Comparing Anorectics and Bulimics on Measures of Depression, Anxiety, and Anger

Seventeen anorectics and 33 bulimics, all female inpatients at Santa Barbara Cottage Hospital's eating disorder unit, and 57 non-eating-disordered female controls from undergraduate psychology classes at Cal Poly State University, San Luis Obispo, were compared on measures of depression, anxiety, and anger. Results indicated that both anorectics and bulimics differed from controls on depression, anxiety, and three of the six scales assessing anger. Bulimics and anorectics, however, did not significantly differ from each other in terms of depression, anxiety, and anger. The implications of these results for practice and research with eating-disordered persons are discussed.     

Beta 2-adrenergic receptor regulation in circulating mononuclear leukocytes in anorexia nervosa and bulimia

Mononuclear leukocyte (MNL) beta 2-adrenergic receptors and their coupled adenylate cyclase system were studied in underweight anorectics (n = 12), weight-recovered anorectics (n = 8), bulimics (n = 8), and age- and sex-matched controls (n = 39). Compared with controls, underweight anorectics had significantly fewer MNL beta 2-adrenergic receptor sites (Bmax) but did not differ in binding affinity (Kd). Weight-recovered anorectics and bulimics did not differ from controls on either Bmax or Kd. Compared with controls, all three patient groups had significantly reduced plasma levels of triiodothyronine (T3), while only underweight anorectics had significantly elevated plasma levels of cortisol. Plasma norepinephrine (NE) response to orthostasis was significantly lower in the three patient groups than in controls. The reduction in beta 2-adrenergic receptor number in underweight anorectics could reflect their elevated cortisol and reduced T3 levels. The decrease in beta 2-adrenergic receptor sites, together with the lower NE response to orthostasis, could be responsible for the reduced sympathetic activity of underweight anorectics.     

Cognition in eating disorders

Abstract

Cognitive functions were investigated in four groups of women: 30 underweight anorexics, 38 normal-weight bulimics, 20 long-term weight-restored anorexics, and 39 normal controls. A MANOVA was used to examine performance on five neuropsychological domains derived from prior principal components analyses of a comprehensive neuropsychological battery. Underweight anorexics performed more poorly than normal controls in four of five neuropsychological domains (focusing/execution, verbal, memory, and visuospatial), while normal-weight bulimics showed poorer performances only in focusing/execution. The absolute differences in scores between eating disorder groups and normal controls were for the most part small, suggesting subtle rather than frank cognitive difficulties. Poorer neuropsychological test performance was associated with anxiety but not depression as measured by the Tryon, Stein, and Chu Tension scale and scale 2 of the MMPI respectively. The findings support previous reports of attentional difficulties in eating disorders but do not support the hypothesis of differential right-hemisphere dysfunction in eating disorders.     

Frequently Asked Medical Questions About Eating Disorder Patients

Abstract

Of the entire gamut of psychological disorders treated by clinicians, eating disorders are the ones most frequently punctuated by concomitant medical complications. Many of these are not serious, but a distinct number of these complications have serious ramifications. Herein, we discuss some of the most frequently encountered medical issues during the treatment of bulimics and anorectics.     

A brain magnetic resonance imaging study of pituitary gland morphology in anorexia nervosa and bulimia

Magnetic resonance imaging (MRI) of the brain was used to examine the morphology and dimensions of the pituitary gland in 18 patients with eating disorders (8 anorectics and 10 bulimics), in comparison with 13 healthy volunteers. None of the 18 patients with anorexia or bulimia had any radiological evidence suggestive of pituitary macroadenoma, cyst, or empty sella. Measurements revealed that the anorectics and bulimics had smaller pituitary gland cross-sectional areas (p less than 0.05) and smaller pituitary gland heights, compared with healthy controls. These preliminary findings in anorectics and bulimics are suggestive of pituitary atrophy secondary to nutritional or endocrine alterations, rather than a primary pituitary pathology.     

Thyrotropin, prolactin, and growth hormone responses to thyrotropin-releasing hormone in anorexia nervosa and bulimia

Serum thyrotropin (TSH), prolactin (PRL), and growth hormone (GH) levels were measured before and after stimulation with thyrotropin-releasing hormone (TRH) in 10 patients with bulimia, 7 with features of the restricting subtype of anorexia nervosa, and 6 with bulimic subtype of anorexia nervosa. The mean basal levels of TSH, PRL, and GH did not differ among the three groups. A delayed TSH response was found in 86% of the restricting anorectics, 80% of the bulimic anorectics, and 22% of the bulimics. The PRL response was normal in all patients, with no significant difference among the three groups. Elevated basal GH levels were found in 29% of the restricting anorectics, 33% of the bulimic anorectics, and 33% of the bulimics. An abnormal GH increase after TRH stimulation was observed in 50% of the restricting anorectics, 20% of the bulimic anorectics, and 13% of the bulimics. These results suggest that some patients with bulimia, and some with anorexia nervosa, have a hypothalamic dysfunction. These neuroendocrine abnormalities do not appear to be due solely to low weight or to metabolic changes resulting from binge eating and are not associated with depressive symptoms.     

Maternal Depression and Anxiety Across the Postpartum Year and Infant Social Engagement,Fear Regulation,and Stress Reactivity

ObjectiveTo examine the effects of maternal depression on infant social engagement, fear regulation, and cortisol reactivity as compared with maternal anxiety disorders and controls and to assess the role of maternal sensitivity in moderating the relations between maternal depression and infant outcome.MethodsUsing an extreme-case design, 971 women reported symptoms of anxiety and depression after childbirth and 215 of those at the high and low ends were reevaluated at 6 months. At 9 months, mothers diagnosed with a major depressive disorder (n = 22) and anxiety disorders (n = 19) and matched controls reporting no symptoms across the postpartum year (n = 59) were visited at home. Infant social engagement was observed during mother–infant interaction, emotion regulation was microcoded from a fear paradigm, and mother's and infant's cortisol were sampled at baseline, reactivity, and recovery.ResultsThe infants of depressed mothers scored the poorest on all three outcomes at 9 months—lowest social engagement, less mature regulatory behaviors and more negative emotionality, and highest cortisol reactivity—with anxious dyads scoring less optimally than the controls on maternal sensitivity and infant social engagement. Fear regulation among the children of anxious mothers was similar to that of the controls and their stress reactivity to infants of depressed mothers. Effect of major depressive disorder on social engagement was moderated by maternal sensitivity, whereas two separate effects of maternal disorder and mother sensitivity emerged for stress reactivity.ConclusionsPathways leading from maternal depression to infant outcome are specific to developmental achievement. Better understanding of such task-specific mechanisms may help devise more specifically targeted interventions.     

Relationship of bone density to estradiol and cortisol in anorexia nervosa and bulimia

Dual photon absorptiometry was used to assess the risk of developing osteoporosis in patients with anorexia nervosa and patients of normal weight with bulimia nervosa. Anorectic patients had significantly lower vertebral bone mineral densities compared with healthy controls. Bulimic patients had values similar to those of controls, and the differences between bulimics and anorectics narrowly missed significance. No significant difference was found between patient groups in measurements of serum estradiol, but anorectics, compared with bulimics, had significantly higher values of 24-hour urinary free cortisol. Hypercortisolemia, by diminishing bone formation and increasing bone resorption, is likely to contribute to the development of osteoporosis in patients with eating disorders.     

Anger and depression among the elderly people with hypertension

ObjectiveTo determine the status of anger and depression among the elderly people with hypertension.Materials and methodsThe study was conducted with 418 elderly people diagnosed with hypertension. The data were collected with a personal information form, Spielberger Trait Anger–Anger Expression Scale and Geriatric Depression Scale.ResultsIt was found out that there was a close correlation between anger and depression among the elderly people and as anger increased so did depression. It was explored that there was a close correlation between duration of hypertension and depression and as the duration of hypertension increased so did depression. Anger scores were higher among the elderly people who were male, worked, smoked and drank alcohol while depression scores were higher among the elderly people who were female, widowed, literate and dependent upon others in leading activities of daily living.ConclusionsThere was a close correlation between anger and depression among the elderly people and between duration of hypertension and depression. Therefore it is necessary to determine anger among the elderly people, to express anger in a proper way and to plan approaches that prevent depression.     

Lupus-prone B6.Nba2 male and female mice display anti-DWEYS reactivity and a neuropsychiatric phenotype

ObjectiveNeuropsychiatric lupus (NPSLE), a manifestation of the autoimmune disease systemic lupus erythematosus (SLE), is characterized by psychiatric symptoms including anxiety and depression and upregulated autoantibodies. The B6.Nba2 spontaneous mouse model develops SLE, but has not previously been tested for NPSLE.MethodsWe investigated the NPSLE phenotype in male and female B6.Nba2 mice (n = 12 each) and age- and sex-matched B6 controls (n = 10 each) via behavioral assessments for anxiety, depression, and memory deficits. Serum anti-dsDNA, anti-nRNP, anti-DWEYS peptide reactive IgG autoantibody levels and soluble TWEAK levels were determined by ELISA. Hippocampal regions were stained for activated microglia and neurons.ResultsBoth male and female B6.Nba2 mice showed elevated anti-dsDNA IgG, anti-nRNP IgG and anti-DWEYS reactive antibodies, elevated serum soluble TWEAK levels, and a strong anxiety and depression phenotype (p < 0.05–0.0001). Male B6.Nba2 mice developed this phenotype at a slightly older age than females. Female B6.Nba2 mice displayed reduced numbers of neurons in the hippocampal region compared to female B6 controls (p < 0.05).ConclusionThe B6.Nba2 mouse model recapitulates many known NPSLE phenotypes, making it a promising model to investigate the development of NPSLE in the context of SLE.     

Sleep deprivation leads to mood deficits in healthy adolescents

Study objectivesThe objectives of the study were to investigate the effects of 36 h of sleep deprivation on the discrete mood states of anger, depression, anxiety, confusion, fatigue, and vigour in healthy adolescents.MethodTwelve healthy adolescent good sleepers (six male), aged 14–18 years (M = 16.17, standard deviation (SD) = 0.83), spent three consecutive nights in the sleep laboratory of the Centre for Sleep Research: two baseline nights with 10-h sleep opportunities and one night of total sleep deprivation. Every 2 h during wakefulness, they completed the Profile of Mood States – Short Form. Mood across two baseline days was compared to mood at the same clock time (0900 h to 1900 h) following one night without sleep.ResultsThe subscales of depression, anger, confusion, anxiety, vigour, and fatigue were compared across days. All mood states significantly worsened following one night without sleep. Females showed a greater vulnerability to mood deficits following sleep loss, with greater depressed mood and anxiety following sleep deprivation only witnessed among female participants. While both males and females reported more confusion following sleep deprivation, the magnitude of this effect was greater for females.ConclusionsThis study provides empirical support for the notion that sleep loss can causally affect mood states in healthy adolescents, with females having heightened vulnerability. Understanding the detrimental effects of insufficient sleep during adolescence is important, as it is a stage where sleep loss and mood dysregulation are highly prevalent. These findings escalate the importance of promoting sleep for the well-being of adolescents at this critical life phase.     

Are psychological characteristics related to risk of the metabolic syndrome? A review of the literature

Backround: We evaluate the evidence that depression, anger, hostility, and anxiety are related to risk for the metabolic syndrome, focusing as well on its components of central adiposity and insulin resistance. In addition, we identify possible moderators of these associations and summarize plausible underlying biobehavioral pathways.Methods: Medline, PsycINFO, PubMed, and Web of Science searches were conducted using the keywords metabolic syndrome, syndrome x, central adiposity/obesity, visceral adiposity/obesity, body fat distribution, waist circumference, waist hip ratio, insulin resistance/sensitivity, glucose tolerance, psychological, depression, hostility, anger, cynicism, and anxiety.Results: The current literature provides cross-sectional evidence for an association between psychological characteristics and the metabolic syndrome. Prospective data, though limited, suggest that depression, hostility, and anger predict increased risk for the metabolic syndrome. Data on modifiers are too limited to permit definitive conclusions. Negative health behaviors and hypothalamic and sympathetic dysregulation are identified as plausible underlying pathways.Conclusions: More prospective studies, conducted with diverse samples, are needed to delineate the direction of this relationship and the proposed biobehavioral mechanisms; experimental investigations are needed to test for causality. Nevertheless, findings suggest that psychological characteristics, especially depression, hostility, and anger, may increase risk for the metabolic syndrome, providing a novel direction for prevention and treatment interventions. This research was supported by HL07560, and the Pittsburgh Mind-Body Center HL076852 and HL076858.     

Shared and unique contributions of anger, anxiety, and depression to coronary heart disease: A prospective study in the normative aging study

Background: Anger, anxiety, and depression have each been identified as risk factors for coronary heart disease (CHD). Whether the apparent risk is a function of unique aspects of each emotion or due to a shared underlying dimension of negative affectivity is unclear.Purpose: The goal of this study was to assess shared and unique contributions of anger, anxiety, and depression to incidentCHD. Methods: Data are from the Veterans Administration Normative Aging Study, an ongoing cohort of older men. Measures of anger, anxiety, and depression were obtained from 1,306 men completing the revised Minnesota Multiphasic Personality Inventory in 1986. From these measures we derived three nearorthogonal scales termed iso(lated)-anger, iso-anxiety, and iso-depression and a fourth scale measuring general distress.Results: During an average of 10.9 years of follow-up, 161 cases of incident CHD occurred. When considered individually, iso-anxiety, iso-anger, and shared general distress were each associated with CHD risk. When all emotions were considered simultaneously, only iso-anxiety and shared general distress were associated with incidentCHD. Conclusions: Considering shared versus unique aspects of negative emotions may clarify the nature of their apparent toxicity in relation toCHDsrisk. General distress shared across negative emotions is an important component in the emotionCHD relation. Aspects of anxiety may also independently increaseCHD risk. This study was supported by a V.A. Medical Research Service Merit Review Award. The V.A. Normative Aging Study is supported by the Cooperative Studies Program/ERIC, Department of Veterans Affairs, and is a component of the Massachusetts Veterans Epidemiology Research and Information Center. Dr. Kawachi is supported by the Mac-Arthur Foundation Network on Socioeconomic Status and Health. Dr. Cole is supported by the National Institute of Allergy and Infectious Diseases via data coordinating centers: Multicenter AIDS Cohort (U01-AI-35043) and Women’s Interagency HIV (U01-AI-42590) Studies.     

Subjective anger and overt aggression in psychiatric outpatients

BackgroundThe attention given to anger and aggression in psychiatric patients pales in comparison to the attention given to depression and anxiety. Most studies have focused on a limited number of psychiatric disorders, and results have been inconsistent. The present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project sought to replicate and extend prior findings examining which psychiatric disorders and demographic characteristics were independently associated with elevated levels of anger and aggression.Method3800 individuals presenting to the Rhode Island Hospital Department of Psychiatry outpatient practice underwent a semi-structured interview to determine current Axis I (N = 3800) and Axis II (N = 2151) pathology. Severity of subjective anger and overt aggression within the past week were also assessed for each patient, and odds ratios were determined for each disorder. Multiple regression analyses were conducted to determine which diagnoses independently contributed to increased levels of anger and aggression.ResultsAlmost half of the sample reported moderate-to-severe levels of current subjective anger, and more than 20% endorsed moderate-to-severe levels of current overt aggression. The frequency of anger was similar to the frequencies of depressed mood and psychic anxiety. Anger and aggression were elevated across all diagnoses except adjustment disorder. Anger and aggression were most elevated in patients with major depressive disorder, panic disorder with agoraphobia, post-traumatic stress disorder, intermittent explosive disorder, and cluster B personality disorders.ConclusionsAnger is as common as depressed mood and psychic anxiety amongst psychiatric outpatients, and problems with anger cut across diagnostic categories. Given the high prevalence of problems with anger in psychiatric patients, more research should be directed towards its effective treatment.     

Affective lability in bipolar disorder and borderline personality disorder

BackgroundThe boundaries between the affective instability in bipolar disorder and borderline personality disorder have not been clearly defined. Using self-report measures, previous research has suggested that the affective lability of patients with bipolar disorder and borderline personality disorder may have different characteristics.MethodsWe assessed the mood states of 29 subjects meeting Revised Diagnostic Interview for Borderlines and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for BPD and 25 subjects meeting DSM-IV criteria for bipolar II disorder or cyclothymia using the Affective Lability Scale (ALS), the Affect Intensity Measure (AIM), and a newly developed clinician-administered instrument, the Affective Lability Interview for Borderline Personality Disorder (ALI-BPD). The ALI-BPD measures frequency and intensity of shifts in 8 affective dimensions. Subjects in the borderline group could not meet criteria for bipolar disorder; subjects in the bipolar/cyclothymia group could not meet criteria for BPD.ResultsPatients in the bipolar group had significantly higher scores on the euthymia–elation subscale of the ALS; patients in the BPD group had significantly higher scores on the anxiety–depression subscale of the ALS. Patients with bipolar disorder had significantly higher total AIM scores and significantly higher score on the AIM positive emotion subscale. In terms of frequency, patients in the borderline group reported the following: (1) significantly less frequent affective shifts between euthymia–elation and depression–elation on the ALI-BPD and (2) significantly more frequent shifts between euthymia–anger, anxiety–depression, and depression–anxiety. In terms of intensity, borderline patients reported the following: (1) significantly less intense shifts between euthymia–elation and depression–elation on the ALI-BPD and (2) significantly more intense shifts between euthymia–anxiety, euthymia–anger, anxiety–depression, and depression–anxiety.ConclusionThe affective lability of patients with borderline and bipolar II/cyclothymic can be differentiated with respect to frequency and intensity using both self-report and clinician-administered measures.     

Social isolation,cognitive reserve,and cognition in older people with depression and anxiety

Abstract

Objectives: Poor social connections may be associated with poor cognition in older people who are not experiencing mental health problems, and the trajectory of this association may be moderated by cognitive reserve. However, it is unclear whether this relationship is the same for older people with symptoms of depression and anxiety. This paper aims to explore social relationships and cognitive function in older people with depression and anxiety.

Method: Baseline and two-year follow-up data were analysed from the Cognitive Function and Ageing Study–Wales (CFAS-Wales). We compared levels of social isolation, loneliness, social contact, cognitive function, and cognitive reserve at baseline amongst older people with and without depression or anxiety. Linear regression was used to assess the relationship between isolation and cognition at baseline and two-year follow-up in a subgroup of older people meeting pre-defined criteria for depression or anxiety. A moderation analysis tested for the moderating effect of cognitive reserve.

Results: Older people with depression or anxiety perceived themselves as more isolated and lonely than those without depression or anxiety, despite having an equivalent level of social contact with friends and family. In people with depression or anxiety, social isolation was associated with poor cognitive function at baseline, but not with cognitive change at two-year follow-up. Cognitive reserve did not moderate this association.

Conclusion: Social isolation was associated with poor cognitive function at baseline, but not two-year follow-up. This may be attributed to a reduction in mood-related symptoms at follow-up, linked to improved cognitive function.     

Resilience to mental health problems and the role of deployment status among U.S. Army Reserve and National Guard Soldiers

Purpose

Research suggests that interpersonal and intrapersonal resiliency factors protect against poor post-deployment mental health outcomes among Reserve/Guard soldiers who have been deployed. There is increasing awareness that never-deployed soldiers are also at risk. The purpose of this study was to examine the relationships between resiliency factors and a range of mental health outcomes among a sample of United States Army Reserve and National Guard (USAR/NG) soldiers who have and have not experienced deployment.

Methods

A subset of data was drawn from Operation: SAFETY (N = 360), an ongoing study examining the health and well-being of USAR/NG soldiers. We used a multivariate path analysis approach to examine the simultaneous effects of unit support, marital satisfaction, and psychological hardiness on the following mental health outcomes, concurrently: anger, anxiety, depression, and posttraumatic stress disorder (PTSD) symptomatology. We also examined interaction effects between resiliency factors and deployment status on mental health outcomes.

Results

Greater unit support (ps < 0.01), marital satisfaction (ps < 0.001), and psychological hardiness (ps < 0.001) were associated with less anger, anxiety, depression, and PTSD symptomatology. Psychological hardiness had significant interactions with deployment status on anxiety, depression, and PTSD, such that the protective effects of psychological hardiness were even stronger among never-deployed soldiers than previously deployed solders.

Conclusion

Resiliency factors can be targeted for intervention to prevent poor mental health outcomes among USAR/NG soldiers, regardless of deployment status. Further, psychological hardiness may be an even more important protective factor among soldiers who have never been deployed.

     

Psychological correlates of myasthenia gravis: a brief report

Myasthenia gravis patients and matched normal controls were assessed on a range of psychological indices; myasthenic patients had higher scores on trait anxiety and suppression of anger. There were no other significant differences between the groups on psychological symptom measures (anxiety, depression or anger) or other trait measures (anger, suppression of anxiety and suppression of depression). It is concluded that trait anxiety and suppression of anger may predispose to myasthenia gravis.     

Cigarette smoking and mood disorders in U.S. adolescents: sex-specific associations with symptoms, diagnoses, impairment and health services use

ObjectiveTo report sex-specific associations between cigarette smoking and DSM-IV disorders, symptoms, and mental health services use related to depression and anxiety in a nationally representative sample of U.S. adolescents.MethodsData on two samples were drawn from the 1999–2004 National Health and Nutrition Examination Surveys to examine the association of ever smoking (versus never smoking) with depression (n = 1884 12–15 year-olds) and anxiety (n = 6336 12–19 year-olds). Sex-specific associations between smoking and DSM-IV diagnoses, subthreshold and severe disorder, symptoms, impairment and mental health services use were assessed using logistic regression modeling.ResultsRates of DSM-IV depression and anxiety were increased in adolescent female ever smokers as compared to never smokers (OR = 3.9, 95% CI: 1.3–11.3 and OR = 10.6, 95% CI: 3.1–37.0, respectively). Females also showed statistically significant increases in severe disorder, subthreshold disorder, all symptoms of major depressive disorder, most symptoms of panic disorder, and increases in severe impairment, especially those related to schoolwork and teachers. Male adolescents showed smaller variations in depression and anxiety by smoking status, but were more likely to seek mental health services.ConclusionsSmoking prevention efforts may benefit from specifically targeting female youth who show signs of depression or anxiety diagnoses through a school-based program, while greater benefits with males may be evident through programs integrated into mental health services.     

Relationship between orexin A and childhood maltreatment in female patients with depression and anxiety

Objective: Childhood maltreatment leads to neuroendocrine changes, which may be associated with an increased vulnerability for psychopathology, such as depression and anxiety in later life. This study aimed to investigate the relationship between childhood maltreatment and orexin A levels in patients with depression and anxiety. The study consisted of 27 female outpatients who presented with depressive and/or anxiety symptoms, and 27 healthy female controls. Childhood trauma history was assessed using the childhood trauma questionnaire (CTQ-28) in patients and controls. Serum levels of orexin and cortisol were measured in all subjects. There were positive correlations between serum orexin levels and CTQ total score and between orexin levels and some CTQ subscale scores, such as physical and emotional neglect, in patients. Orexin levels in patients with a positive history of physical and emotional neglect were higher than those in patients with a negative history of them. In the controls, there was a positive correlation between emotional neglect score and serum orexin level. There were no differences in serum levels of orexin and cortisol between patients and controls. Orexin levels may be associated with childhood maltreatment per se, rather than psychopathology, such as depression or anxiety.