Skip to main content

Advertisement

Log in

Psychopathological traits of adolescents with functional hypothalamic amenorrhea: a comparison with anorexia nervosa

  • Original Article
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Background

Functional hypothalamic amenorrhea (FHA) is a form of anovulation, due to the suppression of hypothalamic–pituitary–ovarian axis, not related to identifiable organic causes. Like adolescents with anorexia nervosa (AN), subjects with FHA show dysfunctional attitudes, low self-esteem, depressive mood, anxiety and inability to cope with daily stress. The aim of the study is to examine similarities and differences between FHA and AN in terms of clinical profiles and psychological variables.

Methods

21 adolescents with FHA, 21 adolescents with anorexia nervosa, and 21 healthy adolescents were included in the study. All the teenagers completed a battery of self-administered psychological tests for the detection of behaviors and symptoms attributable to the presence of an eating disorder (EDI-2), depression (CDI), and alexithymia (TAS-20).

Results

Different from healthy controls, subjects with FHA and with AN shared common psychopathological aspects, such as maturity issues, social insecurity and introversion, a tendency to depression, excessive concerns with dieting, and fear of gaining weight. Nevertheless, adolescents with AN presented a more profound psychopathological disorder as observed at test comparisons with subjects with FHA.

Conclusions

Results show a clinical spectrum that includes AN and FHA and suggest the necessity to treat FHA with a multidisciplinary approach for both organic and psychological aspects.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Gordon CM (2010) Clinical practice. Functional hypothalamic amenorrhea. N Engl J Med 363:365–371

    Article  CAS  PubMed  Google Scholar 

  2. Deligeoroglou E, Athanasopoulos N, Tsimaris P et al (2010) Evaluation and management of adolescent amenorrhea. Ann N Y Acad Sci 1205:23–32

    Article  PubMed  Google Scholar 

  3. Liu JH, Bill AH (2008) Stress-associated or functional hypothalamic amenorrhea in the adolescent. Ann NY Acad Sci 1135:179–184

    Article  CAS  PubMed  Google Scholar 

  4. Marcus MD, Loucks TL, Berga SL (2001) Psychological correlates of functional hypothalamic amenorrhea. Fertil Steril 76:310–316

    Article  CAS  PubMed  Google Scholar 

  5. Reifenstein EC Jr (1946) Psychogenic or hypothalamic amenorrhea. Med Clin North Am 30:1103–1115

    PubMed  Google Scholar 

  6. Berga SL (1996) Functional hypothalamic chronic anovulation. In: Adashi EY, Rock JA, Rosenwaks Z (eds) Reproductive endocrinology, surgery and technology, vol. 1. Lippincott-Raven, Philadelphia, pp 1061–1075

  7. Berga SL (1997) Behaviorally induced reproductive compromise in women and men. Semin Reprod Endocrinol 15:47–53

    Article  CAS  PubMed  Google Scholar 

  8. Mecklenburg RS, Loriaux DL, Thompson RH et al (1974) Hypothalamic dysfunction in patients with anorexia nervosa. Medicine (Baltimore) 53:147–159

    Article  CAS  Google Scholar 

  9. Gadpaille WJ, Sanborn CF, Wagner WW Jr (1987) Athletic amenorrhea, major affective disorders, and eating disorders. Am J Psychiatry 144:939–942

    CAS  PubMed  Google Scholar 

  10. Berga SL, Girton LG (1989) The psychoneuroendocrinology of functional hypothalamic amenorrhea. Psychiatr Clin North Am 12:105–116

    CAS  PubMed  Google Scholar 

  11. Laughlin GA, Yen SS (1997) Hypoleptinemia in women athletes: absence of a diurnal rhythm with amenorrhea. J Clin Endocrinol Metab 82:318–321

    Article  CAS  PubMed  Google Scholar 

  12. Warren MP, Voussoughian F, Geer EB et al (1999) Functional hypothalamic amenorrhea: hypoleptinemia and disordered eating. J Clin Endocrinol Metab 84:873–877

    Article  CAS  PubMed  Google Scholar 

  13. Andrico S, Gambera A, Specchia C et al (2002) Leptin in functional hypothalamic amenorrhea. Hum Reprod 17:2043–2048

    Article  CAS  PubMed  Google Scholar 

  14. Berga SL, Mortola JF, Girton L et al (1989) Neuroendocrine aberrations in women with functional hypothalamic amenorrhea. J Clin Endocrinol Metab 68:301–308

    Article  CAS  PubMed  Google Scholar 

  15. Biller BM, Federoff HJ, Koenig JI et al (1990) Abnormal cortisol secretion and responses to corticotropin-releasing hormone in women with hypothalamic amenorrhea. J Clin Endocrinol Metab 70:311–317

    Article  CAS  PubMed  Google Scholar 

  16. Berga SL, Daniels TL (1997) Women with functional hypothalamic amenorrhea but not other forms of anovulation display amplified cortisol concentrations. Fertil Steril 67:1024–1030

    Article  CAS  PubMed  Google Scholar 

  17. Berga SL, Loucks AB, Rossmanith WG et al (1991) Acceleration of luteinizing hormone pulse frequency in functional hypothalamic amenorrhea by dopaminergic blockade. J Clin Endocrinol Metab 72:151–156

    Article  CAS  PubMed  Google Scholar 

  18. Berga SL, Mortola JF, Yen SS (1988) Amplification of nocturnal melatonin secretion in women with functional hypothalamic amenorrhea. J Clin Endocrinol Metab 66:242–244

    Article  CAS  PubMed  Google Scholar 

  19. Laughlin GA, Dominguez CE, Yen SS (1998) Nutritional and endocrine-metabolic aberrations in women with functional hypothalamic amenorrhea. J Clin Endocrinol Metab 83:25–32

    CAS  PubMed  Google Scholar 

  20. Russell GF (1972) Premenstrual tension and “psychogenic” amenorrhoea: psycho-physical interactions. J Psychosom Res 16:279–287

    Article  CAS  PubMed  Google Scholar 

  21. Giles DE, Berga SL (1993) Cognitive and psychiatric correlates of functional hypothalamic amenorrhea: a controlled comparison. Fertil Steril 60:486–492

    CAS  PubMed  Google Scholar 

  22. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders (DSM IV, 4th edn.). American Psychiatric Association, Washington, DC

  23. Muñoz MT, Argente J (2002) Anorexia nervosa in female adolescents: endocrine and bone mineral density disturbances. Eur J Endocrinol 147:275–286

    Article  PubMed  Google Scholar 

  24. Lanfranco F, Gianotti L, Destefanis S et al (2003) Endocrine abnormalities in anorexia nervosa. Minerva Endocrinol 28:169–180

    CAS  PubMed  Google Scholar 

  25. Jacoangeli F, Masala S, Staar Mezzasalma F et al (2006) Amenorrhea after weight recover in anorexia nervosa: role of body composition and endocrine abnormalities. Eat Weight Disord 11:e20–e26

    Article  CAS  PubMed  Google Scholar 

  26. Austin SB, Ziyadeh NJ, Vohra S et al (2008) Irregular menses linked to vomiting in a nonclinical sample: findings from the National Eating Disorders Screening Program in high schools. J Adolesc Health 42:450–457

    Article  PubMed Central  PubMed  Google Scholar 

  27. Katzman DK (2008) Irregular menses: a warning sign of vomiting for weight control. J Adolesc Health 42:429–431

    Article  PubMed  Google Scholar 

  28. Eddy KT, Le Grange D, Crosby RD et al (2010) Diagnostic classification of eating disorders in children and adolescents: how does DSM-IV-TR compare to empirically-derived categories? J Am Acad Child Adolesc Psychiatry 49:277–287

    PubMed Central  PubMed  Google Scholar 

  29. American Psychiatric Association. Highlights of changes from DSM-IV-TR to DSM-V. American Psychatric Publishing 2013; 1-19

  30. Schneider LF, Monaco SE, Warren MP (2008) Elevated ghrelin level in women of normal weight with amenorrhea is related to disordered eating. Fertil Steril 90:121–128

    Article  CAS  PubMed  Google Scholar 

  31. Nappi RE, Facchinetti F (2003) Psychoneuroendocrine correlates of secondary amenorrhea. Arch Womens Ment Health 6(2):83–89

    Article  CAS  PubMed  Google Scholar 

  32. Michopoulos V, Mancini F, Loucks TL et al (2013) Neuroendocrine recovery initiated by cognitive behavioral therapy in women with functional hypothalamic amenorrhea: a randomized, controlled trial. Fertil Steril 99:2084–2091

    Article  CAS  PubMed  Google Scholar 

  33. Bomba M, Gambera A, Bonini L et al (2007) Endocrine profiles and neuropsychological correlates of functional hypothalamic amenorrhea in adolescents. Fertil Steril 87:876–885

    Article  CAS  PubMed  Google Scholar 

  34. Smink FR, van Hoeken D, Hoek HW (2012) Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 14:406–414

    Article  PubMed Central  PubMed  Google Scholar 

  35. Stice E, Marti CN, Shaw H et al (2009) An 8-year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents. J Abnorm Psychol 118:587–597

    Article  PubMed Central  PubMed  Google Scholar 

  36. Bulik CM, Hebebrand J, Keski-Rahkonen A et al (2007) Genetic epidemiology, endophenotypes, and eating disorder classification. Int J Eat Disord 40(Suppl):S52–S60

    Article  PubMed  Google Scholar 

  37. Kovacs M (1987) CDI—children depression inventory Manuale. Organizzazioni speciali Firenze, Firenze

  38. Garner DM, Olmstead MP, Polivy J (1983) Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eat Disord 2:15–34

    Article  Google Scholar 

  39. Bagby RM, Parker JDA, Taylor GJ. The twenty-item Toronto Alexithymia Scale-I. Item selection and cross-validation of the factor structure. J Psychos Research 1994; 38: 23-32

    Google Scholar 

  40. Bagby RM, Taylor GJ, Parker JDA (1994) The twenty-item Toronto Alexithymia Scale: II. Convergent, discriminant, and concurrent validity. J Psychos Res 38:33–40

    Google Scholar 

  41. Meaney MJ (2001) Maternal care, gene expression, and the transmission of individual differences in stress reactivity across generations. Annu Rev Neurosci 24:1161–1192

    Article  CAS  PubMed  Google Scholar 

  42. Moles A, Rizzi R, D’Amato FR (2004) Postnatal stress in mice: does “stressing” the mother have the same effect as “stressing” the pups? Dev Psychobiol 44:230–237

    Article  CAS  PubMed  Google Scholar 

  43. Diego MA, Field T, Hernandez-Reif M et al (2004) Prepartum, postpartum and chronic depression effects on newborns. Psychiatry 67:63–80

    PubMed  Google Scholar 

  44. Koob GF, Heinrichs SC, Pich EM et al (1993) The role of corticotropin-releasing factor in behavioural responses to stress. Ciba Found Symp 172:277–289

    CAS  PubMed  Google Scholar 

  45. Nemeroff CB (1996) The corticotropin-releasing factor (CRF) hypothesis of depression: new findings and new directions. Mol Psychiatr 1:336–342

    CAS  Google Scholar 

  46. Ball K, Lee C (2000) Relationship between psychological stress, coping and disordered eating: a review. Psychol Health 14:1007–1035

    Article  CAS  PubMed  Google Scholar 

  47. Gatti B (1989) L’anoressia Mentale. In Semi AA (ed) Trattato di psicoanalisi. Raffaello Cortina ed., Milano, pp 579–617

  48. Bomba M et al Heart rate variability in adolescents with functional hypothalamic amenorrhea and anorexia nervosa (submitted paper)

  49. Kanakam N, Raoult C, Collier D et al (2012) Set shifting and central coherence as neurocognitive endophenotypes in eating disorders: a preliminary investigation in twins. World J Biol Psychiatry [Epub ahead of print]

  50. Kanakam N, Krug I, Raoult C et al (2013) Social and emotional processing as a behavioural endophenotype in eating disorders: a pilot investigation in twins. Eur Eat Disord Rev 21:294–307

    Article  PubMed  Google Scholar 

  51. Lachowsky M, Winaver D (2007) Psychogenic amenorrhea. Gynecol Obstet Fertil 35:45–48

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Monica Bomba.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bomba, M., Corbetta, F., Bonini, L. et al. Psychopathological traits of adolescents with functional hypothalamic amenorrhea: a comparison with anorexia nervosa. Eat Weight Disord 19, 41–48 (2014). https://doi.org/10.1007/s40519-013-0056-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-013-0056-5

Keywords

Navigation