Facets of Male Violence Against Women With Substance Abuse Problems: Women With a Residence and Homeless Women.

The aims of this study were to investigate the type and extent to which women with substance abuse problems have been exposed to male violence during their lifetime, and to examine possible differences between women with a residence (WR) and homeless women (HW). The total sample included 79 women (WR, n = 35; HW, n = 44; M age = 47.8 years). Of the total sample, 72 women (91%) had experienced different kinds of male violence, 88% from former partners, and 26% from male friends or acquaintances. Of the 72 women, 71% further reported "Countless occasions of violent events," and 36% had been forced to commit criminal acts. Abused women who had been forced to commit criminal acts were significantly more frequently found to be homeless, have reported parental alcohol and/or drug problems, have witnessed domestic violence in childhood, have been victims of sexual violence, have used illicit drugs as a dominant preparation, and have injected illicit drugs. Almost half of the abused women (46%) met criteria for posttraumatic stress disorder (PTSD), where HW showed an almost 4-time higher risk (RR 3.78) than WR. In conclusion there is a particular vulnerability in women with substance abuse to male violence, which has an important impact on their health status. Thus, from a public health perspective, it is suggested that for those women who have experienced male violence, treatment protocols need to include both assessing and addressing the impact of such experience in relation to substance abuse as well as concomitant health concerns.

Exploring possible association between DßH genotype (C1021T), early onset of conduct disorder and psychopathic traits in juvenile delinquents.

Early onset of conduct disorder (CD) with callous-unemotional traits has been linked to low levels of dopamine ß-hydroxylase (DßH), an enzyme involved in dopamine turnover. The C1021T polymorphism in the DßH gene is a major quantitative-trait locus, regulating the level of DßH. In this study of juvenile delinquents from Northern Russia (n = 180), the polymorphism at -1021 was associated neither with early-onset CD nor with psychopathic traits. Association was found between psychopathic traits and early-onset CD, ADHD and mania.

Pro-bullying attitudes among incarcerated juvenile delinquents: antisocial behavior, psychopathic tendencies and violent crime.

The objective was to evaluate a new scale aimed at assessing antisocial attitudes, the Pro-bullying Attitude Scale (PAS), on a group of 259 voluntarily-recruited male juvenile delinquents from a juvenile correctional institution in Arkhangelsk, North-western Russia. Exploratory factor analysis gave a two-factor solution: Factor 1 denoted Callous/Dominance and Factor 2 denoted Manipulativeness/Impulsiveness. Subjects with complete data on PAS and Childhood Psychopathy Scale (CPS) (n=171) were divided into extreme groups (first and fourth quartiles) according to their total scores on PAS and the two factor scores, respectively. The extreme groups of total PAS and PAS Factor 1 differed in CPS ratings and in violent behavior as assessed by the Antisocial Behavior Checklist (ABC). They also differed in the personality dimension Harm Avoidance as measured by use of the Temperament and Character Inventory (TCI), and in delinquent and aggressive behavior as assessed by the Youth Self Report (YSR). The extreme groups of PAS Factor 2, in turn, differed in aggressive behavior as assessed by the YSR, and in the TCI scale Self-Directedness. When PAS was used as a continuous variable, total PAS and PAS Factor 1 (Callous/Dominance) were significantly positively related to registered violent crime. The possible usefulness of PAS in identifying high-risk individuals for bullying tendencies among incarcerated delinquents is discussed.

Psychosocial determinants and family background in anorexia nervosa--results from the Stockholm Birth Cohort Study.

OBJECTIVE: The aim of this study was to examine the associations between psychosocial factors and family background and incidence of anorexia nervosa (AN) in a Swedish cohort. METHOD: The Stockholm Birth Cohort, SBC (N = 14,294) contains information on social background and general health in males and females, born in Stockholm 1953. Hospitalizations for AN, based on diagnoses from the ICD-8 through ICD-10, were recorded from 1969 to 2002. Cox proportional hazard regression was used to measure the association between psychosocial characteristics and family background and the risk of AN. RESULTS: Higher maternal education was associated with a higher risk for hospitalization for AN. An increased risk for AN was also found among females who stated that they "often compare their future prospects with others." DISCUSSION: Although the study is based on a low number of cases, it confirms earlier findings of higher maternal education among individuals with eating disorders in similar cohorts.

Family psychosocial characteristics influencing criminal behaviour and mortality--possible mediating factors: a longitudinal study of male and female subjects in the Stockholm Birth Cohort.

BACKGROUND: Family psychosocial characteristics in childhood have been associated with children's development into criminal behaviour and mortality. This study explored these possible relationships and examined alcohol and/or drug use and mental problems as possible mediating factors, highlighting gender-specific patterns. METHODS: Data from Swedish subjects born in 1953 (n = 14,294) from the Stockholm Birth Cohort study were examined. Several indicators of adverse family factors and individual problems were included in the present study. The information was derived from various data sources, covering different periods. Gender-specific associations with incidence of criminality (1966-1980) and mortality (1981-2009) were analysed using logistic regression. Furthermore, the population attributable fraction (PAF) was calculated for all variables in the fully adjusted models which were positively related to the outcome. RESULTS: Overall incidence of criminality and mortality was (m/f 32.3/6.6) and (m/f 6.1/3.5), respectively. The results showed that all aspects of family psychosocial and individual problems studied were associated with criminality for both genders. Among males, individual problems seemed to partly mediate these relations, but the associations remained statistically significant. Interestingly, the PAF analysis revealed a reduction in criminality of 17.5% when individual problems with alcohol and/or drug use were considered. Among females, a significant impact of alcohol and/or drug use on the association between family psychosocial characteristics and subsequent criminality was obtained. Inclusion of father's occupational class only somewhat reduced the estimates for the genders. Concerning male mortality, father's alcohol abuse was significantly related to an increased risk. When individual criminality was accounted for, the association was substantially reduced but remained statistically significant. Among females, when adjusting for family psychosocial factors, only the association between parents' mental problems and females' mortality was significant. None of the individual problem variables managed to explain this association. CONCLUSIONS: Family psychosocial characteristics were associated with both subsequent criminal behaviour and mortality. These connections were partly explained by individual risk factors, especially by alcohol and/or drug use. The practical implications of the findings point to the importance of addressing the individual's alcohol and/or drug use in reducing criminal behaviour, which would also lower the mortality rates.

Women with alcohol problems: the possible significance of personality clustering for treatment planning.

INTRODUCTION AND AIMS: Establishing subgroups in clinical practice is important for treatment planning. The aim of the study was to cluster the study group subjects according to personality traits and psychological health variables and to establish possible differences in treatment outcome in terms of: (i) drinking outcomes (gram and number of drinking days); (ii) perceived physiological health; and (iii) use of treatment resources (length of time in treatment and number of visits) among 134 treatment-seeking women with alcohol problems in a clinical context, between the two clusters obtained. DESIGN AND METHODS: Data were collected from 134 consecutive women at a Swedish clinic specialised in treating women with alcohol problems. A hierarchical cluster analysis was performed on the basis of self-rated personality scale scores and psychological health variables. RESULTS: Two clusters were identified: one in which the women displayed personality and psychological health scores indicating problems (Cluster 1); and another where the women showed personality and psychological health scores within the norm range (Cluster 2). Alcohol consumption rates at the start of treatment were the same in both clusters. The consumption rates were also the same at the end of treatment for the cluster, showing a significant decrease in alcohol consumption in each. The Cluster 1 women, however, had a significantly higher number of visits at the clinic, and rated the consequences of their alcohol drinking as being significantly worse than Cluster 2 women. DISCUSSION AND CONCLUSIONS: The importance of individual differences according to personality traits for treatment planning is discussed in terms of the need for variation in treatment time and methods.

Levels of tumour necrosis factor-alpha and interleukin-6 in severely ill patients with eating disorders.

BACKGROUND: The underlying pathophysiology of eating disorders (ED) is dependent on complex interactions between psychological, biological and social factors. The purpose of the present study was to examine a possible increase in cytokines indicating inflammation, as measured by tumour necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in ED patients, and to explore possible relationships between cytokines and self-reported personality traits. METHODS: Female patients with severe ED (n = 26) were recruited consecutively from an inpatient clinic and were compared to age-matched healthy females (n = 12). Commercial ELISA tests developed for the measurement of serum levels of TNF-α and IL-6 were employed. Personality traits were measured using Karolinska Scales of Personality. RESULTS: The patient group displayed increased levels of the cytokine TNF-α and a tendency towards increased IL-6 levels. Spearman's rank correlation coefficient was used to examine possible relationships between levels of cytokines and personality traits. The results showed that IL-6 levels were positively related to both somatic and psychic anxiety and to aggression scales, such as irritability and suspicion. Increased levels of TNF-α, in turn, were significantly correlated with high scores on the depression-related anxiety scale Inhibition of Aggression. However, increased levels of cytokines in the ED group did not seem to be mainly associated with symptoms of depression. CONCLUSION: We cannot rule out the possibility that comorbid conditions in the group contribute to the higher cytokine values. Further studies need to explore the possible influence of cytokines on the severity of ED and whether this might be mediated or moderated by specific personality traits.

Poor school bonding and delinquency over time: bidirectional effects and sex differences.

The association between poor school bonding and delinquency has only been partly addressed in earlier research. Using a longitudinal design, the objective of our study was to investigate possible bidirectional effects and sex differences between adolescents' experienced school bonding and self-rated delinquency over time. A total of 788 adolescents (353 boys and 435 girls) were investigated by questionnaire at age 14 and 16. Poor school attachment and commitment as well as poor teacher attachment were found to be stronger determinants of delinquency for males than for females. Delinquency predicted poor school commitment for both boys and girls, and poor school attachment for girls, thus indicating bidirectional effects over time and sex differences in some of the bidirectional effects. The study concludes that the delinquency propensity of adolescent boys may be affected by all school bonding dimensions, whereas for girls it is their relationship with their teachers that is of significance.

Variation in the catechol-O-methyltransferase Val 158 Met polymorphism associated with conduct disorder and ADHD symptoms, among adolescent male delinquents.

OBJECTIVE: Variation in the catechol-O-methyltransferase gene (COMT) has been associated with antisocial behavior in populations with attention deficit/hyperactivity disorder (ADHD). This study examined whether COMT would predict antisocial behavior in a sample with high levels of behavior problems, not necessarily ADHD. In addition, because previous research suggests that COMT may be associated with ADHD in males, association between COMT and ADHD symptoms was examined. METHOD: This study tested whether variation in three polymorphisms of the COMT gene was predictive of symptoms of conduct disorder and ADHD, in a sample of 174 incarcerated Russian adolescent male delinquents. RESULTS: The Val allele of the ValMet polymorphism was significantly associated with conduct disorder diagnosis and symptoms, whereas the Met allele was associated with ADHD symptoms. CONCLUSION: The ValMet polymorphism of the COMT gene shows a complex relation to behavior problems, influencing conduct disorder and ADHD symptoms in opposite directions in a high-risk population.

Moods and expectancies of female alcohol drinking--an exploratory study.

Gaining access to information concerning mood states and expectations of change preceding a typical drinking occasion is important for understanding the trigger factors for drinking, and for alcohol abuse treatment planning. The objective of the present study was twofold: (i) to explore self-reported states of mood and expectancies preceding a typical drinking occasion vs. relations with parents and drinking outcome; and (ii) to investigate if vulnerability factors in terms of personality and health are related to severity of alcohol problems. The population consisted of 50 women attending a Swedish alcohol clinic. Semi-structured interviews were conducted. A mixed-methods design was used encompassing qualitative interview-data and quantitative data from questionnaires and medical journals. Nine out of ten patients had a diagnosis of alcohol dependence, and four out of five had parents with dependency problems. As compared to a female norm group, the patients displayed significantly higher anxiety-related traits and irritability. Moods were described by patients as mostly negative and expectancies of change were evenly distributed between reducing, enhancing or flight from feeling. An expectancy of flight when drinking was also related to a positive relation to mother. The findings pointed to the need for differentiating between coping with and expectancies of drinking. Further, a hierarchical cluster analysis resulted in two groups, indicating one group characterized by higher risk values on personality scales and more severe consequences of drinking. The contribution of a treatment design informed through a gender and culture perspective to treatment outcome was discussed.

Alcohol use and patterns of delinquent behaviour in male and female adolescents.

AIMS: The overall aim was to study patterns of delinquent behaviour in relation to adolescent alcohol use. The more specific aims were to examine whether alcohol use varied between groups of adolescents with different patterns of delinquent behaviour, and to explore whether the association between delinquent behaviour patterns and alcohol use was similar for males and females. METHODS: The participants were male (n = 406) and female (n = 532) adolescents in the eighth grade (age 14 years) in a medium-sized city of Sweden. We used information about self-rated alcohol use and different types of delinquent behaviour. RESULTS: The results revealed that the occurrence of excessive alcohol use and drunkenness varied between groups of adolescents with different delinquency patterns, and that the associations between alcohol use and patterns of delinquent behaviours were relatively similar for males and females. Adolescents with patterns characterized by more serious non-violent delinquency or by violent delinquency reported the highest occurrence of alcohol use and frequency of drunkenness. Adolescents with well-adjusted behaviour or occasional minor delinquency were less likely to report drinking large amounts of alcohol or to the point of feeling drunk. CONCLUSIONS: The present results further emphasize the importance of distinguishing between different offender groups when examining the relationship between delinquent behaviour and associated problems, such as excessive alcohol use.

Antisocial process screening device: validation on a Russian sample of juvenile delinquents with the emphasis on the role of personality and parental rearing.

The objectives of the present study were 1) to validate the Antisocial Process Screening Device (APSD) in a sample of Russian juvenile delinquents; 2) to examine subgroups of delinquents with higher versus lower levels of childhood problem behaviors with respect to the APSD subscales, personality traits, and parental rearing; and 3) to attempt to replicate the previous finding that the APSD subscale measuring callous/unemotional traits can differentiate subgroups of delinquents with different precursors for problem behaviors (predominantly biological versus predominantly social). A group of 250 Russian juvenile inmates (mean age=16.4) was examined by means of the APSD completed by the staff at the correctional institution. The inmates completed several self-reports assessing their current and childhood behavior problems, personality traits and experienced parental rearing practices. A factor structure of the APSD was obtained that is similar, albeit not identical, to that from the original studies by Frick and colleagues [Frick, P.J., O'Brien, B.S., Wootton, J.M., McBurnett, K., (1994). Psychopathy and conduct problems in children. Journal of Abnormal Psychology, 103, 700-707]; [Frick, P.J., Barry, C.T., Bodin, S.D., (1999). Applying the concept of psychopathy to children: Implications for the Assessment of antisocial youth. In Gacono, C.B. (Ed), The clinical and forensic assessment of psychopathy: A practitioners guide. Hillsdale, NJ: Erlbaum]; [Frick, P.J., Lilienfeld, S.O., Ellis, M., Loney, B., Silverthorn, P., (1999). The association between anxiety and psychopathy dimensions in children. Journal of Abnormal Child Psychology, 27, 383-392]; callous unemotional traits in the present sample were expressed in manipulative behavior. Results further disclosed higher levels of antisocial and aggressive activities, higher levels of personality attributes such as narcissism and novelty seeking, as well as lower cooperativeness, and negatively perceived parental rearing in a subgroup with higher (versus lower) number of childhood symptoms of conduct disorder and oppositional disorder. The juvenile delinquents with higher levels as compared to lower levels of callous unemotional traits also perceived their parents as using more negative rearing strategies. The findings are discussed in terms of interactional processes between personality of the juvenile delinquents and parental rearing in the development of antisocial behavior.

Psychopathy and violence in juvenile delinquents: what are the associated factors?

The purpose of the present study was a) to examine the discriminative power of the Antisocial Process Screening Device (APSD), aggressive traits, impulsiveness, antisocial attitudes and alcohol-related problems between subgroups of Russian juvenile delinquents (n=175) with low versus high levels of violent behavior; and b) to compare the predictive value of these variables in two subgroups defined by higher versus lower levels of psychopathic traits. Results demonstrated that the APSD score, traits of physical aggression and alcohol-related problems were able to discriminate between groups with various levels of violence. Furthermore, the level of violence was the only variant factor when comparing levels of psychopathy. Finally, different sets of predictors emerged for the group with higher versus lower psychopathy scores. The results are discussed in relation to specific features of psychopathy and environmental factors in general and the use of alcohol in particular.

Projective risk variables in early adolescence and subsequent disinhibitory psychopathology.

The objective was to examine early adolescent projective risk indicators for the development of antisocial behaviour as related to adult personality traits, psychopathy, and violent behaviour over the life span. Assessment data included Rorschach (Rr) ratings (at age 11-14 years), personality inventories (EPQ-I and KSP scales), and a shortened Psychopathy Check List (PCL) (administered at age 32-40 years), obtained from a group of 199 male subjects; and smoking habits (at age 36-44 years) obtained from 125 of those subjects. Results, controlled for intelligence, indicated that the high and very high risk groups, as determined by level of total Rr risk scores, were (1) significantly higher on self-rated IVE Impulsiveness, the anxiety-related KSP Muscular Tension, and nonconformity traits, as compared to the low Rr risk group--the very high risk group also scoring significantly higher on the EPQ Psychoticism scale, related to aggressiveness and cruelty; (2) higher on clinically rated PCL total sum and factor scores; and (3) they were overrepresented among Ss with subsequent violent offence, and Ss with heavy smoking habits. The results are discussed in terms of the possible usefulness of psychodynamic oriented cognitive-emotional indicators in the search for underlying mechanisms in the development of disinhibitory psychopathology.

Resilience and vulnerability among refugee children of traumatized and non-traumatized parents.

BACKGROUND: The aim of the study was to explore resilience among refugee children whose parents had been traumatized and were suffering from Post-Traumatic Stress Disorder (PTSD). METHODS: The study comprised 80 refugee children (40 boys and 40 girls, age range 6-17 yrs), divided into two groups. The test group consisted of 40 refugee children whose parents had been tortured in Iraq before coming to Sweden. In accordance with DSM-IV criteria, these children were further divided in two sub-groups, those who were assessed as having PTSD-related symptoms (n = 31) and those who did not have PTSD-related symptoms (n = 9). The comparison group consisted of 40 children from Egypt, Syria and Morocco whose parents had not been tortured. Wechsler Intelligence Scale for Children, 3rd edn. (WISC-III), Diagnostic Interview for Children and Adolescents- Revised (DICA-R), Post-Traumatic Stress Symptoms checklist (PTSS), "I Think I am" (ITIA) and Strengths and Difficulties Questionnaire (SDQ) were used to assess IQ; PTSD-related symptoms; self-esteem; possible resilience and vulnerability. RESULTS: Children without PTSD/PTSS in the traumatized parents group had more favorable values (ITIA and SDQ) with respect to total scores, emotionality, relation to family, peer relations and prosocial behavior than the children in the same group with PTSD/PTSS and these values were similar to those the children in the comparison group (the non-traumatized parents group). The children in the non-traumatized parents group scored significantly higher on the IQ test than the children with traumatized parents, both the children with PTSD-related symptoms and those without PTSD-related symptoms. CONCLUSION: Adequate emotional expression, supportive family relations, good peer relations, and prosociality constituted the main indicators of resilience. Further investigation is needed to explore the possible effects of these factors and the effects of IQ. The findings of this study are useful for treatment design in a holistic perspective, especially in planning the treatment for refugee children, adolescents and their families.

Personality traits and self-injurious behaviour in patients with eating disorders.

The interest in different aspects of personality and the neuropsychological basis for behaviour in eating disorder patients has increased over the last decade. The present study aims at exploring personality traits, self-injurious behaviour (SIB) and suicide attempts in a group of severely ill eating disorder patients. Patients with eating disorders (N = 38) and age-matched controls (N = 67) were examined concerning self-reported personality traits by means of the Karolinska scales of personality (KSP). Psychosocial history and SIB was collected from medical records. Depression was rated by means of the Beck Depression Inventory (BDI). Results indicated significantly higher anxiety-related and detachment traits in both anorexia nervosa (AN) and bulimia nervosa (BN) patients and higher hostility in BN patients than controls. No specific personality traits could be defined as typical for self-injurious or suicidal behaviour. The AN group was lower than the BN group on scales measuring impulsivity, guilt and anxiety. Furthermore, presence of SIB and suicide attempts was more frequent among the BN patients.

Trauma, PTSD and personality: the relationship between prolonged traumatization and personality impairments.

OBJECTIVE: Chronic post-traumatic stress disorder (PTSD) has been associated with personality impairments involving externalized and internalized psychopathology. This study has explored the association between PTSD symptoms as consequences of prolonged torture experiences or early childhood trauma exposure and personality traits. METHOD: One hundred and sixty-one men were included: 36 Iraqi men refugees (mean age = 43.9, SD = 8.7) who had longstanding torture experiences as adults; 42 Swedish prisoners (mean age = 33.8, SD = 7), with early childhood trauma exposure; 31 Arab men refugees (mean age = 41.8, SD = 8.9) without self-reported torture or violence experiences; 52 non-traumatized Swedish males (mean age = 39.3, SD = 5.5). They were assessed for symptoms of PTSD or PTSD hypothetical clusters. Personality profile was assessed by the Karolinska Scales of Personality (KSP). Factor analysis with varimax rotation was conducted and yielded three factors: externalized, internalized and avoidance domains. RESULTS: Individuals who suffered prolonged torture experiences or had early childhood trauma exposure showed impaired personality profiles in internalized and externalized domains. Individuals with or without PTSD showed significant differences p < 0.05 concerning: internalized, externalized and avoidance. ANOVA and post-hoc analysis according to Scheffé showed that the prolonged torture group > early childhood trauma exposure > nontraumatized group. CONCLUSION: Prolonged torture experiences or early trauma exposure may impair personality formation by enhancing the effects of cognitive, affective and behavioural vulnerabilities.

Monoamine oxidase activity and tri-iodothyronine level in violent offenders with early behavioural problems.

The focus is on evaluating the relationships between early behavioural problems and biochemical variables at adult age and their significance for early criminality and violent behaviour in a life perspective. In the present study, using prospective longitudinal data, a sample of males with a history of early criminal behaviour and male controls (n = 103) were investigated concerning (1) teacher-rated behaviours at age 11-14 years; (2) platelet monoamine oxidase (MAO) activity and tri-iodothyronine (T(3)) level at adult age; (3) registered early criminality (11-14 years); (4) records of violent offending up to age 35 years, and (5) interview data on smoking. The main finding was that a combined risk level pattern of low MAO activity and high T(3) level was found significantly more frequently than expected in violent offenders with an early behavioural risk pattern. Furthermore, there was a significant interaction effect between early attention difficulties and smoking on MAO activity, as well as an effect by smoking on MAO activity. The findings are discussed in terms of the possible influence of biological vulnerability to certain behaviours, which in combination with possible childhood stress, enhance the risk for antisocial behaviours and subsequent violence.

Platelet MAO-B, personality, and psychopathology.

The article investigates the relationships between platelet monoamine oxidase-B (MAO-B) activity, personality, and psychopathology (Diagnostic and Statistical Manual of Mental Disorders [4th ed.; American Psychiatric Association, 1994] diagnoses. These relationships were assessed in 178 incarcerated male juvenile delinquents. Even after controlling for smoking, the authors found that both Internalizing and Externalizing Psychopathology were negatively related to MAO-B activity. In the final reduced model, novelty seeking fully mediated the relationships between MAO-B and Externalizing Psychopathology but not between MAO-B and Internalizing Psychopathology. It was hypothesized that low platelet MAO-B activity does not directly predispose individuals to psychopathology but is related to specific personality traits, which in turn represent a vulnerability factor for psychopathology. Future studies should help clarify the nature of the relationships between personality, biological markers, and psychopathology.

Autoantibodies against alpha -MSH, ACTH, and LHRH in anorexia and bulimia nervosa patients.

The hypothalamic arcuate nucleus is involved in the control of energy intake and expenditure and may participate in the pathogenesis of eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN). Two systems are of particular interest in this respect, synthesizing alpha-melanocyte-stimulating hormone (alpha-MSH) and synthesizing neuropeptide Y, respectively. We report here that 42 of 57 (74%) AN andor BN patients studied had in their plasma Abs that bind to melanotropes andor corticotropes in the rat pituitary. Among these sera, 8 were found to bind selectively to alpha-MSH-positive neurons and their hypothalamic and extrahypothalamic projections as revealed with immunostaining on rat brain sections. Adsorption of these sera with alpha-MSH peptide abolished this immunostaining. In the pituitary, the immunostaining was blocked by adsorption with alpha-MSH or adrenocorticotropic hormone. Additionally, 3 ANBN sera bound to luteinizing hormone-releasing hormone (LHRH)-positive terminals in the rat median eminence, but only 2 of them were adsorbed with LHRH. In the control subjects, 2 of 13 sera (16%) displayed similar to ANBN staining. These data provide evidence that a significant subpopulation of ANBN patients have autoantibodies that bind to alpha-MSH or adrenocorticotropic hormone, a finding pointing also to involvement of the stress axis. It remains to be established whether these Abs interfere with normal signal transduction in the brain melanocortin circuitryLHRH system andor in other central and peripheral sites relevant to food intake regulation, to what extent such effects are related to andor could be involved in the pathophysiology or clinical presentation of ANBN, and to what extent increased stress is an important factor for production of these autoantibodies.