Papel de la depresión y la impulsividad en la psicopatología de la bulimia nerviosa / The role of depression and impulsivity in the psychopathology of bulimia nervosa

Introducción. El presente estudio trató de analizar el papel de la depresión y la impulsividad en la psicopatología de la bulimia nerviosa (BN). Materiales y métodos. Se examinó a 70 mujeres con un diagnóstico de bulimia nerviosa basado en la cuarta revisión del Manual diagnóstico y estadístico de los trastornos mentales (DSM-IV), subtipo purgativo, para los síntomas relacionados con el trastorno de la conducta alimentaria, insatisfacción corporal, síntomas afectivos, impulsividad y rasgos de personalidad. Para el análisis estadístico se utilizaron métodos de análisis factorial y de modelos de ecuaciones estructurales. Resultados. La BN se presentó como un proceso que incorporaba 5 dimensiones generales: a) episodios recurrentes de gran voracidad o «atracones» y conductas compensadoras; b) conducta alimentaria restrictiva; c) insatisfacción corporal; d) rasgos de personalidad disocial; y e) una agrupación (cluster) de características que se denominó «inestabilidad emocional». Las 5 dimensiones obtenidas pueden agruparse en 2 factores básicos: insatisfacción corporal/conducta alimentaria y rasgos de personalidad/psicopatología. El primero contiene los ítems clínicos utilizados para la definición de la BN como proceso clínico en el DSM-V y la Clasificación Internacional de las Enfermedades, y refleja la morfología y la gravedad de los síntomas relacionados con la conducta alimentaria. La segunda dimensión incluye una agrupación de síntomas (síntomas depresivos, impulsividad y rasgos límite de personalidad [borderline]), conducta autodestructiva y disocial) que podrían considerarse como la «base psicopatológica de la bulimia nerviosa» y pueden condicionar su curso y su pronóstico (AU)

Introduction. The study aimed to analyze the role of depression and impulsivity in the psychopathology of bulimia nervosa (BN). aterials and methods. Seventy female patients with DSM-IV BN, purging subtype, were assessed for eating-related symptoms, body dissatisfaction, affective symptoms, impulsivity, and personality traits. Factor analysis and structural equation modeling methods were used for statistical analysis. Results. BN appeared as a condition which incorporated 5 general dimensions: a) binge eating and compensatory behaviours; b) restrictive eating; c) body dissatisfaction; d) dissocial personality traits; and e) a cluster of features which was called «emotional instability» The 5 obtained dimensions can be grouped into 2 basic factors: body dissatisfaction/eating behaviour and personality traits/psychopathology. The first one contains the clinical items used for the definition of BN as a clinical condition in the DSM-V and the International Classification of Diseases 10, and reflects the morphology and the severity of the eating-related symptoms. The second dimension includes a cluster of symptoms (depressive symptoms, impulsivity, and borderline, self-defeating and dissocial personality traits) which could be regarded as the «psychopathological core» of BN and may be able to condition the course and the prognosis of BN (AU)

The role of depression and impulsivity in the psychopathology of bulimia nervosa.

INTRODUCTION: The study aimed to analyze the role of depression and impulsivity in the psychopathology of bulimia nervosa (BN). MATERIALS AND METHODS: Seventy female patients with DSM-IV BN, purging subtype, were assessed for eating-related symptoms, body dissatisfaction, affective symptoms, impulsivity, and personality traits. Factor analysis and structural equation modeling methods were used for statistical analysis. RESULTS: BN appeared as a condition which incorporated 5 general dimensions: a) binge eating and compensatory behaviours; b) restrictive eating; c) body dissatisfaction; d) dissocial personality traits; and e) a cluster of features which was called «emotional instability¼ The 5 obtained dimensions can be grouped into 2 basic factors: body dissatisfaction/eating behaviour and personality traits/psychopathology. The first one contains the clinical items used for the definition of BN as a clinical condition in the DSM-V and the International Classification of Diseases 10, and reflects the morphology and the severity of the eating-related symptoms. The second dimension includes a cluster of symptoms (depressive symptoms, impulsivity, and borderline, self-defeating and dissocial personality traits) which could be regarded as the «psychopathological core¼ of BN and may be able to condition the course and the prognosis of BN.

Neurobiological and psychopathological variables related to emotional instability: a study of their capability to discriminate patients with bulimia nervosa from healthy controls.

OBJECTIVE: To analyze the capability of a set of neurobiological and psychopathological variables to discriminate bulimia nervosa (BN) patients from healthy controls. METHOD: Seventy-five female patients with purging BN and 30 healthy controls were compared for psychopathology (impulsivity, borderline personality traits, depressive symptoms and self-defeating personality traits) and neurobiological parameters reflecting hypothalamic-pituitary-adrenal axis activity (morning serum cortisol before and after dexamethasone) and monoamine activity (24-hour urinary excretion of norepinephrine, serotonin, dopamine, and their main metabolites: 3-methoxy-4-hydroxyphenylglycol, 5-hydroxyindoleacetic acid, and homovanillic acid). Furthermore, the relationships between the 2 sets of variables were compared in the 2 samples. RESULTS: BN patients displayed higher impulsivity, more severe depressive features, and more borderline and self-defeating personality traits than controls. The 4 psychopathological variables were strongly interrelated in patients, whereas only depressive features correlated with self-defeating personality traits in controls. Patients had lower 24-hour excretion of serotonin and dopamine than controls, as well as lower ability to suppress cortisol. The relations between the biochemical and the psychopathological variables were only significant in the BN patients, but not in the control group. When discriminant analysis methods were applied, patients and controls differed for psychopathology (impulsive behaviors and borderline personality traits) and biological parameters (baseline cortisol and dopamine excretion), but when the variables were analyzed together, the differences in neurobiological parameters appeared as mediated by the psychopathological status. DISCUSSION: Our results suggest that hypothalamic-pituitary-adrenal axis activity, dopamine activity and other biological parameters are worthy of further study as potential dimensional markers of BN, although they seem to depend on the psychopathological status of the patients, in such a way that the psychopathological items associated with emotional instability (impulsivity and borderline personality traits) seem to be more reliable as clinical markers at the time being.

Bulimia nervosa with history of anorexia nervosa: could the clinical subtype of anorexia have implications for clinical status and treatment response?

OBJECTIVE: To investigate whether the subtype of anorexia nervosa (AN) could influence the bulimic syndrome and treatment response in bulimia nervosa (BN) patients with a history of AN (BN/AN+). METHOD: Seventy female BN patients were assessed for eating disorder, psychopathology and personality, and treated for 6 months. RESULTS: BN/AN+ patients retained some traits of their past condition: lower body weight, higher perfectionism, and higher reward dependence. They also had more severe symptoms, longer evolution time, and worse response to treatment. A history of restricting AN was associated to higher age, longer evolution time, higher impulsivity, and greater tendency to use diet pills and diuretics. A history of binge-purging AN was associated to more severe vomiting, lower body dissatisfaction and less depressive symptoms, as well as better outcome. DISCUSSION: The influence of the AN subtype in BN/AN+ patients is worthy of further study as it might have clinical implications.

Psychopathology and lymphocyte subsets in patients with bulimia nervosa.

The association between lymphocyte subsets and several psychopathological variables which had proved to be able to affect immune cell count in other conditions was investigated in bulimia nervosa patients. Sixty-seven female bulimia nervosa patients and 29 female healthy controls were assessed for nutritional status (weight, blood cells, lymphocyte subsets, biochemical parameters and hormones) and psychopathology (anxiety, depression, hostility, impulsivity and borderline personality traits). A negative correlation between impulsivity and helper T-cells (CD4(+)) was found in controls. In the bulimia nervosa group, the patients with higher anxiety had the lower lymphocyte count, and anxiety and hostility were negatively related to CD4(+) count. In addition, helper/cytotoxic T-cell ratio negatively correlated in this group with impulsivity, hostility and depression. In the light of these results, the potential influence of psychopathology on lymphocyte subset counts seems to be specific in bulimia nervosa patients, and more relevant than in healthy controls.