Stationärer Therapieerfolg bei Patientinnen mit Anorexia Nervosa und komorbiden Persönlichkeitsstörungen

Abstract

Personality disorders (PD) are among the most common comorbid disorders in female patients with Anorexia Nervosa (AN). Recent research findings suggest that comorbid PD are associated with a higher treatment drop-out rate and a worse therapeutic outcome. However, no study to date has distinguished between certain age groups concerning these issues. Therefore, the present study focuses on the prevalence of PD (1), treatment drop-out rates (2) and weight gain (3) in female in-patients with AN. Thereby, we differentiate among three age groups (17-24 years; 25-34 years; 35-65 years). We assessed female in-patients (N=331) with AN at the Helios Clinic in Bad Grönenbach in Germany using the Eating Disorders Inventory-2 and the psychotherapeutic-medical basic documentation at the beginning and at the end of their treatment. Furthermore, we investigated the drop-out rate and weight gain by comparing anorexic patients with and without comorbid PD that were diagnosed by clinicians using ICD-10 criteria. In sum, our patients with AN demonstrated a prevalence rate of 34% for one or more comorbid PD. Interestingly, patients between 17-24 years showed a lower prevalence rate of 22% compared to those between 25-34 years (42%) and 35-65 years (41%). Furthermore, younger age and comorbid PD seemed to be significant predictors for treatment dropout. One of the most striking results was that younger patients (17-24) without a comorbid PD had the highest weight gain during treatment. This could not be observed in patients with a comorbid PD, who demonstrated the highest weight gain between 25 and 34 years of age. Our findings support the hypothesis that comorbid PD are related to a worse outcome in patients with eating disorders. Future studies might do well in assessing dimensional scores of personality disorders and other relevant aspects like for example the amount of social support to draw further conclusions on these associations. Our results emphasize the need for more disorder-specific interventions tailoring at patients with AN and comorbid PD to improve treatment outcome.

Personality Disorder in Adolescent Patients with Anorexia Nervosa

“…Müller et al [44] investigated 32 former adolescent patients 10 years after discharge from inpatient treatment and diagnosed PD in 28%. Another study [31] reported 22% of comorbid PD in a large sample of AN patients, but the mean age of the youngest group was 20 years. A third study examining 57 adolescent patients with AN, restrictive type [45], found a lower proportion of 14% having a comorbid axis II diagnosis.…”

“…The role of comorbid PD in the chronification of eating disorders has not yet been consistently characterized. Although there are various findings, the diagnosis of PD contributed to a greater severity of AN in adults and poorer outcomes following treatment as usual [25, 30, 31]. Current research studies have found a possible connection between treatment response and chronification of symptoms among adult patients with AN and comorbid personality pathology, such as borderline PD (BPD) or obsessive-compulsive PD (OCPD) [8, 32, 33].…”

Evidence-Based and Novel Psychological Therapies for People with Anorexia Nervosa

“…There is the suggestion that a comorbid diagnosis of a PD with anorexia may lead to adverse implications regarding more chronic illness course, lower levels of functioning, higher rates of treatment termination and less positive outcomes. Such implications may be due to various influences of PD traits including increased self-harm/suicide risk, a lack of trust in the therapist interfering with therapy engagement, poor insight into own illness and exacerbated maintaining factors of anorexia like dysregulated emotion control [114,[119][120][121]. In light of this there appears to be a need for adapting the therapy approach used to better suit these individuals and their co-occurring symptoms [122], for example using adapted versions of alternative psychotherapies such as dialectical behavioural therapy (DBT) to treat individuals with comorbid diagnoses of anorexia and BPD [123,124].…”

Specialist psychotherapy with emotion for anorexia in Kent and Sussex: An intervention development and non‐randomised single arm feasibility trial

“…Furthermore, at least 60% of those struggling with an ED have ‘personality disorder’ traits (e.g. emotional dysregulation, relational struggles), anxiety, depression, OCD and other Axis 1 presentations (Kaye & Bulik, 2021; Link et al., 2017; Miller et al., 2021). Standard length treatments (20–30 sessions) are less effective for those with longer illness durations (Schmidt et al., 2015).…”