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Amianto F, Arletti L, Vesco S, Davico C, Vitiello B. Therapeutic outcome and long-term naturalistic follow-up of female adolescent outpatients with AN: clinical, personality and psychopathology evolution, process indicators and outcome predictors. BMC Psychiatry 2023; 23:366. [PMID: 37231436 PMCID: PMC10210459 DOI: 10.1186/s12888-023-04855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious mental illness of growing prevalence in childhood and adolescence. Despite its severity, there are still no completely satisfactory evidence-based treatments. Follow-up studies represent the most effective attempt to enlighten treatment effectiveness, outcome predictors and process indicators. METHODS Seventy-three female participants affected with AN were assessed at intake (T0) and at 6 (T1) and 12 (T2) months of an outpatient multimodal treatment program. Nineteen participants were assessed 15 years after discharge (T3). Changes in diagnostic criteria were compared with the chi-square test. Clinical, personality and psychopathology evolution were tested with ANOVA for repeated measures, using the t-test or Wilcoxon test as post-hoc. T0 features among dropout, stable and healed participants were compared. Healed and unhealed groups at long-term follow-up were compared using Mann-Whitney U test. Treatment changes were correlated to each other and with intake features using multivariate regression. RESULTS The rate of complete remission was 64.4% at T2, and 73.7% at T3. 22% of participants maintained a full diagnosis at T2, and only 15.8% at T3. BMI significantly increased at each time-point. A significant decrease of persistence and increase in self-directedness were evidenced between T0 and T2. Interoceptive awareness, drive to thinness, impulsivity, parent-rated, and adolescent-rated general psychopathology significantly decreased after treatment. Lower reward dependence and lower cooperativeness characterized the dropout group. The healed group displayed lower adolescent-rated aggressive and externalizing symptoms, and lower parent-rated delinquent behaviors. BMI, personality and psychopathology changes were related with each other and with BMI, personality and psychopathology at intake. CONCLUSION A 12-months outpatient multimodal treatment encompassing psychiatric, nutritional and psychological approaches is an effective approach for the treatment of mild to moderate AN in adolescence. Treatment was associated not only with increased BMI but also with positive personality development, and changes in both eating and general psychopathology. Lower relational abilities may be an obstacle to healing. Approaches to treatment resistance should be personalized according to these finding.
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Affiliation(s)
- Federico Amianto
- Department of Neuroscience, Section of Child and Adolescent Neuropsychiatry, University of Turin, Via Cherasco, 15 - 10126, Turin, Italy.
| | - Luca Arletti
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
| | - Serena Vesco
- Department of Pathology and Care of the Children, Regina Margherita Hospital, Turin, Italy
| | - Chiara Davico
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
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Eielsen HP, Vrabel K, Hoffart A, Rø Ø, Rosenvinge JH. Reciprocal relationships between personality disorders and eating disorders in a prospective 17-year follow-up study. Int J Eat Disord 2022; 55:1753-1764. [PMID: 36214278 PMCID: PMC10092669 DOI: 10.1002/eat.23823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aimed to report the presence of categorical and dimensional personality disorders (PD) in adults with longstanding eating disorders (ED) over a period of 17 years and to investigate whether changes in PD predict changes in ED symptoms or vice versa. METHODS In total, 62 of the 80 living patients (78% response rate) with anorexia nervosa (n = 23), bulimia nervosa (n = 25), or other specified feeding or ED (n = 14) at baseline were evaluated during hospital treatment and at 1-year, 2-year, 5-year, and 17-year follow-up. PD were assessed using the Structured Clinical Interview for DSM-IV Axis II disorders, and the eating disorder examination (EDE) interview was used to assess ED. Data were analyzed using multilevel modeling. RESULTS From baseline to the 17-year follow-up, the number of patients with any PD decreased significantly from 74.2% to 24.2%, and the total number of PD diagnoses declined from 80 to 22. Mean EDE score was significantly reduced from 4.2 (SD: 1.1) to 2.0 (SD: 1.6). There was a positive association between ED and PD where the initial level of either disorder was followed by similar levels of the other disorder throughout the entire follow-up period. High baseline levels of borderline PD predicted less decrease in ED symptoms. No significant within-person effects were found. CONCLUSIONS Both ED and PD significantly declined over time. As the severity of either disorder seems to be associated with the other, thorough assessment and treatment that incorporates both the ED psychopathology and the personality disturbances are advisable. PUBLIC SIGNIFICANCE STATEMENT While personality disorders were highly prevalent in the sample of patients with longstanding eating disorders, both disorders were significantly reduced at the 17-year follow-up. The disorders are related in the sense that an initial high level of either disorder is associated with a high level of the other over time. A thorough assessment and attention to both illnesses are advisable in therapy. CLINICAL TRIAL IDENTIFIER NCT03968705.
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Affiliation(s)
- Hanna Punsvik Eielsen
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - KariAnne Vrabel
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Asle Hoffart
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Øyvind Rø
- Division of Mental Health and Addiction, Regional Department for Eating Disorders, Oslo University Hospital, Oslo, Norway.,Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jan H Rosenvinge
- Department of Psychology, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
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Isaksson M, Ghaderi A, Wolf-Arehult M, Ramklint M. Overcontrolled, undercontrolled, and resilient personality styles among patients with eating disorders. J Eat Disord 2021; 9:47. [PMID: 33863394 PMCID: PMC8052746 DOI: 10.1186/s40337-021-00400-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/26/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Personality has been suggested to be an important factor in understanding onset, maintenance, and recovery from eating disorders (ED). The objective of the current study was to evaluate personality style in different ED diagnostic groups as classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5). METHODS The overcontrolled, undercontrolled, and resilient personality styles were compared in four groups of patients with EDs: anorexia nervosa restricting (ANr) (n = 34), anorexia nervosa binge eating/purging (ANbp) (n = 31), atypical anorexia nervosa (AAN) (n = 29), and bulimia nervosa (BN) (n = 76). These groups were compared with a group of patients with borderline personality disorder (BPD) (n = 108), and a non-clinical group (NC) (n = 444). Patient data were collected at two outpatient clinics in Uppsala, Sweden. NC control data were collected through convenience sampling. Participants filled out questionnaires assessing personality style. RESULTS The main findings were more pronounced overcontrol reported by the ANr and AAN groups compared with the BN, BPD, and NC groups, and no significant difference in resilience between the ED and the NC groups. Considerable variability of over- and undercontrol was also found within each group. CONCLUSIONS The results replicate previous findings when EDs are classified according to current diagnostic criteria (DSM-5). Taking personality styles into account may improve our understanding of certain characteristics in EDs, such as social deficits and rigidity that are attributed to poor treatment outcome.
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Affiliation(s)
- Martina Isaksson
- Department of Neuroscience, Psychiatry, Uppsala University, Entrance 10, Floor 3B, SE-751 85, Uppsala, Sweden.
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Stockholm Centre for Eating Disorders, Stockholm Health Care Services, Stockholm County Council, SE-171 77, Stockholm, Sweden
| | - Martina Wolf-Arehult
- Department of Neuroscience, Psychiatry, Uppsala University, Entrance 10, Floor 3B, SE-751 85, Uppsala, Sweden.,Psychiatry Northwest, Region Stockholm, Clinical Management, PO Box 98, SE-191 22, Sollentuna, Sweden
| | - Mia Ramklint
- Department of Neuroscience, Psychiatry, Uppsala University, Entrance 10, Floor 3B, SE-751 85, Uppsala, Sweden
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Naturalistic follow-up of subjects affected with anorexia nervosa 8 years after multimodal treatment: Personality and psychopathology changes and predictors of outcome. Eur Psychiatry 2020; 45:198-206. [DOI: 10.1016/j.eurpsy.2017.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 11/19/2022] Open
Abstract
AbstractBackground:Eating disorders (EDs) are serious mental illnesses of growing clinical and social impact. Despite their severity, there is still no satisfactory evidence-based treatment. Follow-up investigations are the most reliable studies to enlighten long-term outcome predictors and modifiers.Methods:In total, 59 subjects affected with anorexia nervosa were assessed 8 years after their admission into an outpatient multimodal treatment program for eating disorders. The follow-up changes in diagnostic criteria were compared with Chi-square test. Improved and not-improved subjects were compared. Clinical, personality and psychopathology features between T0 and T1 were compared with t-test for repeated measures. Correlation between T0 features and changes at T1 in personality and psychopathology features were assessed.Results:The rate of complete remission was 42%, an overall rate of 67.8% improved, a rate of 18.6% worsened. Concerning personality, a significant decrease of harm avoidance and increase in self-directedness were evidenced. Interoceptive awareness, drive for thinness, bulimia were significantly reduced at follow-up. Many T0 personality facets were related to personality and psychopathology improvement at follow-up.Conclusion:Multimodal treatment encompassing psychiatric, nutritional and psychological approaches is at the moment the most reliable approach for the treatment of moderate to severe anorexia nervosa with a discrete rate of improvement. Some personality and psychopathology characteristics may represent specific factors which favor resistance and impair improvement. Future approaches should consider the personalization of therapeutic approach according to these features.
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Dufresne L, Bussières EL, Bédard A, Gingras N, Blanchette-Sarrasin A, Bégin PhD C. Personality traits in adolescents with eating disorder: A meta-analytic review. Int J Eat Disord 2020; 53:157-173. [PMID: 31633223 DOI: 10.1002/eat.23183] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 09/12/2019] [Accepted: 09/17/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Given the growing interest in personality traits among the young population with eating disorders (EDs) and the recognition that a better understanding of personality can facilitate clinical management, this meta-analytic study reviewed evidence concerning the relationship between personality traits and the presence of an ED during adolescence. METHOD We conducted a systematic literature search to identify studies that examined personality traits among adolescents with an ED (anorexia nervosa, bulimia nervosa, binge-eating disorder, eating disorder not otherwise specified) and that compared these traits with a normative group without an ED. The personality traits investigated in the selected studies were organized according to the personality trait domains presented in the Diagnostic and Statistical Manual of Mental Disorders (fifth ed.). Effect sizes of the mean differences were calculated for each domain. We performed meta-regressions to assess the moderating effect of ED subtype and age on the combined effect sizes. RESULTS Twenty-six studies met our inclusion criteria, containing a total of 63 effect sizes. Adolescents with EDs differed from the non-ED group according to traits related to negative affectivity (g = 0.78), detachment (g = 0.69), and conscientiousness (g = -0.53). The presence of an anorexia nervosa diagnosis moderated the relationship between an ED and personality traits; this diagnosis was more strongly associated with conscientious traits compared to other EDs. DISCUSSION Our findings provide evidence that personality traits are related to EDs in adolescents. Thus, considering personality traits could lead to a better understanding of etiological and maintenance factors for EDs.
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Affiliation(s)
- Laurie Dufresne
- School of Psychology, Laval University, Québec, Québec, Canada
| | - Eve-Line Bussières
- Department of Psychology, University of Quebec at Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Alexandra Bédard
- Faculty of Agricultural and Food Sciences, Institute of Nutrition and Functional Food, Laval University, Québec, Québec, Canada
| | - Nathalie Gingras
- Department of Psychiatry, Laval University, Québec, Québec, Canada
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Abstract
Personality variables have long been implicated in the onset and maintenance of eating disorders, as well as in symptom divergence between anorexia nervosa and bulimia nervosa. Clinical observations are broadly supported by the data, with restricting anorexia nervosa associated with higher levels of constraint and Persistence, and binge-purge behaviors linked to the tendency to take impulsive action when emotionally distressed. Considerable heterogeneity is found within diagnostic categories, however, suggesting that different personality structures may predispose individuals to develop disordered eating through alternative pathways.
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Affiliation(s)
- Allison F Wagner
- Department of Psychology, University of Hawai'i at Mānoa, 2530 Dole Street, Sakamaki C400, Honolulu, HI 96826, USA.
| | - Kelly M Vitousek
- Department of Psychology, University of Hawai'i at Mānoa, 2530 Dole Street, Sakamaki C400, Honolulu, HI 96826, USA
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7
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Cheney AM, Sullivan S, Grubbs K. The Morality of Disordered Eating and Recovery in Southern Italy. Med Anthropol Q 2018; 32:443-457. [PMID: 29356066 DOI: 10.1111/maq.12429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 11/06/2017] [Accepted: 11/13/2017] [Indexed: 11/29/2022]
Abstract
Scholars have traced the processes through which moral subjectivities are constituted in culturally meaningful ways through eating disorders and recovery practices, demonstrating how subjective meanings of eating disorders and recovery from them are imbued with moral undertones and become meaningful ways of existing within specific historical and cultural contexts. Drawing on ethnographic insights and interviews with young women with disordered eating histories in southern Italy, we show how suffering from eating disorders and recovery from them enables women to retool their identities and craft moral selves. We draw attention to the value of medical anthropology in the care and comprehension of well-being of girls and women suffering from disordered eating.
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Affiliation(s)
- Ann M Cheney
- Department of Social Medicine and Population Health, University of California, Riverside
| | - Steve Sullivan
- South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System
| | - Kathleen Grubbs
- Department of Psychiatry, University of California, San Diego
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8
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Mulkerrin Ú, Bamford B, Serpell L. How well does Anorexia Nervosa fit with personal values? An exploratory study. J Eat Disord 2016; 4:20. [PMID: 27437100 PMCID: PMC4950713 DOI: 10.1186/s40337-016-0109-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 07/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite an increasing clinical interest in the use of personal values as a motivational tool in psychological therapies for Anorexia Nervosa (AN), research is limited. This study explored personal values among individuals with AN, with a particular focus on the 'fit' between participants' values and their AN. METHODS A qualitative research design was employed in this study. In-depth, semi-structured interviews were carried out among eight female outpatients and inpatients with a diagnosis of AN or Eating Disorder Not Otherwise Specified - AN type (EDNOS-AN type). Data was analysed using Interpretative Phenomenological Analysis (IPA; Smith, Jarman & Osborne, 1999). RESULTS Three super-ordinate themes emerged from analysis: 'Balancing Values' (difficulty finding balance in relating to and acting on values), 'Congruence and Clashes between AN and Values' (experiences of AN representing a mixed-fit with values) and 'From Ambivalence to Motivation' (ambivalence toward both AN and recovery - in the context of its mixed-fit with values - and experiences of values as a motivational tool in recovery). CONCLUSIONS Study findings support a role for psychological therapies in working with personal values as a means of promoting recovery in AN, through supporting individuals to explore AN's workability in the context of their values. Further research investigating the optimal stage of treatment to work with values as a motivational tool is warranted.
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Affiliation(s)
- Úna Mulkerrin
- />Present address: Dublin Adult and Child Therapy Centre, 11 Sandyford Office Park, Blackthorn Avenue, Sandyford, Dublin 18 Republic of Ireland
| | - Bryony Bamford
- />The London Centre for Eating Disorders and Body Image, Hanover Square, London, W1S1HT UK
| | - Lucy Serpell
- />Research Department of Clinical, Educational and Health Psychology (Torrington Place Site), University College London, Gower Street, London, WC1E 6BT UK
- />Eating Disorder Service, North East London NHS Foundation Trust (NELFT), Porters Avenue Health Centre, 234 Porters Ave, Dagenham, RM8 2EQ UK
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9
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Farstad SM, McGeown LM, von Ranson KM. Eating disorders and personality, 2004–2016: A systematic review and meta-analysis. Clin Psychol Rev 2016. [DOI: 10.1016/j.cpr.2016.04.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Peterson CB, Pisetsky EM, Swanson SA, Crosby RD, Mitchell JE, Wonderlich SA, Le Grange D, Hill L, Powers P, Crow SJ. Examining the utility of narrowing anorexia nervosa subtypes for adults. Compr Psychiatry 2016; 67:54-8. [PMID: 27095335 PMCID: PMC5604313 DOI: 10.1016/j.comppsych.2016.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 02/14/2016] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The purpose of this investigation was to examine whether narrowing the criteria of anorexia nervosa (AN) subtypes among adults based on further delineations of current binge eating and purging (i.e., binge eating only, purging only, binge eating and purging, and restricting only) improves the potential clinical utility of the current DSM-5 system that specifies two types (i.e., current binge eating and/or purging and restricting, specified as the absence of current binge eating and/or purging). METHOD Self-reported eating disorder and psychiatric symptoms based on the Eating Disorder Questionnaire were examined in 347 adults from a multisite clinical sample who met DSM-IV criteria for AN. Classification based on binge eating and purging symptoms yielded the following subtypes: 118 restricting only (AN-R; no current binge eating or purging); 133 binge eating and purging (AN-B & P; current binge eating and purging); 43 binge eating only (AN-B; current binge eating and no current purging); and 53 purging only (AN-P; current purging and no current binge eating). RESULTS The AN-R group had lower current body mass index compared to AN-B & P and AN-P with no group differences in highest, lowest, or desired body mass index. The probability of amenorrhea was higher for the AN-R and AN-B & P groups than the AN-P group. The probability of diet pill use was elevated for the AN-B & P and AN-P groups compared to the AN-R group. The AN-P group also had a higher probability of fasting than the AN-R group. The probability of substance use including tobacco was lower in the AN-R group than the other three groups. No group differences were found on measures of hospitalization, body image, physical symptoms, exercise, or dieting behaviors. CONCLUSIONS These findings do not support the validity or clinical utility of classifying AN into narrower subtypes based on current binge eating, purging, and binge eating with purging given that few differences were found among groups who reported any combination of current binge eating and purging. Future research is needed to replicate these findings and to further examine the AN subtype classification schemes.
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Affiliation(s)
- Carol B. Peterson
- University of Minnesota, Department of Psychiatry, Minneapolis, MN, 55454, USA,The Emily Program, St. Paul, MN, 55108, USA,Corresponding author at: Department of Psychiatry, University of Minnesota Medical School, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN, 55454, USA. Tel.: +1 612 273 9811
| | - Emily M. Pisetsky
- University of Minnesota, Department of Psychiatry, Minneapolis, MN, 55454, USA
| | - Sonja A. Swanson
- Erasmus Medical Center, Department of Epidemiology, Rotterdam, the Netherlands
| | - Ross D. Crosby
- University of North Dakota School of Medicine and Health Sciences, Fargo, ND, 58102, USA,Neuropsychiatric Research Institute, Fargo, ND, 58103, USA
| | - James E. Mitchell
- University of North Dakota School of Medicine and Health Sciences, Fargo, ND, 58102, USA,Neuropsychiatric Research Institute, Fargo, ND, 58103, USA
| | - Stephen A. Wonderlich
- University of North Dakota School of Medicine and Health Sciences, Fargo, ND, 58102, USA,Neuropsychiatric Research Institute, Fargo, ND, 58103, USA
| | - Daniel Le Grange
- University of California, San Francisco, San Francisco, CA, 94113, USA.
| | - Laura Hill
- The Center for Balanced Living, Columbus, OH, 43235, USA.
| | | | - Scott J. Crow
- University of Minnesota, Department of Psychiatry, Minneapolis, MN, 55454, USA,The Emily Program, St. Paul, MN, 55108, USA
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Reas DL, Rø Ø, Karterud S, Hummelen B, Pedersen G. Eating disorders in a large clinical sample of men and women with personality disorders. Int J Eat Disord 2013; 46:801-9. [PMID: 23983043 DOI: 10.1002/eat.22176] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We assessed and compared the prevalence of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS) across six Axis II groups (borderline, obsessive-compulsive, avoidant, dependent, paranoid, and personality disorder NOS) and patients with major depressive disorder (MDD) without personality disorders (PD). METHOD The sample included 3,266 consecutive and first admissions to 16 different treatment units in the Norwegian Network of Psychotherapeutic Day Hospitals between 1993 and 2009. All patients were interviewed with the SCID-II for DSM-III-R (prior to 1996) or DSM-IV (from 1996) and the MINI for Axis I disorders in accordance with the LEAD (longitudinal, expert, all-data) standard. RESULTS The prevalence of any ED in the PD sample was approximately 17% for women and 3% for men. A lower rate of ED (5%) was found for patients with MDD without PD. A significantly higher proportion of patients with borderline personality disorder were diagnosed with BN or EDNOS. The rate of AN was significantly elevated in female patients with obsessive-compulsive personality disorder. Men demonstrated significantly less diagnostic co-occurrence and no significant differential variation across PD groups or MDD. DISCUSSION Data which included a psychiatric comparison group showed less co-occurrence and non-significant variation across PD groups for men, but demonstrated a meaningful and specific pattern of comorbidity between ED and PD for women. There was an elevated risk of ED among female patients with PD, most pronounced for borderline. An almost five-fold higher rate of AN was found among women with obsessive-compulsive PD.
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Affiliation(s)
- Deborah L Reas
- Regional Eating Disorders Service, Division of Mental Health and Addiction, Oslo University Hospital, Norway
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12
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Segura-García C, Chiodo D, Sinopoli F, De Fazio P. Temperamental factors predict long-term modifications of eating disorders after treatment. BMC Psychiatry 2013; 13:288. [PMID: 24200241 PMCID: PMC3833841 DOI: 10.1186/1471-244x-13-288] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 07/31/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating Disorders (EDs) are complex psychiatric pathologies characterized by moderate to poor response to treatment. Criteria of remission and recovery are not yet well defined. Simultaneously, personality plays a key role among the factors that determine treatment outcome. The aim of the present research is to evaluate the possibility of temperamental and character traits to predict the long-term outcome of ED. METHOD A sample of 25 AN and 28 BN female patients were re-assessed face-to-face after a minimum 5-years-follow-up through SCID-I, EDI-2 and TCI-R. Regression Analyses were performed to ascertain the possibility of TCI-R dimensions at the first visit to predict the long-term outcome. RESULTS Clinical and psychopathological symptoms significantly decreased over the time and 23% of participants no longer received a categorical ED diagnosis after at least 5 years of follow-up. TCI-R dimensions failed to predict the absence of a DSM-IV-TR diagnosis in the long term, but Novelty Seeking, Harm Avoidance and Reward Dependence demonstrated to predict the clinical improvement of several EDI-2 scales. CONCLUSIONS Our results support the idea that temperamental dimensions are relevant to the long-term improvement of clinical variables of ED. Low Novelty Seeking is the strongest predictor of poor outcome.
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Affiliation(s)
- Cristina Segura-García
- Department of Health Sciences, Chair of Psychiatry, University Magna Graecia, Catanzaro, Italy.
| | - Dora Chiodo
- Department of Health Sciences, Chair of Psychiatry, University Magna Graecia, Catanzaro, Italy
| | - Flora Sinopoli
- Ambulatory for Clinical Research and Treatment of Eating Disorders, University Hospital Mater Domini, Catanzaro, Italy
| | - Pasquale De Fazio
- Department of Health Sciences, Chair of Psychiatry, University Magna Graecia, Catanzaro, Italy
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13
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Goldschmidt AB, Peterson CB, Wonderlich SA, Crosby RD, Engel SG, Mitchell JE, Crow SJ, Cao L, Berg KC. Trait-level and momentary correlates of bulimia nervosa with a history of anorexia nervosa. Int J Eat Disord 2013; 46:140-6. [PMID: 22987478 PMCID: PMC3570735 DOI: 10.1002/eat.22054] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Some investigators have suggested subtyping bulimia nervosa (BN) by anorexia nervosa (AN) history. We examined trait-level and momentary eating-related and psychosocial factors in BN with and without an AN history. METHOD Interview, questionnaire, and ecological momentary assessment data of eating-related and psychological symptoms were collected from 122 women with BN, including 43 with (BN+) and 79 without an AN history (BN-). RESULTS Body mass index (kg/m(2) ) was lower in BN+ than BN- (p = 0.001). Groups did not differ on trait-level anxiety, shape/weight concerns, psychiatric comorbidity, or dietary restraint; or on momentary anxiety, dietary restriction, binge eating, purging, or exercise frequency, or affective patterns surrounding binge/purge behaviors. Negative affect increased prior to exercise and decreased thereafter in BN+ but not BN-, although groups did not statistically differ. DISCUSSION Results do not support formally subtyping BN by AN history. Exercise in BN+ may modulate negative affect, which could have important treatment implications.
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Affiliation(s)
- Andrea B. Goldschmidt
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Stephen A. Wonderlich
- Department of Clinical Research, Neuropsychiatric Research Institute, and Department of Clinical Neuroscience, University of North Dakota School of Medicine, Fargo, North Dakota, USA
| | - Ross D. Crosby
- Department of Clinical Research, Neuropsychiatric Research Institute, and Department of Clinical Neuroscience, University of North Dakota School of Medicine, Fargo, North Dakota, USA
| | - Scott G. Engel
- Department of Clinical Research, Neuropsychiatric Research Institute, and Department of Clinical Neuroscience, University of North Dakota School of Medicine, Fargo, North Dakota, USA
| | - James E. Mitchell
- Department of Clinical Research, Neuropsychiatric Research Institute, and Department of Clinical Neuroscience, University of North Dakota School of Medicine, Fargo, North Dakota, USA
| | - Scott J. Crow
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Li Cao
- Department of Clinical Research, Neuropsychiatric Research Institute, and Department of Clinical Neuroscience, University of North Dakota School of Medicine, Fargo, North Dakota, USA
| | - Kelly C. Berg
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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von Lojewski A, Fisher A, Abraham S. Have personality disorders been overdiagnosed among eating disorder patients? Psychopathology 2013; 46:421-6. [PMID: 23407268 DOI: 10.1159/000345856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 11/11/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is persuasive evidence for a relationship between eating disorders (EDs) and personality disorders (PDs). Research studies over the last three decades have used various tools to explore PDs in EDs with differing results. We investigated PDs derived from an interview--the International Personality Disorder Examination. METHODS 132 female inpatients with restrictive anorexia nervosa (AN-R), binge-purging AN, bulimia nervosa (BN) and ED not otherwise specified were interviewed. MANCOVA was used to test for differences in dimensional PD scores for the ED diagnostic and behavioural groups. RESULTS Twenty-one percent of patients had a definite DSM-IV PD diagnosis and 37% of patients had ≥1 definite or probable DSM-IV PD diagnoses. Cluster C PDs were most commonly found [avoidant (25%), obsessive-compulsive (9%), dependent (2%)], followed by cluster B PDs [borderline (13%), histrionic (2%)]. Comparison of PD dimensional scores revealed significantly lower PD scores for borderline PD in AN-R when compared to the other diagnostic groups; and significantly higher scores for histrionic, narcissistic, antisocial, and not otherwise specified PDs for BN when compared to the other diagnostic groups. Self-induced vomiting was the only behaviour significantly associated with any PD dimensional scores (borderline and narcissistic). CONCLUSIONS Assessment of PDs using a highly structured interview administered by trained interviewers results in less PD diagnoses compared with previous studies of inpatients with an ED. Avoidance is the most common PD and those patients who induce vomiting are more likely to have borderline features.
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Affiliation(s)
- Astrid von Lojewski
- Department of Obstetrics and Gynaecology, University of Sydney, Royal North Shore Hospital, St Leonards, N.S.W., Australia
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Lahmann C, Henrich G, Henningsen P, Baessler A, Fischer M, Loew T, Tritt K, Pieh C. The impact of personality traits on the success of a multimodal obesity treatment. Behav Med 2011; 37:119-24. [PMID: 22168328 DOI: 10.1080/08964289.2011.635169] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This prospective study investigated personality traits as predictors of the outcome in a 52-week weight-loss program for obesity. Personality traits were rated with the Inventory of Interpersonal Problems (IIP) in 54 consecutive obese outpatients when entering a multimodal weight-reduction program. The value of these variables to predict success was assessed after 12, 26, and 52 weeks of treatment. A stepwise linear regression analysis for all follow-ups was calculated to examine the impact of each IIP item subscale on weight reduction. The IIP item subscale "intrusive or needy" significantly correlated with weight reduction observed at every follow-up examination and accounts for 13.6% to 29.8% of the variance (p values < .05). Obese patients describing themselves as excessively friendly, outgoing, and sociable improved more from a weight-loss program than those with lower instances of these traits. Accordingly, personality traits deserve more attention at initial assessment and while planning treatment of obese patients.
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Affiliation(s)
- Claas Lahmann
- Department of Psychosomatic Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
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Rothschild-Yakar L, Eviatar Z, Shamia A, Gur E. Social cognition in eating disorders: encoding and representational processes in binging and purging patients. EUROPEAN EATING DISORDERS REVIEW 2011; 19:75-84. [PMID: 20672249 DOI: 10.1002/erv.1013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The present study investigates social cognition impairments in 29 women with bingeing/purging spectrum eating disorders (ED) compared to 27 healthy controls. METHOD Measures were used to examine encoding and representational processes in relation to affect perception and affect attribution, as well as the ability to recognize mental causality in social relationships. RESULTS ED patients failed to correctly encode causality in interpersonal relations, exhibited deficits in their ability to ascribe behaviour to mental states, and showed a greater tendency to attribute negative affects in interpersonal relationships. Stepwise regression analyses suggested that ED symptoms could account for deficits in the recognition of causality in interpersonal relations. CONCLUSIONS In addition to addressing ED symptoms, social cognition deficits should be addressed in the psychological treatment of EDs.
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Simpson SG, Morrow E, van Vreeswijk M, Reid C. Group schema therapy for eating disorders: a pilot study. Front Psychol 2010; 1:182. [PMID: 21833243 PMCID: PMC3153792 DOI: 10.3389/fpsyg.2010.00182] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 10/09/2010] [Indexed: 11/27/2022] Open
Abstract
This paper describes the use of Group Schema Therapy for Eating Disorders (ST-E-g) in a case series of eight participants with chronic eating disorders and high levels of co-morbidity. Treatment was comprised of 20 sessions which included cognitive, experiential, and interpersonal strategies, with an emphasis on behavioral change. Specific schema-based strategies focused on bodily felt-sense and body-image, as well as emotional regulation skills. Six attended until end of treatment, two dropped-out at mid-treatment. Eating disorder severity, global schema severity, shame, and anxiety levels were reduced between pre- and post-therapy, with a large effect size at follow-up. Clinically significant improvement in eating severity was found in four out of six completers. Group completers showed a mean reduction in schema severity of 43% at post-treatment, and 59% at follow-up. By follow-up, all completers had achieved over 60% improvement in schema severity. Self-report feedback suggests that group factors may catalyze the change process in schema therapy by increasing perceptions of support and encouragement to take risks and try out new behaviors, whilst providing a de-stigmatizing and de-shaming therapeutic experience.
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Affiliation(s)
- Susan G Simpson
- School of Psychology, Social Work and Social Policy, Division of Education, Arts and Social Sciences, University of South Australia Adelaide, SA, Australia
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18
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Rowe SL, Jordan J, McIntosh VVW, Carter FA, Frampton C, Bulik CM, Joyce PR. Complex personality disorder in bulimia nervosa. Compr Psychiatry 2010; 51:592-8. [PMID: 20965305 DOI: 10.1016/j.comppsych.2010.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Revised: 02/12/2010] [Accepted: 02/14/2010] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Recent research has suggested a move toward a dimensional system for the classification of personality disorders (PDs). Tyrer's dimensional model using severity as a form of categorizing PDs was used to compare eating disorder outcome in women with bulimia nervosa (BN) over 3 years. METHOD One hundred thirty-four women with BN were divided into 4 groups based on PD severity: no PD (n = 32), personality difficulty (n = 27), simple PD (n = 29), and complex PD (n = 46). Eating disorder symptoms and attitudes, general psychosocial functioning, and depressive symptoms were examined at pretreatment and at 1-year and 3-year follow-up (posttreatment). RESULTS The complex PD group had greater Axis I comorbidity and psychopathology than the remaining 3 groups at pretreatment. At 1-year and 3-year follow-up, there were no differences in eating disorder outcome, general psychosocial functioning, and depressive symptoms across the 4 groups. CONCLUSION These results suggest that having an increased number of PDs comorbid with BN does not influence eating disorder outcome up to 3 years after treatment.
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Affiliation(s)
- Sarah L Rowe
- Department of Psychological Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, New Zealand.
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Abstract
To examine relationship between Eating Disorder Behaviors (EDB) and Early Maladaptive Schemas (EMS) across eating disorder (ED) subgroups. EMS and ED behaviors were measured by Young Schema Questionnaire and Eating Behavior Severity Scale, respectively, among patients diagnosed with Restrictive or Binge/purging Anorexia, or bulimia nervosa. Canonical component analysis showed significant association between ED behaviors and EMSs. Canonical factor-pairs (EDB and EMS) revealed specific associations between certain patterns of EDBs, including binge-purging and physical exercise, and certain patterns of maladaptive cognitive schema, including Emotional deprivation, Abandonment, Enmeshments, Subjugation, and Emotional inhibition. ED subgroups significantly differred between the EMS and EDB canonical factors, respectively. Our findings indicate that EMS and EDB are associated, and that the factors that potentially mediate the association differ significantly among ED subgroups. These results are consistent with the notion that EMSs play a specific role in the development and maintenance of ED behaviors.
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Miyake Y, Okamoto Y, Onoda K, Kurosaki M, Shirao N, Okamoto Y, Yamawaki S. Brain activation during the perception of distorted body images in eating disorders. Psychiatry Res 2010; 181:183-92. [PMID: 20153150 DOI: 10.1016/j.pscychresns.2009.09.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 08/05/2009] [Accepted: 09/01/2009] [Indexed: 11/30/2022]
Abstract
Eating disorder (ED) patients have severe disturbances in the perception of body shape and weight. The authors investigated brain activation patterns during the perception of distorted body images in various subtypes of ED. Participants comprised 33 patients with EDs (11 with restricting-type anorexia nervosa (AN-R), 11 with binging-purging type anorexia nervosa (AN-BP), 11 with bulimia nervosa (BN)) and 11 healthy women. Functional magnetic resonance imaging was used to examine cerebral response to morphed images of subjects' own bodies, as well as that of another woman. The amygdala was significantly activated in AN-R patients, AN-BP patients, and healthy women in response to their own fat-image, but this did not occur in BN patients. The prefrontal cortex (PFC) was significantly activated in AN-BP patients and healthy women, but not in AN-R and BN patients. Our results showed that the various EDs are different with respect to significant activation of the amygdala and PFC during the processing of participants' own fat-image. Brain activation pattern differences between the various EDs may underlie cognitive differences with respect to distorted body image, and therefore might reflect a general failure to represent and evaluate one's own body in a realistic fashion.
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Affiliation(s)
- Yoshie Miyake
- Department of Psychiatry and Neurosciences, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Abstract
The assessment of personality and temperament in the context of eating disorders (EDs) poses unique challenges because of the physiological symptoms and sequelae of these illnesses. Four models of the relationship between personality and EDs are presented, along with a discussion of the different methodological designs which can evaluate these models. Current data support the likelihood that neuroticism and perfectionism are risk factors for EDs. Perfectionism and the related obsessive-compulsive personality disorder may also share a common cause with anorexia nervosa. High harm avoidance and low self-directedness also characterize all EDs, though more data are needed to confirm their role as risk factors; importantly however, this combination of traits may diminish one's ability to cope with stressful life events. At the other end of the spectrum, considering impulsivity multidimensionally may be important to understanding the role of this personality trait in EDs, though existing data do not yet allow for conclusions regarding its role as a risk factor versus a consequence of the ED. All of the identified traits that may be risk factors are also exacerbated as a consequence of having, or having had, an ED. Finally, the role of personality disorders in influencing the course and outcome of EDs is still unclear. A fruitful avenue for future research in this area is to utilize personality and temperament to classify individuals in a way that allows for the best chance of identifying genetic loci that confer increased risk for EDs.
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Assessing personality disorders in eating disordered patients using the SCID-II: Influence of measures and timing on prevalence rate. PERSONALITY AND INDIVIDUAL DIFFERENCES 2010. [DOI: 10.1016/j.paid.2009.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Peterson CB, Thuras P, Ackard DM, Mitchell JE, Berg K, Sandager N, Wonderlich SA, Pederson MW, Crow SJ. Personality dimensions in bulimia nervosa, binge eating disorder, and obesity. Compr Psychiatry 2010; 51:31-6. [PMID: 19932823 PMCID: PMC2838502 DOI: 10.1016/j.comppsych.2009.03.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 03/10/2009] [Accepted: 03/16/2009] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The purpose of this investigation was to examine differences in personality dimensions among individuals with bulimia nervosa, binge eating disorder, non-binge eating obesity, and a normal-weight comparison group as well as to determine the extent to which these differences were independent of self-reported depressive symptoms. METHOD Personality dimensions were assessed using the Multidimensional Personality Questionnaire in 36 patients with bulimia nervosa, 54 patients with binge eating disorder, 30 obese individuals who did not binge eat, and 77 normal-weight comparison participants. RESULTS Participants with bulimia nervosa reported higher scores on measures of stress reaction and negative emotionality compared to the other 3 groups and lower well-being scores compared to the normal-weight comparison and the obese samples. Patients with binge eating disorder scored lower on well-being and higher on harm avoidance than the normal-weight comparison group. In addition, the bulimia nervosa and binge eating disorder groups scored lower than the normal-weight group on positive emotionality. When personality dimensions were reanalyzed using depression as a covariate, only stress reaction remained higher in the bulimia nervosa group compared to the other 3 groups and harm avoidance remained higher in the binge eating disorder than the normal-weight comparison group. CONCLUSIONS The higher levels of stress reaction in the bulimia nervosa sample and harm avoidance in the binge eating disorder sample after controlling for depression indicate that these personality dimensions are potentially important in the etiology, maintenance, and treatment of these eating disorders. Although the extent to which observed group differences in well-being, positive emotionality, and negative emotionality reflect personality traits, mood disorders, or both, is unclear, these features clearly warrant further examination in understanding and treating bulimia nervosa and binge eating disorder.
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Affiliation(s)
| | - Paul Thuras
- University of Minnesota, Veterans Administration Medical Center, Minneapolis
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Rothschild L, Lacoua L, Stein D. Changes in implicit and explicit measures of ego functions and distress among two eating disorder subgroups: outcomes of integrative treatment. Eat Disord 2009; 17:242-59. [PMID: 19391022 DOI: 10.1080/10640260902848592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The study examined changes in ego functions and mental distress among eating disorder (ED) adolescent inpatients following integrative treatment. Participants included 31 restricting anorexia nervosa and 25 bingeing/purging spectrum ED inpatients. Rorschach Comprehensive System (CS; Exner, 2003) and self-report measures were administered on admission and discharge. We found that improvement in ego functions, mental distress and ED symptomatology occurred in both ED groups at discharge. Nevertheless, the two ED subgroups exhibited different configurations of change as well as varying patterns of relations between changes in mental distress and ego functions and improvement in ED symptoms. These data further indicate that the restricting and bingeing/purging patients may require different treatment approaches.
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Affiliation(s)
- Lily Rothschild
- Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.
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25
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Jordan J, Joyce PR, Carter FA, McIntosh VVW, Luty SE, McKenzie JM, Frampton CMA, Bulik CM. The Yale-Brown-Cornell eating disorder scale in women with anorexia nervosa: what is it measuring? Int J Eat Disord 2009; 42:267-74. [PMID: 18951459 DOI: 10.1002/eat.20605] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS) assesses eating disorder preoccupations, rituals, and symptom severity. This study examines the YBC-EDS in relation to eating disorder psychopathology, obsessionality, and impulsivity variables in women with anorexia nervosa (AN) and sensitivity of the YBC-EDS to change after psychotherapy. METHOD Participants were 56 women with "spectrum" AN (14.5 < BMI < 19). Variables examined in relation to the YBC-EDS were as follows: eating pathology, obsessionality (obsessive compulsive disorder and personality diagnoses, perfectionism), and impulsivity (borderline personality, impulsive traits, and behaviors). YBC-EDS scores were examined pre- and post-treatment. RESULTS Eating Disorder Examination scores most strongly predicted the YBC-EDS. As expected, perfectionism was significantly associated, but so was impulsivity. YBC-EDS scores were significantly different in those with good versus poor global outcome after therapy. Unexpectedly, maximum lifetime BMI was correlated with the YBC-EDS. DISCUSSION The YBC-EDS most strongly measured eating disorder severity and reflected change after psychotherapy for AN.
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Affiliation(s)
- Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
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26
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Rowe SL, Jordan J, McIntosh VVW, Carter FA, Bulik CM, Joyce PR. Impact of borderline personality disorder on bulimia nervosa. Aust N Z J Psychiatry 2008; 42:1021-9. [PMID: 19016090 DOI: 10.1080/00048670802512040] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The primary aim of the present study was to examine whether the presence of borderline personality disorder (BPD) adversely impacted on outcome 3 years after treatment among women with bulimia nervosa (BN), in comparison to those women with either other personality disorders (other PD) or no personality disorder (no PD). METHOD Participants were 134 women who received cognitive behaviour therapy for BN. The sample was divided into three groups: BPD (n=38), other PD (n=37), and no PD (n=59). Eating disorder (ED) symptoms and attitudes, and personality traits were examined at pretreatment assessment, 1 year and 3 year follow up. RESULTS At pretreatment assessment the BPD group had higher purging frequency, more comorbidity and poorer general functioning than the other PD and no PD groups. By 3 year follow up, however, no significant differences were found in ED symptomatology and general functioning among the groups. Pretreatment differences between the BPD and no PD groups on the personality measures of harm avoidance, self-directedness and cooperativeness disappeared over the course of 3 years. CONCLUSION Although women with BN and comorbid BPD appear more impaired at pretreatment assessment, they do not have poorer outcome than the other PD and no PD groups. The rate and level of improvement across the groups is not affected by the presence of BPD.
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Affiliation(s)
- Sarah L Rowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
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Smith AT, Wolfe BE. Amenorrhea as a diagnostic criterion for anorexia nervosa: a review of the evidence and implications for practice. J Am Psychiatr Nurses Assoc 2008; 14:209-15. [PMID: 21665766 DOI: 10.1177/1078390308320288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Amenorrhea is currently a criterion in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text rev. [DSM-IV-TR]) for the diagnosis of anorexia nervosa (AN). Recently, there has been increased interest in examining the utility of this criterion. This article reviews the historical rationale for inclusion of amenorrhea in the DSM criteria for AN, clinical evidence evaluating amenorrhea as a diagnostic criterion for AN, and the nursing practice implications of amenorrhea as a diagnostic criterion for AN. Data suggest there is limited support for amenorrhea as a diagnostic criterion for AN. J Am Psychiatr Nurses Assoc, 2008; 14(3), 209-215. DOI: 10.1177/1078390308320288.
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Affiliation(s)
- Adrian T Smith
- Wm. F. Connell School of Nursing Boston College, Chestnut Hill, MA
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Jordan J, Joyce PR, Carter FA, Horn J, McIntosh VVW, Luty SE, McKenzie JM, Frampton CMA, Mulder RT, Bulik CM. Specific and nonspecific comorbidity in anorexia nervosa. Int J Eat Disord 2008; 41:47-56. [PMID: 17868127 DOI: 10.1002/eat.20463] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This article reports lifetime Axis I and II comorbidity in women with anorexia nervosa (AN), and ascertains specific and nonspecific comorbidity in AN compared to clinical samples of women with bulimia nervosa (BN) or major depression (DEP). METHOD Outpatient AN (n = 56), BN (n = 132), and DEP (n = 100) samples were assessed using Structured Clinical Interviews I and II for DSM-III-R. Baseline data were compared using univariate statistics and logistic regression. RESULTS In the AN sample as a whole, specific elevations were found for prevalences of obsessive compulsive disorder. The AN-binge eating purging subtype (AN-BP) and the BN sample had elevated prevalences of Cluster B personality disorders. Cluster C prevalences were elevated across samples. CONCLUSION Evidence of AN-specific, eating disorder-specific, and nonspecific comorbidity illustrates the heterogeneity in AN. Further research is need to examine the relative impact of specific and nonspecific comorbidity in AN subtypes and AN as a whole.
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Affiliation(s)
- Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand.
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30
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Exterkate CC, Bakker-Brehm DT, de Jong CAJ. MMPI–2 Profiles of Women With Eating Disorders in a Dutch Day Treatment Sample. J Pers Assess 2007; 88:178-86. [PMID: 17437383 DOI: 10.1080/00223890701268017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this study, we examined the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) profiles of 324 Dutch patients with eating disorders at an eating disorder day treatment program. We studied the MMPI-2 profiles in 5 diagnostic eating disorder groups. All diagnostic subgroups showed high mean elevations of the T scores on the same 6 or 7 scales. Remarkable similarities existed between the mean profile configurations. The MMPI-2 distinguished especially in that patients with restricting anorexia nervosa scored lower on one Validity scale (F), two Clinical scales (1 and 2) and several Supplementary and Content scales of the MMPI-2 compared to the other groups. Only on the validity Scale L did they score higher. The MMPI-2 also distinguished patients with the bulimia nervosa purging type who scored higher on Scale 9 and different on several Content and Supplementary scales. We discuss results with regard to other studies of MMPI (Hathaway & McKinley, 1983) and MMPI-2 profiles of women with anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified in inpatient and outpatient settings.
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Affiliation(s)
- Cecile C Exterkate
- Amarum, Specialist Centre for Eating Disorders, Zutphen, The Netherlands.
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31
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Clark LA. Assessment and diagnosis of personality disorder: perennial issues and an emerging reconceptualization. Annu Rev Psychol 2007; 58:227-57. [PMID: 16903806 DOI: 10.1146/annurev.psych.57.102904.190200] [Citation(s) in RCA: 482] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This chapter reviews recent (2000-2005) personality disorder (PD) research, focusing on three major domains: assessment, comorbidity, and stability. (a) Substantial evidence has accrued favoring dimensional over categorical conceptualization of PD, and the five-factor model of personality is prominent as an integrating framework. Future directions include assessing dysfunction separately from traits and learning to utilize collateral information. (b) To address the pervasiveness and extent of comorbidity, researchers have begun to move beyond studying overlapping pairs or small sets of disorders and are developing broader, more integrated common-factor models that cross the Axis I-Axis II boundary. (c) Studies of PD stability have converged on the finding that PD features include both more acute, dysfunctional behaviors that resolve in relatively short periods, and maladaptive temperamental traits that are relatively more stable-similar to normal-range personality traits-with increasing stability until after 50 years of age. A new model for assessing PD-and perhaps all psychopathology-emerges from integrating these interrelated reconceptualizations.
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Affiliation(s)
- Lee Anna Clark
- Department of Psychology, University of Iowa, Iowa City, Iowa 52242, USA.
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Unoka Z, Tölgyes T, Czobor P. Early maladaptive schemas and body mass index in subgroups of eating disorders: a differential association. Compr Psychiatry 2007; 48:199-204. [PMID: 17292712 DOI: 10.1016/j.comppsych.2006.09.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objectives were (1) to examine whether 3 eating disorder subgroups, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) classification system, exhibit a specific profile in terms of early maladaptive schema (EMS) factors, and (2) to investigate the relationship between body mass index (BMI) and EMS factors in each of the individual eating disorder subgroups. METHODS The presence of EMS was measured by the Young Schema Questionnaire Long Form among patients affected by restrictive anorexia nervosa, binge/purging-type anorexia nervosa, and bulimia nervosa. Principal component factor analysis was used to investigate the factor structure of the EMS across eating disorder subgroups. General linear model analysis was applied to examine the differences of the subgroups in terms of their EMS factors. Differential association between BMI and schema factors was tested by analysis of covariance. RESULTS Four EMS factors were extracted, which accounted for approximately 72% of the variance. The 3 eating disorder subgroups differed in terms of their EMS factor profiles. The analysis of covariance resulted in a significant negative relationship between BMI and EMS factor 2 in the bulimia nervosa group (P < .0099), indicating that higher severity on defectiveness, failure, dependence, enmeshments, subjugation, approval-seeking (EMS factor 2) was associated with lower values on BMI. CONCLUSION The findings of this study indicate that EMSs based on Young's conceptualization of EMS, as measured by the Young Schema Questionnaire, differ significantly among eating disorder subgroups defined by the phenomenological approach used by the DSM-IV diagnoses. These results are consistent with the notion that dysfunctional cognitions may play an important role in the development and maintenance of the symptoms that underlie the DSM-IV classification of the eating disorder subtypes.
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Affiliation(s)
- Zsolt Unoka
- Department of Psychiatry and Psychotherapy, Faculty of General Medicine Semmelweis University, 1083 Budapest, Hungary.
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Zeeck A, Birindelli E, Sandholz A, Joos A, Herzog T, Hartmann A. Symptom severity and treatment course of bulimic patients with and without a borderline personality disorder. EUROPEAN EATING DISORDERS REVIEW 2007; 15:430-8. [PMID: 17726661 DOI: 10.1002/erv.824] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
There are contradictory results concerning the frequency of borderline personality disorder (BPD) in bulimic patients and its impact on eating pathology and treatment outcome. We evaluated 240 patients with bulimia nervosa using EDI-2, SIAB and SCL-90-R. Only a minority of patients had a BPD (13.8%). There were no differences in binging or purging behaviour between patients with and without BPD, but borderline patients had significantly more feelings of ineffectiveness and more disturbances in interoceptive awareness. Bulimic patients with BPD showed significantly more general psychopathology. Although, BPD patients started with higher levels of pathology, there were similar reductions of symptoms over the course of treatment in both groups. Psychotherapy in bulimic patients with a BPD has to focus not only on eating pathology but also on aspects that are caused by the severe personality disturbance.
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Affiliation(s)
- A Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Germany
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Forbush K, Watson D. Emotional inhibition and personality traits: a comparison of women with anorexia, bulimia, and normal controls. Ann Clin Psychiatry 2006; 18:115-21. [PMID: 16754417 DOI: 10.1080/10401230600614637] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Clinical experience has suggested that women with eating disorders (ED) are prone to displace negative feelings about the self onto the body. This study sought to evaluate these clinical observations by examining emotional inhibition and personality traits in women with ED. METHODS Female inpatients and intensive outpatients diagnosed with anorexia nervosa (N = 14) or bulimia nervosa (N = 11) were compared to women without an ED (N = 31). RESULTS The results of the study indicate that participants with ED inhibit their expression of both positive and negative emotions, even after controlling for neuroticism. Women with ED also reported higher levels of hostility and neuroticism. In addition, participants with ED were less aware of their inner thoughts and feelings (private self-consciousness) and had a heightened awareness of the thoughts and expectations of others (public self-consciousness). Finally, women with bulimia nervosa reported higher levels of emotional inhibition, neuroticism, public self-consciousness, and hostility when compared to women with anorexia nervosa. CONCLUSIONS These data suggest that individuals who are not able to identify, and consequently, express their emotions may learn to handle emotional distress, interpersonal conflicts, and unexpressed hostility by turning their expression and lack of insight inward (viz., feeling "fat").
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Affiliation(s)
- Kelsie Forbush
- Department of Psychology, The University of Iowa, Iowa City, IA, USA.
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