Personality and mental state (P.S.E.) within anorexia nervosa

A Brunswikian Model for Body Image Research in Patients with Eating Disorders

Eating disorders have become a national healthl problem, particularly among adolescent girls. Of particular interest with these patienils is their inability to perceive themselves accurately. While many studies have addressed body image distortion, the cognitive process involved has remained elusive. Rather than study this individual process with a group comparisont ietehodology, Brunswik's lens model was employed. Patienits' individual cognitive models were explored prior to aggregating the data on a group level. Impor tant differ enices emerged between anorexic, bulimic, obese, anrd normal female's utilizatioin of available perceptual cues concerning self and other body sizes. All of the participants in the study demonstrated conzsistenti linear models for use of perceptual cue information. Group differenices emerged in relative emphasis placed on each cue. This luse of Brunswik's lens model represents a uniquie applicationi of the methodology that should prove inivalitable for-future studies of self-per-ceptioni in a wide variety of domains.

Comparative Prevalence of Eating Disorders in Obsessive-Compulsive Disorder and Other Anxiety Disorders

Objective. The purpose of this study was to compare the prevalence of comorbid eating disorders in Obsessive-Compulsive Disorder (OCD) and other common anxiety disorders. Method. 179 patients from the same geographical area with a diagnosis of OCD or an anxiety disorder were divided into two groups based on their primary diagnosis. The prevalence of a comorbid eating disorder was calculated in both groups. Results. There was no statistically significant difference in the prevalence of comorbid eating disorders between the OCD and other anxiety disorders group. Conclusions. These results suggest that the prevalence of comorbid eating disorders does not differ in anxiety disorders when compared with OCD. However, in both groups, it remains statistically higher than that of the general population.

Sociotropy-dependency and autonomy as predictors of eating disturbance among Canadian female college students

The authors (a) tested the generalizability of A. Sugarman, D. Quinlan, and L. Devenis's (1982) psychodynamic account of eating disturbances, which posits that overt autonomy strivings associated with eating problems are a defense against unconscious dependency concerns, and (b) evaluated the degree to which autonomy and sociotropy had unique associations with eating disturbances. Canadian female college students (N= 286) completed self-report measures of autonomy, sociotropy, depression, and bulimia as well as the Rorschach Inkblot Test. Findings suggest, contrary to Sugarman and colleagues' psychodynamic account, that experiences of dependency related to self-reported eating pathology do not necessarily lie outside of conscious awareness. Moreover, reported bulimic symptoms were uniquely associated with sociotropy but not autonomy-self-criticism among the participants.

Complex segregation analysis of obsessive-compulsive disorder in 141 families of eating disorder probands, with and without obsessive-compulsive disorder

Probands affected with eating disorders (ED) present a higher number of relatives affected with obsessive-compulsive disorders/tic disorders than a comparison population. Therefore, we hypothesized that ED and obsessive-compulsive disorder (OCD) might share the same biological liability, and that a single major gene might account for that liability. We tested this hypothesis by applying a complex segregation analysis to 141 families of probands affected with ED (89 with anorexia nervosa, restricting and binge-eating types, 52 with bulimia nervosa). Given the hypothesized relationship between OCD and genetic spectrum disorders, we considered these diagnoses as affected phenotype in relatives. In Italian ED families, ED and OCD followed a Mendelian dominant model of transmission. When probands were divided according to co-diagnosis of OCD, best fit in the subgroup of families of 114 probands without OCD co-diagnosis was for a Mendelian dominant model of transmission whereas a Mendelian additive model of transmission represented best fit in the subgroup of families of 27 probands with an OCD co-diagnosis. Genetic transmission was not shown in those families where the only affected phenotype was ED. The existence of a Mendelian mode of genetic transmission within ED families supports the hypothesis that a common genetic liability could account for both ED and OCD.

Personality differences between eating-disordered women and a nonclinical comparison sample: a discriminant classification analysis

The present study evaluated the extent to which eating-disordered and nonclinical comparison samples could be differentiated on self-reported personality measures of autonomy and sociotropy and a projective measure of dependency. Sixty-two women meeting diagnostic criteria for eating disorder and a nonpsychiatric comparison group of 62 women completed the autonomy and sociotropy subscales of the Personal Style Inventory-II and the Rorschach Oral Dependency Scale (ROD). A discriminant classification analysis indicated 85.5% of eating-disordered subjects and 88.7% of control subjects were identified accurately from their scores on autonomy, sociotropy. and ROD. Results suggest that the experience of eating disorders is associated with a mixed clinical presentation characterized by issues related to sociotropy-dependency, and especially, achievement-related vulnerabilities. Potentially fruitful areas for future study include assessing the utility of autonomy and sociotropy as predictors of eating disturbances in prospective research and evaluating their utility in predicting treatment prognosis among patients with eating disorders.

Differential hemispheric involvement in anorexia nervosa

Hemispheric function was assessed in 22 restricting anorexia nervosa (AN) female subjects and 22 normal female controls. Two verbal and two visuospatial tasks and a set of psychopathological tests were administered. The failure of the "classic" lateralization tests to reveal the expected left hemisphere dominance or a right hemisphere deficit in AN group, as compared to controls, is counterbalanced by the tendency of the psychopathological tests to prove the neuropsychological hypothesis of the present study. Neuropsychological interpretation of psychopathological data, however, does not constitute direct evidence and so further studies and more sophisticated techniques are needed.

A clinical and phenomenological study of 185 Spanish adolescents with anorexia nervosa

The objectives of the present study were the following to determine the socio-familial, academic and interpersonal characteristics specific to anorexia nervosa (AN); to study comorbidity in patients with anorexia and morbidity in their parents; and to ascertain whether patients with anorexia nervosa in Spain are similar to those in other countries. The research team revised the clinical records of 185 Spanish adolescents with AN (aged 11-18 years). The results were compared with those obtained from a group of 185 psychiatric patients without AN matched by sex, age, time of consultation and centre. No significant differences were found with regard to broken home, birth order or parent-patient conflict. The parents of patients with anorexia have a higher standard of education and develop more affective disorders. When compared with other patients, the individuals with anorexia nervosa perform much better academically but are more socially withdrawn. Males with anorexia nervosa perform worse academically than females and have more anxiety diagnoses. Patients with anorexia have a high comorbidity for affective and obsessive-compulsive disorders. Sufferers from anorexia nervosa in Spain are clinically analogous to patients with anorexia in other countries. The two characteristics specific to these patients are a high standard of academic performance and an intense degree of social withdrawal, although there are certain factors common to other pathologies relating to adolescence.

Anorexia nervosa 6 years after onset: Part II. Comorbid psychiatric problems

A sample of anorexia nervosa (AN) cases recruited after community screening were contrasted with an age-, sex-, and school-matched comparison (COMP) group with regard to comorbidity at age 21 years, approximately 6 years after the reported onset of the eating disorder. Both groups had originally been examined at age 16 years. Most of the AN cases no longer met criteria for AN, but many continued to meet criteria for bulimia nervosa (BN) or eating disorder NOS. In addition, there was a high rate of obsessive-compulsive disorders (OCDs). Affective disorders had been common throughout the follow-up period, but tended to follow the course of the eating disorder rather than to precede or postdate it. Underlying personality disorders tended to predict poor outcome.

Personality in Anorexia nervosa: an update and a theoretical integration

No single cause is likely to be of supreme importance in the etiology of Anorexia nervosa, but personality factors continue to attract researchers' attention. This paper is a review of evidence on the subject, covering psychometric, interview, and projective investigations. Significant methodological problems exist in the literature, but do not suffice to explain findings of obsessive and inhibited features intermixed with impulsivity, and a high prevalence of defined personality disorders. Adding to previous work by Cloninger and Strober we suggest that vulnerable individuals are temperamentally incapable of coping with the challenges of adolescence by anything other than repetitive, reward seeking behavior. In a social environment that greatly emphasizes thinness as a criterion for self-worth and success, the outcome may be Anorexia nervosa.

Is anorexia nervosa an obsessive-compulsive disorder?

Although anorexia nervosa may vary widely in its severity and outcome, it is usually regarded as an illness in its own right, as patients do not display major changes in the form of the illness over time (Russell, 1970). It readily lends itself to being accorded clear-cut diagnostic criteria (Russell, 1977) and this is reflected in ICD–10 (World Health Organization, 1987). However, the nosological independence of anorexia nervosa has undergone vigorous assault since its classic description by William Gull (1874). For example, the psychological nature of anorexia nervosa was obscured for 30 years by Simmond's (1914) description of anterior pituitary lesions and cachexia, and Kay & Leigh's (1954) influential study of anorexia nervosa concluded with their doubts about its status as a ‘psychiatric entity’.

Eco-systemic analysis of anorexia nervosa

Aspects of the eco-systemic approach were used to provide a framework for the understanding of anorexia nervosa and were empirically tested by comparing 30 anorexics and their parents to 34 matched control subjects and their parents. The theoretical model employed was an adaptation of Conger's Ecological-Systems approach which was based on the principles of Bronfenbrenner's theory of human development. The subjects were compared on selected variables arising from the individual, parent, family, and community systems using (a) the California Psychological Inventory (CPI), (b) the Structural Analysis of Social Behavior (SASB), (c) the Family Environment Scale (FES), and (d) the Pattison Psychological Inventory (PPI). Discriminant analysis revealed that the Affiliation score (SASB) for the anorexic and the control subjects and the Psychopathic Deviancy score (CPI-Clinical) of the mothers of the anorexics and the controls were the variables which contributed most to the discrimination between the groups. With the Affiliation and the Psychopathic Deviancy scores alone, it was possible to correctly classify 87.5 per cent of the research subjects. Analyses also showed statistically significant results at the individual, parent, and family levels. Interactions within the family, as perceived by the anorexics, were characterized by overprotection and control by the mothers, while the anorexics themselves responded with significantly less affiliation to both their mothers and their fathers. The mothers of the anorexics also viewed their daughters as being less friendly in the relationship. The families of the anorexics were less supportive, helpful, and committed to each other than were the families of the control subjects as measured by the FES.

Dexamethasone suppression and energy balance in eating disorders

The dexamethasone suppression test (DST) was investigated in 45 female anorectic out-patients (cross sectional study) nine of whom were followed serially as in-patients (longitudinal study). DST non-suppression was strongly associated with negative energy balance (low body weight and low Ponderal Index) but there was no significant association with the presence of affective or neurotic disturbance in these patients. These findings cast doubt on the value of the DST in the management of depressive illness.

Personality and treatment effectiveness in anorexia nervosa

Compared pre- and posttreatment MMPI profiles of 12 female inpatients with anorexia nervosa using a scale-by-scale analysis of variance. Significant changes in clinical scales and a validity scale confirmed observed behavioral change after treatment. In addition, pretreatment profiles obtained at a different hospital were remarkably similar, which suggests a common constellation of personality characteristics in anorexia nervosa.

The significance of subclassification in anorexia nervosa: a comparative study of clinical features in 141 patients

Within a sample of 141 female anorexia nervosa patients comparative investigations were carried out between three subgroups: dieters, binge-eaters, and vomiters/purgers. A number of significant differences were found, especially with respect to age and duration of illness, previous treatment failures, and long-term outcome. The results appear to support the authors' view that the static idea of anorexia nervosa as a unitary illness should be abandoned and replaced by a dynamic dimensional model according to which, in the course of time, changes may occur in the clinical picture of dysorectic patients.

Depression in anorexia nervosa

In three collaborating institutions 105 hospitalized female anorexia nervosa patients were assessed for depressive symptomatology periodically during treatment. As a whole, patients were mildly to moderately depressed, being as depressed as anxious neurotics and less depressed than depressed neurotics. The more depressed patients showed a variety of characteristics, many of which have previously been shown to be indicators of poor prognosis. Over the course of treatment patients became less depressed. Weight gain was correlated with a decrease in depression.

The self-image of adolescents with acute anorexia nervosa

The Offer Self-Image Questionnaire for Adolescents was administered to 30 female adolescents with a diagnosis of acute anorexia nervosa. Patients were divided ianto an early group (12 to 15 years; N = 15) and a late group (16 to 19 years; N = 15). The mean percent weight loss calculated as deviation from norm weight for age and height was 32%, and the mean duration of illness was 1.3 years, similar for both groups, whereas age of onset of anorexia was significantly (P less than 0.001) different. All patients differed significantly from normal adolescents by displaying disturbances in mood and self-esteem (P less than 0.05), in social relationships (P less than 0.05), and in attitude toward sex (P less than 0.05); late adolescent patients additionally showed maladjustment in impulse control (P less than 0.05), self-perception and body image (P less than 0.01), and in general psychopathology (P less than 0.05). Patients were found well adjusted with regard to moral values, family relationships, and educational goals. The lesser adjustment problems in the younger group agree well with reports finding a more favorable prognosis for patients with an early onset of anorexia nervosa.

Anorexia nervosa at normal body weight!--The abnormal normal weight control syndrome

Disgust with "fatness" and a consequent preoccupation with body weight, coupled with an inability to reduce it to or sustain it at the desired low level, characterizes the abnormal normal weight control syndrome. Individuals remain sexually active in a biological sense and often also socially. Indeed their sexual behaviour may be as impulse ridden as is their eating behaviour, which often comprises phases of massive bingeing coupled with vomiting and/or purgation. The syndrome is unlike frank anorexia nervosa in that the latter involves a regression to a position of phobic avoidance of normal body weight and consequent low body weight control with inhibition of both biological and social sexual activity. In abnormal normal weight control there is a strong and sometimes desperate hedonistic and extrovert element that will often not be denied so long as body weight does not get too low. Individuals nevertheless feel desperately "out of control" and insecure beneath their bravura. The syndrome is much more common in females than in males. There is a clinical overlap with anorexia nervosa and obesity in many cases as the disorder evolves. Depression, stealing, drug dependence (including alcohol) and acute self-poisoning and self-mutilation are common complications. Clinic cases probably only represent the tip of the iceberg of the much more widespread morbidity within the general population. Like anorexia nervosa and for the same reasons the disorder is probably more common than it used to be.