Caratteristiche psicopatologiche, comorbidità, livelli di cortisolo e differenti outcomes in pazienti affetti da Disturbi dell'Alimentazione e storia di abuso infantile: studio di follow-up a 3 anni.

INTRODUCTION: After treatment, a large proportion of patients with Anorexia Nervosa (AN) and Bulimia Nervosa (BN) shows only a partial remission of their eating disorder psychopathology, frequent relapses and a persistence of psychiatric comorbidities. The aim of this study was to evaluate the possible role of childhood abuse on long-term outcomes and its relationship with cortisol levels and HPA-axis alteration. METHODS: One hundred thirty-three Eating Disorder (EDs) patients (61 AN, 72 BN) were studied by means of the Structured Clinical Interview for DSM-IV and psychometric tests, at baseline, at the end of individual Cognitive Behavioral Therapy, and three years after the end of treatment. Seventy-two age and gender matched healthy control (HC) were also recruited. Blood samples were drawn in the morning (8 a.m.) after an overnight fast for determination of cortisol levels. All the patients and HC were asked to provide their written informed consent. The study protocol was approved by the Ethics Committee of the Institution. RESULTS: Patients reporting childhood abuse (overall:24.8%; physical abuse:24.1%; sexual abuse:13.5%) showed lower age onset, higher impulsivity, and a greater rate of psychiatric comorbidity than other patients. At follow-up, a full recovery from any Axis I diagnosis was observed in 4 (12.1%) patients with abuse (vs 31 [31%] of the other patients). This different rate was mainly associated with the persistence of unipolar depression in abused patients (77.8% vs 26.7%). Linear mixed models showed a reduction of depressive symptoms in non-abused patients, but not in those reporting abuse. Patients with abuse showed a higher diagnostic cross-over rate (39.4% vs 13.0%), as compared to the other patients. Patients with abuse showed a lower morning cortisol levels at the baseline as compared with other patients and HC with p<0.001 and non-abused patients showed higher cortisol levels respect to HC. At the follow-up non-abused patients showed a significant reduction of morning cortisol levels with p<0.001, while abused patients maintained the lower levels reported at the baseline. Finally, survival analysis showed that patients with abuse had a higher probability of drop-out during treatment. DISCUSSION: Patients with EDs reporting a history of childhood abuse represent a group of persons with more complex psychopathological features, a dysregulation of HPA-axis activity, a different response to treatment and worse long-term outcomes, thus requiring specific treatment strategies.