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Patients (n = 55) seeking treatment for eating disorders were evaluated for eating attitudes and behaviors, weight history, psychiatric symptoms, and presence of borderline personality organization. Patients were divided into borderline (n = 21) and nonborderline (n = 19) subgroups and were compared on the above dimensions after 1 year. There were relatively few differences between borderline and nonborderline bulimics in severity of symptomatic eating behavior and attitudes at the initial evaluation. However, the borderline patients were significantly more disturbed on a number of relevant dimensions, including general psychiatric symptoms. Follow‐up assessment showed that although most patients in the nonborderline group remitted their symptoms, patients in the borderline group continued to demonstrate clinically significant levels of disturbed eating patterns, Drive‐for‐Thinness, Body Dissatisfaction, and depression. The clinical and research implications for these findings are discussed.

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We investigated a multifactorial approach to the assessment of bulimia nervosa by means of hierarchical factor analysis. Two hundred forty-five bulimia nervosa patients and 68 patients with either anorexia nervosa or eating disorders not otherwise specified were administered a self-report battery that was organized into 21 dimensions relevant to eating disorder patients. When dimensions from this battery were subjected to hierarchical factor analysis, support for bulimia nervosa as a unique diagnostic category was obtained. However, the emergence of 3 secondary factors and 6 primary factors suggests that bulimia nervosa can also be described more complexly. The emergence of a multifactorial model of bulimia nervosa that incorporates several existing undimensional models suggests the potential for both divergent and complicated clinical presentation in bulimia nervosa patients.

Currently, there are no evidence-based treatments or established treatment protocols for patients that present with both eating disorders and substance use disorders/addictions. The lack of available integrated treatment programs, at all levels of care, has left the dually diagnosed patient vacillating between these two disorders. Eating disorder treatment programs frequently exclude patients with active substance use disorders, and addiction programs regularly exclude or do not effectively treat patients with eating disorders. Often, these patients are referred to addiction treatment programs prior to entering into eating disorder treatment. This approach is problematic, as both disorders are associated with high rates of relapse following treatment. Sequential treatments focus on the most acute disorder first, often utilizing multiple providers in different locations, with different theoretical orientations, staff training, and treatment protocols, which can make continuity of care quite difficult. Developing a comprehensive integrated approach to the treatment of comorbid patients will improve treatment delivery, reduce time in treatment, lower overall treatment costs, improve treatment outcome, and lessen consumer confusion. This chapter will provide

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Objective To identify the perceived training needs of case managers working on community support teams in a community mental health center serving a semi-rural/suburban area. Methods Semi-structured interviews were conducted with 18 case managers and 3 supervisors to inquire about areas of training need in case management. Interviews were coded and analyzed for common themes regarding training needs and methods of training improvement. Results Identified training needs called for a hands-on, back to basics approach that included education on the symptoms of severe mental illness, co-morbid substance use problems, and methods of engaging consumers. A mentoring model was proposed as a potential vehicle for disseminating knowledge in these domains. Conclusions Case managers identify significant training needs that would address their basic understanding of severe mental illness. Programs targeting these needs may result in improved outcomes for case managers and the individuals with psychiatric disabilities.

Though DSM‐III‐R equates several different forms of purging behavior, including use of vomiting, laxatives, diuretics, dieting, and exercise, there is little work that has examined patient subgroups based on divergent forms of purging. An attempt to investigate subgroups based on purging criteria was thwarted because of low base rates for specific purging behaviors, despite having a relatively large clinic sample of bulimia nervosa patients (n = 245). As an intermediary step to the investigation of functional equivalence of different forms of purging, we propose classifying patients based on the number of purging behaviors they employ to control weight. Our findings suggest that patients who employ more than one strategy are generally more disturbed on a number of psychiatric indices, including state and trait depression. This contrasts with recent findings that the frequency of any one purging behavior is unrelated to level of depression or course of treatment in clinical samples. This study suggests that clinicians who must evaluate and effectively triage bulimia nervosa patients would benefit from utilizing the number of purging strategies rather than the frequency of any one purging behavior as an indication of severity and possible comorbidity.