Naturalistic follow-up of subjects affected with anorexia nervosa 8 years after multimodal treatment: Personality and psychopathology changes and predictors of outcome.

BACKGROUND: Eating disorders (EDs) are serious mental illnesses of growing clinical and social impact. Despite their severity, there is still no satisfactory evidence-based treatment. Follow-up investigations are the most reliable studies to enlighten long-term outcome predictors and modifiers. METHODS: In total, 59 subjects affected with anorexia nervosa were assessed 8 years after their admission into an outpatient multimodal treatment program for eating disorders. The follow-up changes in diagnostic criteria were compared with Chi-square test. Improved and not-improved subjects were compared. Clinical, personality and psychopathology features between T0 and T1 were compared with t-test for repeated measures. Correlation between T0 features and changes at T1 in personality and psychopathology features were assessed. RESULTS: The rate of complete remission was 42%, an overall rate of 67.8% improved, a rate of 18.6% worsened. Concerning personality, a significant decrease of harm avoidance and increase in self-directedness were evidenced. Interoceptive awareness, drive for thinness, bulimia were significantly reduced at follow-up. Many T0 personality facets were related to personality and psychopathology improvement at follow-up. CONCLUSION: Multimodal treatment encompassing psychiatric, nutritional and psychological approaches is at the moment the most reliable approach for the treatment of moderate to severe anorexia nervosa with a discrete rate of improvement. Some personality and psychopathology characteristics may represent specific factors which favor resistance and impair improvement. Future approaches should consider the personalization of therapeutic approach according to these features.

Identifying neuroanatomical signatures of anorexia nervosa: a multivariate machine learning approach.

BACKGROUND: There are currently no neuroanatomical biomarkers of anorexia nervosa (AN) available to make clinical inferences at an individual subject level. We present results of a multivariate machine learning (ML) approach utilizing structural neuroanatomical scan data to differentiate AN patients from matched healthy controls at an individual subject level. METHOD: Structural neuroimaging scans were acquired from 15 female patients with AN (age = 20, s.d. = 4 years) and 15 demographically matched female controls (age = 22, s.d. = 3 years). Neuroanatomical volumes were extracted using the FreeSurfer software and input into the Least Absolute Shrinkage and Selection Operator (LASSO) multivariate ML algorithm. LASSO was 'trained' to identify 'novel' individual subjects as either AN patients or healthy controls. Furthermore, the model estimated the probability that an individual subject belonged to the AN group based on an individual scan. RESULTS: The model correctly predicted 25 out of 30 subjects, translating into 83.3% accuracy (sensitivity 86.7%, specificity 80.0%) (p < 0.001; χ 2 test). Six neuroanatomical regions (cerebellum white matter, choroid plexus, putamen, accumbens, the diencephalon and the third ventricle) were found to be relevant in distinguishing individual AN patients from healthy controls. The predicted probabilities showed a linear relationship with drive for thinness clinical scores (r = 0.52, p < 0.005) and with body mass index (BMI) (r = -0.45, p = 0.01). CONCLUSIONS: The model achieved a good predictive accuracy and drive for thinness showed a strong neuroanatomical signature. These results indicate that neuroimaging scans coupled with ML techniques have the potential to provide information at an individual subject level that might be relevant to clinical outcomes.

Intrinsic connectivity networks within cerebellum and beyond in eating disorders.

Cerebellum seems to have a role both in feeding behavior and emotion regulation; therefore, it is a region that warrants further neuroimaging studies in eating disorders, severe conditions that determine a significant impairment in the physical and psychological domain. The aim of this study was to examine the cerebellum intrinsic connectivity during functional magnetic resonance imaging resting state in anorexia nervosa (AN), bulimia nervosa (BN), and healthy controls (CN). Resting state brain activity was decomposed into intrinsic connectivity networks (ICNs) using group spatial independent component analysis on the resting blood oxygenation level dependent time courses of 12 AN, 12 BN, and 10 CN. We extracted the cerebellar ICN and compared it between groups. Intrinsic connectivity within the cerebellar network showed some common alterations in eating disordered compared to healthy subjects (e.g., a greater connectivity with insulae, vermis, and paravermis and a lesser connectivity with parietal lobe); AN and BN patients were characterized by some peculiar alterations in connectivity patterns (e.g., greater connectivity with the insulae in AN compared to BN, greater connectivity with anterior cingulate cortex in BN compared to AN). Our data are consistent with the presence of different alterations in the cerebellar network in AN and BN patients that could be related to psychopathologic dimensions of eating disorders.

Does it exist a personality core of mental illness? A systematic review on core psychobiological personality traits in mental disorders.

AIM: Research investigating the relationship between mental disorders and personality traits leads to interesting results. Individuals affected by several mental disorders have been worldwide assessed according to the psychobiological model of personality. This review aims to explore which temperament and character traits are recurrent in mental disorders and to highlight what traits may be shared determinants or consequences of the expression of a mental disorder. METHODS: Systematic search of Medline database between 1998 and 2011 has been conducted to select the studies exploring the Temperament and Character Inventory (TCI) dimensions in the most relevant axis I psychiatric disorders. Of the 110 studies that were retrieved, 88 met the inclusion/exclusion criteria and were analyzed. RESULTS: High HA (HA) and low self-directedness are recurrent and can be considered as a "personality core" regardless of the diagnosis. They may be risk factors and relapse-related, they can indicate incomplete remission or chronic course of mental disorders, and consistently influence patients' functioning. Furthermore, they can be modified by medications or psychotherapy and represent outcome predictors of treatments. CONCLUSION: This "core" may represent a personality diathesis to psychopathology. Relational environment can influence the development of both temperament and character, thus prevention of mental disorders should promote a positive development of these traits. Although further research is needed, psychotherapeutic interventions should be performed also considering that mental disorders could benefit from HA desensitization and SD reinforcement. Finally, these traits may be used to provide diagnostic, prognostic, quality of life and efficacy inferences on psychiatric treatments.

The borderline personality organization in a dimensional perspective: the TCI and SWAP-200 in comparison.

AIM: The categorical assessment of personality disorders, in particular of the borderline personality disorder is being debated by most authors. This study focuses on the structural organization of personality, namely on Kernberg's borderline personality organization (BPO). It aims to explore the dimensional personality assessment and to test the convergence on this construct of two dimensional instruments: the Temperament and Character Inventory (TCI) and the Shedler-Westen Assessment Procedure (SWAP-200). METHODS: BPO was assessed with the Temperament and Character Inventory (TCI) and the Shedler-Westen Assessment Procedure (SWAP-200). Thirty-four BPO subjects were recruited in the study. TCI profiles of BPO subjects were compared with 34 non-BPO matched controls. TCI and SWAP-200 profiles were correlated with each other and with clinical data. RESULTS: BPO subjects showed higher harm avoidance and lower self-directedness (TCI). The SWAP-200 evidenced a schizotypal configuration (categorical classification) and histrionic and schizoid traits (Q-sort classification). CONCLUSION: The instruments displayed limited correlation. Instead they both extensively correlated with clinical history of BPO subjects. Implications for BPO assessment and its relationship with mental disorders are discussed. The knowledge of the BPO dimensional characteristics will improve clinical management and therapeutic strategies for BPO patients. Moreover the comparison of two dimensional instruments on the construct of BPO may shed a light on their strengths and weaknesses.

Amenorrhea in eating disorders: poor stability of symptom after a one-year treatment.

OBJECTIVE: To examine whether patients with Eating Disorders (ED) who restore menses differ from those who remain amenorrheic after treatment and to provide longitudinal data about this debated criterion of Anorexia Nervosa (AN). METHODS: 184 outpatients were recruited: 50 patients with AN Restrictive type, 75 amenorrheic Eating Disorder Not Otherwise Specified (EDNOS) patients, 24 patients who recovered from AN with persistent amenorrhea, and 35 amenorrheic patients without ED. All participants were clinically assessed by psychiatrists and gynaecologists at the beginning of treatment and at the one-year follow-up. They also completed several psychometric tests: Eating Disorder Inventory-2, Temperament and Character Inventory, and Beck Depression Inventory. RESULTS: After treatment, a large portion of the sample resumed menses but very few recovered completely from the ED. No psychopathological variables could clearly predict the recovery of menses in the different groups. However, Body Mass Index and some biological variables were associated with restoration of menses in ED patients. CONCLUSION: Resumption of menses was not associated with a less severe eating symptomatology at the beginning of treatment nor with unequivocal psychopathological changes after treatment. It is important that clinicians consider not only the presence or absence of regular menses but also that they improve both ED screening and assessment in amenorrheic patients. Amenorrhea does not seem to represent a specific predictor of severity of illness or to show prognostic value.

Growing up with a congenital heart disease: neuro-cognitive, psychopathological and quality of life outcomes.

About 1% of newborn presents some form of congenital heart disease (CHD). Eighty-five percent of these children, thanks to medical and surgical improvement, reaches adulthood. This open up new challenges in patients management, such as the evaluation and optimization of psychosocial functioning and quality of life of CHD subjects. The present review collects research literature regarding neurocognitive and psychopathological adjustment, and personality and quality of life of these patients, analyzing variables that may influence their development. Literature data lean towards a multifactorial process implied into an insufficient outcome of neurocognitive development in many patients. Psychopathological development seems "problematic" with the expression of behavioural disorders both externalising and internalising. But current researches don't consent univocal and definitive conclusions. The need for interventions to improve existential outcome for CHD subjects emerges: research on genetic factors and early recognition of at risk subjects must go with the necessity for research aiming to determine protective and risk factors related to personality, environment and relational aspects entailed in the development of CHD subjects. Finally, some evidences noticed in CHD subjects psychopathological and quality of life outcomes which are even better than normal ones. These results depend on the elaboration of their disease that CHD subjects have carried on. Factors regarding mainly personality development are essential in determining these outcomes.

Psychosomatic approach is the new medicine tailored for patient personality with a focus on ethics, economy, and quality.

Over the last 40 years the proliferation of the biopsychosocial (BPS) model across clinical and theoretical research has shown that psychosocial factors can be shown to be causes, co-factors, or sequelae of many illnesses. Scientific presuppositions about the BPS model have been grounded firmly in psychobiological, psycho-behavioural, sociobiological, and socio-behavioural processes. According to the allostatic load model, stressful factors can be psychological ones or any other factor that is able to modify the stress-response system; these might include genetic factors or life experiences. Personality profiles, in particular, seem to be predictive of responses to different stressors. Stress responses preceding or following illness are clearly related, from a psychobiological point of view, to different personality traits, which themselves correlate to specific defence mechanisms. Neural processes underlying these mechanisms interact with the biological substrate of somatic illnesses. Recent advances in brain imaging with regard to neurobiological and behavioural interactions of empathy and alexithymia support the crucial role of the (psycho) therapeutic relationship across the whole of medical practice. Psychotherapies operate as biological factors on mind, brain, and body; indeed it is necessary to reconsider the doctor-patient relationship as a psychotherapeutic process. The basic methodological triad of observation (outer viewing), introspection (inner viewing), and dialogue (inter viewing) becomes essential in medical practice and in scientific research. Psychoanalytic processes such as transference, resistance, the therapeutic alliance, and attachment have been reconsidered from a neuroscientific perspective and reconceived as moments of meeting of the procedural memory and are therefore considered relevant to the relationship with patients in primary care. Indeed, they are useful to an ethical approach to understanding the meaning of illness, and they also influence the results of treatment projects. Because all these aspects impact upon illness duration and quality of life, affecting both the individual concerned and his or her family, the economic consequences of this psychosomatic approach are important in both general and specialist medicine. Medicine is becoming, and will become even more in the future, an integrated science; human illness and the maintenance of good health may be better understood if all medical disciplines are considered as a whole. The domain of psychosomatic medicine has now extended to coincide with that of medical practice. There is increasing evidence, not only in psychiatry, but in all medical fields, that care of the mental well-being of a person is essential for effective care of the body. Not only mens sana in corpore sano, but also corpus sanus in mente sana.

[Obesity and Eating Disorders. Indications for the different levels of care. An Italian Expert Consensus Document]. / Documento di Consensus. Obesità e Disturbi dell'Alimentazione Indicazioni per i diversi livelli di trattamento.

This paper is an Italian Expert Consensus Document on multidimensional treatment of obesity and eating disorders. The Document is based on a wide survey of expert opinion. It presents, in particular, considerations regarding how clinicians go about choosing the most appropriate site of treatment for a given patient suffering from obesity and/or eating disorders: outpatient, partial hospitalization, residential rehabilitation centre, inpatient hospitalization. In a majority of instances obesity and eating disorders are long-term diseases and require a multiprofessional team-approach. In determining an initial level of care or a change to a different level of care, it is essential to consider together the overall physical condition, medical complications, disabilities, psychiatric comorbidity, psychology, behaviour, family, social resources, environment, and available services. We first created a review manuscript, a skeleton algorithm and two rating scales, based on the published guidelines and the existing research literature. As the second point we highlighted a number of clinical questions that had to be addressed in the specific context of our National Health Service and available specialized care units. Then we submitted eleven progressive revisions of the Document to the experts up to the final synthesis that was approved by the group. Of course, from point to point, some of the individual experts would differ with the consensus view. The document can be viewed as an expert consultation and the clinical judgement must always be tailored to the particular needs of each clinical situation. We will continue to revise the Document periodically based on new research information and on reassessment of expert opinion to keep it up-to-date. The Document was not financially sponsored.

Self-esteem and personality in subjects with and without body dysmorphic disorder traits undergoing cosmetic rhinoplasty: preliminary data.

BACKGROUND: Many individuals with body dysmorphic disorder (BDD) seek non-psychiatric treatment. BDD occurs in about 5% of patients who seek cosmetic surgery, and rhinoplasty is the most frequently sought treatment. A correlation exists between individuals' self-esteem and demand for cosmetic surgery. OBJECTIVE: To investigate whether those subjects with BDD traits requesting cosmetic rhinoplasty differ from those without BDD traits in self-esteem, personality and quality of life. METHODS: This study included 54 patients applying to the 1st ENT Division of Turin University. Assessment of the patients before cosmetic rhinoplasty includes: nasal obstruction symptom evaluation, health-related quality of life, Rosenberg self-esteem scale, body dysmorphic disorder questionnaire (BDDQ) and temperament and character inventory (TCI). Based on their responses to BDDQ questions 1, 3 and 4, patients were subdivided into subgroups and then compared. RESULTS: No difference emerged in the objective data. Lower self-esteem, higher harm avoidance (HA) and lower self-directedness (SD) are found in subjects who are worried about how they look, in those with interference in their social life due to this worry and in those who spend more than 3h per day thinking about the way they look. Novelty seeking (NS) is significantly higher in subjects who think about their looks for up to 3h than in those who spend less than 1h. CONCLUSION: Different subgroups of patients are identified. The first group includes pessimistic, shy, insecure subjects; people with fragile and immature personality and poor self-esteem; individuals concerned about the way they look and those who spend more time thinking about it. The second group includes more confident subjects with stronger personality and greater self-esteem. A third, less differentiated group, includes more impulsive (high NS) subjects who spend an intermediate amount of time thinking about the way they look. Patients should be carefully screened and assessed before cosmetic surgery interventions to avoid frustration to both, clinicians and patients.

Day hospital programmes for eating disorders: a review of the similarities, differences and goals.

Day hospital (DH) treatments for eating disorders (EDs) provide intensive daily care and allow patients to maintain and test their social relations and coping skills at home and outside. Although widespread, their description is lacking. This review compares the different types of DH described in the literature and presents our DH experience in Turin, Italy. We searched Psychinfo and Pubmed with the following keywords: anorexia nervosa, bulimia nervosa, EDs, DH, day treatment and partial hospitalisation. We found and reviewed the DH programmes of eleven specialised centres, which have some shared features but also many differences, suggesting that DH treatments are still largely experimental. Briefly, the shared elements are: biopsychosocial model as reference frame; cognitive-behavioural model or techniques; behavioural contract; patients' selection; body image therapy; involvement of family; weight normalisation/weight gain and modification/normalisation of eating behaviour as objectives. Nonetheless, shared opinions concerning inclusion criteria are lacking; the duration of DH treatment is surprisingly different among centres (from 3 to 39 weeks); the approach to eating and compensation behaviours ranges from control to autonomy; followup and psychometric assessment can be either performed or not; psychological and behavioural objectives can be different. This review suggests the existence of two different DH models: the first has a shorter duration and is mainly symptom-focused; the second is more individual-focused, has a longer duration and is focused on patients' relational skills, psychodynamic understanding of symptoms and more gradual changes in body weight. Further investigation is required to make DH treatment programmes measurable and comparable.

Depression and the existential domain in the assessment of quality of life in HIV outpatients with the McGill questionnaire.

AIM: The aim of the present study was to further test criterion validity and factorial validity of the McGIll Quality Of Life (MQOL) questionnaire, and to assess its reliability and sensitivity to clinical change in outpatients with HIV infection. METHODS: The authors present a longitudinal study on a consecutive sample of 216 adults treated with HAART at the outpatient facility of an hospital-based tertiary care center in Italy. Patients completed the MQOL and the Beck Depression Inventory (BDI) both at baseline and follow-up assessments. Patients were classified into subgroups (improved, unchanged, worsened) based on change in BDI scores or CD4 count over time. RESULTS: The pattern of correlation between MQOL subscales and the BDI was as hypothesised. A fairly simple factor structure emerged, with a striking resemblance between the factors and the MQOL subscales. The internal consistency of the MQOL and its subscales was high. The test-retest reliability in clinically unchanged patients was satisfactory. Sensitivity to change, as measured by Guyatt responsiveness statistic, was also satisfactory. CONCLUSIONS: This study contributed to building evidence of reliability and validity for the MQOL questionnaire, which may be particularly useful to assess the so-called "existential" aspects of QOL that are particularly relevant for patients infected with HIV.

Brief Adlerian psychodynamic psychotherapy: theoretical issues and process indicators.

Brief psychotherapy is gaining interest worldwide, because of its good cost/effectiveness ratio and proved efficacy. The aim of the paper was to describe the brief Adlerian psychodynamic psychotherapy (B-APP): a brief, psychodynamically oriented psychotherapy referring to the individual psychology (IP). The B-APP theory refers to the following paradigms: 1) the individual represents a psychosomatic unity integrated in the social context; 2) the individual needs to build and regulate the image of the self; 3) bond patterns regulate human relationships and represent the symbolic ''fil rouge'' connecting the elements of the life-style. Its objectives are: 1) an at least partial resolution of the focus problem; 2) a decrease or a non-increase of symptoms; 3) a global increase of quality of life. The results depend on intrapsychic and relational changes. Indications are more relative than absolute. The possibility of identifying a meaningful focus is fundamental. The treatment scheme includes 15 sessions subdivided into 5 phases. B-APP offers a technical approach to brief psychotherapy which is suitable in many fields of psychiatry and liaison medicine such as preventive interventions in at-risk subjects, somatopsychic disorders and liaison psychiatry, personality and eating disorders, and treatment of emotionally disturbed children. It was applied as psychotherapeutic approach in some clinical outcome studies about eating disorders and severe personality disorders displaying a good efficacy.

Personality and psychopathology correlates of dropout in an outpatient psychiatric service.

AIM: The dropout from care in public psychiatric units is a frequent event and strategies to reduce its incidence are still debated. This study aims to determine which personality and psychopathology dimensions influence the dropout in a psychiatric unit. METHODS: All new patients referred to a public psychiatric outpatient service were tested with self-administered inventories assessing personality traits (TCI), parental bonding (PBI), and psychopathology (SCL-90; BDI; STAXI). Completers were divided into nondropout, late dropout, and early dropout groups which were compared with each other with respect to diagnosis, referral, demographic data and the inventories. Logistic regression was performed between dropout and non dropout subjects with respect to the significantly differing variables. RESULTS: No clinical or demographic characteristic predict dropout. Numerous SCL-90 psychopathology scales, state anger and some TCI personality facets distinguish dropout from in care subjects. Psychoticism and sentimentalism have been evidenced independent predictors of dropout. CONCLUSION: In the present study dropout from the psychiatric unit is more related to personal characteristics than to sociodemographic variables or diagnosis. Dropout is related to personality and psychopathology characteristics which may reduce subject's relational skills and impair therapeutic alliance. These traits may also influence subjects' perception of the service quality and of the assessment procedure. The acknowledgement of such traits as possible determinants of dropout may orient service organization and personnel education to prevent this phenomenon in health care services. Strategies for preventing dropout are discussed.

Clinical, psychological and personality features related to age of onset of anorexia nervosa.

BACKGROUND: To investigate the relationship between age of onset and clinical and personality features of patients with anorexia nervosa (AN). SAMPLING AND METHOD: We assessed 250 outpatients with AN with the Temperament and Character Inventory, the Eating Disorder Inventory 2, the Beck Depression Inventory and the Body Shape Questionnaire. The patients were subdivided into 3 groups: early (n=73), intermediate (n=96) and late onset (n=81), based on age of onset of symptoms. RESULTS: The early-onset group shows higher body dissatisfaction, maturity fear, impulsivity and asceticism than the other 2 groups. This group shows a greater character fragility, as described in particular by a lower self-directedness, than the other 2 groups. CONCLUSIONS: Even several years after the onset of the disorder, early-onset subjects affected by AN seem characterized by a more disturbed personality, with a higher body dissatisfaction than late-onset subjects affected by AN and a pursuit of thinness based on an ascetic drive.

Eating disorders and the Internet: cure and curse.

OBJECTIVE: The role of culture and the mass-media in relation to eating disorders (EDs) is widely acknowledged, and the Internet has become an important part of this over the last few years. The aim of this report is to suggest the general features and potential clinical implications of "pro-Ana" websites and those concerning the treatment of EDs. METHOD: We conducted a Google search using the key words "anorexia nervosa (AN) and treatment", "AN and psychotherapy", "AN and pharmacotherapy", and then "pro-anorexia", "pro-ana sites", "thinspiration" and "anorexicnation". RESULTS: The first group of queries gave respectively 546,000, 212,000 and 39,100 results; the second 257,000, 18,600, 14,200 and 577. Forty-seven of 100 randomly selected pro-ana websites were thoroughly visited. CONCLUSIONS: Internet websites may increase the accessibility of treatments but also strengthen some of the core psychopathological and symptomatological issues of AN, such as asceticism, competition, purging behaviours and obsession for control. Greater attention should be paid to the health policy of countries in which pro-ana websites flourish, and the clinical implications of the websites themselves.

Baseline personality characteristics of responders to 6-month psychotherapy in eating disorders: preliminary data.

OBJECTIVE: The Karolinska Psychodynamic Profile (KAPP) was used for the assessment of the six-month outcome of Brief Adlerian Psychodynamic Psychotherapy (B-APP). METHOD: Fifty-seven eating disordered women (28 with anorexia nervosa, 29 with bulimia nervosa), were included in the study. The sample was evaluated at baseline (time 0) and after six months (T6) with a clinical assessment and with Temperament and Character Inventory (TCI), Eating Disorder Inventory (EDI-2), State-Trait Anger Expression Inventory (STAXI), and KAPP. RESULTS: Based on symptomatologic improvement, two sub-groups were obtained: responders (66.6%) and non-responders (33.3%). Significantly higher baseline scores emerged in the responders group on Ineffectiveness and Impulsivity (EDI-2) and on Harm Avoidance (TCI). Several KAPP items and areas improved in both groups at T6. CONCLUSION: Multimodal treatment centered on B-APP lead to both a global clinical improvement and an improvement in several psychological and psychopathological features as assessed by EDI-2, STAXI and KAPP. The results suggest interesting clinical implications, though outcome predictors are quite weak.

Hormonal and metabolic responses to acute ghrelin administration in patients with bulimia nervosa.

Ghrelin is generally influenced by energy balance status and is inversely associated with body mass index (BMI), being reduced in simple obesity, notable exception being Prader Willi syndrome, and elevated in several conditions of undernutrition, including anorexia nervosa (AN). Interestingly, ghrelin levels have also been found elevated in patients with bulimia nervosa (BN) in spite of normal BMI. In humans, intravenous (iv) ghrelin administration induces endocrine (increase in GH, PRL, ACTH and cortisol) and metabolic (increase in glucose and decrease in insulin) effects as well as an increase in appetite and food intake. In AN, ghrelin administration surprisingly leads to a decreased GH response and absence of glycemic variations but normal PRL, ACTH and insulin response. This pattern would reflect a decrease in sensitivity to ghrelin or, alternatively, the metabolic status of AN. To further clarify the function of ghrelin in eating disorders, the endocrine and metabolic response to acute iv ghrelin (1.0 microg/kg) was studied in seven young women with purging BN (BW, BMI, mean+/-SEM: 20.3+/-0.5 kg/m2). Circulating total ghrelin levels were also measured. The results in BW were compared to those recorded in a group of nine healthy women (HW; BMI 22.3+/-2.5 kg/m2). The GH response to ghrelin in BW overlapped with that in HW. Ghrelin administration also led to a similar increase in PRL, ACTH, cortisol and glucose levels in the two groups. Insulin levels were not significantly modified by ghrelin administration in either group. The overlapping endocrine and metabolic response to ghrelin in the two groups occurred with regard to circulating total ghrelin levels which were higher in BW than in HW. In conclusion, BN, a condition of ghrelin hypersecretion, is connoted by a normal endocrine and metabolic response to exogenous ghrelin administration.