Impact of borderline personality disorder on bulimia nervosa.
ABSTRACT The primary aim of the present study was to examine whether the presence of borderline personality disorder (BPD) adversely impacted on outcome 3 years after treatment among women with bulimia nervosa (BN), in comparison to those women with either other personality disorders (other PD) or no personality disorder (no PD).
Participants were 134 women who received cognitive behaviour therapy for BN. The sample was divided into three groups: BPD (n=38), other PD (n=37), and no PD (n=59). Eating disorder (ED) symptoms and attitudes, and personality traits were examined at pretreatment assessment, 1 year and 3 year follow up.
At pretreatment assessment the BPD group had higher purging frequency, more comorbidity and poorer general functioning than the other PD and no PD groups. By 3 year follow up, however, no significant differences were found in ED symptomatology and general functioning among the groups. Pretreatment differences between the BPD and no PD groups on the personality measures of harm avoidance, self-directedness and cooperativeness disappeared over the course of 3 years.
Although women with BN and comorbid BPD appear more impaired at pretreatment assessment, they do not have poorer outcome than the other PD and no PD groups. The rate and level of improvement across the groups is not affected by the presence of BPD.
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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 10/2012; · 1.38 Impact Factor
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ABSTRACT: The presence of a comorbid eating disorder (ED) and personality disorder (PD) is associated with greater problems and poorer functioning than having an ED alone or PD alone. This pattern is also found for non-ED axis I disorders and PDs. This study aims to examine if an ED, compared to other non-ED axis I disorders, in a PD sample confers greater risks for: number and type of non-ED axis I and axis II disorders, suicide attempts and non-suicidal self-injury, and poorer psychosocial functioning. Standardized interviews were conducted on 166 females and 166 males with PDs. In females with PDs, EDs, as compared to other axis I disorders, were associated with more non-ED axis I and II disorders (particularly borderline and avoidant PD) and poorer global functioning, but not with suicide attempts or non-suicidal self-injury. In males with PDs, EDs were associated with more axis II disorders, particularly borderline PD. Given the small group of males with EDs, these results require replication. Males and females with PDs and EDs may have multiple comorbid disorders, particularly borderline PD and for females, avoidant PD that may warrant targeting in treatment.Psychiatry Research 02/2011; 185(3):427-32. · 2.46 Impact Factor
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ABSTRACT: Despite obvious clinical need, factors underlying early treatment discontinuation among 'real world' borderline personality disorder (BPD) patients are still unknown. This study investigates individual characteristics that can predict early (<three months) dropout among BPD outpatients at a general psychiatric service. Out of a sample of 1437 consecutively treatment-seeking psychiatric outpatients, 162 BPD subjects have been identified by means of the Structured Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Personality. Sociodemographic, clinical and personality variables potentially relevant for dropout were assessed for all participants at baseline. Early dropouts (n=54) were compared to continuers (n=108) on all measures. Logistic regression was then used to identify independent predictors of early dropout. A history of suicide attempts predicted early discontinuation, whereas the presence of an eating disorder and of avoidant personality features protected from early dropout. If confirmed, these findings may help clinicians operating in general psychiatric settings with estimating the risk of premature treatment discontinuation, and stress the need to specifically address suicidal behaviours in order to improve treatment retention among borderline outpatients. In this regard, implementing general psychiatric care with specialised, evidence-based psychotherapeutic interventions may be deemed necessary.Psychiatry Research 04/2012; · 2.46 Impact Factor