Association of serotonin and cortisol indices with childhood abuse in bulimia nervosa

Background: Bulimia nervosa (BN) is reported to co-occur with childhood abu se and alterations in central serotonin (5-hydroxytryptamine [5-HT]) and co rtisol mechanisms. However, findings also link childhood abuse to anomalous 5-HT and cortisol function, and this motivated us to explore relationships between childhood abuse and neurobiological variations in BN. Methods: Thirty-five bulimic and 25 nonbulimic women were assessed for chil dhood physical and sexual abuse, eating symptoms, and comorbid psychopathol ogical tendencies. These women provided blood samples for measurement of pl atelet hydrogen-3-paroxetine binding and serial prolactin and cortisol resp onses following oral administration of the partial 5-HT agonist metachlorop henylpiperazine (m-CPP). Results: Bulimic women showed markedly lower mean SD density (B-max) of par oxetine-binding sites (631.12 +/- 341.58) than did normal eaters (1213.00 /- 628.74) (t(54) = -4.47; P = .001). Paroxetine binding did not vary with childhood abuse. In contrast, measures of peak change on prolactin levels a fter m-CPP administration (Delta -peak prolactin) indicated blunted respons e in abused bulimic women (7.26 +/- 7.06), nonabused bulimic women (5.62 +/ - 3.95), and abused women who were normal eaters (5.73 +/- 5.19) compared w ith nonabused women who were normal eaters (13.57 +/- 9.94) (F-3,F-51 = 3.0 4, P = .04). Furthermore, individuals reporting childhood abuse showed decr eased plasma cortisol levels relative to nonabused women who were normal ea ters. Conclusion: Findings imply that BN and childhood abuse are both generally a ssociated with reduced 5-HT tone but that childhood abuse may be somewhat m ore specifically linked to reduced cortisol levels (ie, hypothalamic-pituit ary-adrenal axis) activity.