Cindy Schmelkin

OBJECTIVE: Anorexia nervosa (AN), a psychiatric disorder characterized by restriction of food intake despite severe weight loss, is associated with increased comorbid anxiety and depression. Secretion of oxytocin, an appetite-regulating neurohormone with anxiolytic and antidepressant properties, is abnormal in AN. The link between oxytocin levels and psychopathology in AN has not been well explored. METHODS: We performed a cross-sectional study of 79 women aged 18-45 years (19 AN, 26 AN in partial recovery [ANPR], and 34 healthy controls [HC]) investigating the relationship between basal oxytocin levels and disordered eating psychopathology, anxiety, and depressive symptoms. AN diagnoses were based on DSM-5 criteria. Data acquisition took place between December 2008 and March 2014. Fasting serum oxytocin levels were obtained, and the following self-report measures were used to assess psychopathology: Eating Disorder Examination Questionnaire, State-Trait Anxiety Inventory, and Beck Depression Inventory-II. RESULTS: Fasting oxytocin levels were low in ANPR compared to HC (P = .0004). In ANPR but not AN, oxytocin was negatively associated with disordered eating psychopathology (r = -0.39, P = .0496) and anxiety symptoms (state anxiety: r = -0.53, P = .006; trait anxiety: r = -0.49, P = .01). Furthermore, ANPR with significant disordered eating psychopathology, anxiety symptoms, or depressive symptoms had lower oxytocin levels compared to those with minimal or no symptoms (P = .04, .02, and .007, respectively). CONCLUSIONS: We speculate that a dysregulation of oxytocin pathways may contribute to persistent psychopathology after partial weight recovery from anorexia nervosa.

OBJECTIVE: Anorexia nervosa is associated with social-emotional functioning deficits and low levels of the social neurohormone oxytocin, even after weight gain. The relationship between low oxytocin levels and social-emotional functioning impairment has not been studied. METHOD: We performed a cross-sectional study of 79 women (19 who were less than 85% of ideal body weight [IBW] with anorexia nervosa [AN], 26 who were 90-120% IBW with a history of AN [AN-WR], and 34 who were 90-120% IBW with no eating disorder history [H]). We administered the Eating Disorder Examination-Questionnaire (EDE-Q), Leibowitz Social Anxiety Scale-Self Report (LSAS-SR), Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ; suspiciousness and insecure attachment subscales), and the Toronto Alexithymia Scale (TAS-20). We also analyzed fasting serum oxytocin levels. RESULTS: Most measures of social-emotional functioning showed impairment in women with AN and AN-WR compared to H. Oxytocin levels were low in AN-WR compared to H. Across groups, low oxytocin levels were associated with difficulty identifying feelings (r = -.45, p = .008) and overall alexithymia (r = -.34, p = .0489). DISCUSSION: We speculate that low oxytocin levels may contribute to alexithymia in women with anorexia nervosa.

Epithelial proliferations in the fallopian tube have been characterized by some as stem cell outgrowths (SCOUTs) and divided into type I and type II. Type II SCOUTs exhibit diffuse cellular beta-catenin nuclear staining (β-catenin), implying a CTNNB1 mutation. SCOUTs are more common in perimenopausal and postmenopausal women and are associated with ovarian cancer but have not been linked directly to malignancy. We analyzed type II SCOUTs in various gynecologic conditions, and searched for endometrioid atypical hyperplasias (tubal endometrioid intraepithelial neoplasia) or adenocarcinomas in the tube. β-catenin SCOUT frequency in cases of neoplasia was 66.7% per case and 30.7% per nonfimbrial cross-section for uterine endometrioid carcinomas versus 25% and 13.3% for controls, respectively (P=0.02 and 0.09). Multiple (3 or more) β-catenin SCOUTs in a single section were uncommon; 6 of 9 were associated with a carcinoma or proliferative lesion in the endometrium. Tubal endometrioid intraepithelial neoplasia/atypical hyperplasia displayed complex growth, including focal cribriform growth patterns and squamous morules. Two cases of type II SCOUTs associated with tubal endometrioid intraepithelial neoplasia/atypical hyperplasia and/or adenocarcinomas in the fallopian tube were identified, both of which coexisted with a separate endometrioid adenocarcinoma, one with bilateral ovarian endometrioid adenocarcinomas. Both benign and neoplastic tubal lesions were β-catenin. This report is the first to link components of a unique β-catenin endometrioid carcinogenic sequence in the fallopian tube. It further emphasizes the multifocal nature of endometrioid neoplasia in the female genital tract and poses questions regarding the frequency and biologic underpinnings of β-catenin proliferations in the oviduct.

Objective: Anorexia nervosa (AN) is associated with social-emotional functioning deficits; however, whether these deficits are secondary to low weight is unclear. Further, the roles of disease severity and abnormal secretion of the social neurohormone oxytocin in social-emotional functioning impairment have not been fully elucidated.\nMethod: We performed a cross-sectional study of 148 women ages 18-45 [46 AN, 48 AN in partial recovery (ANPR), and 54 healthy controls (HC)] between December 2008 and March 2014. We administered the Eating Disorder Examination – Questionnaire (EDE-Q), Leibowitz Social Adjustment Scale – Self Report (LSAS-SR), Dimensional Assessment of Personality Pathology – Basic Questionnaire (DAPP-BQ) (suspiciousness and insecure attachment subscales), and the Toronto Alexithymia Scale (TAS-20). In a subset of 79 subjects, we analyzed fasting oxytocin levels.\nResults: Social fear, public fear, social avoidance, and difficulty describing feelings were increased in ANPR compared to HC (p≤0.034), but not to the extent of AN (p≤0.0498). Suspiciousness, insecure attachment, difficulty identifying feelings, and overall alexithymia score were also increased in ANPR (p≤0.043) at a level similar to AN. Public avoidance did not differ between ANPR and HC. Current body mass index (BMI), EDE-Q global score, and lowest adult BMI correlated with several measures of social-emotional functioning (p≤0.04). Oxytocin levels were low in ANPR compared to HC (p=0.0004) and negatively associated with difficulty identifying feelings (r=-0.45, p=0.007) and overall alexithymia score (r=-0.35, p=0.04).\nConclusion: We conclude that women with AN in partial recovery have persistently abnormal social-emotional functioning and speculate that oxytocin dysregulation and disease severity are contributors.