Childhood Abuse and Platelet Tritiated-Paroxetine Binding in Bulimia Nervosa: Implications of Borderline Personality Disorder
J Clin Psychiatry 2000;61:428-435
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Co-occurrence of bulimia nervosa and
borderline personality disorder has been attributed to shared
factors, including childhood abuse and disturbances in central
serotonin (5-hydroxytryptamine; 5-HT) mechanisms. To explore this
notion, we conducted a controlled assessment of childhood abuse
and 5-HT function in bulimics with and without borderline
Method: Forty patients with bulimia nervosa, confirmed with
the Eating Disorders Examination interview (14 with borderline
personality disorder and 26 without), and 25 normal-eater controls were assessed for clinical symptoms (eating disturbances, mood lability, impulsivity, and dissociation) and childhood sexual and physical abuse. We also conducted tests of platelet tritiated-paroxetine binding in blood samples from 27 of the bulimics (11 with borderline personality disorder and 16 without) and 16 of the controls.
Results: Relative to normal eaters, bulimics
showed greater affective instability, overall impulsivity, and a
history of physical abuse. However, borderline bulimics alone
showed elevated motor impulsivity, dissociation, and rates of
sexual abuse. Paroxetine-binding tests indicated no differences
attributable to comorbid borderline personality disorder, instead
linking bulimia nervosa with or without borderline personality
disorder to substantially reduced 5-HT transporter density.
Conclusion: Results suggest relatively
autonomous pathologic entities: one, relevant to bulimia nervosa,
being associated with abnormal 5-HT transporter function and
affective instability, but relatively independent of childhood
sexual abuse; another, relevant to borderline personality
disorder, onto which sexual abuse, dissociative symptoms, and
behavioral impulsivity converge. We propose that abnormal 5-HT
function may, however, constitute one basis for the frequent
co-occurrence of bulimic and borderline disturbances.