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Background: There is persuasive evidence for a relationship between eating disorders (EDs) and personality disorders (PDs). Research studies over the last three decades have used various tools to explore PDs in EDs with differing results. We investigated PDs derived from an interview - the International Personality Disorder Examination. Methods: 132 female inpatients with restrictive anorexia nervosa (AN-R), binge-purging AN, bulimia nervosa (BN) and ED not otherwise specified were interviewed. MANCOVA was used to test for differences in dimensional PD scores for the ED diagnostic and behavioural groups. Results: Twenty-one percent of patients had a definite DSM-IV PD diagnosis and 37% of patients had ≥1 definite or probable DSM-IV PD diagnoses. Cluster C PDs were most commonly found [avoidant (25%), obsessive-compulsive (9%), dependent (2%)], followed by cluster B PDs [borderline (13%), histrionic (2%)]. Comparison of PD dimensional scores revealed significantly lower PD scores for borderline PD in AN-R when compared to the other diagnostic groups; and significantly higher scores for histrionic, narcissistic, antisocial, and not otherwise specified PDs for BN when compared to the other diagnostic groups. Self-induced vomiting was the only behaviour significantly associated with any PD dimensional scores (borderline and narcissistic). Conclusions: Assessment of PDs using a highly structured interview administered by trained interviewers results in less PD diagnoses compared with previous studies of inpatients with an ED. Avoidance is the most common PD and those patients who induce vomiting are more likely to have borderline features.

This study explored feelings that discriminate between eating disorder and community groups of women. Responses to 25 questions about body image (9), eating (8) self-esteem (3) general psychology (5) were collected in 2002-2003 (N=268) and 2005-2006 (N=472). Wilk's lambda was used to test discrimination. The most discriminating psychological questions were: 'feeling unhappy and unable to cope as well as usual', 'unease attending social functions', 'fearing loss of control over emotions'; and for eating questions were: 'feeling uneasy if other people saw you eating', 'feeling preoccupied with food/eating', 'fearing loss of control over eating'. For body image only 'feeling preoccupied with body weight/shape' and 'fearing loss of control over your body' discriminated. Questions relating to weight and shape for self-esteem ('feeling fat', 'fearing weight gain' and 'wanting to lose weight') discriminated poorly. Results for both cohorts were consistent. Preoccupation with thoughts of eating or body image and fear of loss of control of these would be useful additions to eating disorders criteria. Psychological impairment should also be present.

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Patients who induce vomiting have more psychiatric comorbidity than 'non-vomiters', both lifetime and recent, and may benefit from diagnostic recognition as a separate group, for example 'vomiting' or 'purging' ED, who can then receive specialist treatment for their comorbidity and associated problems.

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