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Bulimia and major affective disorder: experience with 105 patients

Published online by Cambridge University Press:  28 April 2020

J.I. Hudson ,
H.G. Pope Jr.  and
D. Yurgelun-todd
J.I. Hudson
Affiliation:
Laboratories for Psychiatric Research, Mailman Research Center, McLean Hospital, 115 Mill Street Belmont, MA02178, USA
H.G. Pope Jr.
Affiliation:
Laboratories for Psychiatric Research, Mailman Research Center, McLean Hospital, 115 Mill Street Belmont, MA02178, USA
D. Yurgelun-todd
Affiliation:
Laboratories for Psychiatric Research, Mailman Research Center, McLean Hospital, 115 Mill Street Belmont, MA02178, USA
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Summary

Several lines of evidence suggest that bulimia - the syndrome of compulsive binge-eating - may be related to major affective disorder. First, high rates of major affective disorder have been found both among bulimic patients and their relatives. Second, neuroendocrine abnormalities, similar to those found in major affective disorder, have been reported in bulimia. Finally, several antidepressant medications have been shown to be effective in the treatment of bulimia.

To investigate further the relationship between bulimia and major affective disorder, we evaluated 105 consecutive patients (101 women, 4 men), meeting DSM III criteria for bulimia, referred to our center, for the following: (1) rates of current or past major affective disorder and other psychiatric disorders, by DSM III criteria, using the NIMH Diagnostic Interview Schedule (n = 105); (2) family history of psychiatric disorders among first-degree relatives, by DSM III criteria (n = 101); (3) response to the 1 mg oral overnight dexamethasone suppression test (DST) with postdexamethasone plasma cortisol level measured at 16 00 h (n = 43); and (4) response to open trials of antidepressant medications, front several different classes - particularly tricyclic antidepressants, monoamine oxidase (MAO) inhibitors, and trazodone (n = 50).

The results of these studies were as follows: (1) the bulimic patients displayed a 77% lifetime prevalence rate of major affective disorder by DSM III criteria; (2) the morbid risk for major affective disorder among the firstdegree relatives of the bulimic probands was 0.29, similar to the 0.19 morbid risk found among the first-degree relatives of 40 probands with bipolar disorder, but significantly higher than the 0.03 morbid risk found among the first-degree relatives of 46 schizophrenic probands (P<0.001); (3) the bulimic patients showed a 40% rate of nonsuppression to the DST (16 00 h postdexamethasone plasma cortisol Level≥5.0 mcg/dl), significantly higher than the 9% rate of nonsuppression found among 22 normal control subjects (P<0.02); and (4) after one or more trials of antidepressant medications, 38% of the bulimic patients achieved a remission of symptoms (cessation of bingeeating episodes), 34% achieved a marked response (75-99% reduction in the frequency of binge-eating episodes), 16% achieved a moderate response (50-74% reduction in the frequency of binge-eating episodes), and 12% had no response (less than a 50% reduction in the frequency of binge-eating episodes).

Thus, on each of the four indices evaluated, patients with bulimia were similar to patients with major affective disorder, but were distinguishable from patients with other psychiatric disorders and from normal Controls. These results are consistent with the hypothesis that bulimia may be closely related to major affective disorder.

Résumé

Résumé

De nombreux arguments laissent penser que les conduites boulimiques - prises compulsives de nourriture - pourraient être liées au trouble affectif majeur. Tout d'abord, une proportion élevée de troubles affectifs majeurs est retrouvée chez tes patients boulimiques et dans leurs familles. Ensuite, des anomalies endocriniennes identiques á celles identifiées dans les troubles affectifs majeurs ont pu être rapportées dans les boulimies. Enfin, plusieurs traitements antidépresseurs se sont montrés efficaces dans les troubles boulimiques.

Afin de poursuivre l'exploration des relations entre boulimie et trouble affectif majeur, nous avons évalué consécutivement 105 patients (101 femmes, 4 hommes) réunissant les critéres de boulimie du DSM III et qui ont été étudiés dans notre Centre de la façon suivante: (1) établissement du diagnostic de trouble affectif majeur passé ou actuel, ou d‘autres diagnostics psychiatriques à l'aide du manuel d‘entretien standardisé du NIMH (105 patients); (2) recherche de troubles psychiatriques chez les parents de ler degré à l'aide des critères du DSM III (101 patients); (3) étude du test de freinage par la dexaméthasone (1 mg per os) chez 43 patients (cortisol plasmatique mesuré à 16 h): (4) étude de la réponse à différentes classes de médicaments antidépresseurs administré per os, en particulier antidépresseurs tricycliques, IMAO, trazodone (56 patients).

Les résultats de ces études sont tes suivants: (1) le taux de prévalence sur la vie des patients boulimiques pour le trouble affectif majeur est de 77% en utilisant les critères du DSM III; (2) le risque morbide de trouble affectif majeur pour les parents de ler degré des patients boulimiques est à 0,29, comparable au risque à 0,19 retrouvé chez les parents de ler degré des 40 patients bipolaires, et significativement beaucoup plus élevé que le risque à 0,03 retrouvé chez les parents de ler degre des 46 patients schizophrènes ; (3) le taux d‘échappement au test de freinage à la dexaméthasone est de 40% (cortisol plasmatique à 16 h supérieur à 5.0 mcg/dl); ce taux est significativement supérieur de celui de 9% retrouvé chez les 22 sujets témoins normaux (P<0,02); (4) aprés un ou plusieurs essais de traitements antidépresseurs, une rémission symptomatique (disparition des conduites boulimiques) est observée chez 38% des patients. Chez 34% la réponse thérapeutique est nette (75 à 99% de réduction de la fréquence des accès boulimiques). Chez 16% la réponse est modérée (50 à 74% de réduction de la fréquence des accès). Chez 12% il n’y a pas de réponse (moins de 50% de réduction de la fréquence des accès).

Ainsi, pour chacun des 4 indices évalués, les patients boulimiques sont comparables à ceux présentant un trouble affectif majeur et se distinguent à la fois des sujets présentant un autre trouble psychiatrique et des sujets témoins. Ces résultats renforcent l’hypothése d’une relation étroite entre les conduites boulimiques et te trouble affectif majeur.

Keywords

bulimiamajor affective disorderschizophreniadexamethasone suppression testantidepressantsboulimietrouble affectif majeurschizophrénietest de freinage à la dexaméthasoneantidépresseurs
Type
Original article
Information
Psychiatry and Psychobiology , Volume 3 , Issue 1 , 1988 , pp. 37 - 47
Copyright
Copyright © European Psychiatric Association 1988

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