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.     

The severity and status of eating disorder NOS: implications for DSM-V

"Eating disorder NOS" is the most common eating disorder encountered in outpatient settings yet it has been neglected. The aim of this study was to describe the characteristics of eating disorder NOS, establish its severity, and determine whether its high relative prevalence might be due to the inclusion of cases closely resembling anorexia nervosa or bulimia nervosa. One hundred and seventy consecutive patients with an eating disorder were assessed using standardised instruments. Operational DSM-IV diagnoses were made and eating disorder NOS cases were compared with bulimia nervosa cases. Diagnostic criteria were then adjusted to determine the impact on the prevalence of eating disorder NOS. Cases of eating disorder NOS comprised 60.0% of the sample. These cases closely resembled the cases of bulimia nervosa in the nature, duration and severity of their psychopathology. Few could be reclassified as cases of anorexia nervosa or bulimia nervosa. The findings indicate that eating disorder NOS is common, severe and persistent. Most cases are "mixed" in character and not subthreshold forms of anorexia nervosa or bulimia nervosa. It is proposed that in DSM-V the clinical state (or states) currently embraced by the diagnosis eating disorder NOS be reclassified as one or more specific forms of eating disorder.     

Multifactorial assessment of bulimia nervosa

We investigated a multifactorial approach to the assessment of bulimia nervosa by means of hierarchical factor analysis. Two hundred forty-five bulimia nervosa patients and 68 patients with either anorexia nervosa or eating disorders not otherwise specified were administered a self-report battery that was organized into 21 dimensions relevant to eating disorder patients. When dimensions from this battery were subjected to hierarchical factor analysis, support for bulimia nervosa as a unique diagnostic category was obtained. However, the emergence of 3 secondary factors and 6 primary factors suggests that bulimia nervosa can also be described more complexly. The emergence of a multifactorial model of bulimia nervosa that incorporates several existing undimensional models suggests the potential for both divergent and complicated clinical presentation in bulimia nervosa patients.     

Establishing appropriate symptomatic control groups for the eating disorders

Two symptomatic control groups for the eating disorders were defined using high and low scores on the Dietary Restraint and Disinhibition scales of the Three Factor Eating Questionnaire. Clinical subjects diagnosed with anorexia and bulimia nervosa were compared with these symptomatic control groups using measures of body weight, bulimic symptoms, and anorexic symptoms. In comparison to the high-Restraint/low-Disinhibition group, anorexic subjects scored higher on measures of eating disorder symptoms but not on Restraint and Disinhibition. The high-Restraint/high-Disinhibition group differed from bulimia nervosa subjects on measures of eating disorder symptoms but did not differ on Restraint and Disinhibition. The results suggested that a control group defined by high Restraint and low Disinhibition formed an appropriate control group for anorexia nervosa. For bulimia nervosa, the most appropriate control group was defined by high Restraint and high Disinhibition.     

The Continuum Versus Categorical Debate on Eating Disorders: Implications for Counselors

The authors summarize a study by D. A. Williamson et al. (2002) in which clinical groups with anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, and binge eating disorder were contrasted with nonclinical groups of participants (i.e., obese and normal weight). The eating disorder groups were qualitatively different. Also, bulimia nervosa, purging and nonpurging types, may fall on a continuum of pathology with the binge‐eating, purging type of anorexia. Anorexia nervosa, restricting type, may be distinct from bulimia nervosa, purging and nonpurging types, and the binge‐eating, purging type of anorexia.     

Untreated recovery from eating disorders

This retrospective study explored the experience of recovery from anorexia nervosa and bulimia nervosa without professional treatment. A nine-question open-ended electronic survey was posted for a period of four months at a mid-western university. Sixteen female and two male respondents reported recovery from adolescent-onset full syndrome anorexia nervosa or bulimia nervosa. All respondents reported onset factors supporting a sociocultural etiology. Recovery was initiated through the empathic, participatory efforts of parents and friends, or was self-initiated. Respondents with the shortest disorder duration and most complete recovery reported early parental intervention. Onset factors similar to those in research with a clinically treated population were found. Implications of the findings are discussed.     

The Sociocultural Attitudes Toward Appearance Questionnaire (SATAQ-3): reliability and normative comparisons of eating disordered patients

The Sociocultural Attitudes Toward Appearance Questionnaire-3 (SATAQ-3) is a measure of one’s endorsement of societal appearance ideals. The measure has received extensive evaluation in normative samples, but only minimal evaluation in clinical groups. In this study, 440 patients with eating disorders completed the SATAQ-3. Internal consistencies were excellent for the four SATAQ-3 subscales. Groups did not differ by diagnosis on the Information subscale, however, individuals with bulimia nervosa scored higher than individuals with both subtypes of anorexia nervosa (restricting and binge eating/purging) on levels of Internalization-General and Internalization-Athlete. The findings provide informative normative data, along with preliminary results indicative of the potentially greater role of media messages and images in the formation and/or maintenance of bulimia nervosa than anorexia nervosa.     

MMPI-2 profiles of women with eating disorders in a Dutch day treatment sample

In this study, we examined the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) profiles of 324 Dutch patients with eating disorders at an eating disorder day treatment program. We studied the MMPI-2 profiles in 5 diagnostic eating disorder groups. All diagnostic subgroups showed high mean elevations of the T scores on the same 6 or 7 scales. Remarkable similarities existed between the mean profile configurations. The MMPI-2 distinguished especially in that patients with restricting anorexia nervosa scored lower on one Validity scale (F), two Clinical scales (1 and 2) and several Supplementary and Content scales of the MMPI-2 compared to the other groups. Only on the validity Scale L did they score higher. The MMPI-2 also distinguished patients with the bulimia nervosa purging type who scored higher on Scale 9 and different on several Content and Supplementary scales. We discuss results with regard to other studies of MMPI (Hathaway & McKinley, 1983) and MMPI-2 profiles of women with anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified in inpatient and outpatient settings.     

Low self-esteem in eating disordered patients in the absence of depression

Both low self-esteem and depression are well recognised as occurring in patients with eating disorders. 43 patients with eating disorders were studied to assess whether this low self-esteem occurred as part of an affective disorder or was independent of this. The patients, 23 with anorexia nervosa and 20 with bulimia nervosa, were assessed for low self-esteem, using the Rosenberg Self-esteem Questionnaire, and for depression, using the Hospital Anxiety and Depression Scale. The patients had low self-esteem, despite only a minority (33%) being depressed. This study demonstrates that low self-esteem occurs in patients with eating disorders in the absence of depression.     

Psychological treatment of eating disorders

Significant progress has been achieved in the development and evaluation of evidence-based psychological treatments for eating disorders over the past 25 years. Cognitive behavioral therapy is currently the treatment of choice for bulimia nervosa and binge-eating disorder, and existing evidence supports the use of a specific form of family therapy for adolescents with anorexia nervosa. Important challenges remain. Even the most effective interventions for bulimia nervosa and binge-eating disorder fail to help a substantial number of patients. A priority must be the extension and adaptation of these treatments to a broader range of eating disorders (eating disorder not otherwise specified), to adolescents, who have been largely overlooked in clinical research, and to chronic, treatment-resistant cases of anorexia nervosa. The article highlights current conceptual and clinical innovations designed to improve on existing therapeutic efficacy. The problems of increasing the dissemination of evidence-based treatments that are unavailable in most clinical service settings are discussed.     

A review of eating disorders research in Mexico

The objective of this paper is to summarize research findings on eating disorders and the current state of the field in Mexico. Papers published in indexed journals and graduate dissertations were retrieved, using “eating disorders,” “anorexia nervosa,” “bulimia nervosa,” “body image,” “binge eating,” “restrained eating,” “weight and shape concern,” and “dieting” as keywords. These were combined with the Boolean operator “AND” with “Mexico” and “Latin America.” Findings are presented for epidemiology, the validity of assessment instruments, comorbidity, and risk factors. A national representative survey found a prevalence of 1.8% for bulimia nervosa, and no cases of anorexia nervosa. However, the lack of studies with confirmatory clinical interview and other national or regional representative samples makes it difficult to reach conclusions about the actual prevalence. A number of instruments for the detection of eating disorders and disordered eating have been validated for the Mexican population. The comorbidity of eating disorders in Mexico includes drug and alcohol abuse, obesity, and borderline personality disorder. Risk factors found included body weight and cultural pressure to be thin. Future lines of research should include epidemiological studies with representative samples and diagnosis confirmation, longitudinal studies, and the exploration of protective and risk factors specific to this population.     

Thoughts about eating, weight and shape in anorexia nervosa and bulimia nervosa.

Concurrent verbalisation and a self-report questionnaire were used to investigate self-statements in patients with anorexia nervosa, patients with bulimia nervosa, two groups of dieters and non-dieting controls. Thoughts were collected while subjects performed three behavioural tasks, looking at themselves in a full-length mirror, weighing themselves and eating a chocolate covered mint. Both groups of patients had more negative thoughts related to eating, weight and shape than those in the three control groups. In addition, patients with anorexia nervosa showed a greater concern with eating while patients with bulimia nervosa showed a greater concern with weight and appearance. Differences were found between the patients and non-dieting controls using both methods but the self-report questionnaire was less sensitive than concurrent verbalisation to differences between the patients and dieters. Implications of the findings for cognitive-behavioural treatments of the two disorders are discussed.     

Belastungen in der Kindheit und in der Jugend Essgestörter

Depending on definition and sample, a minority of varying size of women with eating disorders report to be victims of sexual and/or physical abuse. These stressful experiences are risk factors for mental disorders in general and not specifically for eating disorders. Parental high expectations and pre-morbid negative self-evaluation seem to be specific risk factors for anorexia nervosa and bulimia nervosa. Probably, patients with bulimia nervosa suffered more childhood adversity than those with restrictive anorexia nervosa. Patients with a history of sexual and/or physical abuse may be more severely ill and more difficult to treat than other patients with eating disorders. Careful questioning about childhood adversity seems advisable. In therapy, maintaining factors—like problems of self-esteem—are more important than predisposing or precipitating factors. For prevention, it is recommended to provide for the safety of children when treating their parents with mental illness—particularly substance use disorders—and to avoid parental high expectations.     

Body images of patients with anorexia nervosa, bulimia nervosa and female control subjects: a comparison with male ideals of female attractiveness

Body images of female patients with anorexia nervosa and bulimia nervosa were assessed against females without eating disorders and compared with male ideals of female attractiveness. A computer program was applied to examine body images of 62 patients with anorexia nervosa, 45 patients with bulimia nervosa, and 40 female and 39 male control subjects. Body size overestimation was most distinct in the two patient groups. Self-ideal discrepancy was highest in bulimia nervosa. Estimation of the society's ideal female body in all three female groups did not differ from men's perception of the most attractive female body. Congruence of ideals of female attractiveness in patients, female, and male control subjects and described differences between patients and female controls support the theory that body image disturbance is a problem of processing self-referential information regarding body image rather than a problem of processing body image related information per se.     

An analysis of social anxiety in anorexic,bulimic, social phobic,and control women

Responses to the Social Phobia and Anxiety Inventory (SPAI) were examined in 23 women with anorexia nervosa, 54 women with bulimia nervosa, 50 female college undergraduates, and 43 social phobic women. Results indicated that women with anorexia nervosa and bulimia nervosa scored comparably high to social phobic women on measures of social anxiety and that these fears were not limited to fears of eating or drinking in public. This study suggests that fears of negative evaluation in women with eating disorders may generalize beyond the fears of scrutiny of body shape and size to more traditional social situations.     

Implicit memory bias for eating- and body appearance-related sentences in eating disorders: an application of Jacoby's white noise task

Jacoby's white noise task and an explicit recognition task were used to investigate whether individuals with eating disorders demonstrate implicit memory bias and explicit memory bias, respectively, for information related to eating and body appearance. Included were 33 women with eating disorders (seven with anorexia nervosa and 26 with bulimia nervosa), 29 with nonclinical eating disorder-related concerns, and 36 healthy controls. Results showed partial support for implicit memory bias but no support for explicit memory bias. These findings suggest that eating disorders may be characterized by relative initial automatic bias for eating disorder-relevant information but not by bias at later stages of information processing. However, previous studies have demonstrated explicit memory bias in eating disorders, which is inconsistent with this interpretation. Future research is required to clarify the precise cognitive biases associated with eating disorders.     

Health-Related Quality of Life in Women with Eating Disorders: Association with Subjective and Objective Binge Eating

This study examined health-related quality of life (QOL) and its association with different forms of binge eating in 53 women with eating disorders. Participants had enrolled in treatment for anorexia nervosa, bulimia nervosa, binge eating disorder, or other eating disorders not otherwise specified and completed measures of QOL, eating-related psychopathology, and mood disturbance. Eating- and mood-related psychopathology, and to a lesser extent, mental-component QOL scores, were severely impaired in this sample relative to population norms. QOL was significantly and independently predicted by subjective bulimic episodes and compensatory behaviors, including food avoidance, laxative abuse, and self-induced vomiting, accounting for 32% of the variance. Subjective bulimic episodes and food avoidance also independently predicted the physical-component QOL, accounting for 27% of the variance. These findings suggest that subjective bulimic episodes may be independently associated with impairment in QOL and may require specific attention as targets of treatment.     

Obsessive-compulsive symptoms in eating disorders

Obsessive-compulsive symptoms were measured in a consecutive series of new referrals with anorexia nervosa (n = 29) and bulimia nervosa (n = 77). In contrast with previous reports, there was no significant difference on MOCI scores between eating disorder groups and normal controls. A consecutive series of 38 patients with bulimia nervosa then entered a structured treatment programme. Poor outcome cases had a higher score on the MOCI-doubting sub-scale. However, there was no significant difference in obsessive-compulsive scores between those who were binge-free and those who were bingeing daily at the end of treatment and there was no significant in outcome between high and low-scorers on the MOCI. This study fails to support the view that the eating disorders are a subtype of OCD. Previous conflicting results are attributed to selection bias and the effects of low body weight.