MCMI-II borderline personality disorder in anorexia and bulimia nervosa

The aim of the present study is to explore the MCMI-II personality style and MCMI-II possible disorder of borderline personality (BPD) in various groups of women. 93 patients-31 anorexia nervosa restricting subtype (ANr), 31 anorexia nervosa binge-eating/purging subtype (ANp), and 31 bulimia nervosa purging subtype (BNp); 31 women at high risk for eating disorder or symptomatic control group (S-CG) and 31 without known pathology or not symptomatic control group (NS-CG)-completed the Spanish version of the MCMI-II. The results revealed: (1) clinically significant borderline personality traits [74>Base Rate (BR) <85]: 16.1% ANr, 12.9% ANp, and 45.2% BNp versus 3.2% of the S-CG and none of the NS-CG; (2) possible disorder (BR>84): 29% ANr, 41.9% ANp and 29% BNp. According to the MCM-II, women with BNp displayed more BPD traits than possible disorder (though these were more severe). However, the probability of a possible disorder was higher in ANp (more disorders than traits).     

Empathy in families of women with borderline personality disorder, anorexia nervosa, and a control group

This is a study of empathy in the families of 27 women with borderline personality disorder (BPD), 28 women with restricting anorexia nervosa (AN), and 27 women without a clinical diagnosis (NC). The daughters and both parents responded to the Interpersonal Reactivity Index (IRI), an instrument for assessing four dimensions of empathy. In addition, they were personally interviewed, with the Family Interview for Protectiveness and Empathy (FIPE), about the extent of empathy expressed by the parents to their daughter during her development. On the IRI, women with BPD scored highest on the immature and lowest on the mature aspects of empathy, whereas scores of AN and NC women were all within normal limits. Parents of BPDs had the lowest IRI scores, while parents of AN and NC groups were similar to each other and to criterion group scores. IRI scores of AN daughters were positively correlated with their parents' scores whereas BPDs' scores were negatively correlated with those of their parents. There were no correlations between the IRI scores of NC subjects and their parents. On the FIPE, borderline daughters and parents agreed about the relative absence of empathic parenting, whereas AN and NC daughters and parents agreed as to the presence of empathic parenting. The theoretical and clinical implications of these contrasting findings are discussed.     

Relationship of obsessive-compulsive personality to obsessive-compulsive disorder: a review of the literature

The nature of the relationship between obsessive-compulsive personality and obsessive-compulsive disorder has been the subject of considerable debate. The present article dealt with clinical opinion and reviewed empirical data bearing on this issue. It was concluded that, although the two clinical entities bear a surface similarity in terms of shared behavioral features and defenses, obsessive-compulsive personality is neither a necessary nor sufficient factor in the development of obsessive-compulsive disorder, though the latter appears to be more frequently associated with premorbid obsessive-compulsive personality patterns than with other personality patterns. Suggestions for future research study are made.     

Personality disorders and personality dimensions in anorexia nervosa

Information on the relationship between anorexia nervosa (AN) and personality disorders (PDs) and dimensions of temperament and character (measured by the Temperament and Character Inventory [TCI; Cloninger, Przybeck Svrakic, & Wetzel, 1994]) is limited. This study examines the predictive validity of the TCI for PD diagnoses assessed by the International Personality Disorder Examination-ICD-10 (IPDE-ICD-10; Loranger, Janca, & Sartorius, 1997) interviews of 46 women with DSM-IV-defined AN. Patients with a PD reported higher levels of harm-avoidance and lower levels of self-directedness than those without a PD. Scores on the TCI were predictive of the number of PD features present, particularly for those PDs in the anankastic, anxious, and dependent groups accounting for 40% to 51% of the variance. Cluster analysis based on scores on the TCI identified a subgroup of patients characterized by low levels of novelty seeking, self-directedness, and cooperativeness and high levels of harm avoidance. This cluster included the majority of those with avoidant, anxious, or dependent PDs. Assessment of particular personality dimensions was able to predict PDs in an anorexic sample. Since normal personality dimensions have greater validity than the categorical PDs, a consideration of normal temperament and character may assist in clinical decisionmaking and considerations concerning treatment.     

Sexual,body-image,and personality attitudes in anorexia nervosa

Assessment of adolescent females with anorexia nervosa was carried out at the time of hospitalization and again at discharge. Findings were compared to those from a normal weight control group. The anorexic subjects at the start of treatment indicated significantly negative attitudes about sexual issues. They also reported a significantly poorer self-evaluation of their body, personality, and social skills than was evident in the comparison group. An improvement in attitude regarding these issues was demonstrated by the end of treatment. The function of weight loss in dealing with these problem areas was discussed.     

Nature over nurture: temperament, personality, and life span development

Temperaments are often regarded as biologically based psychological tendencies with intrinsic paths of development. It is argued that this definition applies to the personality traits of the five-factor model. Evidence for the endogenous nature of traits is summarized from studies of behavior genetics, parent-child relations, personality structure, animal personality, and the longitudinal stability of individual differences. New evidence for intrinsic maturation is offered from analyses of NEO Five-Factor Inventory scores for men and women age 14 and over in German, British, Spanish, Czech, and Turkish samples (N = 5,085). These data support strong conceptual links to child temperament despite modest empirical associations. The intrinsic maturation of personality is complemented by the culturally conditioned development of characteristic adaptations that express personality; interventions in human development are best addressed to these.     

A study of temperament and personality in anorexia and bulimia nervosa

Although temperament and personality traits could influence the development and course of eating disorders, only a few studies examined the similarities and differences in personality between anorexia and bulimia nervosa. We compared 72 patients with DSM-IV eating disorders and 30 healthy controls. Dimensions of personality and personality disorders were evaluated with the Eysenck's EPQ, Cloninger's TCI, and the SCID-II questionnaires. The rates of impulsivity and clinical features were evaluated using specific rating scales. A comorbid personality disorder was found in 61.8% of patients with eating disorder. Avoidant personality disorder appeared was relatively common in anorexia nervosa restricting type; borderline personality disorder was most frequent in bulimia nervosa and the binge eating-purging type of anorexia nervosa. From a dimensional perspective, anorexic patients presented high scores in the dimension of persistence. Higher harm avoidance and impulsivity was found in bulimic patients. The overall eating disorders group presented high scores in neuroticism and low scores in self-directedness. Eating disorder patients have heterogeneous features of temperament and personality traits. Cluster C personality disorders seem more common in anorexia nervosa restricting type and impulsive personality features are associated with bulimic symptoms. Impulsivity seems to be a key aspect of temperament of bulimic patients, whereas anorexic symptoms are linked to persistent temperament traits.     

Implicit self- and other-associations in obsessive-compulsive personality disorder traits

This study investigated automatic associations with the self and with others in the context of obsessive-compulsive personality disorder (OCPD). Participants scoring high (n=20) or low (n=20) on DSM-IV OCPD traits performed three irrelevant-feature tasks in which language of the words (Dutch vs. English) was the relevant stimulus feature and word content (OCPD self-view, OCPD other-view, high self-esteem and low self-esteem) the irrelevant feature. Results showed that the high and low OCPD group differed with respect to both explicit and implicit OCPD cognitions. Typically, high OCPD participants showed better performance on OCPD-congruent trials than on OCPD-incongruent trials, whereas low OCPD participants displayed the opposite pattern. This was evident from a semantic Simon effect and from a semantic priming effect. Correlations between direct and indirect measures of OCPD beliefs and of self-esteem were low. Moreover, the indirect OCPD measures contributed uniquely and independently of explicit beliefs to the prediction of OCPD.     

Pattern of comorbidity among anxious and odd personality disorders: the case of obsessive-compulsive personality disorder

The aim of this study was to examine the pattern of comorbidity among obsessive-compulsive personality disorder (OCPD) and other personality disorders (PDs) in a sample of 400 psychiatric inpatients. PDs were assessed using the Semistructured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Odds ratios (ORs) were calculated to determine significant comorbidity among OCPD and other axis II disorders. The most elevated odds ratios were found for the cooccurrence of OCPD with cluster A PDs (the "odd" PDs, or paranoid and schizoid PDs). These results are consistent with those of previous studies showing a higher cooccurrence of OCPD with cluster A than with cluster C ("anxious") PDs. In light of these observations, issues associated with the nosologic status of OCPD within the Diagnostic and Statistical Manual of Mental Disorders clustering system remain unsettled.     

Determinants of adolescent obesity: a comparison with anorexia nervosa

This report investigates childhood and adolescent obesity through a comparison with anorexia nervosa, an eating disorder typically associated with the opposite end of the eating behavior spectrum. Many similarities in the etiologies of the two conditions are discussed, particularly with regard to the influence of family interactional patterns. More specifically, it appears that the families of both anorexics and the obese are characterized by overprotectiveness and enmeshment, resulting in a poor sense of identity and effectiveness. Such children, usually compliant and dependent in childhood, misuse the eating function in an attempt to assert their independence and gain control of their lives in adolescence. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), anorexia nervosa, but not obesity, meets the definition of an eating disorder. Although it appears that DSM-III-R is accurate in not classifying obesity as an eating disorder, it is important to keep the etiological similarities of the two conditions in mind when treating obesity.     

Beliefs in personality disorders: a test with the personality disorder belief questionnaire

The hypothesis that each personality disorder (PD) is characterized by a specific set of beliefs was tested in a sample of 643 subjects, including non-patient controls, axis-I and axis-II patients, diagnosed with SCID-I and -II interviews. Beliefs of six PDs (avoidant, dependent, obsessive-compulsive, paranoid, histrionic, borderline) were assessed with the Personality Disorder Belief Questionnaire (PDBQ). Factor analyses supported the existence of six hypothesized sets of beliefs. Structural equation modeling (SEM) supported the hypothesis that each PD is characterized by a specific set of beliefs. Path coefficients were however in the medium range, suggesting that PDs are not solely determined by beliefs. Nevertheless, empirically derived cutoff scores of the six belief subscales were reasonably successful in classifying subjects, percentages ranging form 51% to 83%. It appeared that there was a monotonical increase in scores on each belief subscale from non-patient controls, to patients without any PD, to patients with PDs (other than the pertinent PD), to patients with the pertinent PD. This suggests that PD-related beliefs are at least partly associated with (personality) psychopathology in general. Another explanation is that many patients' position on the underlying dimensions is not high enough to lead to a DSM PD diagnosis, but high enough to lead to an elevated belief score.     

The heterogeneous structure of schizotypal personality disorder: item-level factors of the Schizotypal Personality Questionnaire and their associations with obsessive-compulsive disorder symptoms, dissociative tendencies, and normal personality

A. Raine et al.'s (1994) 3-factor scheme is currently the most widely accepted model of schizotypal personality disorder (SPD). Factor analytic studies of the Schizotypal Personality Questionnaire (SPQ; A. Raine, 1991) subscales, which represent the 9 Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for SPD, have provided the model's primary support. The use of only 9 modeled variables, however, limits the number of factors that can be extracted. To explicate this structure more fully, the authors conducted item-level factor analyses of the SPQ in a large student sample that completed the instrument twice within a 2-week interval. The authors' analyses failed to support either the 3-factor model of SPD or the 9 existing DSM-based subscales of the SPQ. Instead, 5 replicable dimensions emerged that capture recurrent symptom pairings found in the broader SPD literature: Social Anhedonia, Unusual Beliefs and Experiences, Social Anxiety, Mistrust, and Eccentricity/Oddity. These factors are only weakly correlated with each other and show differential correlational patterns with the Big Five personality traits, dissociative tendencies, and symptoms of obsessive-compulsive disorder. Moreover, they are congruent with dimensional models of personality psychopathology. Implications for SPD in DSM-V are discussed.     

Cognitive therapy with obsessive-compulsive disorder: a comparative evaluation.

After a 4-week waiting period 21 obsessive-compulsives were randomly allocated to two treatment conditions (1) Rational Emotive Therapy (RET) and (2) exposure in vivo. RET consisted of analysing irrational thoughts; exposure in vivo was self-controlled. After six sessions and another 4-week waiting period all patients received six sessions of exposure in vivo. Both treatments resulted in significant improvement on anxiety/discomfort, Maudsley Obsessional Compulsive Inventory, and Dutch Obsessional Compulsive Questionnaire and in a reduction of scores on the Irrational Beliefs Test. Results were maintained to a follow-up 6 months later. No significant differences were found between the two conditions.     

Metacognitions in patients with hallucinations and obsessive-compulsive disorder: the superstition factor

On the basis of the analogy between intrusive thoughts and auditory hallucinations established by Morrison et al. [(1995). Intrusive thoughts and auditory hallucinations: a cognitive approach. Behavioural and Cognitive Psychotherapy, 23, 265-280], the present work compares the metacognitive beliefs and processes of five groups of patients (current hallucinators, never-hallucinated people with a diagnosis of schizophrenia, recovered hallucinators, obsessive-compulsive disorder (OCD) patients, and a clinical control group) and a non-clinical group. The results show that of the five metacognitive factors considered in this study, two were found to be different in the current hallucinators group in comparison to any other group in the design. Likewise, it is found that the metacognitive beliefs of the current hallucinators coincide with those of the OCD patients in various factors, particularly that relating to superstition, and this is interpreted as lending support to the model of Morrison et al. (1995). Furthermore, the results are discussed in the light of existing research on Thought-Action Fusion, stressing the role that may be played by superstitious beliefs and magical thinking in auditory hallucinations and OCD.     

"On my way here, I passed a man with a scab": understanding a case of severe obsessive-compulsive disorder

The author describes the psychoanalysis of "John" to illustrate her view of the psychodynamic organization of obsessive-compulsive disorder. She begins with Freud's recognition of the patient's sadism and of the patient's terror of the oedipal situation, which led to the regression to the anal-erotic level of psychic organization. The author then calls upon ideas from contemporary British object relations theory to describe the damage to the objects and to the sense of self in the individual's inner world that occurs as a further defense when overwhelming danger is experienced. This integrated conceptualization is clearly illustrated in John's clinical material.     

Group coleadership: a new role for parents of adolescents with anorexia and bulimia nervosa

This paper describes a model for coleadership of a multifamily group which is part of an outpatient treatment program for adolescents with anorexia and bulimia nervosa at The Children's Hospital in Boston. This clinic is a collaborative effort between the Departments of Psychiatry and Adolescent Medicine and has been involved with more than 600 patients and their families. The parents of a recovered adolescent girl have shared group leadership with the author for six years and have added an innovative dimension to the group process as a result of their own experiences. Theoretical and empirical observations are presented and guidelines for maximizing coping abilities are outlined.     

Influence of co-morbid generalized anxiety disorder, panic disorder and personality disorders on the outcome of cognitive behavioural treatment of obsessive-compulsive disorder

This study examined co-morbid generalized anxiety disorder and/or panic disorder and personality disorders as predictors of treatment outcomes in adult outpatients with obsessive-compulsive disorder. The patients received exposure with response prevention (ERP) treatment with the addition of either elements of cognitive therapy (ERP+CT) or relaxation training (ERP+REL). It was hypothesized that the addition of cognitive interventions would yield better treatment outcomes for patients with co-morbid generalized anxiety disorder and/or panic disorder. It was also hypothesized that patients with any personality disorder would show less treatment gains in both conditions. Using intention-to-treat criteria, patients with generalized anxiety disorder and/or panic disorder co-morbidity showed less treatment gains at post-treatment across both treatment conditions. This group showed significantly more treatment gains in the ERP+CT condition at the post-treatment and the 12-month follow-up assessments compared with patients in the ERP+REL condition. However, this was not significant when comparing treatment completers. Patients with a co-morbid Cluster A or B personality disorder showed significantly less treatment gains in both treatment conditions at the 12-month follow-up assessment. Among treatment completers, patients with a Cluster C personality disorder showed significantly better outcomes at the post-treatment assessment in the ERP+REL treatment condition. These results, clinical implications, and the importance of further investigations are discussed.