Comorbidity of DSM-III-R eating disorders and personality disorders

Abstract

The purpose of this study was to assess the relationship of eating disorders to personality disorders. Two hundred subjects were independently administered the Structured Clinical Interview for DSM‐III‐R (SCID) and the Personality Disorder Examination (PDE) face‐to‐face by two experienced clinicians. One hundred forty‐six also completed the Personality Diagnostic Questionnaire‐Revised (PDQ‐R). Rates of personality disorder among patients with and without eating disorders were determined by each of the three instruments. Comorbidity between bulimia nervosa and anorexia nervosa and a conservative estimate of individual Axis II disorders was examined. Eating disorders with and without personality disorders were compared on age at onset and two measures of illness severity. Results indicate that the association, in general, between personality disorders and eating disorders varies by diagnostic method. Bulimia nervosa, however, is associated with borderline personality disorder and anorexia nervosa with avoidant personality disorder. Eating disorders with personality disorders are characterized by chronicity and low levels of functioning compared with eating disorders without personality disorders. © 1993 by John Wiley & Sons, Inc.

Exploring the construct validity of the eating disorder continuum.

“…Overall, analyses indicated that these variables showed the expected linear relationship to eating disorder continuum placement, thereby supporting the construct validity of the eating disorder continuum hypothesis for women. These results also extend prior work that showed a variety of psychological, behavioral, and cognitive characteristics related to clinical eating disorders (Brookings & Wilson, 1994;Fairburn, 1995;Garner, 1991;Skodol et al, 1993;Stotland & Zuroff, 1990) to be related as expected to women's continuum placement. Moreover, consistent with the limited empirical research that does not show a clear relationship between eating disturbances and certain psychological and behavioral characteristics (Brookings & Wilson, 1994), eating disorder continuum placement was not differentiated by Extraversion, Openness to Experience, Agreeableness, and Conscientiousness.…”

Exploring the construct validity of the eating disorder continuum.

“…Overall, analyses indicated that these variables showed the expected linear relationship to eating disorder continuum placement, thereby supporting the construct validity of the eating disorder continuum hypothesis for women. These results also extend prior work that showed a variety of psychological, behavioral, and cognitive characteristics related to clinical eating disorders (Brookings & Wilson, 1994;Fairburn, 1995;Garner, 1991;Skodol et al, 1993;Stotland & Zuroff, 1990) to be related as expected to women's continuum placement. Moreover, consistent with the limited empirical research that does not show a clear relationship between eating disturbances and certain psychological and behavioral characteristics (Brookings & Wilson, 1994), eating disorder continuum placement was not differentiated by Extraversion, Openness to Experience, Agreeableness, and Conscientiousness.…”

Prospective 10‐year Follow‐up in Adolescent Anorexia Nervosa—Course, Outcome, Psychiatric Comorbidity, and Psychosocial Adaptation

“…This is very similar to the 29 % prevalence rate in a very recent follow-up study on adolescent anorexia nervosa by Wentz Nilsson et al (1999). Consistent with the results of the latter group and those of other authors (Braun, Sunday, & Halmi, 1994 ;Skodol et al, 1993), Cluster-C personality disorders were by far the most common. The preponderance of anxious-dependent-obsessive personality disorders and anxiety disorders on axis I in former anorectic patients followed up for at least 10 years supports the assumption that restraint, risk avoidance, and social inhibition are characteristic features of the anorectic personality.…”

Prototype personality diagnosis in clinical practice: A viable alternative for DSM–5 and ICD–11.

“…The data provide strong evidence for the interrater reliability of prototype diagnosis of PDs in clinical practice. Whereas field trials and inter-interview studies comparing diagnoses made by different structured interviews and questionnaires for the same PDs administered days or a few weeks apart have shown low correlations and even lower kappa coefficients indicating convergent diagnoses (Clark, Livesley, & Morey, 1997; Pilkonis et al, 1995; Skodol, Oldham, Rosnick, Kellman, & Hyler, 1991), we found high correlations in the range of r = .70 between two assessments made by independent assessors from naturalistic clinical hours. Prototype diagnoses also demonstrated strong differentiation across disorders (what might be called discriminant interrater reliability), something not seen in previous research.…”

Exploring the construct validity of the eating disorder continuum.

“…Overall, analyses indicated that these variables showed the expected linear relationship to eating disorder continuum placement, thereby supporting the construct validity of the eating disorder continuum hypothesis for women. These results also extend prior work that showed a variety of psychological, behavioral, and cognitive characteristics related to clinical eating disorders (Brookings & Wilson, 1994;Fairburn, 1995;Garner, 1991;Skodol et al, 1993;Stotland & Zuroff, 1990) to be related as expected to women's continuum placement. Moreover, consistent with the limited empirical research that does not show a clear relationship between eating disturbances and certain psychological and behavioral characteristics (Brookings & Wilson, 1994), eating disorder continuum placement was not differentiated by Extraversion, Openness to Experience, Agreeableness, and Conscientiousness.…”

Prospective 10‐year Follow‐up in Adolescent Anorexia Nervosa—Course, Outcome, Psychiatric Comorbidity, and Psychosocial Adaptation

“…This is very similar to the 29 % prevalence rate in a very recent follow-up study on adolescent anorexia nervosa by Wentz Nilsson et al (1999). Consistent with the results of the latter group and those of other authors (Braun, Sunday, & Halmi, 1994 ;Skodol et al, 1993), Cluster-C personality disorders were by far the most common. The preponderance of anxious-dependent-obsessive personality disorders and anxiety disorders on axis I in former anorectic patients followed up for at least 10 years supports the assumption that restraint, risk avoidance, and social inhibition are characteristic features of the anorectic personality.…”

Prototype personality diagnosis in clinical practice: A viable alternative for DSM–5 and ICD–11.

“…The data provide strong evidence for the interrater reliability of prototype diagnosis of PDs in clinical practice. Whereas field trials and inter-interview studies comparing diagnoses made by different structured interviews and questionnaires for the same PDs administered days or a few weeks apart have shown low correlations and even lower kappa coefficients indicating convergent diagnoses (Clark, Livesley, & Morey, 1997; Pilkonis et al, 1995; Skodol, Oldham, Rosnick, Kellman, & Hyler, 1991), we found high correlations in the range of r = .70 between two assessments made by independent assessors from naturalistic clinical hours. Prototype diagnoses also demonstrated strong differentiation across disorders (what might be called discriminant interrater reliability), something not seen in previous research.…”

Exploring the construct validity of the eating disorder continuum.

“…Overall, analyses indicated that these variables showed the expected linear relationship to eating disorder continuum placement, thereby supporting the construct validity of the eating disorder continuum hypothesis for women. These results also extend prior work that showed a variety of psychological, behavioral, and cognitive characteristics related to clinical eating disorders (Brookings & Wilson, 1994;Fairburn, 1995;Garner, 1991;Skodol et al, 1993;Stotland & Zuroff, 1990) to be related as expected to women's continuum placement. Moreover, consistent with the limited empirical research that does not show a clear relationship between eating disturbances and certain psychological and behavioral characteristics (Brookings & Wilson, 1994), eating disorder continuum placement was not differentiated by Extraversion, Openness to Experience, Agreeableness, and Conscientiousness.…”

Prospective 10‐year Follow‐up in Adolescent Anorexia Nervosa—Course, Outcome, Psychiatric Comorbidity, and Psychosocial Adaptation

“…This is very similar to the 29 % prevalence rate in a very recent follow-up study on adolescent anorexia nervosa by Wentz Nilsson et al (1999). Consistent with the results of the latter group and those of other authors (Braun, Sunday, & Halmi, 1994 ;Skodol et al, 1993), Cluster-C personality disorders were by far the most common. The preponderance of anxious-dependent-obsessive personality disorders and anxiety disorders on axis I in former anorectic patients followed up for at least 10 years supports the assumption that restraint, risk avoidance, and social inhibition are characteristic features of the anorectic personality.…”

Prototype personality diagnosis in clinical practice: A viable alternative for DSM–5 and ICD–11.

“…The data provide strong evidence for the interrater reliability of prototype diagnosis of PDs in clinical practice. Whereas field trials and inter-interview studies comparing diagnoses made by different structured interviews and questionnaires for the same PDs administered days or a few weeks apart have shown low correlations and even lower kappa coefficients indicating convergent diagnoses (Clark, Livesley, & Morey, 1997; Pilkonis et al, 1995; Skodol, Oldham, Rosnick, Kellman, & Hyler, 1991), we found high correlations in the range of r = .70 between two assessments made by independent assessors from naturalistic clinical hours. Prototype diagnoses also demonstrated strong differentiation across disorders (what might be called discriminant interrater reliability), something not seen in previous research.…”