Clinical

Risk Factors For Bulimia Nervosa Elucidated

WESTPORT, Jun 25 (Reuters) - Researchers in the UK, US and Canada provide new insight into the risk factors both leading to development of bulimia nervosa and perpetuating the condition. The findings are reported in the June issue of Archives of Psychiatry.

Researchers from Oxford University in the UK conducted a case-control risk-factor study that involved 102 subjects with bulimia nervosa, 204 healthy control subjects and 102 subjects with other psychiatric disorders. The results confirm "...that the great majority of the previously implicated risk factors were indeed risk factors for bulimia nervosa," according to Dr. Christopher G. Fairburn of Oxford University.

In addition, the British investigators discovered that parental problems, parental alcohol disorder and negative self evaluation should be added to the growing list of risk factors for bulimia nervosa.

Also in the journal, Dr. David C. Jimerson of Beth Israel Deaconess Medical Center in Boston, Massachusetts, and a multicenter team report "...new evidence that impaired central nervous system serotonergic responsiveness may contribute to the onset or maintenance of abnormal eating patterns in patients with bulimia nervosa."

Dr. Jimerson's team examined neuroendocrine response patterns in 15 women with bulimia nervosa and 14 age-matched healthy controls. They found that "...fenfluramine-stimulated increase in serum prolactin concentration [in bulemics] was significantly less than for controls." Moreover, reduced prolactin secretion was inversely related to the frequency of binge eating episodes in bulimic patients.

Meanwhile, researchers in Ontario, Canada, came to the same finding of serotonergic abnormalities in bulimia nervosa in a model "...using neuroendocrine and subjective responses to the postsynaptic serotonin receptor agonist meta-chlorophenylpiperazine."

The Canadian group, led by Dr. Robert D. Levitan of the Toronto Hospital, examined the responses to meta-chlorophenylpiperazine in 16 patients with bulimia nervosa and in 14 normal controls.

Dr. Levitan's study is "...the first to find blunted neuroendocrine and altered subjective responses to serotonergic challenge in this population," according to the report. The finding supports "...dysfunction at or downstream of central serotonergic receptors..." in patients with bulimia nervosa.

Dr. Katherine A. Halmi of Cornell University in New York writes in an editorial that the three reports confirm and extend the model of bulimia development in which "...bulimia nervosa develops after the stress of dieting." She notes that Dr. Fairburn's research adds to the list of antecedent conditions for the disturbed eating behavior characteristic of the disorder, and that the other two studies add to evidence of a serotonergic involvement in bulimics, in either the development or perpetuation of the disorder, or both.

Arch Gen Psychiatry 1997;54:507-517,521-527,529-534.

by Sandra Katzman