Nibbles
What triggers the onset of an eating disorder? Two recent papers in Psychological Medicine examine the role of psychosocial stresses in precipitating the onset of anorexia nervosa and bulimia nervosa. Using the Life Events and Dif®culties Schedule, Ulrike Schmidt and her colleagues found that both anorectics and bulimics were more likely than controls to have experienced a major dif®culty in the year before the onset of their disorder . These dif®culties most commonly involved close relationships. Moreover, the anorectics were more likely than the bulimics to have had dif®culties in the area of sexuality which might be expected to evoke feelings of shame or disgust.
The second study used a different research interview to look at a community sample of bulimics. The bulimics reported signi®cantly more life events in the year before onset of the disorder than controls and the two most frequently reported events were a major house move or a new sexual relationship.
Moving from onset to outcome, research from Germany (Herzog et al., 1997) has examined the prognostic value of a range of laboratory ®ndings at presentation in anorexia nervosa. The Heidelberg±Mannheim study followed up 84 patients for an average of 11.9 years. The most powerful predictor of mortality was the serum albumin level, although this may be spuriously high initially due to dehydration and reduced metabolism. Raised levels of serum creatinine and uric acid re¯ected severity of purging and predicted a chronic course.
One of the dif®culties in assessing the importance of biochemical disturbances in anorectic patients is how to distinguish those which may be of aetiological signi®cance from those which arise as a consequence of the disease itself. A paper from the Institute of Psychiatry in London investigated whether abnormalities of serotoninergic function persist after weight restoration. The authors found no difference between nine weight-restored former anorectics and controls in responses to the D-fen¯uramine challenge test, even though the anorectics continued to exhibit eating-related psychopathology. They conclude that abnormalities in the serotonin system in anorexia nervosa are more likely to be state' than trait'.