A systematic study of personality disorders in bulimia nervosa

Abstract

Although clinicians have long believed that personality disorders, particularly borderline personality, are frequent among patients with eating disorders, there are few systematic data about this association. This study used a structured interview to ascertain the frequency of personality disorders among patients with bulimia nervosa and to determine whether measures of personality disturbance changed during short-term treatment for the eating disorder.;It was hypothesized that borderline would be the most frequent personality diagnosis in this sample, and that there would be positive correlations between changes in bulimic and depressive symptomatology and changes in DSM-III-R personality traits.;The Personality Disorder Examination (PDE, Loranger et al., Preliminary Version, 1985), was administered to 34 inpatients and 35 outpatients meeting DSM-III-R criteria for bulimia nervosa, and was readministered six weeks later to 18 inpatients and 21 outpatients. Eating disorder and other Axis I (clinical syndrome) diagnoses were obtained via the Structured Clinical Interview for DSM-III-R (SCID-I, Spitzer et al., 1987). Clinical state was assessed via binge frequency, the Eating Attitudes Test (Garner and Garfinkel, 1979), the Beck Depression Inventory (Beck et al., 1961), and clinicians' Global Impression ratings.;Results indicated that 30% of the patients in the total sample received initial PDE diagnoses. Borderline personality was the most frequent diagnosis, occurring in 25% of the total sample. Of the patients who had repeat PDEs, 31% received an initial PDE diagnosis, and 23% received a repeat PDE diagnosis. From initial to repeat PDE, the number of PDE diagnoses decreased from 35 to 12, and 9 of the 12 personality trait scores decreased significantly. In addition, there were significant correlations between reductions in measures of personality disorder and improvement of the eating disturbance.;These data suggest that personality disorders diagnosed according to DSM-III-R criteria may not necessarily reflect underlying qualities or enduring patterns which are stable over time, but might alternatively represent temporary states or symptoms which may vary in relation to other symptom-related changes, making them difficult to measure in some patients. Therefore, the assessment of DSM-III-R personality disorder may be confounded by the presence of a serious eating disorder.