Personality subtypes in adolescents with anorexia nervosa

Gazzillo, Francesco; Lingiardi, Vittorio; Peloso, Anna Maria; Giordani, Silvia; Vesco, Serena; Zanna, Valeria; Filippucci, Ludovica; Vicari, Stefano

doi:10.1016/j.comppsych.2013.03.006

Cited by 42 publications

(41 citation statements)

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“…Several studies (Gazzillo et al, 2013;Thompson-Brenner and Westen, 2005;Westen and Harnden-Fischer, 2001) identified at least three personality subtypes that cut across eating disorder diagnoses in adult patients: (a) dysregulated/under-controlled pattern, characterized by emotional dysregulation and impulsivity; (b) constricted/over-controlled pattern, characterized by emotional inhibition, cognitively sparse representations of the self and others, and interpersonal avoidance; and (c) high-functioning/perfectionistic pattern, characterized by psychological strengths combined with perfectionism and negative affectivity. In a study based on a sample of adolescent patients with EDs, these personality subtypes were strongly related to clinicians' reactions, assessed with the Therapist Response Questionnaire (Betan et al, 2005), and added considerably to other factors-such as ED diagnosis, patient global functioning, and treatment length-in explaining therapists' responses (Satir et al, 2009).…”

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confidence: 99%

Eating Disorders and Therapist Emotional Responses

Colli¹,

Speranza

Lingiardi

et al. 2015

Journal of Nervous &Amp; Mental Disease

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The aims of this study were to identify (a) patterns of clinicians' emotional responses to patients with eating disorders (ED); (b) patient, clinician, and treatment variables associated with therapist emotional responses; and (c) the influence of patient personality on therapist emotional responses. A random national sample of psychodynamic and cognitive-behavioral psychotherapists (N = 149) was asked to examine one patient (>18 years old) with an ED. Clinicians completed the SWAP-200, the Therapist Response Questionnaire, and the Clinical Questionnaire-Eating Disorder Form to provide general information about themselves, patients, and therapies. Results suggested a therapist pattern of emotional response in relation to different ED diagnosis and indicated meaningful influence of therapist experience and patient variables (such as sexual abuse, dissociative symptoms, and self-harm) on therapist emotional reactions. Finally, regression analysis suggested that therapist responses are more related to patient personality than ED symptoms. This study confirms the importance of patient personality in evoking specific therapists' reactions.

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confidence: 99%

Eating Disorders and Therapist Emotional Responses

Colli¹,

Speranza

Lingiardi

et al. 2015

Journal of Nervous &Amp; Mental Disease

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“…The common factor model of understanding the comorbidity between PDs and AN or BN, respectively, posits that a common trait ranging from constriction/perfectionism to impulsivity may result in specific associations between AN and cluster C PDs, notably the obsessive compulsive PD, as well as BN and cluster B, notably the borderline PD [41, 1,8,42]. …”

Section: Models Of Understanding and Clinical Implicationsmentioning

confidence: 99%

“…Previous studies [8][9][10] show that a comorbid borderline, avoidant, or obsessive-compulsive PD may worsen the long-term treatment-outcome of EDs. Moreover, a comorbid PD may complicate treatment challenges by increasing the risk of premature treatment termination due to a fragile therapeutic alliance [9,11], prolonging treatment for non-therapeutic reasons [12][13][14] or resulting in insufficient focus on alleviating ED-symptoms due to the need to address the PD.…”

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confidence: 99%

The comorbidity of personality disorders in eating disorders: a meta-analysis

et al. 2016

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Purpose: The present meta-analysis summarized the proportion of comorbid personality disorders (PDs) in patients with anorexia (AN) and bulimia nervosa (BN), respectively, and examined possible moderating variables. Methods:A search of the databases PsychINFO, Embase, and Medline for the period 1980 -2016 identified 87 studies from 18 different countries. Results:The mean proportion of PDs among patients with any type of eating disorder (ED) was .52 compared to .09 in healthy controls. There were no statistically significant differences between AN (.49) and BN (.54) in proportions of any PD or PD clusters except for obsessive compulsive PD (.23 vs .12 in AN and BN respectively).Conclusions: Both ED diagnoses had a similar comorbidity profile with a high prevalence of borderline and avoidant PDs. Moderator analyses conducted for any ED and any PD yielded significant differences for diagnostic systems with respect to EDs, method for assessing PD as well as patient weight and age.Keywords: personality disorders, anorexia nervosa, bulimia nervosa, meta-analysis, comorbidity Running head: EATING-AND PERSONALITY DISORDERS 3The Comorbidity of Personality Disorders in Eating Disorders: A Meta-Analysis Eating disorders (EDs), notably anorexia (AN) and bulimia nervosa (BN), are characterized by self-inflicted weight loss and recurrent episodes of bingeing and purging,respectively. An irrational overvaluation of the importance of controlling food, weight, and body shape represent the specific clinical features [1]. Severe EDs impair quality of life and interpersonal relations [2], and increase the number of productive years lost to disability [3].The standardized mortality rate is about five times higher than in the general population [4,5], and it takes six to nine years before 70% of the patients no longer meet the diagnostic criteria for an ED [6,7].Comorbid personality disorders (PDs) are frequently encountered in the treatment of EDs, and may become as protracted and impairing as the EDs. Previous studies [8][9][10] show that a comorbid borderline, avoidant, or obsessive-compulsive PD may worsen the long-term treatment-outcome of EDs. Moreover, a comorbid PD may complicate treatment challenges by increasing the risk of premature treatment termination due to a fragile therapeutic alliance [9,11], prolonging treatment for non-therapeutic reasons [12][13][14] or resulting in insufficient focus on alleviating ED-symptoms due to the need to address the PD. However, there are inconsistent findings from studies [15,16] and reviews [17,18] as to whether a concurrent PD predicts a poor outcome of an ED, whether PDs improve at the same rate as the ED or tend to persist after the alleviation of ED symptoms [19][20][21][22].In order to develop and examine comprehensive treatment models in terms of their cost-effectiveness, ability to overcome treatment challenges, and to prevent an unfavourable ED outcome, it is essential to determine how frequently or likely comorbid PDs are expected to appear in EDs. Research to date h...

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“…Thus, eating disorder patients with high levels of impulsivity may fall into the cluster B, whereas the overcontrolled/constricted subtype fall into the cluster C PDs (Claes, Vandereycken, & Vertommen, 2005;Gazzillo et al, 2013;Skodol et al, 1993). The impulsivity-perfectionism dimension is thus found both in eating disorders (Lilenfeld et al, 2006;Fairburn et al, 2003;Fairburn et al, 2008;Gazzillo et al, 2013) and in PDs (Gazzillo et al, 2013;Skodol et al, 1993). The majority of eating disorder patients move between anorexia-and bulimia nervosa (Eddy et al, 2008;Milos et al, 2005;Castellini et al, 2011).…”

Section: Personality Traits Along a Perfectionism-impulsivity Dimensionmentioning

confidence: 99%

Epidemiology of eating disorders part III: social epidemiology and case definitions revisited

Rosenvinge

Pettersen

2015

Advances in Eating Disorders

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The previous papers in this series (Rosenvinge & Pettersen, 2014a,b) outlined a historical panorama and presented knowledge about the distribution of eating disorders in various populations as well as about putative risk factors. This final paper focuses on social epidemiology, notably the current status of treatment dissemination and prevention research. We also discuss some comorbidity findings and transdiagnostic issues as an alternative to the DSM based definition of an epidemiological case, and how such an alternative definition may introduce new perspectives of prevention. Key words: eating disorders, epidemiology, reviewThe authors declare no conflict of interest in preparing this work 3 The present article is the final one of three about the epidemiology of eating disorders. The first one (Rosenvinge & Pettersen, 2014a) outlined basic epidemiological concepts, approaches and issues. In addition, it outlined a historical panorama of the epidemiology of eating disorders up to the early 1990s depicting, the evolvement of eating disorders from being one, curious and rare disorder (i.e., anorexia nervosa) to a set of disorders distributed in the population to an extent which has caught public concern and scientific effort for the past 30 or 40 years. This evolvement has resulted in case definitions through the DSM and ICD manuals, and being worldwide disseminated they haves had a major impact on case definition-and identification methods in epidemiological eating disorder research.The second paper in this series (Rosenvinge & Pettersen, 2014b) outlined recent knowledge about descriptive epidemiology; how many who actually have a DSM eating disorder or significant eating problems at a given point of time (i.e., the point prevalence), or in the past (i.e., the lifetime prevalence), as well as about the number of new cases appearing per year (i.e., the incidence). In addition, we focused on issues within analytic epidemiology, notably what is known about risk factors for developing eating disorders or for staying ill for a longer period of time.Case identification methods require a case definition which is useful for analytic and social epidemiological purposes, and not just for describing the prevalence or incidence.Traditionally, the DSM taxonomy has provided a gold standard. This may be questioned in view of mental disorders most likely to come along with eating disorders, most likely to affect their course, and where the comorbidity may point to transdiagnostic factors possibly relevant to epidemiological research. The first aim of this paper is to discuss the relevance and implications of such perspectives in constructing an epidemiological case definition.Social epidemiology becomes relevant when we have some answers from descriptive epidemiology to the "how many-questions", and from analytical epidemiology to the "who, and "why"-questions. One part of social epidemiology concerns prevention, and which may take the approach of health promotion at a universal (general population) level, i.e., by...

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Personality subtypes in adolescents with anorexia nervosa

Cited by 42 publications

References 61 publications

Eating Disorders and Therapist Emotional Responses

Eating Disorders and Therapist Emotional Responses

The comorbidity of personality disorders in eating disorders: a meta-analysis

Epidemiology of eating disorders part III: social epidemiology and case definitions revisited

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