what negative effects have been shown to be associated with stimulant laxatives

• Research article
• Open Access
• Published: 04 Nov 2021

Personality characteristics and medical touch of stimulant laxative abuse in eating disorder patients—a pilot study

• Jodie Benabe³,
• Ashlie Watters^1,2,
• Judy Oakes^1,4 &
• Philip S. Mehler^1,ii,5

Journal of Eating Disorders book 9, Article number:146 (2021) Cite this article

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Abstract

Background

Stimulant laxative abuse as a purging behavior can be profound in those with eating disorders. However, the psychopathology leading to stimulant laxative abuse is poorly understood. Furthermore, the medical impact of stimulant laxative corruption has not been studied in this population.

Methods

Six individuals abusing stimulant laxatives underwent a barium enema to assess for testify of the cathartic colon syndrome and 29 individuals engaging in any purging behaviors completed the Tri-dimensional Personality Questionnaire-Short Form, Sensitivity to Punishment/Sensitivity to Reward Questionnaire-Short Course, Brook Low Inventory, and the Land Trait Feet Inventory questionnaires.

Results

Three of the six patients completing the barium enema had the radiographic findings consequent with cathartic colon. Individuals engaging in laxative corruption showed higher Novelty Seeking compared to those engaging in other forms of purging, and those engaging in whatever form of purging beliefs showed greater Sensitivity to Punishment compared to Sensitivity to Reward. There was as well the presence of greater Impairment Avoidance than Advantage Dependence in this population.

Conclusion

There may be different psychopathology that contributes to the abuse of stimulant laxatives than that associated with other forms of purging. Regardless of the driving gene, farther inquiry is warranted to observe best therapeutic interventions given the potential to develop the cathartic colon syndrome with ongoing use of stimulant laxatives.

Plainly English Summary

Cathartic colon is a condition whereby the colon, or lower intestine, is converted into an inert tube incapable of propagating fecal matter. Information technology is thought to develop due to over-utilise of stimulant laxatives. However, it is unclear if this condition truly exists and whether it contributes to the constipation experienced by individuals with eating disorders who have all-encompassing past histories of abusing laxatives. It is too unclear if laxative abuse presents with different medical complications than other forms of purging. The purpose of this study is to determine whether radiographic evidence of cathartic colon tin can be plant in eating disorder patients abusing stimulant laxatives, whether at that place are different medical complications with laxative corruption versus other forms of purging, and to examine the psychological composition of individuals who engage in severe laxative abuse. Specifically, the authors investigated the interrelationship between Harm Avoidance and Reward Dependence, with emphasis on gaining a better understanding of Reward Dependence by examining both Sensitivity to Reward and Sensitivity to Penalty in patients who engage in severe laxative abuse. Our findings propose that stimulant laxative abuse may cause the development of cathartic colon changes and that there may be unique psychopathology that contributes to the corruption of stimulant laxatives. Given the higher Novelty Seeking personality-dimension in those abusing laxatives, it is possible that this purging behavior may be considered addiction-like in nature, which would have distinct treatment implications.

Background

Cathartic colon, a condition whereby the colon is pathologically transformed into an inert tube incapable of peristalsis, is an entity historically associated with the abuse of stimulant laxatives. It is believed that longer periods of abuse and college doses of stimulant laxatives are associated with greater impairment to the colonic myenteric nerve plexus [1,two,3]; yet, it is believed to be potentially reversible with discontinuation of stimulant laxatives [4]. These patients may complain of severe constipation that is only partially relieved by progressively larger doses of laxatives. Characteristic findings on barium enema include loss of haustral markings, pseudostrictures (smooth tapering contractions that appear, disappear, and reappear in other parts of the colon and are, thus, non true strictures), and colonic dilatation.

Patients with anorexia nervosa, binge-purging subtype (AN-BP), and bulimia nervosa (BN) frequently corruption stimulant laxatives, with some studies citing upwards to 75% of these individuals abusing this grade of medications [5, 6]. Furthermore, it has been reported that some individuals may take up to 50–100 stimulant laxatives daily in endeavour to reach the desired issue [7], and even small-scale degrees of stimulant laxative abuse may increase the incidence of eating disorders [eight]. Fifty-fifty with use of laxatives, these patients will keep to mutter of astringent constipation, and it is unclear if these complaints are due to the physiologic changes of colonic dysmotility that develop with malnutrition, colonic damage due to stimulant laxative corruption, or in relation to the psychologic comorbidities nowadays in those with eating disorders (i.e., functional gastrointestinal symptoms) [7, 9]. In one study, afterward completing six weeks of inpatient therapy, patients reported improvement with most gastrointestinal (GI) symptoms, including bloating, belching, nausea, and diarrhea but did non study significant comeback in complaints of constipation [10], although colonic transit times have been shown to ameliorate with simply several weeks of nutritional rehabilitation [11, 12]. However, show for cathartic colon in this population has never been investigated. It is also uncertain if laxative abuse predisposes to unlike medical complications than other forms of purging.

Research indicates that laxative abuse may be associated with greater psychopathology and an increase in clinical severity amid persons with eating disorders [5, xiii, xiv]. However, information technology is unclear what drives these patients to abuse such large amounts of stimulant laxatives and whether psychological distress contributes to their feelings of constipation. Cloninger [15] originally proposed a biosocial model of personality which stressed three dimensions of temperament: Harm Avoidance (HA), the tendency to react strongly to anxiety- or cloy-provoking stimuli, thereby over-estimating the risk of getting hurt; Reward Dependence (RD), the trend to answer strongly to social rewards in guild to increase the chance of future rewards and/or prevent punishment, likewise as the ability to more than easily form emotional attachments; and Novelty Seeking (NS), the propensity to reply emotionally to novel stimuli, interim with increased excitability and impulsivity [15, 16]. Damage Avoidance and Advantage Dependence tend to be loftier in those with binge-eating and purging behaviors [16,17,18,nineteen], and high Novelty Seeking has besides been establish to be a significant chance cistron for the development of addictions and use of risky behaviors, also as binge-eating and purging behaviors [20,21,22].

Sensitivity to Reward (SR), a dimension characterized by a drive to increment pleasurable experience, and Sensitivity to Punishment (SP), a dimension characterized by a want to avoid negative consequences, are components of Reward Dependence that are thought to represent stable personality traits [23]. Enquiry regarding Sensitivity to Punishment and Sensitivity to Advantage in the eating disorder population has resulted in mixed findings in those engaging in rampage-purge behaviors [vi, 16, 24,25,26], although they have non been specifically examined in people abusing laxatives [sixteen, 25,26,27,28,29].

This written report aims to determine whether the cathartic colon syndrome is found in inpatient adults with severe-to-farthermost AN-BP who corruption stimulant laxatives. Given the complex nature of laxative abuse and the severity of clinical presentation, this study further seeks to understand the personality and emotional features in this population, as well equally any other medical concerns associated with laxative corruption vs other forms of purging. Specifically, this study aims to explore the interrelationship betwixt the dimensions of personality using the Tri-dimensional Personality Questionnaire-Short Grade (Short-TPQ), and the Sensitivity to Penalisation/Sensitivity to Advantage Questionnaire-Brusk Form (SPSRQ-20).

Methods

Participants

There were 29 patients diagnosed with AN-BP, per the DSM-5 [30], who were enrolled in this cross-exclusive written report betwixt February 1, 2019 and February 29, 2020. Eligible patients were screened within the first week of admission and were then grouped based on their purging behaviors. Patients who were purging via colonic evacuation were grouped every bit ANBP-50 (n = 12) and patients who engaged in purging methods other than bowel evacuation, such as emesis or diuretics, were in the ANBP group (due north = 17). Patients who used more viii stimulant laxatives daily for at least 2/3 of a month, for at to the lowest degree 6 months prior to access, were eligible for the barium enema process (northward = 6). Individuals using pills, teas, or enemas containing stimulant laxatives containing the post-obit ingredients, in any formulation, were eligible for participation: bisacodyl, senna, sodium picosulfate, or brush oil. Patients with a known disease of the colon including, simply not express to, ulcerative colitis, Crohn'south disease, and previous colonic surgeries; patients younger than eighteen years of age; and patients with an iodine allergy were excluded.

Once enrolled, patients were asked follow-up questions regarding their laxative use, such as the daily amount taken and length of time of employ. When a patient reported a range of laxative use per twenty-four hours, the average of that range was reported. All participants were asked to consummate questionnaires which measured personality constructs and emotional characteristics. The report was evaluated and approved past the Colorado Multiple Institutional Review Board.

Barium enema

Barium enema is a minimally invasive procedure and is considered the aureate standard for diagnosis of cathartic colon. Barium enema is a fluoroscopic (x-ray) exam of the large intestine that is completed by instilling barium into the colon through a small tube inserted into the rectum. A number of ten-ray pictures are then obtained of the colon. This procedure requires use of laxatives to cleanse the bowel showtime 24 h before the procedure, besides as a limited liquid diet the day before the procedure, per institutional policy.

Personality measures

The Short-TPQ is a 44-item cocky-report questionnaire which measures three college society personality dimensions—Impairment Avoidance, Reward Dependence, and Novelty Seeking [31]. Items are answered as either True/False, with higher dimension scores indicating a greater tendency toward that personality construct. The Curt-TPQ was derived from Version-4 of the Tri-dimensional Personality Questionnaire (TPQ-four) which demonstrates moderate-to-expert internal consistency and adept test–retest reliability [31]. The three personality dimensions of the TPQ-4 each contain lower society subscales, with the exception of the Persistence subscale (RD2), which is not included in the Curt-TPQ. Despite particular parsimony, the Brusk-TPQ contains comparable reliability and validity to the TPQ-4. It was chosen due to concerns regarding item burnout in an acute hospital setting.

The Sensitivity to Punishment/Sensitivity to Reward Questionnaire, Short Form (SPSRQ-xx) is a 20-item self-report questionnaire comprising two 10-item scales, each containing Yes/No questions which measure Sensitivity to Reward and Sensitivity to Punishment, constructs which represent Reward Dependence [32]. College scores suggest greater sensitivity to that construct. The SPSRQ-xx was derived from a 48-item version of the SPSRQ and was found to have improved psychometric properties [33].

Emotional characteristics

The Beck Depression Inventory (BDI) is a 21-item self-report questionnaire which measures different dimensions of low [34]. Items are scored using a 4-betoken Likert scale from 0 to iii. Higher scores point endorsement of greater low severity, with scoring equally follows: 0–9 (no low), 10–18 (mild depression), 19–29 (moderate depression), and xxx and higher up (severe low). The BDI has high internal consistency reliability among psychiatric populations and has been shown to adequately measure depression in persons with eating disorders [35, 36].

The State Trait Feet Inventory (STAI), is a forty-item cocky-report questionnaire containing ii 20-detail scales which measure situational or state anxiety (STAI-S, form Y-1) and general or trait feet (STAI-T, course Y-ii) [37]. Items are scored using a 4-indicate Likert calibration from 0 to three. Higher scale scores betoken endorsement of greater state or trait anxiety severity, with scoring every bit follows for STAI-S: 20–40 (balmy), 41–fifty (moderate), and 50 and above (astringent), and for STAI-T: twenty–40 (mild), 41–52 (moderate), and 52 and to a higher place (astringent).

Statistical analysis

Univariate statistics were used to describe the accomplice. All variables were examined for normal distribution using the Shapiro-Wilks test. Summary statistics are reported equally mean and standard deviation (SD). Paired t-tests were used to compare the scores from the psychological questionnaires between the ANBP-L and ANBP groups. Due to the exploratory nature of this study, no adjustments for comparisons were implemented. Degrees of liberty are shown in parentheses later on the test statistic. Pearson correlations were used to assess correlations between the personality measures. P values < 0.05 were considered statistically meaning, and all analyses were completed using SAS Enterprise Guide software version seven.1 (SAS Institute, Cary, NC).

Results

Participants' characteristics are shown in Table one. The majority of the accomplice was female (97%), mean age was xxx.5 years (SD: 9.eight; range 19–52), and the mean admitting percentage of ideal torso weight (%IBW) was 64.6% (SD: 8.4). The patients in the ANBP-L group self-reported using a median of 30 laxatives per day (IQR: 19–50; range: 8–200). All 17 patients in the ANBP group as well engaged in emesis as a form of purging and none endorsed the use of diuretics. There were no pregnant differences in admission %IBW, historic period, or duration of eating disorder between groups.

Table 1 Demographics of the cohort (N = 29)

Full size table

Effects of laxative abuse

Patients abusing laxatives were less probable to take a metabolic alkalosis compared to those engaging in other forms of purging (p = 0.001). At that place was no statistically pregnant deviation in creatinine, potassium, sodium, or weekly weight gain when comparison those abusing laxatives versus other forms of purging (Tabular array one), although both the ANBP-Fifty and ANBP groups were at risk for decreased renal office on admission as suggested past the college than expected creatinine for torso weight (creatinine 1.two mg/dL and 0.nine mg/dL, respectively).

From the ANBP-Fifty group, at that place were vi patients who underwent the barium enema procedure. Three patients had findings on the barium enema that were consistent with cathartic colon (Table 2). One patient was found to take generalized paucity of haustral markings in the left colon, portions of the transverse colon measured up to 8 cm in diameter (consequent with dilatation), and a prominent redundant transverse and sigmoid colon. Another patient was establish to have meaning redundancy of the entire big bowel with loss of haustral folds primarily near the splenic flexure, and with dilatation of the cecum and proximal ascending colon up to approximately ten.vii cm. A tertiary patient was found to accept shine appearance of the sigmoid with decreased haustra and a prominent bore of the ascending and descending colon measuring upward to 7 cm. A fourth patient was found to have a tortuous colon with normal haustral folds and without dilatation, while the last two patients did not have abnormalities noted on imaging. At that place was no statistical departure in amount of laxative abuse between those diagnosed with cathartic colon and those not meeting criteria for this diagnosis (p = 0.25).

Table 2 Demographics and laxative use of the barium enema accomplice (Due north = 6)

Full size table

Personality and emotional questionnaires

Participants were asked to complete 2 personality assessments and two measures of emotional characteristics. With the exception of the TPQ-Novelty Seeking, at that place were no statistically pregnant differences found between ANBP-50 and ANBP groups on personality and emotional measures, even with inclusion of lower order TPQ scales. The mean score for patients in the ANBP-L group was significantly higher at 6.ix points (SD: 2.9) on TPQ-Novelty Seeking when compared to patients in the ANBP cohort, with a mean score of 4.5 points (SD: 2.4), t(26) = 2.37, p = 0.03 (Table 3).

Tabular array three Differences between the ANBP-L and ANBP groups on the personality and emotional questionnaires

Full size table

When examining the cohort as a whole, the boilerplate Sensitivity to Punishment score was greater at 7.8 points (SD: two.3) compared to the average score for Sensitivity to Reward at 4.half-dozen points (SD:2.1), t(54) = 5.43, p < 0.0001. Additionally, the average Harm Avoidance score was significantly greater at 16.8 points (SD: 4.vii) compared to the average Reward Dependence score at 4.5 points (1.nine), t(54) = 12.6, p < 0.0001 for the entire cohort.

Correlations were examined amongst the college social club TPQ scales (HA, RD, and NS), lower order TPQ subscales, and both SPSRQ scales. For the ANBP-50 cohort, Sensitivity to Penalisation had a pregnant moderate-to-strong negative correlation with TPQ-Novelty Seeking (r = −0.68, p = 0.02). For the ANBP group, TPQ-Harm Avoidance had a significantly strong correlation with Sensitivity to Punishment (r = 0.85, p < 0.0001). TPQ-Harm Avoidance also had a moderate to strong positive correlation with Sensitivity to Advantage (r = 0.56, p = 0.02). In that location was no significant difference between groups on the BDI score. Likewise, the groups did not differ significantly on the STAI.

Discussion

Patients abusing stimulant laxatives were less likely to have a metabolic alkalosis than those engaging in other forms of purging, as would be expected given the increased bicarbonate loss that is seen with excessive stooling. Those abusing laxatives were not at a statistically significant increased chance for reduced renal function compared to the non-laxative purgers, which is likely due to the similar potassium levels between these groups equally potassium seems to be the greatest contributor toward the development of kidney illness in this population [38]. Similar weight proceeds between the ANBP-50 and ANBP groups suggest that laxative abusers do not showroom greater edema formation than those engaging in other forms of purging.

Colonic findings on the barium enema radiographs in this pilot study lend support for the development of cathartic colon in individuals with eating disorders abusing stimulant laxatives, which would as well support the need to abruptly discontinue stimulant laxative use in this population versus a gradual taper. Indeed, three of the six patients were found to take loss of haustra and dilated bowel. Although i could argue that these colonic changes were present prior to the stimulant laxative abuse and were the principal cause of the stimulant laxative use, one written report establish that intestinal dilatation was present in 44.8% of those abusing laxatives and 23.1% of those non using stimulant laxatives, while loss of haustra was noted in 27.6% of those using stimulant laxatives and was absent-minded in those not using stimulant laxatives [39]. Therefore, the findings of loss of haustra in this population, coming together criteria for cathartic colon, advise the radiologic findings developed as a event of the laxative abuse equally opposed to being a contributor toward the laxative use. Besides, although there was no correlation betwixt the extent of stimulant laxative abuse and radiographic findings, it remains very possible that this human relationship would have resulted with a more robust sample size.

The present airplane pilot study also farther sought to elucidate the personality constructs and emotional characteristics of persons with extreme and severe forms of AN-BP. Overall, our results indicate statistically significant differences for the entire cohort (ANBP + ANBP-50) in that TPQ-Impairment Abstention was greater than TPQ-Reward Dependence, reflective of a greater hypersensitivity to danger and inflexibility, and use of an eating disorder as a coping strategy. Sensitivity to Punishment was also significantly greater than Sensitivity to Advantage for the entire cohort, demonstrating a greater emphasis on increased motivation to avoid negative consequences, possibly related to greater reliance on compensatory behaviors to control weight [40].

The primary findings likewise showed that ANBP-L patients scored significantly greater than ANBP counterparts in TPQ-Novelty Seeking. While research indicates that high degrees of Novelty Seeking are associated with bulimic features, this may signal that the ANBP-L was distinct from the entire accomplice of persons with ANBP [41]. As previously mentioned, Novelty Seeking is a construct that is predictive of addiction and risk-taking behavior [22]. A meta-analysis found that high Novelty Seeking in BN does not seem to change even after recovery, though there is some evidence that it may lessen with recovery in mixed-AN groups [17]. Still, this may demonstrate potential connected vulnerability to relapse via this dimension, with some enquiry on patients diagnosed with ANBP indicating that laxative abuse be treated as an habit [42]. Another possibility could be that use of laxatives serve as a means to self-damage. A characteristic feature of AN is an over-evaluation of shape and weight, and it has been noted that laxatives are not an effective strategy for weight loss. Given the already low body weight of our sample, the lack of alternate compensatory behaviors in the ANBP-L cohort, and the significantly greater TPQ-Novelty Seeking for the ANBP-L group, laxatives may serve this office. Indeed, Tozzi et al. discussed laxative abuse as a means of self-penalty and that "the cocky-harm and potentially anxiolytic features should non be overlooked" [43].

None of the TPQ lower club scales showed statistically meaning differences betwixt groups. While disorderliness (NS4) was not statistically pregnant, there might be clinical significance to aid explain the greater TPQ-Novelty Seeking for the ANBP-L accomplice than that for the non-laxative abusers (Table 3). Patients that score high on disorderliness tend to anger more easily when their demands and wants are non chop-chop met, are disorganized, and do not do well with routines or rules [44]. Interestingly, although laxative abuse has been associated with greater impulsivity (NS2) [45, 46], it was non significantly dissimilar betwixt groups. Indeed, impulsivity is a multifaceted construct postulated to involve various components that may crave a number of unlike measures for accurate assessment [47]. Given that the Short-TPQ is best used to test hypotheses at the level of higher social club factors, information technology would take proven beneficial to examine impulsivity via various measures, in addition to the specific types and numbers of impulsive behaviors [47]. Moreover, our sample of patients was distinct due to astringent and extreme depression body weights every bit specified past the DSM-5 [thirty].

Limitations

One limitation of this study is the pocket-sized sample size. These authors hoped to recruit a larger sample of participants; however, due to COVID-nineteen, this study had to exist completed earlier full enrollment was accomplished. In addition, the TPQ-Short was chosen due to concerns nigh subject fatigue. Adaptations of the TPQ (such as the Temperament and Character Inventory [TCI] and its revisions) include additional dimensions of personality not studied hither. Given the small sample size and low trunk weight, it is hard to generalize these results to a larger population of persons with ANBP-Fifty. It is also possible some results did not reach significance due to the small-scale sample size. Furthermore, given that the literature is scant pertaining to personality research on laxative abuse, and non-existent in persons of such low body weight, it can be challenging to empathize our findings in relation to past research.

Future research should include the incorporation of other variables, such as those which measure impulsivity and risk-taking, more comprehensive personality dimensions, and a thorough assessment of ANBP-Fifty eating disorder dynamics. Indeed, given that the Short-TPQ is best used to test hypotheses at the level of higher order factors, information technology would have proven beneficial to examine impulsivity via diverse measures, in addition to the specific types and numbers of impulsive behaviors [47]. Further data collection on this topic should too go on in mind that some research suggests that the number of purging methods may be associated with greater affliction [48]. Boosted research would practice well to aggrandize on measures utilized and to take a longitudinal approach to examine potential differences in constructs both over the form of treatment and in recovered persons. It would likewise be beneficial to investigate whatsoever association betwixt clinical outcomes and severity of laxative corruption, as well as to consider risk factors for laxative abuse in anorexia nervosa while including the use of a control group consisting solely of anorexia nervosa restricting subtype to assess for whatever potential effects of malnutrition alone on the colonic anatomy. The latter expanse might also shed calorie-free on other predisposing considerations for laxative abuse that are distinct amongst eating disorders, such as trauma history, historic period of onset, duration and grade of disease, history of wellness bug, etc.

Conclusion

The findings in this pilot study are suggestive of the development of cathartic colon resulting from the abuse of stimulant laxatives. In add-on, the written report indicates that there may be different psychopathology that contributes to the abuse of stimulant laxatives equally opposed to other forms of purging in those with eating disorders. Given the higher Novelty Seeking personality-dimension in those abusing laxatives, it is possible that this behavior could exist viewed as habit-like in nature in some persons. Given the painful psychological effects and risks associated with laxative abuse, information technology is important for clinicians to explore any potentially promising avenues for intervention.

Availability of information and materials

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Acute:

Astute Center for Eating Disorders at Denver Health

AN:

Anorexia nervosa

ANBP:

Anorexia nervosa, binge-purge subtype, no laxative use

ANBP-L:

Anorexia nervosa, binge-purge subtype, with laxative abuse

BDI:

Beck Depression Inventory

BN:

Bulimia nervosa

DSM-5:

Diagnostic and Statistical Manual of Mental Disorders

HA:

Harm avoidance

HA1:

Anticipatory worry

HA2:

Fear of uncertainty

HA3:

Shyness

N1:

Exploratory excitability

NS:

Novelty seeking

NS2:

Impulsiveness

NS3:

Extravagance

NS4:

Disorderliness

RD:

Reward dependence

RD1:

Sentimentality

RD3:

Attachment

RD4:

Dependency

Short-TPQ:

Tri-dimensional Personality Questionnaire-Curt Grade

SP:

Sensitivity to penalisation

SPSRQ:

Sensitivity to Punishment and Sensitivity to Reward Questionnaire

SR:

Sensitivity to reward

STAI:

Land-Trait Anxiety Inventory

TCI:

Temperament and Character Inventory

TPQ:

Tridimensional Personality Questionnaire

Y-1:

S-Feet calibration

Y-2:

 T-Anxiety Calibration

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Acknowledgements

The authors would like to acknowledge the assistance in study pattern and implementation of the following individuals: Kamila Cass PhD, Alanna Hager PhD, and Kristen Lohse PsyD.

Funding

The nowadays inquiry was internally funded by the Shana Glassman Memorial Endowed Chair in Full general Internal Medicine at Denver Health Infirmary and Authority. The funder had no office in study blueprint, information collection or analysis, decision to publish, or grooming of the manuscript.

Author data

Affiliations

1. ACUTE Center for Eating Disorders at Denver Wellness, 723 Delaware Street, Denver, CO, 80204, Usa

   Dennis Gibson, Ashlie Watters, Judy Oakes & Philip S. Mehler

2. Department of Medicine, University of Colorado Schoolhouse of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, United states

   Dennis Gibson, Ashlie Watters & Philip S. Mehler

3. Department of Psychiatry, Academy of Colorado School of Medicine, 13001 East 17th Pl, Aurora, CO, 80045, U.s.

   Jodie Benabe

4. Department of Medicine, Denver Health Infirmary Authority, 780 Bannock Street, Denver, CO, 80204, USA

   Judy Oakes

5. Eating Recovery Center, 7351 E Lowry Blvd, Denver, CO, 80230, USA

   Philip S. Mehler

Contributions

DG and JB conceptualized the study, interpreted data and were major contributors to writing the manuscript. AW compiled and analyzed the data and was a major contributor to writing the manuscript. JO was a major correspondent in writing the manuscript and in interpreting the results. PM was contributed to writing of the manuscript and offered mentorship. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Dennis Gibson.

Ethics declarations

Ethics approving and consent to participate

This study was reviewed and approved by the Colorado Multiple Institutional Review Board (Protocol # 17-1628). All participants read, understood and signed the consent form.

Consent for publication

Not applicable.

Competing interests

PM reports equity in the Eating Recovery Center-Denver. DG, JB, AW and JO declare that they have no competing interests.

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Gibson, D., Benabe, J., Watters, A. et al. Personality characteristics and medical bear on of stimulant laxative abuse in eating disorder patients—a airplane pilot study. J Eat Disord 9, 146 (2021). https://doi.org/10.1186/s40337-021-00502-9

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• Received: 09 June 2021

• Accepted: 21 October 2021

• Published: 04 November 2021

• DOI : https://doi.org/10.1186/s40337-021-00502-9

Keywords

• Anorexia nervosa rampage-purge
• Laxative
• Barium enema
• Cathartic colon
• Beck Depression Inventory
• Tri-dimensional Personality Questionnaire-Curt Form
• State-Trait Anxiety Inventory
• Sensitivity to Punishment/Sensitivity to Reward Questionnaire-Short Form

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Source: https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-021-00502-9

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