Hostility and helper T-cells in patients with bulimia nervosa.

OBJECTIVE: The study aimed to analyze the correlation between lymphocyte counts and several psychopathological variables associated with psychological instability (depression, hostility, impulsivity, self-defeating personality traits, and borderline personality symptoms) in patients with bulimia nervosa (BN). METHOD: Sixty BN patients were assessed, using specific scales for eating pathology, general psychopathology, impulsivity, depression, and borderline personality features. Lymphocyte and lymphocyte subset counts were performed. Plasma cortisol at 8:00, before and after administration of 1 mg of dexamethasone at 23:00, was determined. The influence of body weight, and the use of tobacco, alcohol, and caffeine was controlled. The relationship between each isolated variable and the number of immune cells was analyzed. In a second step, supplementary post-hoc analysis of the variables was introduced to confirm the accuracy of the psychopathological assessment. RESULTS: Hostility was negatively correlated with the number of helper T-cells (CD4+). Patients with high hostility had lower CD4+ cell counts and lower CD4+/CD8+ ratios. In the post-hoc control study, hostility was significantly related with other "interpersonal" items. CONCLUSIONS: These results support the idea that hostility, as an expression of disturbed interpersonal relationships, could play a role as a modulator of immune activity in patients with BN.

Antecedentes de abusos sexuales en pacientes con bulimia nerviosa: su influencia en el estado clínico / History of sexual abuse in patients with bulimia nervosa: its influence on clinical status

Introducción. Los estudios que han analizado la relación entre abusos sexuales y bulimia nerviosa (BN) han arrojado resultados discordantes. El objetivo del presente estudio fue valorar la influencia de los antecedentes de abuso sexual en el estado clínico de un grupo de pacientes diagnosticados de BN con criterios DSM-IV. Métodos. Fueron evaluados 70 pacientes con BN usando instrumentos clínicos específicos: el Test de Actitudes Alimentarias–40 ítems (EAT-40), el Test de Investigación de Bulimia Edimburgo (BITE), el Listado de Comprobación de Síntomas (SCL-90), la Entrevista Clínica Estructurada para los Trastornos del Eje II del DSM-IV (SCID-II), el Test de 16 Factores de Personalidad (16-PF) y una entrevista clínica para la valoración del uso pasado y actual de sustancias. Los datos de los 15 pacientes con una historia previa de abusos sexuales (21,4 % de la muestra) fueron comparados con los de los 55 pacientes sin tales antecedentes. Resultados. Ambos grupos fueron muy similares con respecto a la intensidad de los síntomas. Sólo la tendencia a la somatización y puntuaciones más altas en el factor E del 16-PF (dominancia) aparecieron asociados a los antecedentes de abusos sexuales en la muestra. Conclusiones. Los resultados apoyan la idea de que los abusos sexuales pueden asociarse a una mayor vulnerabilidad no específica para presentar trastornos psicopatológicos, pero no aumentan la intensidad de la psicopatología en los pacientes con BN

Introduction.Studies analyzing the relationship between sexual abuse and bulimia nervosa (BN) have reported discrepant results. This study aimed to assess the role of a history of sexual abuse in the clinical status of a group of patients diagnosed of BN using DSM-IV diagnostic criteria. Methods. Seventy patients with BN were assessed using specific clinical tools: Eating Attitudes Test-40 items (EAT-40), Bulimia Investigation Test Edinburgh (BITE), Symptom Checklist (SCL-90), Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), Sixteen Personality Factors Test (16-PF) and a clinical interview for the assessment of past and current substance abuse. The data from the 15 patients with a history of sexual abuse (21.4 % of the sample) were compared with those from the 55 patients without such a history. Results. Both groups were very similar regarding symptom severity. Only the tendency to somatization and higher scores in the factor E of the 16-PF (dominance) were associated with antecedents of sexual abuse in the sample. Conclusions. The results support the idea that sexual abuse may be related to higher non-specific vulnerability to psychopathology, but do not increase symptom severity in BN patients

[History of sexual abuse in patients with bulimia nervosa: its influence on clinical status]. / Antecedentes de abusos sexuales en pacientes con bulimia nerviosa: su influencia en el estado clínico.

INTRODUCTION: Studies analyzing the relationship between sexual abuse and bulimia nervosa (BN) have reported discrepant results. This study aimed to assess the role of a history of sexual abuse in the clinical status of a group of patients diagnosed of BN using DSM-IV diagnostic criteria. METHODS: Seventy patients with BN were assessed using specific clinical tools: Eating Attitudes Test-40 items (EAT-40), Bulimia Investigation Test Edinburgh (BITE), Symptom Checklist (SCL-90), Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), Sixteen Personality Factors Test (16-PF) and a clinical interview for the assessment of past and current substance abuse. The data from the 15 patients with a history of sexual abuse (21.4 % of the sample) were compared with those from the 55 patients without such a history. RESULTS: Both groups were very similar regarding symptom severity. Only the tendency to somatization and higher scores in the factor E of the 16-PF (dominance) were associated with antecedents of sexual abuse in the sample. CONCLUSIONS: The results support the idea that sexual abuse may be related to higher non-specific vulnerability to psychopathology, but do not increase symptom severity in BN patients.

[Purging behaviors and nutritional status in anorexia nervosa and bulimia nervosa]. / Conductas purgativas y estado nutricional en anorexia nerviosa y bulimia nerviosa.

AIMS: The aim of the study was to investigate whether the use of purgative methods in patients with eating disorders (anorexia nervosa [AN] and bulimia nervosa [BN]) could be capable of producing changes in the nutritional status of the patients. SETTING AND PATIENTS: The group under study was composed of 184 female eating disordered outpatients. One hundred and sixteen patients (63.0%) fulfilled the DSM-IV diagnostic criteria for BN (90 purging type, 26 nonpurging type). Sixty eight patients (37.0%) fulfilled the DSM-IV criteria for the diagnosis of AN (48 restricting type, 20 binging-purging type). METHODS: The assessment process included anthropometry (body circumferences and skinfold thickness) and body impedance analysis. RESULTS: The two subgroups of AN patients significantly differed from each of the BN subgroups. From a nutritional point of view, some significant differences between the two DSM-IV subtypes of AN existed, but not between the purging type and the nonpurging type of BN. CONCLUSIONS: The paper discusses the clinical significance of these findings. An alternative subtypification of AN patients is proposed: 1) restricting type [patients who control their food intake and do not purge]; 2) purging type [patient with true episodes of binging which are followed by purgative behaviors]; and 3) pseudopurging type [patients with subjective binging episodes who use purging methods].

Conductas purgativas y estado nutricional en anorexia nerviosa y bulimia nerviosa / Purging behaviours and nutritional status in anorexia nervosa and bulimia nervosa

Objetivos: La intención del estudio fue comprobar si el empleo de métodos purgativos en pacientes con trastornos alimentarios (anorexia nerviosa [AN], y bulimia nerviosa [BN]) podía reflejarse en la existencia de un estado nutricional específico. Ámbito y pacientes: El grupo en estudio estuvo formado por 184 pacientes ambulatorios con diagnóstico confirmado de trastorno de la alimentación DSM-IV. Ciento dieciséis pacientes (63 por ciento) padecían BN: 90 del subtipo purgativo y 26 del subtipo no-purgativo. Sesenta y ocho pacientes (37,0 por ciento) cumplían los criterios diagnósticos del DSM-IV para la AN: 48 del subtipo restrictivo y 20 del subtipo compulsivo-purgativo. Intervenciones: El proceso de evaluación incluyó antropometría (perímetros corporales y pliegues cutáneos) y análisis de la impedancia corporal. Resultados: Los dos subgrupos de pacientes AN presentaron diferencias significativas frente a cada uno de los subgrupos de pacientes BN. Desde el punto de vista nutricional, fueron encontradas diferencias entre pacientes con patrones purgativos y no purgativos dentro de la población anoréxica pero no entre los pacientes bulímicos. Conclusiones: La significación clínica de estos hallazgos es discutida y se propone la identificación alternativa de tres subgrupos de pacientes AN: 1) tipo restrictivo [pacientes que controlan la ingesta y no utilizan métodos de purga]; 2) tipo purgativo [pacientes con verdaderos atracones que utilizan métodos de purga], y 3) tipo pseudo-purgativo [pacientes con episodios subjetivos de descontrol alimentario que utilizan métodos de purga] (AU)

Aims: The aim of the study was to investigate whether the use of purgative methods in patients with eating disorders (anorexia nervosa [AN] and bulimia nervosa [BN]) could be capable of producing changes in the nutritional status of the patients. Setting and Patients: The group under study was composed of 184 female eating disordered outpatients. One hundred and sixteen patients (63.0%) fulfilled the DSMIV diagnostic criteria for BN (90 purging type, 26 nonpurging type). Sixty eight patients (37.0%) fulfilled the DSM-IV criteria for the diagnosis of AN (48 restricting type, 20 binging-purging type). Methods: The asessment process included anthropometry (body circumferences and skinfold thickness) and body impedance analysis. Results: The two subgroups of AN patients significantly differed from each of the BN subgroups. From a nutritional point of view, some significant differences between the two DSM-IV subtypes of AN existed, but not between the purging type and the nonpurging type of BN. Conclusions: The paper discusses the clinical significance of these findings. An alternative subtypification of AN patients is proposed: 1) restricting type [patients who control their food intake and do not purge]; 2) purging type [patient with true episodes of binging which are followed by purgative behaviors]; and 3) pseudopurging type [patients with subjective binging episodes who use purging methods] (AU)