Self-destructiveness and serotonin function in bulimia nervosa

Studies have linked bulimia nervosa (BN) to alterations in brain serotonin (5-hydroxytryptamine: 5-HT) activity and to heightened propensity for parasuicidality and self-injuriousness. The coincidence of self-destructiveness and 5-HT abnormality in BN is of interest, given documentation (in various populations) of an inverse association between 5-HT activity and potential for self-harm. The present study examined the connection between 5-HT status and self-destructiveness in BN. Structured interviews and self-report questionnaires were used to assess 40 bulimic and 21 normal-eater women for: (a) history of parasuicidal or self-injurious acts; and (b) mood and impulse-regulation problems. We then applied tests, presumed to reflect 5-HT function, of serial prolactin (PRL) and cortisol (CORT) responses after oral administration of the partial 5-HT agonist, meta-chlorophenylpiperazine (m-CPP). Relative to non-bulimic women, bulimic women (on average) showed blunting of PRL and CORT following m-CPP. The blunting of neuroendocrine responses was, however, most remarkable in bulimic women with a history of self-destructiveness. These findings suggest that some serotonergic anomalies reported in BN sufferers (i.e. reduced neuroendocrine response after m-CPP) may be most characteristic of individuals in the population showing clear-cut self-destructive potential.