The natural course of bulimia nervosa and eating disorder not otherwise specified is not influenced by personality disorders

OBJECTIVE: To examine prospectively the natural course of bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS) and to test the effects of personality disorder (PD) comorbidity on the outcomes. METHOD: Ninety-two female patients with current BN (N=23) or EDNOS (N=69) were evaluated at baseline enrollment in the Collaborative Longitudinal Personality Disorders Study (CLPS). Eating disorders (EDs) were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders. Personality disorders (PDs) were assessed with the Diagnostic Interview for DSM-IV PD (DIPD-IV). The course of BN and EDNOS was assessed with the Longitudinal Interval Follow-up Evaluation and the course of PDs was evaluated with the Follow-Along version of the DIPD-IV at 6, 12, and 24 months. RESULTS: Probability of remission at 24 months was 40% for BN and 59% for EDNOS. To test the effects of PD comorbidity on course, ED patients were divided into groups with no, one, and two or more PDs. Cox proportional regression analyses revealed that BN had a longer time to remission than EDNOS (p<.05). The number of PDs was not a significant predictor of time to remission, nor was the presence of Axis I psychiatric comorbidity or Global Assessment of Functioning scores. Analyses using proportional hazards regression with time-varying covariates revealed that PD instability was unrelated to changes in ED. CONCLUSIONS: BN has a worse 24-month course (longer time to remission) than EDNOS. The natural course of BN and EDNOS is not influenced significantly by the presence, severity, or time-varying changes of co-occurring PDs, co-occurring Axis I disorders, or by global functioning.     

The interaction of personality disorders and eating disorders: a two-year prospective study of patients with longstanding eating disorders

OBJECTIVE: The current study aimed to investigate the relation between personality disorders and symptoms of both eating disorders and general psychopathology over time. METHOD: Seventy-four patients, with a mean age of 30 years and admitted to a hospital for treatment of a chronic eating disorder, were assessed using the Eating Disorder Inventory (EDI), the Eating Disorder Examination (EDE), the Symptom Check List-90-Revised (SCL-90-R), and the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II) at admission, and after 1 and 2 years. RESULTS: At the 2-year follow-up, there was considerable reduction in both personality and symptoms (effect size = 0.83-0.94). Panel modeling using structural equation modeling techniques indicated that symptomatic changes generally preceded changes in the personality disorder. DISCUSSION: Eating disorder symptoms and general symptomatology had direct effects on a dimensional personality disorder index. Thus, personality disorders may be at least partially a consequence of general symptomatology in chronic eating disorders. Symptom improvement appears to precede changes in personality in this sample of patients with chronic eating disorders.     

Axis I comorbidity onset and parasuicide in women with eating disorders

OBJECTIVE: We examined differences in the onset pattern of comorbid disorders in eating-disordered women with and without a history of parasuicide to elucidate potential etiologic differences between the two groups. METHODS: Fifty-four women with a current or past eating disorder partcipated. Of these women, 27 had a history of suicide attempts and self-injury and 27 had no history of suicide attempts or self-injury. The age and pattern of onset for the eating disorder relative to comorbid major depression, anxiety disorder, and substance use disorder were compared between the groups. RESULTS: The onset of major depression and anxiety disorders occurred at a younger age in the parasuicidal group. In addition, the onset of major depression in the parasuicidal group occurred significantly more often before the onset of the eating disorder. DISCUSSION: The eating disorder may be secondary to a mood disturbance in women with parasuicidal histories.     

Eating disorders among female adolescents in Switzerland: Prevalence and associations with mental and behavioral disorders

Objectives: To measure the prevalence of eating disorders in a national representative sample of adolescent girls and association of eating disorders with other behavioral/mental problems in Switzerland. Methods: As part of a national health survey, a subsample of 1,084 15 to 20-year-old female students attending school aged filled in a self-administered anonymous questionnaire focusing on eating behavior and body image. Factor analysis made on these specific questions reveals two major dimensions: weight and image concern (WIC) and problematic eating conduct (PEC). The correlates of these two dimensions were measured using bivariate analyses. Results: Among girls, 62% say they want to lose weight, 36% feel too fat, 37% report fasting episodes, 18.9% fear not to be able to stop eating, 9.1% engage in binge eating at least once a week (1.9% daily), 1.6% self-induced vomit at least once a week (0.2% daily). Girls who exhibit high WIC (N = 198) or high PEC (N = 75) scores report significantly more mood problems (p < .05), suicidal conducts (p < .05), or violent and aggressive behaviors (p < .05). No association is found with substance use. Associations with acting-out behavior are stronger among high PEC subjects, whereas those with mood disorders are stronger among high WIC subjects. Conclusion: A large proportion of adolescent girls show concerns regarding their weight and body image whereas a less important proportion exhibit dysfunctional eating behavior. The results confirm the associations between eating disorder and mood, suicide, and conduct problems but infirm the association with substance use. Girls who exhibit problematic conducts appear to require more attention from health resources. © 1998 by John Wiley & Sons, Inc. Int J Eat Disord 24: 207–216, 1998.     

Eating disorder symptomatology and substance use disorders: Prevalence and shared risk in a population based twin sample

Objective:

Research shows a significant association between eating disorders (ED) and substance use disorders (SUD). The objective of this study is to examine the prevalence, chronology, and possibility of shared familial risk between SUD and ED symptomatology.

Method:

Subjects included 1,206 monozygotic and 877 dizygotic adult female twins. ED symptomatology included anorexia (AN) and bulimia nervosa (BN) diagnosis, symptoms associated with diagnostic criteria, and BN symptom count. SUD included alcohol, illicit drug, and caffeine abuse/dependence. Generalized estimated equation modeling was used to examine phenotypic associations, and Choleksy decompositions were used to delineate the contribution of genes and environment to comorbidity.

Results:

There were no significant differences between SUD prevalence in women with AN and BN. Women with BN reported BN preceded SUD development while the reverse was true for AN. Twin analyses showed possible familial overlap between BN symptomatology and all SUD examined.

Discussion:

Results suggest an important difference in the chronology of EDs and SUDs. Women with BN may be turning to substances to dampen bulimic urges. Women with AN may be engaging in substance use initially in an effort to lose weight. Results also suggest familial factors contribute to the comorbidity between BN and SUD. © 2010 by Wiley Periodicals, Inc. (Int J Eat Disord 2010;)     

Eating disorders and health in elite women distance runners.

OBJECTIVES: To examine the presence of eating disorder syndromes in elite women distance runners in the United Kingdom and any associated differences in training, dieting, general health, and well-being. METHOD: Athletes were selected from the top of their respective ranking lists for all middle and long-distance races in 1996/1997. All running disciplines were included (track, road, cross-country, and fell/mountain running). Athletes were sent the Eating Disorders Examination Questionnaire and a questionnaire on demographics, athletic training, diet, and health. Of the 226 athletes identified, 181 (81%) completed and returned the questionnaires. RESULTS: Twenty-nine athletes (16%) had an eating disorder at the time of the study (7 had anorexia nervosa [AN], 2 had bulimia nervosa [BN], and 20 had eating disorders not otherwise specified [EDNOS]) and a further 6 had received previous treatment. Comparing the eating disorder group with the rest of the sample showed no difference in age, height, preferred race distance, or the number of hours/week spent training. However, they had a significantly lower body mass index (BMI), lower self-esteem, and poorer mental health. Current and past dieting were significantly more common in the eating disorder group. DISCUSSION: The levels of AN and EDNOS are higher than would be expected in similarly aged, nonathletic women. The demands for leanness rather than exercise intensity appear to be the main risk in these elite runners. The early detection and prevention of eating disorders in women athletes should have high priority.     

Comparing clinical and research treatments for eating disorders

OBJECTIVE: This study evaluated whether there is a gap between research and practice in the treatment of eating disorders. METHOD: Psychologists in clinical practice (N = 126) were surveyed regarding their treatment of a recent client with an eating disorder and a content analysis of published treatment outcome studies for eating disorders (N = 76) was conducted. RESULTS: The treatment of eating disorders in clinical and research settings was found to differ significantly on several variables, including the types of therapeutic issues addressed and the frequency of comorbidity seen in clients. Logistic regression analyses found that the frequency with which psychologists read journal articles about eating disorders was significantly related to whether their clients received empirically validated treatment. DISCUSSION: Psychologists in clinical practice are not using empirically validated treatments not only because of a lack of training but also because such treatments provide little guidance for dealing with the issues and comorbid problems that their clients with eating disorders often have.     

Do eating disorders co‐occur with personality disorders? Comparison groups matter

OBJECTIVE: To assess and compare lifetime rates of occurrence of eating disorders (ED) with four Axis II personality disorders (PD) and with major depressive disorder (MDD) without PD. The eating disorders met criteria outlined in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). METHOD: Six hundred sixty-eight patients recruited for the Collaborative Longitudinal Personality Disorders Study (CLPS) were reliably assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders and the Diagnostic Interview for DSM-IV Personality Disorders. The distribution of ED diagnoses was compared among four PD study groups (schizotypal, borderline, avoidant, obsessive-compulsive) and a fifth study group with MDD without any PD. RESULTS: The distribution of lifetime diagnoses of anorexia nervosa (N = 40), bulimia nervosa (N = 56), and eating disorder not otherwise specified (N = 118) did not differ significantly across the five study groups, between the MDD group versus all PD groups, and among the four PD study groups. CONCLUSIONS: ED diagnoses did not differentially co-occur significantly across common Axis I and II disorders. The pattern of ED lifetime co-occurrence rates demonstrates the powerful influence of base rates and highlights that declarations of comorbidity demand significant variations from base-rate patterns.     

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.     

Patterns of menstrual disturbance in eating disorders

OBJECTIVE: To describe menstrual disturbance in eating disorders (ED). METHOD: We describe menstrual history in 1,705 women and compare eating, weight, and psychopathological traits across menstrual groups. RESULTS: Menstrual dysfunction occurred across all eating disorder subtypes. Individuals with normal menstrual history and primary amenorrhea reported the highest and lowest lifetime body mass index (BMI), respectively. Normal menstruation and oligomenorrhea groups reported greater binge eating, vomiting, and appetite suppressant use. Amenorrhea was associated with lower caloric intake and higher exercise. Harm avoidance, novelty seeking, perfectionism, and obsessionality discriminated among menstrual status groups. No differences in comorbid Axis I and II disorders were observed. CONCLUSION: Menstrual dysfunction is not limited to any eating disorder subtype. BMI, caloric intake, and exercise were strongly associated with menstrual function. Menstrual status is not associated with comorbidity. Menstrual irregularity is an associated feature of all ED rather than being restricted to AN only.