[Traumatic childhood background, impulsiveness and hypothalamus-pituitary-adrenal axis dysfunction in eating disorders. A pilot study]. / Antecedentes traumáticos infantiles, impulsividad y disfunción del eje hipotálamo-hipofisario-adrenal en los trastornos de la conducta alimentaria. Un estudio piloto.

INTRODUCTION: Some studies have stressed the importance of childhood traumatic events in the etiology of eating disorders (ED), suggesting that the abnormalities in the response mechanisms to stress and in the functioning of the hypothalamus, pituitary-adrenal axis (HPA) could be important in the physiopathology of eating behavior disorders. Some preliminary findings suggest that some ED subtypes, as the post-traumatic stress disorder, have a hyperreactivity state of the HPA axis with increased sensitivity to dexamethasone. METHODS: A total of 25 patients diagnosed of ED according to DSM-IV criteria, without any major depressive episode or history of bipolar or psychotic disorder were included. To assess the HPA axis, the dexamethasone suppression test was performed with 0.25 mg. The patients were administered the Bernstein childhood trauma questionnaire, the Green trauma history questionnaire, impulsiveness specific questionnaires and the SCID-II questionnaire for personality disorders. RESULTS: 12% had a traumatic background that did not show any relationship with the EBD subtype. The most impulsive patients with more borderline traits had a significantly greater number of traumatic backgrounds (p<0.005). A significant relationship was found between cortisol suppression and presence of traumatic history (p<0.005). The most impulsive patients with more borderline traits had lower post-dexamethasone cortisol plasma levels (p<0.005). CONCLUSIONS: Trauma in ED is associated to greater impulsiveness and presence of borderline personality traits that entails an HPA axis dysfunction and is translated into enhanced suppression of plasma cortisol.

Antecedentes traumáticos infantiles, impulsividad y disfunción del eje hipotálamo-hipofisario-adrenal en los trastornos de la conducta alimentaria. Un estudio piloto / Traumatic childhood background, impulsiveness and hypothalamus pituitary-adrenal axis dysfunction in eating disorders. A pilot study

Introducción. Algunos estudios han destacado la importancia de los acontecimientos traumáticos infantiles en la etiología de los trastornos de la conducta alimentaria (TCA), sugiriendo que las alteraciones en los mecanismos de respuesta al estrés y en el funcionamiento del eje hipotálamo-hipofisarioadrenal (HILA) pudieran ser de importancia en la fisiopatología de dichos trastornos. Algunos hallazgos preliminares sugieren que algunos subtipos de TCA, al igual que el trastorno por estrés postraumático, presentan un estado de hiperreactividad del eje HILA con un aumento de sensibilidad para la dexametasona. Métodos. Se incluyeron 25 pacientes diagnosticados de TCA según criterios DSM-IV, sin episodio depresivo mayor actual ni historia de trastorno bipolar o psicótico. Para valorar el eje HHA se realizó la prueba de supresión de la dexametasona con 0,25 mg. A los pacientes se les administró el cuestionario de traumas infantiles de Bernstein, el cuestionario de antecedentes traumáticos de Green, cuestionarios específicos de impulsividad y el cuestionario SCID- II para trastornos de la personalidad. Resultados. El 12 por ciento presentaban antecedentes traumáticos sin encontrarse relación con el subtipo de TCA. Las pacientes más impulsivas y con más rasgos límites presentaban de forma significativa mayor número de antecedentes traumáticos (p < 0,005). Se encontró una relación significativa entre la supresión del cortisol y la presencia de antecedentes traumáticos (p < 0,005). Las pacientes más impulsivas y con más rasgos límites presentaban menores niveles plasmáticos de cortisol posdexametasona (p < 0, 005).Conclusiones. El trauma en los TCA se asocia a una mayor impulsividad y a la presencia de rasgos límites de la personalidad y ello conlleva una disfunción del eje HHA que se traduce en una hipersupresión de cortisol plasmático (AU)

A prospective study of the paradoxical relationship between impulsivity and lethality of suicide attempts.

BACKGROUND: Biological studies suggest that lower serotonergic activity is associated with both greater suicide lethality and impulsive personality traits. These results may lead to the conclusion that impulsivity in the attempt should be associated with greater lethality. However, Klerman's review of epidemiologic suicide studies suggests an inverse relationship between impulsivity and lethality. This seemingly paradoxical relationship between impulsivity and lethality has not been explored in large representative clinical samples of suicide attempts. METHOD: During 1996 to 1998, 478 individuals who attempted suicide were studied in a general hospital in Madrid, Spain. Impulsivity was measured as described in the literature by combining 2 items of Beck's Suicidal Intent Scale (active preparation for attempt and degree of premeditation). Lethality of the attempt was assigned 1 of 4 levels according to the need for medical and/or psychiatric treatment. RESULTS: More than half of the attempts were impulsive (55%; 95% confidence interval [CI], 51% to 59%), approximately one fourth of the attempts had an intermediate level of impulsivity (28%; 95% CI, 24% to 32%), and approximately one sixth of the attempts were not impulsive (17%, 95% CI, 13% to 21%). There was an inverse association between the impulsivity and lethality of the suicide attempt (chi2 = 62.639, df = 6, p < .0001). The most impulsive attempts tended to result in less morbidity, while the less impulsive attempts tended to be more lethal. CONCLUSION: If the inverse relationship between impulsivity and lethality is replicated in other large and representative samples, new studies will be needed to clarify the complex interactions between the clinical dimensions (lethality, impulsivity as a state, and impulsivity as a personality trait) and the biological correlates (particularly serotonergic function) of suicidal behavior.