Personality disorder cognitions in the eating disorders

Vincent Square Eating Disorders Clinic, Central and North West London NHS Foundation Trust, Osbert Street, London, UK.
Behaviour Research and Therapy (Impact Factor: 3.85). 11/2008; 47(1):77-82. DOI: 10.1016/j.brat.2008.10.010
Source: PubMed


The eating disorders are frequently found to be comorbid with Axis II cluster B and C personality disorders. It is important to identify the personality-level cognitions that typify these disorders. This study of a clinical group examines the personality disorder cognitions in the eating disorders. The cognitions that were most relevant to the eating disorder pathology were those relating to avoidant and obsessive-compulsive personality disorder. Other personality disorder cognitions were associated with comorbid psychopathology in largely clinically meaningful ways. These findings extend our understanding of the comorbidity of eating disorders and personality pathology, suggesting that some cases need to be assessed and formulated with such cognitions in mind. Treatment strategies are required that address both the eating and the personality pathology, while considering the impact of these cognitions on the therapeutic relationship.

Download full-text


Available from: Glenn Waller, Jan 09, 2014
1 Follower
60 Reads
  • Source
    • "Of the 59 patients, 35 had a diagnosis of bulimia nervosa (purging subtype = 29; non-purging subtype = 6); 5 had a diagnosis of atypical bulimia nervosa; 8 had a diagnosis of anorexia nervosa; 6 had a diagnosis of atypical anorexia nervosa; and 5 were diagnosed with eating disorder unspecified (all 5 had binge-eating symptoms). After comparison of diagnostic groups' scores (see below), the patients were treated as a single transdiagnostic sample (Fairburn, Cooper and Shafran, 2003), in keeping with the earlier finding that personality disorder cognitions do not vary across eating disorders (Connan et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: The personality disorders are commonly comorbid with the eating disorders. Personality disorder pathology is often suggested to impair the treatment of axis 1 disorders, including the eating disorders. Aims: This study examined whether personality disorder cognitions reduce the impact of cognitive behavioural therapy (CBT) for eating disorders, in terms of treatment dropout and change in eating disorder attitudes in the early stages of treatment. Method: Participants were individuals with a diagnosed eating disorder, presenting for individual outpatient CBT. They completed measures of personality disorder cognitions and eating disorder attitudes at sessions one and six of CBT. Drop-out rates prior to session six were recorded. Results: CBT had a relatively rapid onset of action, with a significant reduction in eating disorder attitudes over the first six sessions. Eating disorder attitudes were most strongly associated with cognitions related to anxiety-based personality disorders (avoidant, obsessive-compulsive and dependent). Individuals who dropped out of treatment prematurely had significantly higher levels of dependent personality disorder cognitions than those who remained in treatment. For those who remained in treatment, higher levels of avoidant, histrionic and borderline personality disorder cognitions were associated with a greater change in global eating disorder attitudes. Conclusions: CBT's action and retention of patients might be improved by consideration of such personality disorder cognitions when formulating and treating the eating disorders.
    Behavioural and Cognitive Psychotherapy 02/2013; 42(2):1-14. DOI:10.1017/S1352465812001117 · 1.69 Impact Factor
  • Source
    • "While there has been substantial research (Sansone, Levitt, & Sansone, 2006) linking the eating disorders with individual personality pathologies (borderline personality disorder, obsessive–compulsive personality disorder, avoidant personality disorder), the comorbidity between those personality disorders (Dolan, Evans, & Norton, 1995) means that it is not clear how to characterise such links in a parsimonious way. For example, despite the stress in the eating disorders literature on overlaps with borderline personality disorder (Sansone et al., 2006), it has been demonstrated that the most powerful association is with anxiety-based cluster C personality disorder cognitions (Connan et al., 2009). This is in keeping with the suggestion that there are key anxiety-based personality elements in the eating disorders (Pallister & Waller, 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study examined whether comorbid personality disorder pathology in the eating disorders clusters into broader patterns, and whether those clusters have clinical validity in terms of levels of eating pathology and axis 1 comorbidity. The sample consisted of 214 eating-disordered women who completed measures of personality disorder cognitions, eating pathology and axis 1 pathology at assessment. Three clusters of eating disorder patients emerged-low levels of personality pathology overall, high levels of cognitions underpinning anxiety-based personality pathology, and high levels of all of the dimensions of personality pathology. These groups were validated by differences in levels of eating cognitions and axis 1 pathology. Personality disorder cognitions are clinically relevant to the eating disorders, but they might best be understood as broader sets of cognitions ('anxiety-centred' and 'general'), rather than in terms of individual personality disorder comorbidity or existing DSM personality disorder clusters. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.
    European Eating Disorders Review 01/2013; 21(1). DOI:10.1002/erv.2209 · 2.46 Impact Factor
  • Source
    • "Using the PBQ, Connan and colleagues (Connan et al., 2009) examined the personality disorder beliefs associated with eating disorders. The authors noted that individuals with eating disorders frequently meet diagnostic criteria for Axis II disorders, in particular cluster B and C personality disorders. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This article presents an overview of the Personality Beliefs Questionnaire (PBQ)--a 126-item self-report measure of beliefs associated with 10 personality disorders. It consolidates the literature on the PBQ over the last 20 years to provide a summary of the psychometric status, revisions and applications of the PBQ scales. The PBQ scales are psychometrically reliable (α = 77-94, test-retest stability r=.57-.93) and discriminate between individuals with and without a specific personality disorder. Two revisions have been made to the measure: A 14-item subscale measuring beliefs central to borderline personality disorder has been identified, and a short form version of the PBQ has been validated. The PBQ has been used to measure cognitive mechanisms of treatment outcomes, and has been found to be sensitive to changes in beliefs. Given the proposed shift in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) to a dimensional conceptualization of psychological components of personality dysfunction, the PBQ is likely to remain relevant and useful for identifying such components in individuals with personality disorders.
    Journal of Clinical Psychology 01/2012; 68(1):88-100. DOI:10.1002/jclp.20856 · 2.12 Impact Factor
Show more