assigned to two treatment groups-fluoxetine (n=35) and buspirone (n=22) At baseline, and after treatment we assessed the serotonin level in serum. RESULTS: At least 50% reduction in severity of bulimic symptoms was observed in 15/35 (42.9%) patients treated with fluoxetine and in 11/22 (50.0%) patients receiving buspirone. Depressive symptoms (Beck Depression Inventory) decreased significantly in both treatment groups (from 22.8 to 9.6 points in fluoxetine group and from 19.8 to 10.0 in buspirone group; difference between groups- not significant). Side effects, such as headaches and nausea occurred in both groups rarely and did not cause withdrawal from treatment. Statistical trend towards increased serotonin level in serum was observed after treatment with fluoxetine, and was not associated with buspirone administration. CONCLUSION: Buspirone may have similar efficacy as fluoxetine in reducing bulimic and depressive symptoms in patients with bulimia, however may not cause significant changes of serotonin level in serum.

[Evaluation of oral health in bulimia nervosa]. / Ocena stanu narzadu zucia w bulimii.

AIM: The aim of the study was to evaluate the dental status of bulimics with self inducing vomiting. METHOD: 33 bulimic female patients aged between 17 to 20, who were in need of hospitalization in the Department of Psychiatry, Poznan University of Medical Sciences, were compared to 31 age and sex matched healthy controls aged between 18 to 36. For each subject dental examination including calculation of caries, erosion and oral hygiene indexes: PlI, OHI-S, DMFT and TWI was performed. In both groups salivary flow and pH of the whole saliva were measured. RESULTS: Bulimics manifest a significantly higher retention of dental plaque and also higher frequency of enamel erosion, which were not present in the control group. Additionally, bulimics had more intense caries. Stimulated and resting salivary flow were poor, although they had the lowest pH values but were within the normal range. CONCLUSION: Patients with bulimia nervosa showed a higher number and severity of enamel erosion. There is also the high difference in amount of dental plaque, caries and changes in salivary secretion. These results highlight a need for close cooperation between the dentist and the patient's physician, which will then improve the diagnosis and treatment of this disease.

The 5-HT2A -1438 A/G and 5-HTTLPR polymorphisms and personality dimensions in adolescent anorexia nervosa: association study.

Disturbances of serotonergic neurotransmission and temperamental vulnerability have both been implicated in the pathogenesis of anorexia nervosa (AN). We genotyped the -1438 A/G polymorphism in the 5-HT2A receptor gene and serotonin transporter linked-polymorphic region (5-HTTLPR) in 132 adolescent subjects with AN and in 93 healthy controls. Personality dimensions in AN patients were assessed with the Temperament and Character Inventory. In a case-control model, we tested the hypothesis that these genetic variants confer susceptibility to AN. We also analyzed whether two polymorphisms show association with temperamental and character traits. No significant difference was found in the 5-HTTLPR frequency between AN patients and controls; however, there was a statistical trend towards a higher frequency of the A allele of the -1438 A/G polymorphism in patients than in controls (64.9 vs. 56.7%, chi2 test, p=0.08). We also found a significant association between the A allele of this polymorphism and two temperamental traits. Patients homozygous for the A allele showed lower reward dependence than G/G homozygotes, and A/A homozygotes showed lower harm avoidance than heterozygotes. Low reward dependence and harm avoidance were more characteristic of the restrictive-type AN than of other subtypes of the disorder. No association of 5-HTTLPR with personality dimensions in AN patients was observed. Our results may suggest that the A allele of the -1438 A/G polymorphism confers some genetic risk for adolescent AN patients, especially in those with personality traits, which are typical of the restrictive-type AN.

[Evaluation of temperament and personality in bulimia nervosa]. / Ocena temperamentu i charakteru w bulimii.

UNLABELLED: Previous studies revealed the possibility of abnormal personality development role in the etiology of eating disorders. It was found that a diagnosis of personality disorders, mostly borderline personality and/or histrionic personality can be made in about 44-46% of bulimic patients. The inconsistencies in identifying personality types using categorical assessment approaches have encouraged a conceptualization of the personality from a dimensional perspective. It was revealed that the Tridimensional Personality Questionnaire (TPQ) and Temperament and Character Inventory (TCI) are useful in studying patients with eating disorders. AIM: The aim of the study was personality dimensions and depression symptoms assessment in bulimic patients. METHOD: We studied 36 women with purging type bulimia according to DSM-IV and ICD 10 criteria. The mean age of the studied women was 19.7 years. The control group were 44 healthy women: university and last year high school students (mean age 20.4). We assessed body height, body mass and Body Mass Index (BMI). Severity of depression symptoms was assessed with the use of Beck Depression Index (BDI), and personality dimensions with the use of (TCI). CONCLUSIONS: Women from the study group had higher harm avoidance (HA) scores, which shows that bulimic patients are shy, fearful, doubtful, tend to be inhibited in most social situations. Mood disorders present in the studied women influenced HA scores. The results of the study revealed lower possibilities of self-directness in bulimic patients in comparison with the control group. Negative correlation between BDI and SD scores, shows that a decrease of depression severity may lead to an increase of self-esteem, independence and effectiveness of bulimic patients.