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.     

Obsessive-compulsive characteristics in women who have recovered from bulimia nervosa

OBJECTIVE: The goal of this study was to follow up on reports that obsessive-compulsive characteristics, which are commonly elevated in bulimia nervosa (BN), may also be elevated in individuals who have recovered from BN (BN-R). METHOD: Self-ratings on the Maudsley Obsessional-Compulsive Inventory (MOCI), the Restraint Scale (a measure of dieting behavior related to weight concerns), and questionnaires reflecting eating disorder-related symptoms were evaluated for women who met criteria for BN (n = 25) or BN-R (n = 21) and were free of obsessive-compulsive disorder, and for healthy female controls (n = 28). RESULTS: MOCI scores for the BN-R group (5.5 +/- 5.4) were similar to those for the BN group (5.4 +/- 4.4) and were significantly elevated (p < 0.05, p < 0.02, respectively) in comparison to controls (2.5 +/- 1.9). Of note, MOCI scores for the BN-R group were significantly correlated with scores on the Restraint Scale (r = 0.60, p < 0.02). CONCLUSION: Further studies are needed to assess the relationship between elevated obsessive-compulsive characteristics and eating patterns in individuals recovered from BN.     

The relationship between perceived mutuality and bulimic symptoms, depression, and therapeutic change in group

This pilot study examined (a) the effectiveness of short-term group relational therapy (RT) in comparison to short-term group cognitive-behavioral therapy (CBT), and (b) the relationship between perceived mutuality (PM) in relationships and severity of bulimic and depressive symptoms in women with bulimia nervosa (BN). Fifteen women ages 20-54 diagnosed with BN (n=11) or binge-eating disorder (BED, n=4) were randomly assigned to a 16-week manualized RT or CBT group. The following measures were administered at baseline, at 8 and 16 weeks, and at 6th- and 12th-month follow-ups: Eating Disorders Inventory-2 (EDI-2), Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI), and the Mutual Psychological Development Questionnaire (MPDQ). A series of mixed design analyses of variance (ANOVA) were computed to examine group therapy effectiveness and outcomes related to PM and symptom severity. Both group RT and CBT treatment conditions showed significant improvement in reducing binge eating, vomiting, and depression at end of treatment and across follow-up assessment times. Low levels of PM with father at baseline were associated with high levels of bulimic and depressive symptoms across assessment times, whereas low PM with mother was only associated with high levels of depression. Pilot study findings supported the idea that group work focused primarily on PM and relational factors can be effective in treating women with bulimic and depressive symptoms. Findings also suggest that relationships with fathers play an important role in recovery.     

Requiring remission of undue influence of weight and shape on self-evaluation in the definition of recovery for bulimia nervosa

OBJECTIVE: The current study evaluated the concurrent validity of requiring remission of undue influence of weight and shape on self-evaluation (undue influence) in defining recovery from bulimia nervosa (BN). METHODS: Three groups completed the Beck Depression Inventory, the Mood and Anxiety Symptom Questionnaire, the Body Shape Questionnaire, and the Social Adjustment Scale: 31 women were fully recovered from BN (FR), 28 women had no behavioral symptoms of BN (partially recovered [PR]), and 59 matched non-eating-disordered controls (MC). RESULTS: The PR group had more pathologic scores on depression, anxiety, body dissatisfaction, and social adjustment compared with both the FR and MC groups, which did not differ from each other. DISCUSSION: These findings suggest that including remission of cognitive symptoms in a standardized definition of recovery may prove to be clinically useful in establishing reliable prognostic indicators. Future research should evaluate the role played by cognitive symptoms in triggering relapse.     

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.     

Pain perception in recovered bulimia nervosa patients

OBJECTIVE: Decreased pain sensitivity is found in individuals who are ill with bulimia nervosa (BN). The purpose of this study is to determine whether altered pain perception persists after recovery from bulimia nervosa (RBN). METHODS: Eleven women who were recovered from BN for more than 1 year were compared with 15 healthy volunteer women. The participants received two pain evaluations--thermal pain stimulation (TPS), which evaluates threshold and tolerance to heat, and the submaximal effort tourniquet test (SETT), which assesses threshold and tolerance to ischemic pain induced by inflation of a blood pressure cuff. RESULTS: Compared with the controls, the RBN women showed elevated pain threshold as measured with the SETT and a tendency to elevated pain threshold on the TPS. DISCUSSION: Decreased pain sensitivity persists after recovery from BN and may reflect altered modulatory function in this illness.     

Regional cerebral blood flow after recovery from anorexia or bulimia nervosa

OBJECTIVE: Abnormalities of regional cerebral blood flow (rCBF) have been found in individuals who are ill with anorexia (AN) or bulimia nervosa (BN). Little is known about whether rCBF normalizes after recovery from AN and BN. METHOD: Eighteen control women (CW), 10 recovered restricting type AN, 8 recovered AN with a binging history, and 9 recovered BN participants without a history of AN were studied using positron emission tomography and [(15)O]water in order to assess rCBF. RESULTS: Partial volume corrected rCBF values in cortical and subcortical brain regions were similar between groups. Neither current body mass index nor age correlated with rCBF values. CONCLUSION: The results from this study indicate that rCBF normalizes with long-term recovery. Thus, altered rCBF is unlikely to confound functional imaging studies in AN or BN after recovery.     

Eating behaviors and attitudes in women with infertility: a controlled study

OBJECTIVE: Infertility arises from a complex pathogenic process in which it is often difficult to identify etiology. Psychological and behavioral factors may play a role in some cases of infertility. The extent to which eating behaviors and attitudes contribute to infertility is unknown. METHOD: In this study, 120 subjects with infertility, 80 fertile women, and 90 patients suffering from anorexia nervosa, restricting subtype (AN-R), were assessed with the Eating Disorder Inventory (EDI-2). RESULTS: The EDI-2 highlights differences among patients with AN-R and fertile and infertile subjects. Infertile patients had higher scores on the Interpersonal Distrust, Interoceptive Awareness, and Maturity Fears EDI-2 subscales than fertile subjects. Logistic regression identifies the independent variables of interpersonal distrust, interoceptive awareness, maturity fears, and asceticism as predictors of infertility. DISCUSSION: Infertile patients without eating disorders share some psychological features of women with AN. These features do not include disturbed eating attitudes and behaviors, but rather feelings of inadequacy, insecurity, and maturity fears.     

The effects of movement, relaxation, and education on the stress levels of women with subclinical levels of bulimia

The purpose of this study was to assess the impact of a multidisciplinary intervention program on the attitudes and symptoms associated with bulimia nervosa (BN). The Bulimia Test (BULIT) and subscales from the Eating Disorder Inventory-2 (EDI-2) associated with BN were administered to 373 females to determine eligibility for participation in the study. In order to qualify for the study, participants had to be female, not be anorexic, and meet one of four criteria indicating that they had some of the symptoms of BN. Following the screening, 12 females were randomly assigned to a control group (C, n=6) or an intervention group (I, n=6). The I group then participated in an 8-week multidisciplinary intervention program consisting of small group discussions, movement improvisation, and relaxation techniques. Dependent variables consisted of scores from standardized instruments for anxiety, self-esteem, and BN. A multivariate analysis of variance (MANOVA) on the difference score from post- to pretest was calculated for state and trait anxiety. That analysis indicated that compared to the C group, which showed no reduction in anxiety, the I group had a significant reduction in anxiety following the intervention program. No significant differences were found between groups for self-esteem or symptoms of BN. Conclusions were that anxiety levels were lowered in the I group; however, attitudes or behaviors associated with BN were not affected by the intervention.     

The clinical presentation of Japanese women with anorexia nervosa and bulimia nervosa: a study of the Eating Disorders Inventory-2

OBJECTIVE: The current study described the clinical presentation of anorexia nervosa (AN) and bulimia nervosa (BN) in Japan utilizing the Eating Disorders Inventory-2 (EDI-2) and assessed whether the clinical profile of eating disorder cases in Japan differs significantly from North American data. METHOD: Statistical comparisons of Japanese AN, BN, and non-eating-disordered (NonED) EDI-2 data were conducted across diagnostic groups and with the North American standardization sample. RESULTS: The Japanese diagnostic groups reported significant between-group differences on all eight EDI-2 subscales. Compared with the standardization sample, all the Japanese groups reported significantly greater maturity fears, the Japanese AN-restricting subtype group (AN-R) reported lower levels of drive for thinness and perfectionism, the Japanese BN group reported lower levels of drive for thinness, and the Japanese NonED Group reported lower levels of drive for thinness and perfectionism but higher rates of ineffectiveness. DISCUSSION: Differences between the Japanese and North American groups suggest that certain cultural differences exist in eating disorder profiles.     

The Eating Disorder Inventory in a UK National Health Service Obesity Clinic and its response to modest weight loss

OBJECTIVE: Using the Eating Disorder Inventory (EDI-2) to identify a normative range in a UK obese population referred to a specialist hospital obesity clinic and to assess the response of the scale to the nonsurgical treatment of obesity. METHODS: A total of 100 obese (BMI>30) patients attending an obesity clinic completed the EDI-2. In a separate sample, 45 obese patients participated in a dietary weight loss program consisting of an acute (10 weeks) and a long-term (2 year) weight maintenance phase. The EDI-2 was administered at baseline and at the end of the acute weight loss phase. RESULTS: Most obese subjects showed elevated scores for body dissatisfaction (BD), which improved with weight loss. Eight percent had EDI scores suggesting psychological traits central to eating disorders. CONCLUSION: Most obese subjects do not have a trait central to an eating disorder as defined by the EDI-2, but do have high scores for BD that respond to weight loss. A few patients show scores suggesting an eating disorder that may benefit from psychological evaluation.     

Examining body image discrepancies and perceived weight status in adult Japanese women

This study examined potential differences and similarities between attitudes about body shape and eating behaviors in Japan versus America. Discrepancies between various body ideals (e.g., own versus ideal; Japanese versus American) and perceived weight status were examined in a sample of adult Japanese women. Forty-five adult Japanese women rated various body ideals using the Stunkard Body Shape Questionnaire. They also answered questions about their perceived body weight and completed the Eating Disorders Inventory (EDI-2). Participants rated the ideal body shape for Japanese women to be significantly thinner than for American women. Body image discrepancy predicted drive for thinness and bulimic symptoms as measured by the EDI-2. Furthermore, there was an interaction between perfectionism and perceived overweight status, such that among participants high on perceived weight status, perfectionism predicted greater bulimic symptomology. The relative importance of the internalization of the Western beauty ideal to the rise of eating disorders in Japan is discussed. Similarities between the findings of this study and studies conducted on American samples are highlighted, and areas for future research are proposed.     

Psychological Risk Factors for the Development of Restrictive and Bulimic Eating Behaviors: A Polish and Vietnamese Comparison

The aim of this paper is to identify psychological factors which are culture specific or common predictors for restrictive and bulimic behaviors towards eating for young women raised in different cultures. The study included 661 young women from Poland (n = 233) and Vietnam (n = 428). Subjects filled-in the Eating Disorders Inventory (EDI-3) and the Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS), and body measurements were collected to calculate anthropometric indices. Women form Vietnam were less satisfied with their appearance than were their Polish peers, but Vietnamese showed a lower level of preoccupation with being overweight and fear of obesity. Intercultural differences indicate that Vietnamese women show greater intensities for psychological variables, connected with restrictive and bulimic eating behaviors, verified in the research model: low self-esteem, personal alienation, interpersonal insecurity, interpersonal alienation, emotional dysregulation, interoceptive deficits, perfectionism and asceticism, and anxiety.     

Interoceptive sensitivity deficits in women recovered from bulimia nervosa

Self-report studies suggest that patients with bulimia nervosa (BN) evidence difficulties with interoceptive awareness. Indeed, interoceptive deficits may persist after recovery of BN and may be a biological trait that predisposes symptom development in BN. However, no studies to date have directly assessed interoceptive sensitivity, or accuracy in detecting and perceiving internal body cues, in patients with or recovered from BN. Nine women who had recovered from BN and 10 healthy control women completed the Heart Beat Perception Task (HBPT) in which individuals were required to estimate the number of heartbeats between intervals of time. Accuracy scores were compared between groups. Significant differences were found between the groups on the HBPT ((F _1,19) = 7.78, p = .013, Cohen's d = 1.16) when controlling for age. These results suggest that deficits in interoceptive sensitivity are present in individuals recovered from BN. Thus interoceptive deficits may be one factor that bridges the gap between brain dysfunction and symptom presentation in BN.     

Personality,clinical features,and test instructions can affect executive functions in Eating Disorders

Cognitive deficits in Eating Disorders have been related to the executive function domain. Yet, to date, only few works investigated the relationship between neuropsychological and clinical issues, and these studies were separately conducted either on Anorexia Nervosa (AN) or Bulimia Nervosa (BN).In this study, three groups of AN, BN and matched controls were administered the Trail Making Test, the Wisconsin Card Sorting Test, and the Hayling Sentence Completion Test, in addition to personality and clinical assessments (Temperament and Character Inventory, SCL-90-R, EDI-2).Results from AN indicated a relationship between cognitive rigidity and fixed psychological traits. Conversely, BN showed broader correlations among slowness, inhibition, and psychopathology-state indexes, confirming the clear relation published in the literature.We also hypothesize that task peculiar characteristics can affect high-order attentional activities in Eating Disorders. In fact, these patients do not differ from controls when the examiner provides overt instruction and run-in examples, but they can find serious difficulties when the correct rule is to be derived and modified from feedbacks during the test, as in the Wisconsin Card Sorting Test. Perfectionist stable traits support this hypothesis, especially in AN, as excessive cognitive control can either improve or damage set-shifting and decision-making procedures.     

Functional impairment associated with bulimic behaviors in a community sample of men and women

OBJECTIVE: To examine functional impairment associated with bulimic behaviors in a community sample of men and women. METHOD: Binge eating, purging, fasting, extreme weight and shape concerns, and "days-out-of-role" were assessed in a community sample of men (n = 1,290) and women (n = 1,757) aged 15-94 years. RESULTS: Participants who reported regular eating disorder behaviors had higher levels of functional impairment than those who did not. This was the case for both men and women and for each of the behaviors assessed, although differences between purgers and nonpurgers were not statistically significant. Also in both men and women, participants who reported eating disorder behaviors and weight or shape concerns had higher levels of impairment than those who reported these behaviors in the absence of weight or shape concerns. In multivariate analysis, binge eating, fasting and weight or shape concerns all contributed to the likelihood of impairment in men, whereas only the presence of weight or shape concerns was significantly associated with impairment in women. CONCLUSION: Whereas bulimic behaviors are associated with elevated levels of functional impairment in both men and women, weight or shape concerns may be more central to the experience of this impairment in women.     

Personality, perfectionism, and attitudes toward eating in parents of individuals with eating disorders

OBJECTIVE: This study compares personality and eating-related traits in parents of probands with eating disorders, with age-band matched healthy normal controls. METHOD: Data were abstracted from an international genetic study of anorexia nervosa. Information was available for the Multidimensional Perfectionism Scale (MPS), the Eating Disorders Inventory (EDI), and the Temperament and Character Inventory (TCI). Comparisons were done by multivariate analysis of variance. RESULTS: Mothers of probands showed elevated levels of perfectionism on the MPS and more concerns about weight and shape on the EDI compared with controls. Mothers who had daughters with diagnoses other than the restricting subtype of anorexia nervosa showed elevated levels of perfectionism on the MPS. CONCLUSION: These data are compatible with the notion that some personality traits, such as perfectionism, and weight and shape concerns may cluster in families of probands with eating disorders.     

Using the eating disorder examination to identify the specific psychopathology of binge eating disorder

OBJECTIVE: The clinical features of binge eating disorder (BED) are not well established. Therefore, a comprehensive assessment of the specific psychopathology of BED as compared to anorexia nervosa (AN) and bulimia nervosa (BN) is warranted. This comparison was the aim of the present study. METHOD: Detailed ratings from an investigator-based interview, the Eating Disorders Examination (EDE), were compared across three groups of female patients: those with BED, AN, and BN, as well as normal-weight and overweight control subjects. RESULTS: When comparing BED to AN and BN, patients with BED had lower levels of restraint, eating concerns comparable to AN patients but lower than BN patients, and weight and shape concerns comparable to BN patients but higher than AN patients. Significantly more eating disorder psychopathology was found for BED patients as compared to the overweight controls on all bar the EDE restraint subscale. On the majority of individual EDE items, BED patients' scores were similar to those of AN and BN patients, including importance of shape and weight in self-evaluation and preoccupation with shape and weight. No significant relationship was found between BED patients' degree of overweight and eating psychopathology. DISCUSSION: Our findings support the status of BED as an eating disorder and suggest that the elevated EDE scores reflect the combined impact of being objectively overweight and having disordered cognitions and behaviors about eating, shape, and weight.     

Perceived expressed emotion in the siblings and parents of hospitalized patients with anorexia nervosa

OBJECTIVE: The present study investigated the relationship between the level of perceived Expressed Emotion (EE) of the siblings and parents of patients hospitalized with anorexia nervosa and its effect on weight gain and psychological functioning. METHOD: The Level of Expressed Emotion (LEE) Scale was administered on admission to 19 patients with anorexia nervosa who completed the LEE three times so as to identify their perceptions of their relationship with their closest age sibling, mother, and father. They were also required to complete the Eating Disorder Inventory 2 (EDI-2). Patients' closest age sibling completed the Family Attitude Scale (FAS). The patients' body mass index (BMI) was calculated 6 weeks later, and the EDI-2 readministered. RESULTS: Perceived EE was not predictive of BMI change after 6 weeks of hospitalization. A composite perceived family EE score was a significant predictor of change on the Interpersonal Distrust, Maturity Fears, and Perfectionism subscales of the EDI-2. DISCUSSION: These findings suggest that patients' perceptions of their relationships with their closest aged sibling, mother, and father are poor predictors of weight gain and improvement in psychological functioning following 6 weeks of inpatient treatment.     

Adolescents with bulimia nervosa and eating disorder not otherwise specified-purging only

OBJECTIVE: The purpose of the study was to better understand the phenomenology of bulimic symptomatology in an adolescent clinic sample. METHOD: Adolescents with bulimia nervosa (BN; n = 36) and eating disorders not otherwise specified-purging but no objective bulimic episodes (EDNOS-P; n = 20) were compared on the Eating Disorder Examination (EDE), the Beck Depression Inventory (BDI), the Rosenberg Self-Esteem Scale (RSES), and the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). RESULTS: Subjects with EDNOS-P and BN were equivalent in terms of age and weight, but were less likely to have intact families. Nearly one half of EDNOS-P subjects purged exclusively outside of eating episodes in which they experienced a sense of loss of control. Although still at clinically significant levels, EDNOS-P subjects reported less concerns regarding weight, shape, and eating relative to BN. Groups were not significantly different on psychiatric comorbidity, but differed on self-esteem. DISCUSSION: Results prompt reappraisal of current criteria of BN to encompass those who purge without binge eating.