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The comorbidity of eating disorders and personality disorders: A metaanalytic review of studies published between 1983 and 1998

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Abstract

Comorbid personality disorders in eating disordered patients may seriously affect the treatment and course of their illness. Several studies show such a comorbidity, though with inconsistent findings. Qualitative reviews attribute this to methodological shortcomings, but the qualitative method may itself create new shortcomings. To circumvent this, the present, more extensive review applies a meta-analytic approach. Using the databases MEDLINE and PSYCHLIT, the 28 articles published between 1983 and 1998 that presented empirical evidence for an eating disorder and personality disorder comorbidity suitable for meta-analysis were included. We found a higher proportion of eating disordered patients with any personality disorder (average proportion =0.58) related to comparison groups (average proportion =0.28). Compared with anorexia nervosa patients, a higher proportion of patients with bulimia nervosa had a concurrent cluster B personality (average proportion =0.44 ) and a borderline personality disorder (average proportion =0.31). However, no differences between anorexia nervosa and bulimia nervosa patients in proportions of cluster C were found (average proportion =0.45 and 0.44 respectively). Patients with eating disorders and patients with bulimia nervosa in particular, should be routinely assessed for a concurrent personality disorder using structured clinical interviews. In future research, more stringent assessment procedures are highly recommended to address the question of causality between eating disorders and personality disorders, and how eating disorder symptoms and personality disorder symptoms are related to treatment effects.

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References

  1. Bruch H.: Four decades of eating disorders. In: Garner D., Garfinkel P. (Eds.), Handbook of psychotherapy for anorexia nervosa and bulimia. New York, Guilford Press, 1985, pp. 7–18.

    Google Scholar 

  2. Herzog D.B., Hamburg P., Brotman A.: Psychotherapy and eating disorders: An affirmative view. Int. J. Eating Disord., 62, 651–657, 1987.

    CAS  Google Scholar 

  3. Keel P.K., Mitchell J.E.: Outcome in bulimia nervosa. Am. J. Psychiatry, 154, 313–323, 1997.

    PubMed  CAS  Google Scholar 

  4. Rossiter E.M., Agras W.S., Telch C.F., Schneider J.A.: Cluster B personality disorder characteristics predict outcome in the treatment of bulimia nervosa. Int. J. Eating Disord., 13, 349–357, 1993.

    Article  CAS  Google Scholar 

  5. Ames-Frankel J., Devlin M.J., Walsh T., Strasser T.J., Sadik C., Oldham J.M., Roose SP.: Personality disorder diagnoses in patients with bulimia nervosa: Clinical correlates and changes with treatment. J. Clin. Psychiatry, 53, 90–96, 1992.

    PubMed  CAS  Google Scholar 

  6. Yates W.R., Sieleni B., Reich J., Brass C.: Comorbidity of bulimia nervosa and personality disorder. J. Clin. Psychiatry, 50, 57–59, 1989.

    PubMed  CAS  Google Scholar 

  7. Löwenkopf E.I.: Bulimia: Concept and theory. Compr. Psychiatry, 24, 546–554, 1983.

    Google Scholar 

  8. Sours JA: Starving to death in a sea of objects. New York, Aronson, 1980.

    Google Scholar 

  9. Fornari V., Kaplan M., Sandberg D.E., Matthews M., Skolnick N., Katz J.L.: Depressive and anxiety disorders in anorexia nervosa and bulimia nervosa. Int. J. Eating Disord., 12, 21–29, 1992.

    Article  Google Scholar 

  10. Herzog D.B., Keller M.B., Lavori P.W., Kenny G.M., Sacks N.R.: The prevalence of personality disorders in 210 women with eating disorders. J. Clin. Psychiatry, 53, 147–152, 1992.

    PubMed  CAS  Google Scholar 

  11. Toner B.B., Garfinkel P.E., Garner D.M.: Affective and anxiety disorders in the longterm follow-up of anorexia nervosa. Int. J. Psychiatry Med., 18, 357–364, 1988.

    Article  PubMed  CAS  Google Scholar 

  12. Powers P.S., Coovert D.L., Brightwell D.R., Stevens B.A.: Other psychiatric disorders among bulimic patients. Compr. Psychiatry, 29, 503–508, 1988.

    Article  PubMed  CAS  Google Scholar 

  13. Schwalberg M.D., Barlow D.H., Alger S.A., Howard L.J.: Comparisons of bulimics, obese binge eaters, social phobics, and individuals with panic disorder on comorbidity across DSM-III-R anxiety disorders. J. Abnorm. Psychol., 101, 675–681, 1992.

    Article  PubMed  CAS  Google Scholar 

  14. Schneier F.R., Johnson J., Hornig C.D., Liebowitz M.R., Weissman M.M.: Social phobia: Comorbidity and morbidity in an epidemiologic sample. Arch. Gen. Psychiatry, 42, 282–288, 1992.

    Article  Google Scholar 

  15. Halmi K.A., Eckert E., Marchi P., Sampugnaro V., Apple R., Cohen J.: Comorbidity of psychiatric diagnoses in anorexia nervosa. Arch. Gen. Psychiatry, 48: 712–718

  16. Corruble E., Ginestet D., Guelfi J.D.: Comorbidity of personality disorders and unipolar major depression: A review. J. Affect. Disord., 37, 157–170, 1996.

    Article  PubMed  CAS  Google Scholar 

  17. Sanderson W.C., Wetzler S., Beck A.T, Betz F.: Prevalence of personality disorders among patients with anxiety disorders. Psychiatry Res., 51, 167–174, 1994.

    Article  PubMed  CAS  Google Scholar 

  18. Braun D.L., Sunday S.R., Halmi K.A.: Psychiatric comorbidity in patients with eating disorders. Psychol. Med., 24, 859–867, 1994.

    Article  PubMed  CAS  Google Scholar 

  19. Piran N., Lerner P., Garfinkel P.E., Kennedy S.H., Brouillette C.: Personality disorders in anorexic patients. Int. J. Eating Disord., 7, 589–599, 1988.

    Article  Google Scholar 

  20. Wonderlich S.A., Swift W.J., Slotnick H.B., Goodman S.: DSM-III-R personality disorders in eating-disorder subtypes. Int. J. Eating Disord., 9, 607–616, 1990.

    Article  Google Scholar 

  21. Norman D., Blais M.A., Herzog D.: Personality characteristics of eating-disordered patients as identified by the Millon Clinical Multiaxial Inventory. J. Person. Disord., 7, 1–9, 1993.

    Article  Google Scholar 

  22. Pope H.G., Frankenburg F.R., Hudson J.I., Jonas J.M., Yurgelun-Todd D.: Is bulimia associated with borderline personality disorder? A controlled study. J. Clin. Psychiatry, 48, 181–184, 1987.

    PubMed  Google Scholar 

  23. Pope H.G, Hudson J.I.: Are eating disorders associated with borderline personality disorder? A critical review. Int. J. Eating Disord., 8, 1–9, 1989.

    Article  Google Scholar 

  24. Skodol A.E., Oldham J.M., Hyler S.E., Kellman H.D., Doidge N., Davies M.: Comorbidity of DSM-III-R eating disorders and personality disorders. Int. J. Eating Disord., 14, 403–416, 1993.

    Article  CAS  Google Scholar 

  25. Wonderlich S.A., Mitchell J.E.: Eating disorders and personality disorders. In: Yager Y., Gwirtsman H.E., Edelstein C.K. (Eds.), Special problems in managing eating disorders. Washington DC., American Psychiatric Press, 1992.

    Google Scholar 

  26. Streiner D.L.: Using meta-analysis in psychiatric research. Can. J. Psychiatry, 36, 357–362, 1991.

    PubMed  CAS  Google Scholar 

  27. Fahy T.A., Eisler I., Russell G.F.M.: Personality disorder and treatment response in bulimia nervosa. Br. J. Psychiatry, 162, 765–770, 1993.

    Article  PubMed  CAS  Google Scholar 

  28. Zerbe K.J., Marsh S.R., Coyne L.: Comorbidity in an inpatient eating disordered population: clinical characteristics and treatment implications. Psychiatric Hospital, 24, 3–7, 1993.

    PubMed  CAS  Google Scholar 

  29. Thornton C., Russell J.: Obsessive-compulsive comorbidity in the dieting disorders. Int. J. Eating Disord., 21, 83–87, 1997.

    Article  CAS  Google Scholar 

  30. Martinussen M., Fjukstad B.: Metados: A computer program for meta-analysis calculations. University of Tromsø, Norway, 1995.

    Google Scholar 

  31. Martinussen M., Bjørnstad J.F.: Meta-analysis calculations based on independent and non-independent cases. Educational and Psychological Measurement, 59, 928–950, 1999.

    Article  Google Scholar 

  32. Hunter J.E., Schmidt F.L.: Methods of metaanalysis: Correcting error and bias in research findings. Newbury Park, CA, Sage, 1990.

    Google Scholar 

  33. Viswesvaran C., Schmidt F.L.: A Meta-analytic comparison of the effectiveness of smoking cessation methods. J. Appl. Psychol., 77, 554–561, 1992.

    Article  PubMed  CAS  Google Scholar 

  34. Cooper J.L., Morrison T.L., Bigman O.L., Abramowitz S.I., Blunden D., Nassi A., Krener P.: Bulimia and borderline personality disorder. Int. J. Eating Disord., 7, 43–49, 1988.

    Article  Google Scholar 

  35. Gartner A.F., Marcus R.N., Halmi K., Loranger A.W.: DSM-III-R personality disorders in patients with eating disorders. Am. J. Psychiatry, 146, 1585–1591, 1989.

    PubMed  CAS  Google Scholar 

  36. Gwirtsman H.E., Roy-Byrne P., Yager J., Gerner R.H.: Neuroendocrine abnormalities in bulimia. Am. J. Psychiatry, 140, 559–563, 1983.

    PubMed  CAS  Google Scholar 

  37. Johnson C., Tobin D., Enright A.: Prevalence and clinical characteristics of borderline patients in an eating disordered population. J. Clin. Psychiatry, 50, 9–15, 1989.

    PubMed  CAS  Google Scholar 

  38. Kennedy S.H., McVey G., Katz R.: Personality disorders in anorexia nervosa and bulimia nervosa. J. Psychiatr. Res., 24, 259–269, 1990.

    Article  PubMed  CAS  Google Scholar 

  39. Levin A.P., Hyler S.E.: DSM-III personality diagnosis in bulimia. Compr. Psychiatry, 27, 47–53, 1986.

    Article  PubMed  CAS  Google Scholar 

  40. Sansone R.A., Fine M.A., Seuferer S., Bovenzi J.: The prevalence of borderline personality symptomatology among women with eating disorders. J. Clin. Psychol., 45, 603–610, 1989.

    Article  PubMed  CAS  Google Scholar 

  41. Schmidt N.B., Telch M.J.: Prevalence of personality disorders among bulimics, nonbulimic binge eaters, and normal controls. J. Psychopathol. Behav. Assess., 12, 169–185, 1990.

    Article  Google Scholar 

  42. Yager J., Landsverk J., Edelstein C.K., Hyler S.E.: Screening for axis II personality disorders in women with bulimic eating disorders. Psychosomatics, 30, 255–262, 1989.

    Article  PubMed  CAS  Google Scholar 

  43. Zanarini M.C., Frankenburg F.R., Pope H.G., Hudson J.I., Yurgenlun-Todd D., Cicchetti C.J.: Axis II comorbidity of normal- weight bulimia. Compr. Psychiatry, 30, 20–24, 1990.

    Article  Google Scholar 

  44. Bossert-Zaudig S., Zaudig M., Junker M., Wiegand M., Krieg J.-C.: Psychiatric comorbidity of bulimia nervosa in patients: Relationship to clinical variables and treatment outcome. Eur. Psychiatry, 8, 15–23, 1993.

    Google Scholar 

  45. Bulik C.M., Sullivan P.F., Joyce P.R., Carter F.A.: Temperament, character, and personality disorder in bulimia nervosa. J. Nerv. Ment. Dis., 183, 593–598, 1995.

    Article  PubMed  CAS  Google Scholar 

  46. Carroll J.M., Touyz S.W., Beumont P.J.V.: Specific comorbidity between bulimia nervosa and personality disorders. Int. J. Eating Disord., 19, 159–170, 1996.

    Article  CAS  Google Scholar 

  47. Gillberg I.C., Råstam M., Gillberg C.: Anorexia nervosa 6 years after onset: part I. personality disorders. Compr. Psychiatry, 36, 61–69, 1995.

    Article  PubMed  CAS  Google Scholar 

  48. Matsunaga H., Kiriike N., Nagata T., Yamagami S.: Personality disorders in patients with eating disorders in Japan. Int. J. Eating Disord., 23, 399–408, 1998.

    Article  CAS  Google Scholar 

  49. Vaz Leal F., Salcedo S.: Trastornos de personalidad en pacientes con trastornos alimentarios: un estudio controlado. Actas Luso Esp. Neurol. Psiquiatr. Cienc. Afines, 21, 181–187, 1993.

    Google Scholar 

  50. Saccomani L., Savoini M., Cirrincione M., Vercellino F., Ravera G.: Long-term outcome of children and adolescents with anorexia nervosa: Study on comorbidity. J. Psychosom. Res., 44, 565–571, 1998.

    Article  PubMed  CAS  Google Scholar 

  51. Samuels J.F., Nestadt G., Romanoski A.J., Folstein M.F., McHugh P.R.: DSM-III personality disorders in the community. Am. J. Psychiatry, 151, 1055–1062, 1994.

    PubMed  CAS  Google Scholar 

  52. Bodlund O., Ekselsius L., Lindström E.: Personality traits and disorders among psychiatric outpatients and normal subjects on the basis of the screen questionnaire. Nordic Journal of Psychiatry, 47, 425–433, 1992.

    Article  Google Scholar 

  53. Maier W., Lichtermann D., Klinger T., Heun R., Hallmayer J.: Prevalence of personality disorders (DSM-III-R) in the community. J. Pers. Dis., 6, 187–196, 1992.

    Article  Google Scholar 

  54. Kennedy S.H., Katz R., Rockert W., Mendlowitz S., Ralevski E., Clewes J.: Assessment of personality disorders in anorexia nervosa and bulimia nervosa. A comparison of self-report and structured interview methods. J. Nerv. Ment. Dis., 183, 358–364, 1995.

    Article  CAS  Google Scholar 

  55. Duijsens I.J., Diekstra R.F.W.: DSM-III-R and ICD-10 personality disorders and their relationship with the big five dimensions of personality. Personality and Individual Differences, 21, 119–133, 1996.

    Article  Google Scholar 

  56. Dyce J.A.: The big five factors of personality and their relationship to personality disorders. J. Clin. Psychol., 53, 587–593, 1997.

    Article  PubMed  CAS  Google Scholar 

  57. Troop N.A., Holbrey A., Treasure J.L.: Stress, coping and crisis support in eating disorders. Int. J. Eating Disord., 24, 157–166, 1998.

    Article  CAS  Google Scholar 

  58. Troop N.A., Treasure JL.: Psychosocial factors in the onset of eating disorders: response to life events and difficulties. Br. J. Med. Psychol., 70, 373–385, 1997.

    Article  PubMed  Google Scholar 

  59. Leon G.A., Fulkerson C.L., Perry L., Cudek R.: Personality and behavioral vulnerabilities associated with risk status for eating disorders in adolescent girls. J. Abnorm. Psychol., 102, 438–444, 1993.

    Article  PubMed  CAS  Google Scholar 

  60. Podar I., Hannus A., Allik J.: Personality and affectivity characteristics associated with eating disorders: A comparison between eating disordered, weight preoccupied and normal samples. J. Pers. Assess., 73, 133–147, 1999.

    Article  PubMed  CAS  Google Scholar 

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This work was presented at the 6th annual meeting of the European Council on Eating Disorders, Stockholm, Sweden, September 16th 1999.

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Rosenvinge, J.H., Martinussen, M. & Østensen, E. The comorbidity of eating disorders and personality disorders: A metaanalytic review of studies published between 1983 and 1998. Eat Weight Disord 5, 52–61 (2000). https://doi.org/10.1007/BF03327480

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