Traumatic childhood background, impulsiveness and hypothalamus-pituitary-adrenal axis dysfunction in eating disorders. A pilot study

Abstract

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.

Method. 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 ED 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.