Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Neuropsychobiology 2012;66:230–236 DOI: 10.1159/000341877 The Acute Salivary Ghrelin Response to a Psychosocial Stress Is Enhanced in Symptomatic Patients with Bulimia Nervosa: A Pilot Study Palmiero Monteleone a, b Alfonso Tortorella b Pasquale Scognamiglio b Ismene Serino c Alessio Maria Monteleone b Mario Maj b a Chair of Psychiatry, Department of Medicine and Surgery, University of Salerno, Salerno, and Departments of b Psychiatry and c Experimental Medicine , University of Naples SUN, Naples, Italy the first study showing deranged salivary ghrelin reactivity to a psychosocial stressor in symptomatic patients with BN. The extent to which this could contribute to the binge-eat- ing behaviour of BN subjects awaits clarification. Copyright © 2012 S. Karger AG, Basel Introduction Bulimia nervosa (BN) is an eating disorder character- ized by episodes of massive food ingestion with associ- ated feelings of loss of control (binge eating), followed by vomiting, prolonged starvation and other compensatory behaviours aiming to reduce energy intake or to increase its expenditure, generally with no pathological change in body weight. Stress is a documented precipitating factor for both binge eating and BN [1–4]. The affect regulation theory of binge eating posits that many individuals binge in re- sponse to stress or negative mood states in an attempt to reduce anxiety and/or negative emotions by increasing feelings of pleasure derived by the ingestion of food or by distracting oneself from one’s problems [5–7]. Alterna- tively, the restraint theory conceptualizes that individu- als who restrict food intake to control their body weight Key Words Bulimia nervosa  Binge eating  Cortisol  Ghrelin  Stress Abstract Background: Stress is a precipitating factor for both binge eating and bulimia nervosa (BN); however, the biological mechanisms through which it may trigger binge eating are poorly understood. There is evidence that the adrenal hor- mone cortisol and the gastric peptide ghrelin might be in- volved in stress-induced food ingestion. We hypothesized that symptomatic patients with BN might disclose deranged responses of ghrelin and/or cortisol to stressors and that this could be related to their binge-eating behaviour. Methods: Here we investigated salivary cortisol and ghrelin responses to the Trier Social Stress Test (TSST) in 10 women with acute BN and 10 age-matched healthy females. Eating-related psy- chopathology and behaviours were assessed by self-report measures. Results: No significant differences emerged be- tween bulimic patients and healthy controls in the pre-stress salivary levels of both cortisol and ghrelin. The BN patients displayed normal cortisol but enhanced ghrelin responses to TSST. No significant correlations emerged between stress- induced salivary hormone changes and self-report mea- sures of binge eating. Conclusion: To our knowledge, this is Received: March 2, 2012 Accepted after revision: July 16, 2012 Published online: October 23, 2012 Palmiero Monteleone, MD Department of Psychiatry, University of Naples SUN Largo Madonna delle Grazie IT–80138 Naples (Italy) Tel. +39 081 566 6517, E-Mail monteri  @  tin.it © 2012 S. Karger AG, Basel 0302–282X/12/0664–0230$38.00/0 Accessible online at: www.karger.com/nps