Cortisol awakening response in binge-purging and restrictive anorexia nervosa

2017 ◽  
Vol 41 (S1) ◽  
pp. S558-S558
Author(s):  
M. Nigro ◽  
A.M. Monteleone ◽  
F. Pellegrino ◽  
M. Cimino ◽  
V. Di Maso ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Hpa Axis ◽  
Cortisol Awakening Response ◽  
Eating Disorder Inventory ◽  
Severe Restriction ◽  
Healthy Women ◽  
Stress Response System ◽  
Competing Interest ◽  
Hpa Axis Functioning ◽  
First Time

IntroductionAnorexia nervosa (AN) is a complex psychiatric disorder characterized by severe restriction of food intake and aberrant behaviours. The endogenous stress response system, including the hypothalamus-pituitary-adrenal (HPA) axis, may have a role in the pathophysiology of AN.ObjectivesIt has been shown that specific clinical traits of AN, such as binge-purging behaviours, may be associated with higher psychopathology and poorer outcomes. Therefore, the HPA axis functioning could differ between patients with restrictive AN (ANR) and those with binge-purging AN (ANBP).AimsIn order to evaluate whether HPA axis functioning differs between the two subtypes of AN, we assessed the cortisol awakening response (CAR) of symptomatic ANR and ANBP patients.MethodsOur sample included 17 ANBP and 18 ANR patients, and 42 healthy women. All of them filled in the Eating Disorder Inventory-2 (EDI-2). For CAR assessment, participants collected saliva samples at home. Saliva cortisol concentrations were measured by an enzyme immunoassay method.ResultsANR and ANBP patients exhibited a CAR significantly higher than healthy women. Furthermore, the CAR of ANBP women was higher than that of ANR women and positively correlated with the bulimia subitem score of the EDI-2.ConclusionsPresent findings show, for the first time, differences in the CAR between ANBP and ANR subtypes supporting the idea that binge-purging behaviours may have a specific connection with HPA axis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Investigation of Salivary Cortisol Response to Awakening in Underweight and Weight-Restored Patients with Anorexia Nervosa

2017 ◽  
Vol 41 (S1) ◽  
pp. S283-S283
Author(s):  
F. Pellegrino ◽  
A.M. Monteleone ◽  
M. Nigro ◽  
V. Ruzzi ◽  
M. Cimino ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Hpa Axis ◽  
Normal Weight ◽  
Cortisol Awakening Response ◽  
Healthy Controls ◽  
State Trait Anxiety Inventory ◽  
State Dependent ◽  
Competing Interest ◽  
First Time ◽  
Primary Phenomenon

IntroductionAnorexia nervosa (AN) is characterized by dysregulated eating that leads to chronic malnutrition, which may be responsible for several physical complications, including endocrine alterations, such as hyperactivity of the hypothalamus-pituitary-adrenal (HPA) axis.ObjectivesSeveral studies have shown a dysregulation of the cortisol awakening response (CAR) in symptomatic AN patients. However, it has not been established if the deranged CAR of underweight AN patients is a primary phenomenon or an alteration secondary to malnutrition.AimsThe aim of this study was to explore the salivary CAR in both underweight and weight-restored patients with AN.MethodsWe recruited 59 women: 18 undernourished AN patients, 15 weight-restored AN women and 26 normal-weight healthy controls. Saliva samples were collected in the morning, immediately after awakening and after 15, 30 and 60 minutes, in order to measure saliva levels of cortisol. Participants filled in the state-trait anxiety inventory (STAI) to test their anxiety levels in the morning of the test.ResultsCompared to healthy controls, underweight AN patients showed an enhanced CAR whereas the weight recovered patients had a normal CAR. These results were not correlated with levels of anxiety.ConclusionsFor the first time, our results demonstrate that the deranged CAR found in acute AN patients is not present in weight-restored ones, suggesting that altered activity of the HPA axis of symptomatic AN patients is a state-dependent phenomenon.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Cortisol awakening response in patients with anorexia nervosa or bulimia nervosa: relationships to sensitivity to reward and sensitivity to punishment

2014 ◽  
Vol 44 (12) ◽  
pp. 2653-2660 ◽  
Author(s):  
P. Monteleone ◽  
P. Scognamiglio ◽  
A. M. Monteleone ◽  
D. Perillo ◽  
M. Maj
Keyword(s):  
Anorexia Nervosa ◽  
Bulimia Nervosa ◽  
Hpa Axis ◽  
Personality Characteristics ◽  
Cortisol Awakening Response ◽  
Behavioural Inhibition ◽  
Sensitivity To Reward ◽  
Healthy Women ◽  
Hpa Axis Activity ◽  
Sensitivity To Punishment

BackgroundSensitivity to punishment (SP) and sensitivity to reward (SR) are personality characteristics that may have relevance for the pathophysiology of eating disorders (EDs). Moreover, personality characteristics are known to modulate the activity of the hypothalamus–pituitary–adrenal (HPA) axis, which is the main component of the endogenous stress response system. As stress has been implicated in the aetiology and the maintenance of EDs, we aimed to study the HPA axis activity in relation to SP and SR, as conceptualized by Gray's reinforcement sensitivity theory (RST), in patients with anorexia nervosa (AN) or bulimia nervosa (BN).MethodTwenty-five women with AN, 23 women with BN and 19 healthy women volunteered for the study. HPA axis activity was assessed by measurement of the salivary cortisol awakening response (CAR). The subjects’ SP and SR were measured by the behavioural inhibition system (BIS)/behavioural approach system (BAS) scales.ResultsThe CAR was significantly enhanced in AN patients, but not in BN patients, compared to healthy women. The CAR correlated significantly with BAS measures, negatively in healthy controls and positively in binge-purging AN patients and BN women. SP, measured by the BIS scale, was higher in patients than in controls.ConclusionsThese findings confirm the occurrence of an enhanced activity of the HPA axis in symptomatic AN, but not in symptomatic BN, and show for the first time that the CAR is associated with SR, as conceptualized by the RST, negatively in healthy subjects but positively in binge-purging ED patients.

Attachment style and salivary cortisol awakening response in eating disorders

2016 ◽  
Vol 33 (S1) ◽  
pp. S162-S162
Author(s):  
F. De Riso ◽  
R. Giugliano ◽  
A.M. Monteleone ◽  
M. Nigro ◽  
F. Pellegrino ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Attachment Style ◽  
Hpa Axis ◽  
Adult Attachment ◽  
Attachment Styles ◽  
Cortisol Awakening Response ◽  
Anxious Attachment ◽  
Significant Difference ◽  
Anxious Group ◽  
Hpa Axis Functioning

IntroductionEarly life experiences can influence hypotalamus-pituitary-adrenal (HPA) axis regulation and adult attachment styles. Furthermore, several studies showed that in patients with eating disorders (EDs) there is a prevalence of insecure attachment. However, the relationship between adult attachment style, HPA axis functioning and onset of EDs is largely unknown.Objectives and aimsIn order to evaluate possible associations between attachment styles and HPA axis functioning in EDs, we investigated Cortisol Awakening Response (CAR) in ED patients with different attachment styles.MethodsTwenty adult patients with EDs were classified in three groups, according to the Experience in Close Relationship questionnaire (6 with secure attachment, 6 with anxious attachment and 8 with avoidant attachment). Saliva samples were collected at awakening and 15, 30 and 60 minutes after.ResultsThere was a significant difference among the groups in both awakening and post-awakening cortisol concentrations. In particular, compared to secure and avoidant groups, the anxious group exhibited lower cortisol concentrations at awakening and post-awakening with a preservation of the timing of the CAR.DiscussionPresent findings demonstrate that anxious attachment style is linked to flattened CAR in EDs. This pattern has been associated with other psychiatric disorders. Therefore, attachment style could influence the HPA functioning and it could play, although not specifically, a role in pathophysiology of EDs.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Oxytocin secretion in anorexia nervosa and bulimia nervosa: Investigation of its relationships to temperament personality dimensions

2016 ◽  
Vol 33 (S1) ◽  
pp. S161-S162
Author(s):  
M. Nigro ◽  
A.M. Monteleone ◽  
L. Steardo ◽  
G. Patriciello ◽  
V. Di Maso ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Bulimia Nervosa ◽  
Personality Traits ◽  
Healthy Controls ◽  
Novelty Seeking ◽  
Personality Dimensions ◽  
Character Inventory ◽  
Underweight Patients ◽  
Competing Interest ◽  
First Time

IntroductionSome temperament characteristics of personality seem to be modulated by oxytocin. Patients suffering from eating disorders (EDs) display aberrant personality traits.Objectives and aimsWe investigated the relationships between plasma oxytocin levels and personality dimensions of patients with anorexia nervosa (AN) and bulimia nervosa (BN) and compared them to those of healthy controls.MethodsPlasma oxytocin levels were measured in 23 women with AN, 27 women with BN and 19 healthy controls and assessed their personality traits by means of the Cloninger's Temperament and Character Inventory-Revised (TCI-R).ResultsAN patients showed plasma levels of the hormone significantly lower than BN and healthy controls. In healthy women, plasma oxytocin levels resulted significantly correlated negatively with novelty seeking scores and positively with both harm avoidance (HA) scores and the attachment subscale scores of the reward dependence: these correlations explained 82% of the variability in circulating oxytocin. In BN patients, plasma oxytocin resulted negatively correlated with HA, whereas no significant correlations emerged in AN patients.ConclusionsThese findings confirm a dysregulation of oxytocin secretion in AN but not in BN and show, for the first time, that the association of circulating oxytocin to patients’ temperament traits is totally lost in underweight patients with AN and partially lost or even inverted in women with BN. These findings suggest a role of oxytocin in certain deranged behaviours of ED patients, which are influenced by the subjects’ personality traits.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Asymmetry of salivary cortisol and α-amylase responses to psychosocial stress in anorexia nervosa but not in bulimia nervosa

2011 ◽  
Vol 41 (9) ◽  
pp. 1963-1969 ◽  
Author(s):  
P. Monteleone ◽  
P. Scognamiglio ◽  
B. Canestrelli ◽  
I. Serino ◽  
A. M. Monteleone ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Stress Response ◽  
Bulimia Nervosa ◽  
Hpa Axis ◽  
Salivary Cortisol ◽  
Social Stress ◽  
Stress Test ◽  
Trier Social Stress Test ◽  
Enzyme Linked Immunosorbent Assay ◽  
First Time

BackgroundThe stress response involves the activation of the hypothalamic–pituitary–adrenal (HPA) axis and the sympathetic nervous system (SNS). As a role for stress in determining of the onset and the natural course of eating disorders (EDs) has been proposed, the study of the psychobiology of the stress response in patients with anorexia nervosa (AN) and bulimia nervosa (BN) should be helpful in understanding the pathophysiology of these disorders. The two neurobiological components of the stress response can be easily explored in humans by the measurement of salivary cortisol and α-amylase response to a stressor. Therefore, we assessed salivary cortisol and α-amylase responses to the Trier Social Stress Test (TSST) in symptomatic patients with AN and BN compared to healthy controls.MethodSeven AN women, eight BN women and eight age-matched healthy females underwent the TSST between 1530 and 1700 h. Salivary cortisol and α-amylase levels were measured by an enzyme-linked immunosorbent assay (ELISA).ResultsCompared to healthy women, AN patients showed a normal cortisol response to the TSST, although this occurred at significantly increased hormone levels, and an almost complete absence of response of α-amylase. BN women, however, exhibited enhanced pre-stress levels of salivary α-amylase but a normal response of the enzyme and cortisol to the TSST.ConclusionsThese findings demonstrate, for the first time, the occurrence of an asymmetry between the HPA axis and SNS components of the stress response in the acute phase of AN but not in BN. The pathophysiological significance of this asymmetry remains to be determined.

Visuo-Haptic information processing in patients suffering of anorexia nervosa

2017 ◽  
Vol 41 (S1) ◽  
pp. S558-S559
Author(s):  
G. Risso ◽  
R.M. Martoni ◽  
M.C. Cavallini ◽  
S. Erzegovesi ◽  
G. Baud-Bovy
Keyword(s):  
Anorexia Nervosa ◽  
Visual Information ◽  
Sensory Input ◽  
Likelihood Estimation ◽  
Individual Variability ◽  
Haptic Information ◽  
Multimodal Information ◽  
Sensory Modalities ◽  
Competing Interest ◽  
First Time

IntroductionSeveral studies recently investigated how Anorexia Nervosa patients (ANp) process multimodal information. Longo (2015) hypothesized that ANp might be less reliant on visual perception of bodies than healthy controls (HC). Case et al. showed that processing of multimodal information might be disrupted in ANp. Literature lacks of studies that measure precisely and compare directly the contributions of each sensory input.ObjectiveTo investigate the integration of visual and haptic inputs in ANp compared with HC and measure the weight of each input.MethodWe used a visuo-haptic integration task with a setup adapted from Gori et al. (2008) to measure each sensory input's when judging the size of a cube according to Maximum Likelihood Estimation theory which describes the optimal multimodal integration behaviour (Ernst and Banks, 2002). Fifteen ANp and 16 HCs were recruited.ResultsRegardless the group, we found considerable individual variability about the integration processes; moreover, many participants did not integrate optimally. Correlation analysis suggested that ANp rely less on visual information then HC.ConclusionsDespite using a setup previously validated with children, the observation that many HC did not integrate optimally is not in line with the results of previous studies, making it difficult the comparison with the AN group. The setup might not be adapted to adults and it needs to be improved. Our study shows for the first time how it might be possible to measure and compare directly the contribution of two different sensory modalities. This could provide precious information to deeply investigate the pathology.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Childhood trauma and cortisol awakening response in eating disorders: A dose-dependent trauma effect

2016 ◽  
Vol 33 (S1) ◽  
pp. S165-S165
Author(s):  
F. Monaco ◽  
A.M. Monteleone ◽  
F. Pellegrino ◽  
F. De Riso ◽  
G. Patriciello ◽  
...  
Keyword(s):  
Childhood Trauma ◽  
Patient Group ◽  
Hpa Axis ◽  
Traumatic Experiences ◽  
Cortisol Awakening Response ◽  
Control Group ◽  
Healthy Controls ◽  
Hpa Axis Functioning ◽  
Hpa Axis Activity ◽  
Dose Dependent

IntroductionA role for the hypothalamus-pituitary-adrenal (HPA) axis has been suggested in the pathophysiology of anorexia nervosa (AN) and bulimia nervosa (BN), and childhood trauma experiences have been detected frequently in patients with AN and BN. Since trauma exposure in the childhood may persistently affect HPA axis functioning, we explored HPA axis activity in AN and BN patients with and without childhood trauma history.Objectives and aimsWe aimed to examine possible associations between childhood traumatic experiences and HPA axis functioning, as assessed by the cortisol awakening response (CAR), in adult patients with AN or BN as compared to adult healthy controls.MethodsSaliva samples were collected by 41 patients with symptomatic AN, 32 with symptomatic BN and 45 healthy controls at wakening and after 15, 30 and 60 min. They filled in the Childhood Trauma Questionnaire (CTQ), which assesses five specific types of childhood trauma.ResultsAs compared to the control group, the no-maltreated AN patient group exhibited an enhanced CAR whereas the no-maltreated BN patient group showed a similar CAR. On the contrary, both AN and BN patients with a positive history of childhood maltreatment exhibited statistically significant blunted CAR as compared to no-maltreated patients. Moreover, in maltreated ED patients the CAR tended to decrease when the number of trauma types increased.DiscussionPresent findings confirm a dysregulation of the HPA axis activity in symptomatic patients with AN and BN and suggest a dose-dependent effect of childhood adverse experiences on the CAR of adult ED patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Salivary cortisol measurement in normal-weight, obese and anorexic women: comparison with plasma cortisol

2001 ◽  
pp. 165-171 ◽  
Author(s):  
P Putignano ◽  
A Dubini ◽  
P Toja ◽  
C Invitti ◽  
S Bonfanti ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Hpa Axis ◽  
Salivary Cortisol ◽  
Plasma Cortisol ◽  
Visceral Obesity ◽  
Normal Weight ◽  
Obese Patients ◽  
Healthy Women ◽  
Free Cortisol ◽  
Drug Free

OBJECTIVE: To compare salivary, plasma and urinary free cortisol (UFC) measurements in patients with anorexia nervosa, in whom an overdrive of the hypothalamic-pituitary-adrenal (HPA) axis is well established but information on salivary cortisol is lacking, in viscerally obese patients in whom subtle abnormalities of cortisol secretion and metabolism are postulated, and in normal-weight healthy women. PARTICIPANTS AND EXPERIMENTAL DESIGN: Measurement of salivary cortisol offers a convenient way to assess the concentrations of free, biologically active cortisol in plasma in different physiopathological settings. Forty-seven drug-free, newly diagnosed women with active restrictive anorexia nervosa, 30 restrictive anorexic women undergoing chronic psychopharmacological treatment, 47 women with mild-to-moderate visceral obesity, 103 women with severe central obesity and 63 normal-weight healthy women entered the study. Salivary and blood samples were collected at 0800 h, 1700 h and 2400 h, together with three consecutive 24-h urine specimens for UFC determination. In controls and patients with anorexia nervosa (n=83), salivary and plasma cortisol were also measured after a 1-mg overnight dexamethasone suppression test (DST). In patients with anorexia nervosa, mood was rated by the Hamilton scale for anxiety and depression. RESULTS: Untreated patients with anorexia nervosa showed increased plasma and salivary cortisol and UFC concentrations (all P<0.001 compared with controls), and decreased cortisol suppression after DST in plasma and saliva (P<0.0001 and P<0.005 respectively compared with controls). These alterations were less pronounced, although still statistically significant, in treated patients with anorexia nervosa. Salivary cortisol was highly correlated with paired plasma cortisol in the whole population and after splitting the participants by group (P<0.0001). However, for plasma cortisol values greater than 500 nmol/l (the corticosteroid-binding globulin saturation point), this parallelism was lost. Taking plasma cortisol as a reference, the level of agreement for post-dexamethasone salivary and plasma cortisol was 58.9% among suppressors and 77.8% among non-suppressors (chi2 test: P<0.01). Decreased 0800 h/2400 h cortisol ratios were observed in plasma and saliva in drug-free patients with anorexia nervosa (P<0.005 and P<0.05 respectively compared with controls), and in saliva in severely obese patients (P<0.05 compared with controls). Depression and anxiety scores were unrelated to cortisol concentrations in any compartment. CONCLUSIONS: Salivary cortisol measurement is a valuable and convenient alternative to plasma cortisol measurement. It enables demonstration of the overdrive of the HPA axis in anorexia nervosa and subtle perturbations of the cortisol diurnal rhythm in women with visceral obesity. With the establishment of more specific and widely acceptable cut-off values for dynamic testing, measurement of salivary cortisol could largely replace plasma cortisol measurement.

Functional Connectivity of Reward Circuits in Eating Disorders

2017 ◽  
Vol 41 (S1) ◽  
pp. S36-S36
Author(s):  
A. Favaro ◽  
P. Santonastaso
Keyword(s):  
Anorexia Nervosa ◽  
Functional Connectivity ◽  
Resting State ◽  
Obstetric Complications ◽  
Functional Magnetic Resonance ◽  
Resonance Imaging ◽  
Resting State Functional Connectivity ◽  
Healthy Women ◽  
Competing Interest

ObjectiveAnorexia nervosa display alterations of reward systems and some authors hypothesize the presence of a “starvation addiction”. The aim of the study is to explore the resting-state functional connectivity of dorsal and ventral striatal nuclei.Method51 subjects with lifetime anorexia nervosa (AN) (35 acute and 16 recovered) and 34 healthy controls underwent high resolution and resting-state functional magnetic resonance imaging.ResultsThe AN group showed a reduced functional connectivity of the putamen in comparison to healthy women and this reduction appeared to be stronger in patients with lifetime binge eating or purging. Both acute and recovered AN groups showed larger left accumbens area in comparison to healthy women. Moreover, the functional connectivity of bilateral nucleus accumbens and putamen showed significant negative correlations with the number of obstetric complications in the AN group.Discussionthe present study supports the hypothesis that AN is associated with structural and functional alterations of striatal networks and unveils a possible role of obstetric complications in the pathogenesis of striatal dysfunction.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Dissociazione e alessitimia in un campione di pazienti con Disturbo del Comportamento Alimentare

2010 ◽  
Vol 12 (1-2) ◽  
Author(s):  
Marco La Marra ◽  
Walter Sapuppo ◽  
Giorgio Caviglia
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Emotional States ◽  
Eating Disorder Inventory ◽  
Dissociative Experiences Scale ◽  
Dissociative Experiences

The aim of this study has been to investigate the dissociative phenomena and the difficulties related to perceive, understand and describe the proper ones and other people's emotional states in a sample of 53 patients with Eating Disorders. The recruited sample is made by 14 Anorexia Nervosa (AN) patients, 15 with Bulimia Nervosa (BN), 12 with Eating Disorder Non Otherwise Specified (EDNOS) and 12 with Binge Eating Disorder (BED). To all subjects was administred the Eating Disorder Inventory-2, the Dissociative Experiences Scale and the Scala Alessitimica Romana. In according with literature, we confirme the relationships among Eating Disorders, the dissociative phenomena and Alexithymia.

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