Anger attacks in eating disorders.

As central nervous system serotonergic dysregulation has been postulated to exist in both eating and aggression disorders, we hypothesized that anger attacks would be more common among patients with eating disorders than among control subjects. In addition, we wanted to examine possible relationships between the presence of anger attacks and the type or severity of the eating disorder. Subjects were 39 normal female volunteers and 132 female outpatients with anorexia nervosa, bulimia nervosa, or both. Forty-one (31%) of the patients met criteria for anger attacks compared with four (10%) of the control subjects. Bulimic patients reported the highest prevalence of anger attacks to be associated with greater severity of illness. In addition, patients with eating disorders who have anger attacks had significantly more depressive symptoms than patients without these attacks. Central serotonergic function is involved in such diverse processes as feeding behavior, mood regulation, and anger and aggression. The higher prevalence of anger attacks among patients than among control subjects may reflect central hyposerotonergic function, found in previous studies to be present in both eating disorders and pathologic aggression. Supporting this interpretation is the finding that the prevalence of anger attacks increased, although nonsignificantly, with the severity of bulimia, which has previously been shown to be inversely correlated with central serotonergic activity.