Advertisement

The Biological Basis of Bulimia Nervosa

  • Sarah Brien
Chapter

Abstract

Bulimia nervosa is a distressing disorder. This chapter attempts to address some of the research findings from studies performed since 1979 when bulimia was first diagnosed as a psychiatric illness by Russell.1 The increasing prevalence of bulimia in our society highlights the continuing need for research to aid our understanding as to why certain individuals will become bulimic and continue to maintain their behaviour in spite of the obvious physical and emotional detriment to themselves. A myriad of factors contribute to its initiation and maintenance and an eclectic view becomes both necessary and appropriate. Although the following chapter will concentrate specifically on the role of the neurotransmitter serotonin in its pathogenesis and maintenance, the disorder bulimia involves a range of other factors. A thorough discussion of the psychological and social aspects of this disorder is not feasible here, but where appropriate reference to pertinent aspects of these approaches will be made.

Keywords

Anorexia Nervosa Eating Disorder Binge Eating Bulimia Nervosa Addictive Behaviour 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Notes

  1. 1.
    G. Russell, ‘Bulimia Nervosa: An Ominant Variant of Anorexia Nervosa’, Psychological Medicine, 9 (1979): 429–48.CrossRefGoogle Scholar
  2. 2.
    American Psychiatric Association (APA), Diagnostic and Statistical Manual (Washington, DC: APA, 1980).Google Scholar
  3. 3.
    American Psychiatric Association (APA), Diagnostic and Statistical Manual (Washington, DC: APA, 1987).Google Scholar
  4. 4.
    P. J. Cooper and C. G. Fairburn, ‘The Depressive Symptoms of Bulimia Nervosa’, British Journal of Psychiatry, 148 (1986): 268–74.CrossRefGoogle Scholar
  5. 5.
    C. G. Fairburn and P. J. Cooper, ‘The Clinical Features of Bulimia Nervosa’, British Journal of Psychiatry, 144 (1984): 238–46.CrossRefGoogle Scholar
  6. 6.
    H. G. Pope, J. I. Hudson and J. P. Mailet, ‘Bulimia in the Late Nineteenth Century: The Observations of Pierre Janet’, Psychological Medicine, 15 (1985): 739–43.CrossRefGoogle Scholar
  7. 7.
    J. H. Lacey, C. Chadbund, A. H. Crisp et al., ‘Variation in Energy Intake of Adolescent Schoolgirls’, Journal of Human Nutrition, 32 (1978): 419–26.Google Scholar
  8. 8.
    M. Vollrath, R. Koch and S. Angst, ‘Binge Eating and Weight Concern Among Young Women’, British Journal of Psychiatry, 160 (1992): 498–503.CrossRefGoogle Scholar
  9. 9.
    Eating Disorders Association, Basic Factsheet (1994), abstract.Google Scholar
  10. 10.
    J. E. Mitchell and G. Goff, ‘Bulimia in Male Patients’, Psychosomatics, 25 (1984): 909–13.CrossRefGoogle Scholar
  11. 11.
    T. Habermas, ‘Possible Effects of the Popular and Medical Recognition of Bulimia Nervosa’, British Journal of Medical Psychology, 65 (1992): 59–66.CrossRefGoogle Scholar
  12. 12.
    E. Hackmann, A. WirzJustice and M. Lichsteiner, ‘The Uptake of Dopamine and Serotonin in the Rat Brain During Progesterone Decline’, Psychopharmacologia, 32 (1973): 183–91.CrossRefGoogle Scholar
  13. 13.
    D. M. Garner, P. E. Garfinkel and M. O’Shaughnessy, ‘The Validity of the Distinction between Bulimia with and without Anorexia Nervosa’, American Journal of Psychiatry, 142 (1985): 581–7.CrossRefGoogle Scholar
  14. 14.
    J. H. Lacey, ‘Self Damaging and Addictive Behaviour in Bulimia Nervosa: A Catchment Area Study’, British Journal of Psychiatry, 163 (1993): 190–4.CrossRefGoogle Scholar
  15. 15.
    J. H. Lacey and C. D. Evans, ‘The Impulsivist: A Multi-impulsive Personality Disorder’, British Journal of Addiction, 81 (1986): 715–23.Google Scholar
  16. 16.
    C. C. Holderness, J. Brooks-Gunn and M. P. Warren, ‘Co-morbidity of Eating Disorders and Substance Abuse. Review of the Literature’, International Journal of Eating Disorders, 16 (1994): 1–34.CrossRefGoogle Scholar
  17. 17.
    M. D. Beary, J. H. Lacey and J. Merry, ‘Alcoholism and Eating Disorders in Women of Fertile Age’, British Journal of Addiction, 81 (1986): 685–9.CrossRefGoogle Scholar
  18. 18.
    J. Brisman and M. Siegel, ‘Bulimia and Alcoholism; Two Sides of the Same Coin?’, Journal of Substance Abuse, 1 (1984): 113–8.CrossRefGoogle Scholar
  19. 19.
    W. J. Filstead, D. P. Parrella and J. Ebbitt, ‘High Risk Situations for Engaging in Substance Abuse and Binge Eating Behaviours’, Journal of Studies on Alcohol, 49 (1988): 136–41.CrossRefGoogle Scholar
  20. 20.
    J. I. Hudson, H. G. Pope, D. Yurgelun-Todd et al. , ‘A Controlled Study of Lifetime Prevalence of Affective and other Psychiatric Disorders in Bulimic Outpatients’, American Journal of Psychiatry, 144 (1987): 1283–7.CrossRefGoogle Scholar
  21. 21.
    J. E. Mitchell, R. Pyle, E. C. Eckert et al., ‘The Influence of Prior Alcohol and Drug Abuse Problems on Bulimia Nervosa Treatment Outcome’, Addictive Behaviours, 15 (1990): 169–73.CrossRefGoogle Scholar
  22. 22.
    M. Strober, ‘Family Genetic Studies of Eating Disorders’, Journal of Clinical Psychiatry, 52 (1991): 9–12.Google Scholar
  23. 23.
    A. S. Kaplan and D. B. Woodside, ‘Biological Aspects of Anorexia Nervosa and Bulimia Nervosa’, Journal of Consulting and Clinical Psychology, 55 (1987): 645–53.CrossRefGoogle Scholar
  24. 24.
    K. M. Pirke, M. B. Kellner, E. Frieb et al., ‘Satiety and Cholecystokinin’, International Journal of Eating Disorders, 15 (1994): 63–9.CrossRefGoogle Scholar
  25. 25.
    T. L. Abel, ‘Gastric Electromechanical and Neurohormonal Function in Anorexia Nervosa’, Gastroenterology, 93 (1987): 958–65.Google Scholar
  26. 26.
    S. F. Leibowitz and G. Shur Posner, ‘Brain Serotonin and Eating Behaviour’, Appetite, 7 (1986):1–14.CrossRefGoogle Scholar
  27. 27.
    A. Heller, J. A. Harvey and R. Y. Moore, ‘A Demonstration of a Fall in Brain Serotonin Following CNS Lesions in the Rat’, Biochemical Pharmacology, 11 (1962): 859–66.CrossRefGoogle Scholar
  28. 28.
    N. E. Anden, K. Fuze and K. Carsson, ‘Effects of Large Mesencephalic-Diencephalic Lesions on Noradrenaline, Dopamine and Serotonin Neurones of the Central Nervous System’, Experientia, 22 (1966): 759–64.CrossRefGoogle Scholar
  29. 29.
    G. Curzon and P. J. Knott, ‘Effects on Plasma and Brain Tryptophan in the Rat, of Drugs and Hormones that Influence the Concentration on Unesterified Fatty acids in Plasma’, British Journal of Pharmacology, 50 (1974): 197–214.CrossRefGoogle Scholar
  30. 30.
    J. D. Fernstrom and R. J. Wurtman, ‘Brain Serotonin Content: Physiological Regulation by Plasma Neutral Amino Acids’, Science, 178 (1972): 414–6.CrossRefGoogle Scholar
  31. 31.
    A. R. Green and G. Curzon, ‘The Effect of Tryptophan Metabolites on Brain Serotonin Metabolism’, Biochemical Pharmacology, 19 (1970): 2061–8.CrossRefGoogle Scholar
  32. 32.
    D. A. Bender, ‘Oestrogens and Vitamin B6–Actions and Interactions’, World Review of Nutrition and Dietetics, 51 (1987): 140–88.CrossRefGoogle Scholar
  33. 33.
    R. Martin du Pon, C. Mauron, B. Glaeser et al., ‘Effects of Various Oral Glucose Doses on Plasma Neutral Amino Acid Levels’, Metabolism, 31 (1982): 937–43.CrossRefGoogle Scholar
  34. 34.
    J. D. Fernstrom and R. J. Wurtman, ‘Brain Serotonin Content: Increase Following Ingestion of Carbohydrate Diet’, Science, 174 (1971): 1023–5.Google Scholar
  35. 35.
    D. A. Bender, A. E. Laing, J. A. Vale et al., ‘Effects of Oestrogen Administration of Tryptophan Metabolism in Rats and in Menopausal Women Receiving Hormone Replacement Therapy’, Biochemical Pharmacology, 32 (1983): 843–8.CrossRefGoogle Scholar
  36. 36.
    V. N. Luine and J. C. Rhodes, ‘Gonadal Hormone Regulation of MAO and other Enzymes in Hypothalamic Area’, Neuroendocrinology, 36 (1983): 235–41.CrossRefGoogle Scholar
  37. 37.
    V. N. Luine and B. S. McEwan, ‘Effect of Oestradiol on the Turnover of Type A Monoamine Oxidase’, Journal of Neurochemistry, 28 (1977): 1221–7.CrossRefGoogle Scholar
  38. 38.
    A. Biegon and B. S. McEwan, ‘Modulation by Oestradiol of Serotonin-1 Receptors in Brain’, Journal of Neuroscience, 2 (1982): 199–205.Google Scholar
  39. 39.
    W. Ladisch, ‘Effects of Progesterone on Regional Serotonin Metabolism in the Rat Brain’, Neuropharmacology, 13 (1974): 877–83.CrossRefGoogle Scholar
  40. 40.
    W. Ladische, ‘Influence of Progesterone on Serotonin Metabolism: A Possible Causal Factor for Mood Changes’, Psychoneuroendocrinology, 2 (1977): 257–66.CrossRefGoogle Scholar
  41. 41.
    D. Hoyer and P. Scoeffter, ‘Serotonin Receptors: Subtypes and Second Messengers’, Journal of Receptor Research, 11 (1991): 197–14.Google Scholar
  42. 42.
    M. Da Prada, A. M. Cesurs, J. M. Launay et al., ‘Platelets as a Model for Neurones’, Experientia, 44 (1988): 115–26.CrossRefGoogle Scholar
  43. 43.
    R. Samaninin, O. Ghezzi, L. Valzelli et al., ‘The Effect of Selective Lesioning of Brain Serotonin or Catecholamine Containing Neurones on the Anorectic Activity of Fenfluramine and Amphetamines’, European Journal of Pharmacology, 19 (1972): 318–22.CrossRefGoogle Scholar
  44. 44.
    D. G. Schlundt, W. G. Johnson and M. P. Jarrell, ‘A Naturalistic Functional Analysis of Eating Behaviour in Bulimia and Obesity’, Advances in Behaviour Research and Therapy, 7 (1985): 149–62.CrossRefGoogle Scholar
  45. 45.
    E. C. Johnson Sabine, K. H. Wood and A. Wakeling, ‘Mood Changes in Bulimia Nervosa’, British Journal of Psychiatry, 145 (1984): 521–6.Google Scholar
  46. 46.
    B. R. Greenberg, ‘Predictors of Binge Eating in Bulimic and Non bulimic Women’, International Journal of Eating Disorders, 5 (1986: 269–84.CrossRefGoogle Scholar
  47. 47.
    A. P. Levin and S. E. Hyler, ‘DSM IIIR Personality Diagnosis in Bulimia’, Comparative Psychiatry, 27 (1986): 47–53.CrossRefGoogle Scholar
  48. 48.
    H. M. van Praag and S. de Haan, ‘Central Serotonin Metabolism and Frequency of Depression’, Psychiatric Research, 1 (1979): 219–24.CrossRefGoogle Scholar
  49. 49.
    H. Meltzer, ‘Serotonergic Dysfunction in Depression’, British Journal of Psychiatry, 155 (1989): 25–31.Google Scholar
  50. 50.
    H. Y. Meltzer, R. C. Arora, R. Babner et al., ‘Serotonin Uptake in Blood Platelets of Psychiatric Patients’, Archives of General Psychiatry, 38 (1981): 1322–6.CrossRefGoogle Scholar
  51. 51.
    M. S. Joseph, T. D. Brewerton, V. I. Rees et al., ‘Plasma Tryptophan/ Large Neutral Amino Acid Ratio and the Dexamethasone Suppression Test in Depression’, Psychiatric Research, 11 (1984): 185–92.CrossRefGoogle Scholar
  52. 52.
    M. J. Russ, S. H. Ackerman, M. Banay Schwartz et al., ‘Plasma Tryptophan to Large Neutral Amino Acid Ratios in Depressed and Non Depressed Subjects’, Journal of Affective Disorders, 19 (1990): 19–24.CrossRefGoogle Scholar
  53. 53.
    M. K. De Meyer, P. A. Shea, H. Hendrie et al., ‘Plasma Tryptophan and Five other Amino Acids in Depressed and Normal Subjects’, Archives of General Psychiatry, 38 (1981): 642–6.CrossRefGoogle Scholar
  54. 54.
    A. Biegon, N. Essar, M. Israeli et al., `Serotonin 5HT2 Receptor Binding on Blood Platelets as a State Dependent Marker in Major Affective Disorder’, Psychopharmacology Berlin, 102 (1990): 73–5.CrossRefGoogle Scholar
  55. 55.
    M. Stanley, J. Virgilio and S. Gershon, ‘Tritiated Imipramine Binding Sites are Decreased in the Frontal Cortex of Suicides’, Science, 216 (1982): 1337–9.CrossRefGoogle Scholar
  56. 56.
    O. S. Goldbloom, L. Hicks and P. E. Garfinkel, ‘Platelet Serotonin Uptake in Bulimia Nervosa’, Biological Psychiatry, 17 (1990): 839–42.Google Scholar
  57. 57.
    M. Asberg, P. Thoren and L. Traskman, ‘Serotonin Depression - A Biochemical Subgroup within the Affective Disorders’, Science, 191 (1976): 47881.Google Scholar
  58. 58.
    M. Asberg, P. Thoren and L. Traskman, ‘5HIAA in CSF: A Biochemical Suicide Predictor’, Archives of General Psychiatry, 33 (1976): 1193–7.CrossRefGoogle Scholar
  59. 59.
    J. I. Hudson, H. G. Pope and J. M. Jonas. Pope and J. M. Jonas, ‘Family History Study of Anorexia and Bulimia Nervosa’, British Journal of Psychiatry, 142 (1983): 133–8.CrossRefGoogle Scholar
  60. 60.
    J. O. Viesselman and M. Roig, ‘Depression and Suicidality in Eating Disorders’, Journal of Clinical Psychiatry, 46 (1985): 118–24.Google Scholar
  61. 61.
    B. T. Walsh, S. P. Roose and A. H. Glamman, ‘Bulimia and Depression’, Psychosomatic Medicine, 47 (1985): 123–31.CrossRefGoogle Scholar
  62. 62.
    H. G. Pyle, J. E. Mitchell and E. Eckert, ‘Bulimia Nervosa: A Report of 34 Cases’, Clinical Psychiatry, 42 (1981): 60–4.Google Scholar
  63. 63.
    W. J. Swift, D. Andrews and N. E. Barklage, ‘The Relationship Between Affective Disorders and Eating Disorders: A Review of the Literature’, American Journal of Psychiatry, 143 (1986): 290–9.CrossRefGoogle Scholar
  64. 64.
    D. C. Jimerson, M. D. Lesern, W. H. Kaye et al., ‘Eating Disorders and Depression: Is there a Serotonin Connection’, Biological Psychiatry, 28 (1990): 443–54.CrossRefGoogle Scholar
  65. 65.
    P. Garfinkel and D. Garner (eds), Anorexia Nervosa: A Multidimensional Perspective (New York: Bruner Mazel, 1982).Google Scholar
  66. 66.
    A. B. Levy, K. N. Dixon and S. L. Stern, ‘How are Depression and Bulimia Related?’, American Journal of Psychiatry, 146 (1989): 162–9.CrossRefGoogle Scholar
  67. 67.
    A. W. Brotman, D. B. Herzog and S. W. Woods, ‘Antidepressant Treatment of Bulimia: The Relationship between Bingeing and Depressive Symptamology’, Journal of Clinical Symptomology, 45 (1984): 7–9.Google Scholar
  68. 68.
    E. F. Coccaro, L. J. Siever and H. M. Klar, ‘Serotonergic Studies in Affective and Personality Disorder Patients: Correlates with Suicidal and Impulsive Aggressive Behaviour’, Archives of General Psychiatry, 46 (1989): 587–99.CrossRefGoogle Scholar
  69. 69.
    T. D. Brewerton, E. A. Mueller, M. D. Lesern et al., ‘Neuroendocrine Responses to m-chlorophenylpiperazine and L-tryptophan in bulimia’, Archives of General Psychiatry, 49 (1992): 852–61.CrossRefGoogle Scholar
  70. 70.
    A. Apter, H. M. van Praag, R. Plutchik et al., ‘Interrelationships among Anxiety, Aggression, Impulsivity and Mood: A Serotonergically Linked Cluster’, Psychiatry Research, 32 (1990): 191–9.CrossRefGoogle Scholar
  71. 71.
    B. E. Wolfe, D. C. Jimerson and J. M. Levine, ‘Impulsivity Ratings in Bulimia Nervosa: Relationship to Binge Eating Behaviours’, International Journal of Eating Disorders, 15 (1994): 289–92.CrossRefGoogle Scholar
  72. 72.
    D. C. Jimerson, ‘Low Serotonin and Dopamine Metabolite Concentrations in Cerebrospinal Fluid from Bulimic Patients with Frequent Binge Episodes’, Archives of General Psychiatry, 49 (1992): 132–8.CrossRefGoogle Scholar
  73. 73.
    J. Polivy and C. P. Herman, ‘Dieting and Binging: A Causal Analysis’, American Psychologist, 40 (1985): 193–201.CrossRefGoogle Scholar
  74. 74.
    S. A. French and R. W. Jeffrery, ‘Consequences of Dieting to Lose Weight: Effects on Physical and Mental Health’, Health Psychology, 13 (1994):195–212.CrossRefGoogle Scholar
  75. 75.
    G. M. Goodwin, C. G. Fairburn and P. J. Cowen, ‘Dieting Changes Serotonergic Function in Women not Men; Implications for the Aetiology of Anorexia Nervosa’, Psychological Medicine, 17 (1987): 839–42.CrossRefGoogle Scholar
  76. 76.
    S. F. Abraham and P. J. Beumont, ‘How Patients Describe Bulimia or Binge Eating’, Psychological Medicine, 12 (1982): 632–5.CrossRefGoogle Scholar
  77. 77.
    J. E. Mitchell, R. L. Pyle and E. D. Eckert, ‘Frequency and Duration of Binge Eating Episodes in Patients with Bulimia’, American Journal of Psychiatry, 138 (1981): 835–6.CrossRefGoogle Scholar
  78. 78.
    G. R. Leon, K. Carroll, B. Chernyk et al., ‘Binge Eating and Associated Habit Patterns within College Students and Identified Bulimic Populations’, International Journal of Eating Disorders, 4 (1985): 43–57.CrossRefGoogle Scholar
  79. 79.
    J. C. Rosen, H. Leitenberg, C. Fisher et al., ‘Binge Eating Episodes in Bulimia Nervosa: The Amount and Type of Food Consumed’, International Journal of Eating Disorders, 5 (1986): 255–67.CrossRefGoogle Scholar
  80. 80.
    N. E. Rosenthal, M. J. Genhart, B. Caballero et al., ‘Psychobiological Effects of Carbohydrate and Protein Rich Meals in Patients with Seasonal Affective Disorder and Normal Controls’, Biological Psychiatry, 25 (1989): 1029–40.CrossRefGoogle Scholar
  81. 81.
    D. Marazziti, E. Macchi, A. Rotondo et al., ‘The Involvement of the Serotonin System in Bulimia Nervosa’, Life Sciences, 43 (1988): 2123–6.CrossRefGoogle Scholar
  82. 82.
    S. F. Liebowitz, ‘The Role of Serotonin in Eating Disorders’, Drugs, 39 (1990): 33–48.CrossRefGoogle Scholar
  83. 83.
    H. G. Pope, J. I. Hudson and I. M. Jonas, ‘Bulimia Treated with Imipramine: A Placebo Controlled Double Blind Study’, American Journal of Psychiatry, 140 (1983): 554–8.CrossRefGoogle Scholar
  84. 84.
    A. W. Brotman, D. B. Herzog and S. W. Woods, ‘Antidepressant Treatment of Bulimia: The Relationship Between Bingeing and Depressive Symptomology’, Journal of Clinical Psychiatry, 45 (1984): 7–9.Google Scholar
  85. 85.
    W. H. Kaye, M. H. Ebert and H. E. Gwirtsman et al., ‘Differences in Brain Serotonergic Metabolism between Nonbulimic and Bulimic Patients with Anorexia Nervosa’, American Journal of Psychiatry, 141 (1984):1598–601.CrossRefGoogle Scholar
  86. 86.
    T. D. Brewerton, E. Mueller and T. E. George, ‘Blunted Prolactin Response to the Serotonin Agonist mCPP in Bulimics’, in International Neuro-Psychopharmacological Congress, San Juan, Puerto Rico, 1986, p. 186.Google Scholar
  87. 87.
    P. L. Delgado, D. S. Charney and L. H. Price et al., ‘Neuroendocrine and Behavioural Effects of Dietary Tryptophan Restriction in Healthy Subjects’, Life Sciences, 45 (1989): 2323–32.CrossRefGoogle Scholar
  88. 88.
    W. H. Kaye, H. E. Gwirtsman, T. D. Brewerton et al., ‘Bingeing Behaviour and Plasma Amino Acids: A Possible Involvement of Brain Serotonin in Bulimia Nervosa’, Psychiatric Research, 23 (1988): 31–4.CrossRefGoogle Scholar
  89. 89.
    G. B. Collins, M. Kotz and J. W. Janesz, ‘Alcoholism in the Families of Bulimic Anorexics’, Cleveland Clinic Quarterly, 52 (1985): 65–7.CrossRefGoogle Scholar
  90. 90.
    K. M. Pirke, M. Dogs and M. M. Fichter et al., ‘Gonadotrophins, Oestradiol and Progesterone during the Menstrual Cycle in Bulimia Nervosa’, Clinical Endocrinology, 29 (1988): 265–70.CrossRefGoogle Scholar
  91. 91.
    D. Stewart, ‘Reproductive Function in Eating Disorders’, Annals of Medicine, 24 (1992): 287–91.CrossRefGoogle Scholar

Copyright information

© Adrian Bonner and James Waterhouse 1996

Authors and Affiliations

  • Sarah Brien

There are no affiliations available

Personalised recommendations