Serum oxytocin levels are elevated in body dysmorphic disorder and related to severity of psychopathology.

The neurobiological mechanisms underlying the pathophysiology of body dysmorphic disorder (BDD) are not well-understood. Oxytocin is a central nervous system peptide which regulates socioemotional functioning and may mediate physiologic processes in a range of psychiatric disorders, particularly those characterized by interpersonal dysfunction. Examining the role of oxytocin in the development and maintenance of BDD may elucidate new targets for intervention. The present study examined endogenous serum oxytocin levels in BDD. Given the prominent deficits in social functioning in BDD, we expected that BDD would be characterized by low basal serum oxytocin concentrations, relative to healthy controls, and that low oxytocin levels would be associated with BDD symptom severity as well as poor performance on measures of social cognition. Twenty individuals with BDD and 28 healthy controls completed a fasting blood draw consisting of frequent sampling every five minutes for one hour to measure pooled levels of oxytocin. Contrary to our hypotheses, people with BDD displayed higher concentrations of oxytocin, compared to their healthy control counterparts, and their oxytocin levels were positively correlated with BDD symptom severity. There were no associations between oxytocin levels and measures of social cognition. These findings suggest increased production of endogenous oxytocin in BDD. Prospective research is needed to determine whether this contributes to or is a consequence of BDD symptomatology.

Impact of physiologic estrogen replacement on anxiety symptoms, body shape perception, and eating attitudes in adolescent girls with anorexia nervosa: data from a randomized controlled trial.

OBJECTIVE: Anorexia nervosa is characterized by low weight, aberrant eating attitudes, body image distortion, and hypogonadism. Anxiety is a common comorbid condition. Estrogen replacement reduces anxiety in animal models, and reported variations in food intake across the menstrual cycle may be related to gonadal steroid levels. The impact of estrogen replacement on anxiety, eating attitudes, and body image has not been reported in anorexia nervosa. We hypothesized that physiologic estrogen replacement would ameliorate anxiety and improve eating attitudes without affecting body image in anorexia nervosa. METHOD: Girls 13-18 years old with anorexia nervosa (DSM-IV) were randomized to transdermal estradiol (100 µg twice weekly) with cyclic progesterone or placebo patches and pills for 18-months, between 2002 and 2010. The State-Trait Anxiety Inventory for Children (STAIC), the Eating Disorders Inventory-2 (EDI-2), and the Body Shape Questionnaire (BSQ-34) were administered. 72 girls completed these measures at baseline (n=38 [girls receiving estrogen] and n=34 [girls receiving placebo]) and 37 at 18 months (n=20 [girls receiving estrogen] and n=17 [girls receiving placebo]). The primary outcome measure was the change in these scores over 18 months. RESULTS: Estrogen replacement caused a decrease in STAIC-trait scores (-3.05 [1.22] vs. 2.07 [1.73], P=.02), without impacting STAIC-state scores (-1.11 [2.17] vs. 0.20 [1.42], P=.64). There was no effect of estrogen replacement on EDI-2 or BSQ-34 scores. Body mass index (BMI) changes did not differ between groups, and effects of estrogen replacement on STAIC-trait scores persisted after controlling for BMI changes (P=.03). Increases in serum estradiol were significantly associated with decreases in STAIC-trait scores (Spearman ρ = -0.45, P=.03). CONCLUSIONS: Estrogen replacement improved trait anxiety (the tendency to experience anxiety) but did not impact eating attitudes or body shape perception. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00088153.

Distribution of potassium levels on admission for CPR--severe hypokalaemia with dysmorphophobic eating disorders.

AIM: To evaluate the prevalence and cause of severe hypokalaemia in patients administered for cardiopulmonary resuscitation (CPR) for non-traumatic cardiac arrest. METHODS: We conducted a retrospective database review in the setting of a University hospital on 281 consecutive adult patients admitted to emergency admission, cardiac catheterization laboratory or intensive care units for resuscitation from non-traumatic cardiac arrest. The first available potassium value was evaluated. RESULTS: The mean potassium level was 3.9 ± 0.9 mmol/l and thus within the reference range of 3.5-5.0 mmol/l, but the overall prevalence of hypokalaemia was high (31.0%). Moderate rather than severe hypokalaemia was typically observed, with 95% of patients exhibiting potassium levels above 2.7 mmol/l. Among those six patients with extreme hypokalaemia defined as a potassium levels below the 2.5 percentile, two adult females were identified to suffer from previously untreated body scheme disorder with furosemide abuse (potassium 1.1 and 1.4 mmol/l). Another patient (potassium 2.1 mmol/l) suffered from poorly controlled bulimia nervosa and acute diarrhoea due to GI infection and one (potassium 2.4 mmol/l) from untreated bulimic anorexia. CONCLUSIONS: In contrast to moderately reduced potassium which is a frequent finding in adult patients at the time of admission for non-traumatic cardiac arrest, severe hypokalaemia is uncommon. The high prevalence of patients with body dysmorphophobic eating disorders in this group underscores accidental self-induced hypokalaemia may evolve as an important differential diagnosis in cardiac arrest in young female patients.