Eating disorders and concurrent psychopathology: a reconceptualisation of clinical need through Rasch analysis

Abstract

Therapies for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and eating disorder not otherwise specified (EDNOS) take as their focus, perhaps of necessity, the eating disorder symptomatology. However, there is increasing evidence of comorbidity of psychopathological mechanisms (e.g. perfectionism, depression) with eating disorders which, left untreated, may diminish any therapeutic effects. Thus identifying the extent of comorbidity in an eating disorder population and assessing the relationship between psychopathological mechanisms and the eating disorder is important. Rasch analysis was applied to the findings from questionnaires (EDI-2; SCL90-R) completed by 105 female patients referred to an eating disorder unit. General psychopathology was found to be more indicative of 'caseness' than eating disorder psychopathology. In particular, interpersonal sensitivity, depression and mild interpersonal aspects of psychoticism emerged as important factors across eating disorders. The comorbidity of psychopathological mechanisms needs to be given consideration in the successful treatment of eating disorders.

Differences and Similarities Between Bulimia Nervosa, Compulsive Buying and Gambling Disorder

“…Moreover, the BN+CB patients were those presenting with the highest loading in general psychopathology and maladaptive personality traits. These results coincide with those obtained in several studies showing that comorbidity impacts the severity of the symptoms (Fernández-Aranda et al, 2006, 2008Hughes et al, 2013;Jiménez-Murcia et al, 2009; Jiménez-Murcia, Fernández-Aranda, Granero, & Menchón, 2014), including illness evolution and treatment response (Fletcher, Kupshik, Uprichard, Shah, & Nash, 2008;Granero et al, 2014;Jiménez-Murcia et al, 2009Milos, Baur, Muehlebach, & Spindler, 2013).…”

“…These results coincide with those obtained in several studies showing that comorbidity impacts the severity of the symptoms (Fernández-Aranda et al, 2006, 2008Hughes et al, 2013;Jiménez-Murcia et al, 2009;Jiménez-Murcia, Fernández-Aranda, Granero, & Menchón, 2014), including illness evolution and treatment response (Fletcher, Kupshik, Uprichard, Shah, & Nash, 2008;Granero et al, 2014;Jiménez-Murcia et al, 2009Milos, Baur, Muehlebach, & Spindler, 2013). With regards to novelty seeking, disorders characterized by higher impulsivity (CB, GD and BN+CB) had more in common with each other than with the BNÀCB group.…”

Perfectionism and sense of coherence among patients with eating disorders

“…A low degree of meaningfulness and sense of coherence may lead to beliefs that approval and love from other persons are conditioned. The present study has not regarded comorbidity with other psychiatric diagnoses howsoever this is common in eating disorders (Fletcher et al, 2008;Milos, Spindler & Schnyder, 2004). Eating disorder diagnoses were well-defined in the health records but other psychiatric diagnoses were inconsequently reported in the material for this study.…”

“…Items No 36, 52 and 63 are related to self-oriented perfectionism according to MPS-H (EDI-SOP), while items No 13, 29 and 43 are related to socially prescribed perfectionism (EDI-SPP) according to the same scale ( Bardone-Cone, 2006;Fletcher, 2008). The third and latest version of the instrument, the EDI-3, is now published.…”

General psychopathology in anorexia nervosa: the role of psychosocial factors

“…Interpersonal sensitivity, as a psychopathological factor comorbid to ED, has rather recently attracted attention. Fletcher, Kupshik, Uprichard, Shah and Nash (2008), for example, in a study with 105 female patients referred to an eating disorder unit, found that general psychopathology using SCL-90 was more indicative of 'caseness' than eating disorder psychopathology as measured by Eating Disorder Inventory (EDI-2). Three factors including interpersonal sensitivity, depression and mild interpersonal aspects of psychoticism emerged as important factors in EDs.…”