Reactivity to 35% carbon dioxide in bulimia nervosa and panic disorder

Psychiatry Res. 2015 Aug 30;228(3):571-5. doi: 10.1016/j.psychres.2015.05.050. Epub 2015 Jun 11.


The inhalation of 35% carbon dioxide (CO₂) induces panic and anxiety in people with panic disorder (PD) and in people with various other psychiatric disorders. The anxiogenic effect of CO₂ in people with eating disorders has received sparse attention despite the fact that PD and bulimia nervosa (BN) have several common psychological and neurobiological features. This study compared CO₂-reactivity across three groups of participants: females with BN, females with PD, and female controls without known risk factors for enhanced CO₂-reactivity (e.g., social anxiety disorder, first degree relatives with PD). Reactivity was measured by self-reported ratings of panic symptomatology and subjective anxiety, analyzed as both continuous variables (change from room-air to CO₂) and dichotomous variables (positive versus negative responses to CO₂). Analyses of each outcome measure demonstrated that CO₂-reactivity was similar across the BN and PD groups, and reactivity within each of these two groups was significantly stronger than that in the control group. This is the first study to demonstrate CO₂-hyperreactivity in individuals with BN, supporting the hypothesis that reactivity to this biological paradigm is not specific to PD. Further research would benefit from examining transdiagnostic mechanisms in CO₂-hyperreactivity, such as anxiety sensitivity, which may account for this study's results.

Keywords: Biological challenge; Bulimia nervosa; Carbon dioxide; Panic disorder.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adolescent
  • Adult
  • Bulimia Nervosa / blood
  • Bulimia Nervosa / chemically induced*
  • Bulimia Nervosa / diagnosis*
  • Carbon Dioxide / administration & dosage*
  • Carbon Dioxide / blood
  • Female
  • Humans
  • Panic Disorder / blood
  • Panic Disorder / chemically induced*
  • Panic Disorder / diagnosis*
  • Phobic Disorders / blood
  • Phobic Disorders / chemically induced
  • Phobic Disorders / diagnosis
  • Risk Factors
  • Young Adult


  • Carbon Dioxide