Cardiovascular stress reactivity and recovery in bulimia nervosa and binge eating disorder
Research Highlights
►Bulimic patients (BN) compared with patients with binge eating disorder (BED) and non-binge obese (NBED) showed higher stress reactivity. ►Heart rate variability during mental stress was unchanged in BN and BED patients. ►Recovery capacity in BN and BED patients was limited.
Introduction
Bulimia nervosa (BN) and binge eating disorder (BED) are both characterized by recurrent episodes of binge eating, but differ in compensatory behavior. Bulimic patients regularly use self-induced vomiting or misuse laxatives to control their weight, whereas individuals with binge eating disorder usually suffer from uncontrolled weight gain and obesity (Munsch and Beglinger, 2005).
It is thought that stress plays an important role in the pathology of both disorders (Pinaquy et al., 2003, Koo-Loeb et al., 1998). Heightened negative mood has frequently been described as a precursor to binge eating episodes in BN and BED (Levine and Marcus, 1997, Eldredge and Agras, 1996, Telch and Agras, 1996) as well as obesity. Individuals with BN and BED experience greater negative mood before binge eating episodes and perceive challenging situations as more stressful compared with healthy individuals (Pinaquy et al., 2003, Wolff et al., 2000, Hansel and Wittrock, 1997, Kjelsas et al., 2004). Additionally, several studies have shown an increase in hunger and desire to binge following experimental stress tasks (Cattanach et al., 1988, Gluck et al., 2004, Tuschen-Caffier and Vogele, 1999). Therefore, understanding the physiological mechanisms underlying stress responses would be useful for the identification of physiological correlates of binge eating patterns in BN and BED disorders.
There is evidence that people with BN and BED differ in autonomic functioning from healthy individuals. Patients with BN exhibit blunted sympathetic activation in response to mental stress (Koo-Loeb et al., 1998) and reduced 24 h blood pressure (Cong et al., 2004). Furthermore, results of a comparison of BED and controls suggested higher stress vulnerability in the BED population (Friederich et al., 2006). However, obesity might confound these results, as other studies on obese subjects have shown a change of stress response profiles due to obesity itself (Laederach-Hofmann et al., 2000, Valensi et al., 1995).
Similarities in biological stress vulnerability could be a key to understanding binge eating behavior in BN and BED. But studies of autonomic stress responses in BN and BED individuals are rather scarce. The purpose of this study was to assess the stress responses of patients with similar binge eating behavior but different diagnoses. In order to investigate the capacity of the autonomic nervous system to adapt to stressful conditions, we measured heart rate variability (HRV) and assessed autonomic activity during mental stress testing. We hypothesized that BN and BED patients would show similar disturbances of autonomic stress responses in comparison with non-binge eaters (NBED).
Section snippets
Participants and study protocol
Thirty-eight women agreed to participate. Bulimia nervosa (BN) was diagnosed in 12 participants, binge eating disorder (BED) in 13 and obesity without binge eating behavior (NBED) in 13 participants, according to DSM IV diagnostic criteria (Amercian Psychological Association, 1994). Individuals had to show stabilized electrolyte conditions, unchanged weight levels during the past 10 to 12 weeks and had to undergo a routine physical examination and diagnostic interview conducted by an experienced
Participant characteristics
Participants differed in age and BMI (Table 1). Post hoc tests indicated that the BN group was younger on average than the other two groups. There were also significant BMI differences between the three groups (F(2,37) = 24.24, p = 0.001). The average BMI of patients in the BED and NBED groups were both in the obesity range, (means 37.87 ± 6.42 and 35.99 ± 5.00 kg/m2 respectively), whereas the BN group was in the normal BMI range (23.15 ± 5.61 kg/m2). Differences in the concentration of glucose and plasma
Discussion
We studied autonomic and cardiovascular responses to mental stress in different types of binge eating disorder. We hypothesized that patients with binge eating but different diagnoses (BN versus BED) might have impairments in autonomic adaptation during stress exposure, in comparison with non-binge obese patients. We observed clear-cut cardiovascular activation during stress exposure in all three groups, consistent with previous studies of healthy individuals. Similarly, baroreflex sensitivity
Acknowledgments
We gratefully acknowledge the postdoctoral Fellowship from the Swiss National Science Foundation to N. Messerli-Burgy (PBBE1-117004).
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