ALTERATIONS IN SEROTONIN ACTIVITY AND PSYCHIATRIC-SYMPTOMS AFTER RECOVERY FROM BULIMIA-NERVOSA

Background: Women with bulimia nervosa (BN) have disturbances of mood and behavior and alterations of monoamine activity when they are binge ing and purging. It is not known whether these alterations are seconda ry to pathological eating behavior or traits that could contribute to the pathogenesis of BN. Methods: To avoid the confounding effects of p athological eating behavior, we studied 30 women after long-term recov ery (>1 year with no bingeing or purging, normal weight, and regular m enstrual cycles) from BN. Subjects were compared with 31 healthy volun teer women. We assessed psychiatric diagnoses and symptoms to determin e whether there was any persistent disturbance of behavior after recov ery. We measured cerebrospinal fluid (CSF) levels of the major metabol ites of serotonin (5-hydroxyindoleacetic acid [5-HIAA]), dopamine (hom ovanillic acid [HVA]), and norepinephrine (3-methoxy-4-hydroxyphenylgl ycol [MHPG]) as well as hormonal and behavioral response to m-chloroph enylpiperazine (m-CPP), a serotonin-specific agent. Results: Women who were recovered from BN had mild to moderate negative moods and obsess ions with perfectionism and exactness and exaggerated core eating diso rder symptoms compared with healthy volunteer women. Recovered BN wome n had increased levels of CSE 5-HIAA compared with control women (117 +/- 33 vs 73 +/- 15 pmol/mL; P less than or equal to.001) but normal C SF HVA and MHPG concentrations. Recovered BN women had an anxious and disorganized behavioral response to m-CPP but a normal hormonal respon se. Conclusions: Persistent serotonergic and behavioral abnormalities after recovery raise the possibility that these psychobiological alter ations might be trait-related and contribute to the pathogenesis of BN .