This study evaluated the extent to which personality disorder (PD) diagnoses drawn in active bulimics explained pretreatment and posttreatment comorbid features, once possible secondary effects of bulimia nervosa (BN) on the mental status were controlled. We used structured interviews to assign axis II diagnoses to 73 DSM-III-R bulimics, and then examined whether or not classification into borderline PD (BPD), other PD (OPD), or no PD (NPD) groups (a) predicted pretreatment and posttreatment differences in comorbid symptoms, and (b) explained the severity of comorbid symptoms independent of effects attributable to BN sequelae. Groups never differed on eating-symptom measures, with all showing satisfactory average improvements over 3 months. However, on pretreatment and posttreatment comorbid symptoms, BPD subjects displayed more depression, reliance on maladaptive defenses, and other pathological features than did other groups. More importantly, after controlling for the effects of possible sequelae of BN on comorbid symptoms at each point in time, a borderline/nonborderline distinction always explained significant residual proportions of variance in comorbid symptoms. These findings suggest that despite tendencies for BN to exacerbate concurrent symptoms, axis II diagnoses remain meaningful as indicators of comorbid features.

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Eating and psychiatric symptoms as a function of Axis II comorbidity in bulimic patients. Three-month and six-month response after therapy.

Using DSM-III-R criteria, the authors organized 61 bulimic patients into "Borderline," "Other Personality Disorder," and "No Personality Disorder" groups, and then examined eating and comorbid symptoms at 3-month intervals during 6 months of multimodal therapy. Personality-disorder classifications seemed to predict neither the severity nor responsiveness to treatment of bulimic symptoms; all groups showed reliable and clinically significant improvements in eating habits over time. Conversely, the borderline patients showed reliably more comorbid symptoms than did any other group; their scores on disorder-specific dimensions--like borderline "traits" and maladaptive defenses--remained distinctly elevated throughout treatment. Our findings indicate that 1) a "borderline/nonborderline" distinction predicts temporally stable--and theoretically meaningful--differences in comorbid profiles, and 2) there exists an intriguing degree of independence, at least during ongoing treatment, between severity of character pathology and degree of change obtained on eating symptoms. Theoretical and clinical implications are discussed.

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Seasonal mood patterns in eating disorders.

There has been an increasing body of research literature suggesting a seasonal pattern of mood fluctuations and eating behavior in bulimic patients. Fornari et al. [5] reported worsening of bulimic symptoms during winter. There is a logical connection between Seasonal Affective Disorder (SAD) and bulimia nervosa as both show increased appetite and carbohydrate craving and probably share a common neurobiologic abnormality such as serotonergic dysfunction. The aim of this study was to determine the prevalence of SAD in a sample of 259 consecutively evaluated outpatients admitted to an eating disorders clinic (254 women and 5 men). Eating disorder diagnosis was established on the basis of DSM-III-R criteria, and a modified version of the Seasonal Pattern Assessment Questionnaire was used to determine seasonality among patients. The sample was comprised of the following: 53.7% bulimics, 27.4% anorexics, 15.1% were classified as having an eating disorder not otherwise specified, and 3.9% had a diagnosis other than an eating disorder. The results indicated that 27.0% of the eating disorder patients met criteria for SAD. Of this group, 86 (71.4%) were bulimic, 35 (18.6%) were anorexic, and 20 (10.0%) were nonspecified. Details and additional findings are discussed.

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