MCMI characteristics of DSM-III-R bulimics

The literature on bulimia has suggested that bulimic women exhibit a number of pathological personality characteristics. However, the Millon Clinical Multiaxial Inventory (MCMI), an objective measure of personality functioning, has not previously been utilized to assess the personality characteristics of a bulimic population. The MCMI was administered to 37 female bulimics, 32 female general psychiatric outpatients, and 30 normal female controls in order to assess the relationship between bulimia and pathological personality traits. Bulimic women were found to score higher than the other groups on MCMI Scales 1 (Schizoid), 2 (Avoidant), and 3 (Dependent). They also scored lower than the other two groups on Scale 6 (Antisocial). Results are discussed within the framework of parallels between the MCMI profiles of bulimics and the existing literature on bulimics' personality characteristics.     

Rorschach assessment of purging and nonpurging bulimics

Research in bulimia has flourished in recent years, and yet minimal attention has been devoted to explorations of the bulimic's basic personality organization. We utilized the Rorschach to differentiate between purging and nonpurging bulimics and controls. There were 15 subjects in each group. The Comprehensive System (Exner, 1986) was used for the scoring of the protocols. Statistically significant differences were not found between the two bulimia groups, but interesting trends were detected in the areas of depression, anger, and self-preoccupation. Results appear to be constrained by the low rate of purging behavior. Comparisons between the combined bulimia groups and the controls resulted in solidly characterizing the bulimics as displaying perceptual inaccuracies, disordered thinking, a vulnerability to interpersonal problems, a damaged self-image, and a pessimistic outlook. The strengths of the study were its use of the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) nonpatients bulimic subtypes and a control group that was comparable in terms of demographics. Future Rorschach studies with bulimics displaying higher frequencies of binging and purging behaviors are suggested.     

Rorschach Assessment of Purging and Nonpurging Bulimics

Research in bulimia has flourished in recent years, and yet minimal attention has been devoted to explorations of the bulimic's basic personality organization. We utilized the Rorschach to differentiate between purging and nonpurging bulimics and controls. There were 15 subjects in each group. The Comprehensive System (Exner, 1986) was used for the scoring of the protocols. Statistically significant differences were not found between the two bulimia groups, but interesting trends were detected in the areas of depression, anger, and self-preoccupation. Results appear to be constrained by the low rate of purging behavior. Comparisons between the combined bulimia groups and the controls resulted in solidly characterizing the bulimics as displaying perceptual inaccuracies, disordered thinking, a vulnerability to interpersonal problems, a damaged self-image, and a pessimistic outlook. The strengths of the study were its use of the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) nonpatient bulimic subtypes and a control group that was comparable in terms of demographics. Future Rorschach studies with bulimics displaying higher frequencies of binging and purging behaviors are suggested.     

Bulimia,dietary restraint,and concern for dieting

The concept of dietary restraint has recently been used to explain binge-eating in dieters. It has been proposed that the violation of various restraint rules typically leads to hinging in individuals exhibiting high dietary restraint. This study examined the role of dietary restraint in a clinical sample of bulimics. After eating a preload to break dietary restraint, bulimic binge-eaters (those who binge but do not purge) were found to eat significantly more than bulimics who binged and purged (bulimia nervosa) and significantly more than normals. In addition, purging bulimics were found to have more concern about dieting than binge-eaters, while normals were found to have less concern about dieting and less anxiety about eating than both bulimic groups. These data suggest that the psychopathology of bulimia nervosa and bulimia (binge-eating) may be substantially different. It was proposed that the most distinguishing characteristic may be the preoccupation with dieting, weight, and body size, which is more extreme in bulimia nervosa.     

Prevalence of personality disorders among bulimics,nonbulimic binge eaters,and normal controls

We examined the comorbidity of bulimia and personality pathology among college women. Subjects included women (n=23) meeting DSM-III-R criteria for bulimia nervosa (bulimics), women (n=23) who reported binge eating but did not fulfill the criteria for bulimia nervosa (binge eaters), and women (n=23) who did not binge eat (normals). The subjects completed an assessment battery consisting of the Personality Disorders Examination and the SCID as well as the Beck Depression Inventory, the Rosenberg Self-Esteem Index, and measures of impulsivity and self-defeating tendencies. Fourteen of 23 bulimics (61%) met criterion for a personality disorder using DSM-III-R Axis II criteria. In comparison, 3 of 23 (13%) binge eaters and 1 of 23 (4%) normal subjects received an Axis II diagnosis. Borderline and self-defeating diagnoses were the predominant personality disorders in 96% of the bulimics exhibiting clinically significant personality pathology. Bulimics also exhibited significantly more depression, impulsivity, and self-defeating behavior and lower self-esteem than binge eaters and normals. The findings are discussed within a conceptual framework that posits an interaction between personality pathology and restrained eating.     

PA News & Notes

In this study, we examined Millon Clinical Multiaxial Inventory–III (MCMI–III; Millon, 2009) characteristics in an Old Order Amish outpatient sample (n = 166), with a comparison group of Old Order Amish who were not receiving mental health treatment at the time of testing (n = 80). We also graphically compared the 2 Amish groups to a non-Amish psychiatric sample in the literature. Consistent with our hypotheses, the Old Order Amish outpatients scored significantly higher than the Old Order Amish comparison group on the majority of MCMI–III scales, with mostly medium effect sizes, suggesting that the MCMI–III is a useful personality instrument in discriminating between Old Order Amish clinical and nonclinical groups. In addition, the Amish outpatients scored similar to a non-Amish psychiatric sample in the literature on most personality scales. Future MCMI–III studies with the Amish are needed to replicate and generalize our findings.     

Body-image disturbances in bulimia nervosa: influences of actual body size

This study evaluated body-image distortion and ideal body-size preferences in 423 nonbulimic women and 108 bulimics. Analyses of covariance were utilized to compare the bulimic and nonbulimic groups on measures of current and ideal body size. Weight was used as a covariate to evaluate the influence of actual body size on perception of current body size and selection of ideal body size. Bulimics chose current body sizes that were significantly larger than those picked by nonbulimics regardless of actual body size. Bulimics also chose thinner ideal body sizes than did nonbulimics, regardless of actual body size. These results suggest that body-image distortion and extreme preference for thinness are a fundamental characteristic of bulimia nervosa. These results were discussed in terms of how perception of a large body size and preference for a very thin body size might interact to produce a high degree of dissatisfaction and overconcern with body size in bulimia nervosa.     

The neglected bulimic: The nonpurger

For nearly 10 years bulimia has been recognized officially as a distinct eating disorder, and yet in that time only minimal attention has focused on the nonpurging subtype. The present investigation compared 21 DSM-III-R diagnosed nonpurging bulimics with 22 non-eating-disordered controls on three standardized questionnaires and during a unique assessment task. In this procedure subjects imagined that they were the character in a series of slides and audiotaped flooding scenes. The content of the stimuli ranged from food and weight cues to issues hypothesized to play a role in the development or maintenance of bulimia (e.g., rejection or loss of control fears). A MANOVA conducted on the three questionnaires was highly significant, with the Beck Depression Inventory and the Restraint Scale being responsible for the elevated bulimic scores. A repeated-measures ANOVA performed on the self-report ratings during the exposure task also achieved significance, as the bulimics reported higher anxiety reactions than controls to each experimental stimulus. Significant skin conductance reactions were detected when a group of only the most psychophysiologically responsive bulimics and controls were compared. The importance of continued comprehensive evaluations with DSM-III-R nonpurging bulimics was emphasized.This research was supported by grants both from the University of New Mexico's Research Allocation Committee and the Biomedical Research Support Grant committee. Portions of this paper were presented at the Association for the Advancement of Behavior Therapy annual conference, Boston, November 1987.     

La boulimie à l'épreuve du Rorschach : étude des représentations de soi et d'objet dans une analyse multivariée

The aim of this study was to examine self and objet representation disorders defined by bulimic women. 113 bulimics and 115 non-bulimics, aged 18 to 58, both outpatient women, where assessed by the Rorschach test according to the french method. 14 topics were selected from ther international psychopathological literature then translated into 14 Rorschach indices from the analysis of each protocol. Ten of the fourteen selected indices distinguish the two groups in a significant way. A multivariate analysis (AFCM) reveals in the bulimic group five dimensions corresponding to 63% of the inertia. If the first dimension appears to be related to general psychopathology, the four others are more specific to bulimic representation disorders.     

Personality disorders, depression, and coping styles in Argentinean bulimic patients

This study investigates the coping styles of bulimic patients with personality disorders (PDs) and the effects of the level of depression on the relations between PDs and coping. The sample consisted of 75 Argentinean bulimic outpatients engaged in treatment. Patients completed the SCID II (Structural Interview for DSM IV-Personality Disorders), COPE (Coping Inventory), and the SCL-90-R (Symptom Checklist-90-Revised). No differences in the coping styles of bulimic patients with or without a PD were found. However, when three specific PDs were considered-Avoidant, Obsessive-Compulsive, or Borderline PDs-clear differences in the coping styles of the bulimics were found. However, the differences disappeared when depression was controlled. Regarding the severity of the three specific PDs, coping styles were only found to be associated with the Avoidant PD. Depression showed to affect the relations between coping styles and two specific PDs-Avoidant and Borderline PDs-in bulimic patients.     

The presence of bulimia in high school females

The purpose of this study is to show that the appetite disorder bulimia is present in high school females. Previous research has shown the presence of bulimia in college women. The study was conducted using the entire female population of a large suburban, midwestern community high school. The Eating Disorder Inventory was used to identify the presence of bulimia. Data collected were classified for analysis using the bulimia scale as identified by the EDI. Using analysis of variance (ANOVA) these data were compared on each of the seven scales using bulimia diagnosis and age. The correlation was significant (.01) on five of the seven scales. It was concluded that there is a bulimic population at the high school level which includes females, ages 14-18. The percentages of bulimic females in categories of black, white and others were equal. This is significant because bulimia has not previously been recognized as present in the black population. Knowledge of the attitudes of bulimic students will help those professionals who work with adolescents to recognize bulimic behavior. Community referral agencies and individuals who can help the affected and provide support for the family should be identified and utilized.     

Depression and bulimia: the link between depression and bulimic cognitions

This study assessed the link between bulimic and depressive cognitions. Twenty-nine bulimics and 16 controls from the general population were first assessed on levels of depression using the Schedule for Affective Disorders and Schizophrenia-Change Version and the Beck Depression Inventory (BDI). Bulimics were significantly more depressed than controls. Bulimics differed significantly from controls on all cognitive measures associated with depression (Automatic Thoughts Questionnaire, Dysfunctional Attitude Scale, and Attributional Style Questionnaire), but differences on these measures were nonsignificant when depression, as measured by the BDI, was controlled. Bulimics differed from controls regardless of level of depression on the three scales of the Restraint Inventory, the Rationalization and All-or-None scales of the Thoughts About Eating Inventory, and most of the eight scales of the Eating Disorders Inventory. Bulimics showed more maladaptive thinking associated with depression, but these differences likely reflect the levels of depression for each group. The differences on the measures of cognitive and behavioral symptoms of bulimia remained when the level of depression was controlled statistically. This suggests that although depression can be frequently diagnosed in a bulimic sample, specific maladaptive cognitions and behaviors reflect a distinct disorder (bulimia) and are not simply the expression of an affective disorder.     

Use of the Millon Clinical Multiaxial Inventory in the psychological assessment of domestic violence: A review

An Millon Clinical Multiaxial Inventory (MCMI)-based literature review found that the personality disorders of antisocial, aggressive–sadistic, passive–aggressive (negativistic), and, to some extent, narcissistic are more prevalent in the MCMI profile codes of male spouse abusers. There is a relative absence of Axis I syndromes, although substance abuse of moderate intensity was also extant in these profiles. Some patients produced a normal profile on the MCMI, and their domestic violence may not be a product of a personality disorder. We conclude that the MCMI may be a useful instrument to assess the personality of males in treatment for domestic violence. Elevations of these defined scales may be used as markers to evaluate personality styles at risk for domestic abuse.     

Addictive personality traits in bulimic patients

Forty-five female patients attending for treatment for bulimia nervosa completed the EPQ and an Impulsiveness Inventory (I₇). An Addiction score, derived from items on the EPQ, was obtained confirming that this group of bulimic patients score almost as high as drug addicts and certainly well above the normal range. On individual personality scales, the bulimic Ss scored higher than normals on N, P, Imp and Emp, but lower on E, Vent and Social Desirability.     

Rorschach evaluation of adolescent bulimics

It has become apparent that the excessive dieting engaged in by many girls when they reach puberty frequently serves as an impetus for the later development of eating disorders. While the existence of bulimia nervosa has been well documented in late-adolescent girls, only minimal research has been devoted to delineating the personality characteristics that distinguish bulimics from normal adolescents. The present study utilized the Rorschach to contrast 12 DSM-III-R diagnosed adolescent bulimics with 12 female adolescent controls. Exner's (1986) Comprehensive System was used for scoring the protocols. Statistically significant group differences were detected on both the overall Depression and the Schizophrenia Indices, as well as on several subcomponents of each. Additionally, bulimics averaged a greater number of aggression responses. The data suggested that the adolescent bulimics were more depressed, self-punitive, and negativistic than their peers, and that they had more disordered thoughts, inaccurate perceptions, and impaired judgment. The cognitive disturbances were not limited to the areas of food and weight. The results are alarming for this young population, particularly since the severity of symptoms certainly will increase over time if left untreated. Recommendations are made for early symptom identification and intervention.     

Psychological characteristics of dieters and bulimics.

Two studies examined the continuum and discontinuity models of the relation between dieting and bulimia nervosa. In Study 1, 21 dieters, 19 bulimics, and 33 nondieting controls were compared on 24 measures. Multivariate analyses revealed that each of the groups differed significantly from the other two. Univariate analyses found 18 significant differences between bulimics and dieters and 1 significant difference between dieters and controls. In Study 2, 86 subjects completed measures of psychological functioning, dieting, and bulimia nervosa. On the basis of regression analyses using factor scores from the psychological variables as predictors, high scores on a psychopathology factor and low scores on a defensiveness factor predicted both bulimia and dieting. Low self-concept scores also predicted bulimia. These data indicate that both continuity and discontinuity characterize the relation between dieting and bulimia.     

Confirmatory factor analysis of eating disorder symptoms in college women

Recent studies have found that the eating disorders can best be conceptualized as multidimensional. Four factors have consistently emerged from factor analytic studies of eating disorder symptoms: dietary restraint, bulimic behaviors, neurotic personality characteristics, and body image/body dysphoria. Confirmatory factor analysis was utilized to determine if this four-factor structure of eating disorder symptoms would be found in a sample of college women. Principal components analysis extracted four factors which were supported with a confirmatory factor analysis procedure. These four factors were negative affect and body dysphoria, bulimic behaviors, restrictive eating, and body image. The negative affect and body dysphoria factor was positively correlated with the other factors (i.e., bulimic behaviors, restrictive eating, and body image). This factor structure was similar to the factor structure found in samples of patients with bulimia and anorexia nervosa, except that the factors were more highly intercorrelated in the nonclinical sample. Results suggest that the measures of eating disorder symptoms used in this investigation are measuring the same multidimensional constructs in clinical and nonclinical subjects.This paper is partially based upon the master's thesis of the first author.     

Personality characteristics of drug addicts and alcoholics on the Millon Clinical Multiaxial Inventory

The Million Clinical Multiaxial Inventory (MCMI) was administered to 106 alcoholics and 100 addicts in separate VA inpatient rehabilitation treatment programs. The alcoholics scored higher on the personality style scales of Avoidant, Passive-Aggressive, Schizotypal, Borderline and Paranoid, while the opiate addicts scored higher on the Narcissistic personality disorder scale. Separate cluster analyses for both groups further revealed common personality styles among both groups. Several MCMI scales showed significant correlations with age, but in no case were the effects attributed to age larger than 5% of the total variance. The MCMI may alert clinicians to subtle similarities and differences between and among alcoholics and opiate addicts.     

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.     

Personality-based clusters in bulimia nervosa: differences in clinical variables and ecological momentary assessment

The present study examined whether personality-based subgroups of bulimic individuals differed in eating disorder behavior, comorbid psychopathology, treatment history, and momentary assessments of mood and behavior. Participants completed an Ecological Momentary Assessment (EMA) protocol for a period of 2 weeks. Latent profile analysis on the Dimensional Assessment of Personality Pathology revealed 3 groupings of bulimic participants: Interpersonal-emotional, Stimulus seeking-hostile, and Low personality pathology. The personality-based groups differed in histories of mood, anxiety, substance use disorders, features of borderline personality disorder, treatment history, and several momentary measures. These findings suggest that personality variation within the bulimia nervosa diagnostic construct may be associated with meaningful conceptual and clinical differences, including daily experiences in the natural environment.