Personality traits after recovery from eating disorders: Do subtypes differ?

OBJECTIVE: We compared individuals recovered from anorexia (AN) and bulimia nervosa (BN) to determine characteristics that are shared by or distinguish eating disorder (ED) subtypes. METHOD: Sixty women recovered for > or = 1 year from AN or BN were compared with 47 control women (CW). Assessments included the Yale-Brown-Cornell Eating Disorder Scale, the Spielberger State-Trait Anxiety Inventory, the Beck Depression Inventory, the Yale-Brown Obsessive Compulsive Scale, the Temperament and Character Inventory, and Structured Clinical Interviews for DSM-IV. RESULTS: Individuals recovered from an ED had similar scores for mood and personality variables that were significantly higher than the scores for CW. Few recovered subjects had Cluster B personality disorder. Most individuals recovered within 6 years of their ED onset. A latent profile analysis identified an "inhibited" and "disinhibited" cluster based on personality traits. CONCLUSION: A wide range of symptoms persist after recovery and do not differ between subtypes of ED. These findings may aid in identifying traits that create vulnerabilities for developing an ED.     

Objective and subjective binge eating in underweight eating disorders: associated features and treatment outcome

Objective:

To define the utility of the DSM‐IV‐TR definition of binge eating, as it applies to anorexia nervosa (AN) and underweight eating disorder not otherwise specified (ED‐NOS).

Method:

We investigated the psychopathological features associated with bulimic episodes in 105 underweight individuals with eating disorders who reported regular objective bulimic episodes with or without subjective bulimic episodes (OBE group, n = 33), regular subjective bulimic episodes only (SBE group, n = 36) and neither objective nor subjective bulimic episodes (n = 36, no‐RBE group). The Eating Disorder Examination (EDE), anxiety, depression, and personality tests were administered before and upon completion of inpatient cognitive behavior therapy (CBT) treatment 6 months later.

Results:

Compared with the SBE group, OBE subjects had higher body mass index, and more frequent self‐induced vomiting, while both OBE and SBE groups had more severe eating disorder psychopathology and lower self‐directness than the no‐RBE group. Dropout rates and outcomes in response to inpatient CBT were similar in the three groups.

Discussion:

Despite a few significant differences at baseline, the similar outcome in response to CBT indicates that categorizing patients with underweight eating disorder on the basis of the type or frequency of bulimic episodes is of limited clinical utility. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012;)     

Personality disorders among subjects recovered from eating disorders

OBJECTIVE: Personality disorders are common in symptomatic eating disorders subjects. Because personality symptoms could be exaggerated by malnutrition or Axis I disorders, we studied women who had recovered from eating disorders for at least 1 year to see if personality disorder symptoms persisted in the well state. METHOD: Personality disorders were evaluated in 10 women recovered from anorexia nervosa (AN), 28 women recovered from bulimia nervosa (BN), and 16 women recovered from AN and BN, using the Structured Clinical Interview for DSM-III-R personality disorders. RESULTS: Fourteen of 54 subjects (26%) met the criteria for at least one personality disorder, such as self-defeating, obsessive-compulsive, or borderline personality disorder. Cluster B personality disorders were closely associated with bulimic subtypes. CONCLUSIONS: While a recovery from eating disorders may have an attenuating influence on the symptoms of personality disorders, such personality disorder diagnoses persist after recovery in some recovered subjects.     

Pregnancy: outcome and impact on symptomatology in a cohort of eating-disordered women

OBJECTIVE: This study investigates both the impact of eating disorders (ED) on pregnancy outcome and the impact of pregnancy on cognitive and behavioral symptoms of EDs. METHOD: Data on pregnancy outcome (live birth [LB], therapeutic abortion [TAB], and spontaneous abortion [SAB]) and ED symptomatology were collected as part of a large, prospective longitudinal study of anorexia nervosa (AN) and bulimia nervosa (BN). Data were gathered using a semistructured interview administered every 6 months to 246 subjects. RESULTS: We identified 54 women who reported 82 pregnancies (46 LB, 25 TAB, and 11 SAB). Pregnancy outcome was not significantly related to any of the clinical variables studied. Women with BN showed a significant decrease in the severity of their ED symptoms during pregnancy, and this decrease was sustained through 9 months postpartum. Women with AN also demonstrated a significant reduction in ED symptoms, however, these symptoms returned to prepregnancy levels by 6 months postpartum. CONCLUSIONS: Our prospective findings reveal an elevated TAB rate for ED women along with a general reduction in the severity of ED symptoms during pregnancy.     

In search of predictors of dropout from inpatient treatment for anorexia nervosa.

OBJECTIVE: The purpose of the present study was to investigate risk factors associated with premature dropout in the treatment of anorexia nervosa (AN). METHOD: Eighty-one women who received free inpatient treatment for AN on a clinical research unit at a university-based psychiatric facility participated in this study. Demographic, lifetime, and baseline clinical characteristics as well as self-report measures of eating disorder symptomatology and associated psychopathology were assessed upon admission. RESULTS: Results indicated that AN subtype was [corrected] modestly predictive of treatment dropout. DISCUSSION: With the exception of AN subtype [corrected], successful completion of inpatient treatment may be unrelated to the severity of eating disorder symptomatology and associated psychopathology. Continued empirical research into factors that influence treatment dropout is clearly needed.     

Treatment perception in adolescent onset anorexia nervosa: retrospective views of patients and parents

OBJECTIVE: To investigate perception of treatment in former patients with anorexia nervosa (AN) and their parents, and to determine whether this was related to outcome and treatment characteristics. Client satisfaction is important for treatment engagement and adherence. METHOD: Forty-six (of 55) girls with adolescent onset AN, 33 mothers and 26 fathers participated in a follow-up study conducted 8.8 (SD 3.3) years after start of treatment. The former patients were assessed using diagnostic interviews. Only nine participants (19%) had an eating disorder (ED) at follow-up. Perception of treatment was assessed by questionnaires. RESULTS: Parents reported having an overall positive perception of treatment. However, reports from former patients were significantly more negative than from the parents. In former patients, the "perception of therapists" total score and the items "therapists' knowledge of ED" and "usefulness of pediatric inpatient treatment" correlated with ED symptoms at follow-up. The perception of therapists' scores of the parents were not associated with the ED outcome of their daughters. More family therapy sessions were associated with the former patients' satisfaction with the therapists, while higher age at admission was associated with their mothers' satisfaction. CONCLUSION: In spite of good ED outcome, former patients were only moderately satisfied with their treatment, whereas parental satisfaction was high.     

Self-reported history of anorexia nervosa and current quality of life: findings from a community-based study

Purpose

To evaluate the impact of a lifetime history of anorexia nervosa (AN) on current quality of life (QoL) and eating disorder (ED) symptomatology.

Method

3,034 participants from a randomly selected sample of households in the Australian population were interviewed for current ED symptoms and QoL (SF-36).

Results

89 participants (2.9 %) reported a history of AN, 73 of whom were female. These participants scored lower on six of the eight subscales on the SF-36, including all of the mental health subscales, and were more likely to report binge eating and extreme weight or shape concerns than participants who did not report a history of AN. On the other hand, participants who reported a history of AN were less likely to be overweight. None of the participants who reported a history of AN met current criteria for AN; however, one met criteria for bulimia nervosa non-purging subtype and four met criteria for binge eating disorder. The endorsement of current ED symptoms was found to moderate the impact of a history of AN on scores of the social functioning and role limitations due to emotional health SF-36 subscales, such that participants who reported a history of AN scored lower on these subscales if they also reported current ED symptoms.

Conclusions

A history of AN has a deleterious impact on current QoL, despite remittance from the disorder. This may be explained in part by the presence of certain ED symptoms, including objective binge eating and the persistence of extreme weight and shape concerns.     

Two-year prospective study of personality disorders in adults with longstanding eating disorders

OBJECTIVE: The current study had three objectives: to report the presence of personality disorders (PDs) in adults with longstanding eating disorders (EDs) at admission to inpatient treatment, and at 1 and 2-year follow-up; to compare the frequency of PDs in anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS); and to investigate whether recovered patients had lower frequency of PDs. METHOD: Seventy-four patients with a mean age of 30 years and long-lasting EDs were assessed with the Structured Clinical Interview for DSM-IV Axis-II disorders at admission to inpatient treatment, and at 1 and 2-year follow-up. RESULTS: At admission, 57 patients (77%) had one or more PDs, whereas 42 patients (57%) had one or more PDs at 2-year follow-up No statistically significant differences in frequencies of PDs among patients with AN, BN, and EDNOS were found. Recovered patients had a lower frequency of PDs (p < .01). DISCUSSION: At 2-year follow-up, there were substantial reductions in the frequency of PDs in patients with long-lasting EDs.     

Relationship of weight and eating disorders in type 2 diabetic patients: a multicenter study

OBJECTIVE: Previous work suggested that the degree of psychiatric symptomatology evidenced in overweight individuals was related to the severity of binge eating problems and not related to the severity of overweight. In a multicenter study, we investigated the relationship between weight and eating disorders (EDs) in a sample of type 2 diabetic patients. METHODS: Three hundred twenty-two patients with type 2 diabetes were stratified to various weight categories. Glycemic control, eating and body-related psychological problems, self-esteem, depressive, and general psychopathology of diaetic patients with and without an ED were compared. RESULTS: Eighty-one percent of all type 2 diabetic patients were overweight or obese. Prevalence rates of EDs ranged from 6.5% to 9.0%. Binge eating disorder was the most diagnosed ED. There was a strong relationship between body mass index (BMI) and eating disturbance-related variables and a weak or no relationship between BMI and depression or general psychopathologic variables. Patients with an ED showed a greater psychopathology compared to patients without an ED. The diagnosis of an ED did not seem to have a specific influence on glycemic control. CONCLUSIONS: Our results in a type 2 diabetic sample indicate that weight might have an impact on body and eating-related psychological distress in type 2 diabetic patients, but is of minor or no importance for depressive symptomatology, lower self-esteem, and general psychiatric symptomatology. Type 2 diabetic patients with an ED, however, suffer from considerable psychiatric symptomatology.     

Development of emotion acceptance behavior therapy for anorexia nervosa: A case series

This case series describes the development of a novel psychotherapeutic intervention for older adolescents and adults with anorexia nervosa (AN). Emotion acceptance behavior therapy (EABT) is based on a model that emphasizes the role of anorexic symptoms in facilitating avoidance of emotions. EABT combines standard behavioral interventions that are central to the clinical management of AN with psychotherapeutic techniques designed to increase emotion awareness, decrease emotion avoidance, and encourage resumption of valued activities and relationships outside the eating disorder. Five patients with AN aged 17–43 years were offered a 24‐session manualized version of EABT. Four patients completed at least 90% of the therapy sessions, and three showed modest weight gains without return to intensive treatment. Improvements in depressive and anxiety symptoms, emotion avoidance, and quality of life also were observed. These results offer preliminary support for the potential utility of EABT in the treatment of older adolescents and adults with AN. © 2010 by Wiley Periodicals, Inc. Int J Eat Disord 2011