Sara McCluskey

Polycystic ovary syndrome and bulimia

One hundred fifty-three patients classified as suffering from polycystic ovarian syndrome (PCOS) and 109 patients who were suffering from a clear organic disorder or endocrinopathy received the bulimia investigation test (Edinburgh) (BITE) questionnaire for abnormal eating behaviors. Patients with PCOS showed a significant increase in their mean BITE score for approximately a third had abnormal eating patterns, and 6% have scores suggestive of clinical bulimia compared with only 1% of women in the group with organic endocrinopathies. The work suggests that women with PCOS should be screened for abnormal eating behaviors and raises the possibility that treatment by psychological means should be considered when abnormal eating behaviors are present.

Polycystic ovarian morphology and bulimia nervosa: a 9-year follow-up study

OBJECTIVE To examine long-term changes in polycystic ovarian morphology in women with polycystic ovaries and bulimia nervosa after treatment of the latter condition. DESIGN Longitudinal follow-up study. SETTING Eating disorder unit of a university hospital. PATIENT(S) Eight women originally treated for bulimia nervosa (T(0)) who underwent ultrasonography up to 2 years after treatment (T(1)) and had a second ultrasonographic scan 9 years later (T(2)). INTERVENTION(S) Treatment of bulimia nervosa that combined cognitive behavioral therapy with insight-orientated psychotherapy. MAIN OUTCOME MEASURE(S) Ovarian morphology evaluated by ultrasonography, using the criteria of Adams to define polycystic ovaries; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of eating disorders. RESULT(S) At T(1), 7 women had recent bulimia and 1 was quiescent. The woman with quiescent disease had normal ovaries. Of the 7 bulimic women, 6 had polycystic ovaries and 1 had multifollicular morphology. At T(2), 5 women were bulimic, all of whom had polycystic ovaries. Three women had normal eating patterns and normal ovarian morphology. CONCLUSION(S) This study clearly shows a strong association between resolution of bulimia and changes in ovarian morphology, suggesting that changes in the former mirror changes in the latter. It also demonstrates normalization of ovarian morphology in previously polycystic ovaries.

Eating Behaviour, Physical Symptoms an Psychological Factors Associated with Weight Reduction Following the Scopinaro Operation as Modified by Gazet

Sixteen morbidly obese patients (12 females, four males) underwent the Scopinaro operation according to Gazet. Profound weight loss occurred, along with marked improvements in eating patterns, mood and psychosocial functioning which were reported retrospectively 1 year and repeated 2 years after surgery. Continued binge eating, comfort eating and ‘eating sensibly/making up in private’ were associated with reduced weight loss, suggesting that a therapeutic cognitive behavioural programme to correct eating problems in association with the Scopinario operation may increase weight loss. Some physical symptoms were related to increased (burping) or decreased (hunger, thirst) intake of food, but the patterns of preoperative symptoms did not predict postoperative physical symptoms or weight loss. Subjects were divided into two subgroups with (n = 8) or without (n = 8) a history of self-damaging and addictive behaviours. The aberrant behaviour subgroup had more disturbed eating patterns preoperatively (higher BITE severity scores) but similar BITE scores postoperatively. Mean BMIs were similar before and after surgery. This suggested that patients with these aberrant behaviours should not be denied surgery. Half of the female patients reported early sexual abuse, and were lighter than the non-abused group. This merits further investigation.

Pre-menarchal bulimia nervosa

Although pre-pubertal anorexia nervosa has been well described, pre-pubertal bulimic behaviour in the context of this disorder appears to be uncommon. There have been no published reports of pre-pubertal bulimia nervosa occurring independently. Of 323 patients with bulimia nervosa attending an eating disorders research clinic between 1980 and 1989, the authors identified six patients who described pre-menarchal binge eating in the absence of a concurrent history of anorexia nervosa or massive obesity. Three (0.93%) of these patients described a pre-menarchal onset of bulimia nervosa, but there was no evidence that they were pre-pubertal. The implications of these findings are discussed.

Pouch Dilatation following Laparoscopic Adjustable Gastric Banding: Psychobehavioral Factors (Can Psychiatrists Predict Pouch Dilatation?)

Background: Laparoscopic adjustable gastric banding is increasingly being performed in morbidly obese individuals for weight loss. Some patients develop pouch dilatation as a postoperative complication that limits the utility of the procedure. Surgical variables are poor predictors of this complication. 5 patients from a series of 157 who underwent LAGB at a single center developed the condition. Methods: Psychiatric and surgical case-notes were analyzed retrospectively for the presence of operationally defined psychiatric disorders and compared to 10 controls from the same population. Results: Cases were significantly more likely to have past or current binge eating, emotionally triggered eating with reduced awareness of the link, a history of affective disorder, reduced sexual functioning and successful preoperative weight loss. No difference between groups was observed for compliance with orlistat, childhood sexual abuse, relationships with parents, history of bulimia nervosa, rate of band inflation or preoperative BMI. Conclusions: Psychological factors may be better predictors of pouch dilatation than biomedical variables. Disordered eating can be an attempt to modulate negative emotions. Pouch dilatation may be a consequence of this eating behavior.

Bulimia nervosa and food allergy: A case report

A case of bulimia nervosa with immunologically documented food allergy is presented; the relationship of the two disorders is briefly discussed, with reference to the recent literature, and comment is made on the implication for clinicians dealing with these patient populations.

Kallmann's syndrome and anorexia nervosa: A diagnostic dilemma

Kallmanns syndrome is a rare cause of primary amenorrhea, with impairment of release of gonadotropin-releasing hormone and anosmia. We present a case in which Kallmanns syndrome had been diagnosed, but who also fulfilled the diagnostic criteria for anorexia nervosa. We discuss the diagnostic dilemma.