Skip to main content
SpringerLink
Log in

Recent research of relationships among eating disorders and personality disorders

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

This review focuses on recent research examining the relationships among eating disorders (ED) and personality disorders (PD). Studies that have examined rates of PD in patients with ED and rates of ED in patients with PD have generally reported high rates of diagnostic co-occurrence, although the marked inconsistency and variability in rates across studies is striking. Methodologic limitations and conceptual problems make interpretation of the existing literature ambiguous. Overall, circumspect review suggests that anorexia nervosa may be associated with obsessional and perfectionistic forms of personality disturbances, bulimia nervosa with impulsive and unstable personality disturbances, and binge eating disorder with avoidant and anxious forms of personality disturbances. In terms of longitudinal associations, PD may be more closely associated with the course of general psychiatric or psychosocial functioning than with fluctuations in the course of ED. The significance (and more precise nature) of these associations, however, is unclear and will require sophisticated longitudinal studies to arrive at more definitive answers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Kendall PC, Clarkin JF: Introduction to special section: comorbidity and treatment implications. J Consul Clin Psychol 1992, 60:833–834.

    Article  CAS  Google Scholar 

  2. Grilo CM, Devlin MJ, Cachelin FM, Yanovski SZ: Report of the National Institutes of Health Workshop on the development of research priorities in eating disorders. Psychopharmacol Bull 1997, 33:321–333.

    PubMed  CAS  Google Scholar 

  3. Skodol AE, Oldham JM, Hyler SE, et al.: Comorbidity of DSM-III-R eating disorders and personality disorders. Int J Eating Dis 1993, 14:403–416.

    Article  CAS  Google Scholar 

  4. Vitousek K, Manke F: Personality variables and disorders in anorexia nervosa and bulimia nervosa. J Abnorm Psychol 1994, 103:137–147.

    Article  PubMed  CAS  Google Scholar 

  5. Rosenvinge JH, Martinussen M, Ostensen E: The comorbidity of eating disorders and personality disorders: a meta-analytic review of studies published between 1983 and 1998. Eating Weight Disord 2000, 5:52–61.

    CAS  Google Scholar 

  6. Loranger AW, Lenzenweger MF, Gartner AF, et al.: Trait-state artifacts and the diagnosis of personality disorders. Arch Gen Psychiatry 1991, 48:720–728.

    PubMed  CAS  Google Scholar 

  7. Boyd JH, Burke JK, Gruenberg E, et al.: Exclusion criteria of DSM-III: a study of co-occurrence of hierarchy-free syndromes. Arch Gen Psychiatry 1984, 41:983–989.

    PubMed  CAS  Google Scholar 

  8. Gangestad S, Snyder M: To carve nature at its joints: on the existence of discrete classes in personality. Psychol Bull 1985, 92:317–349.

    Google Scholar 

  9. Allison DB: A note on the selection of control groups and control variables in comorbidity research. Compr Psychiatry 1993, 34:336–339.

    Article  PubMed  CAS  Google Scholar 

  10. Berkson J: Limitations of the application of the four-fold table analysis to hospital data. Biometrics Bull 1946, 2:4753.

    Google Scholar 

  11. du Fort GG, Newman SC, Bland RC: Psychiatric comorbidity and treatment seeking: sources of selection bias in the study of clinical populations. J Nerv Ment Dis 1993, 181:467–474.

    Article  Google Scholar 

  12. Rutter M: Comorbidity: meanings and mechanisms. Clin Psychol Sci Prac 1994, 1:100–104.

    Article  Google Scholar 

  13. Kraemer HC: Statistical issues in assessing comorbidity. Stat Med 1995, 14:721–733.

    Article  PubMed  CAS  Google Scholar 

  14. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 3. Washington, DC: American Psychiatric Association; 1987.

    Google Scholar 

  15. Grilo CM, Levy KN, Becker DF, et al.: DSM-III-R axis I and II disorders in inpatients with eating disorders. Psychiatr Serv 1996, 47:426–429.

    PubMed  CAS  Google Scholar 

  16. Zanarini MC, Frankenburg FR, Dubo ED, et al.: Axis I comorbidity of borderline personality disorder. Am J Psychiatry 1998, 155:1733–1739. This is a large carefully conducted study of borderline personality disorder.

    PubMed  CAS  Google Scholar 

  17. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association; 1994.

    Google Scholar 

  18. McGlashan TH, Grilo CM, Skodol AE, et al.: The collaborative longitudinal personality disorders study: baseline axis I/II and axis II/II co-occurrence. Acta Psychiatr Scand 2000, 102:256–264. This report contains baseline characterization of axis I/II and axis II/II diagnostic co-occurrences. This is a major prospective repeated measures longitudinal study of four major PD groups with a comparison group of major depressive disorder without PD.

    Article  PubMed  CAS  Google Scholar 

  19. Gunderson JG, Shea MT, Skodol AE, et al.: The Collaborative Longitudinal Personality Disorders Study: development, aims, designs and sample characteristics. J Pers Disord 2000, 14:300–315.

    CAS  PubMed  Google Scholar 

  20. Grilo CM, McGlashan TH: Stability and course of personality disorders. Curr Opin Psychiatry 1999, 12:157–162.

    Article  Google Scholar 

  21. Grilo CM, McGlashan TH, Skodol AE: Course and stability and course of personality disorders: the need to consider comorbidities and continuities between axis I psychiatric disorders and axis II personality disorders. Psychiatr Q 2000, 71:291–307.

    Article  PubMed  CAS  Google Scholar 

  22. Becker DF, Grilo CM, Edell WS, McGlashan TH: Comorbidity of borderline personality disorder with other personality disorders in hospitalized adolescents and adults. Am J Psychiatry 2000, 157:2011–2016.

    Article  PubMed  CAS  Google Scholar 

  23. Andersen AE, Bowers WA, Watson T: A slimming program for eating disorders not otherwise specified: reconceptualizing a confusing, residual diagnostic category. Psychiatr Clin North Am 2001, 24:271–280.

    Article  PubMed  CAS  Google Scholar 

  24. Stice E, Hayward C, Cameron RP, et al.: Body-image and eating disturbances predict onset of depression among female adolescents: a longitudinal study. J Abn Psychol 2000, 109:438–444.

    Article  CAS  Google Scholar 

  25. Striegel-Moore RH, Dohm FA, Solomon EE, et al.: Subthreshold binge eating disorder. Int J Eat Disord 2000, 27:270–278.

    Article  PubMed  CAS  Google Scholar 

  26. Marino MF, Zanarini MC: Relationship between EDNOS and its subtypes and borderline personality disorder. Int J Eat Disord 2001, 29:349–353.

    Article  PubMed  CAS  Google Scholar 

  27. Grilo CM: The assessment and treatment of binge eating disorder. J Pract Psychiatry Beh Health 1998, 4:191–201.

    Google Scholar 

  28. Yanovski SZ, Nelson JE, Dubbert BK, Spitzer RL: Association of binge eating disorder and psychiatric comorbidity in obese subjects. Am J Psychiatry 1993, 150:1472–1479.

    PubMed  CAS  Google Scholar 

  29. Telch CF, Stice E: Psychiatric comorbidity in women with binge eating disorder: prevalence rates from a non-treatment seeking sample. J Consult Clin Psychol 1998, 66:768–776.

    Article  PubMed  CAS  Google Scholar 

  30. Wilfley DE, Friedman MA, Dounchis JZ, et al.: Comorbid psychopathology in binge eating disorder: relation to eating disorder severity at baseline and following treatment. J Consult Clin Psychol 2000, 68:641–649.

    Article  PubMed  CAS  Google Scholar 

  31. Grilo CM, Masheb RM: DSM-IV psychiatric co-morbidity in binge eating disorder: relation to gender and eating disorder symptomatology. Paper presented at the annual meeting of the Association for the Advancement of Behavior Therapy; Philadelphia, PA, November 2001.

  32. Wilson GT, Fairburn GT: Treatment of eating disorders. In Treatments that Work. Edited by Nathan PE, Gorman JM. New York: Oxford University Press; 2001:501–530.

    Google Scholar 

  33. Wilson GT, Loeb KL, Walsh BT, et al.: Psychological versus pharmacological treatments of bulimia nervosa: predictors and processes of change. J Consult Clin Psychol 1999, 67:451–459.

    Article  PubMed  CAS  Google Scholar 

  34. Fahy TA, Russell GFM: Outcome and prognostic variables in bulimia nervosa. Int J Eat Disord 1993, 14:135–146.

    Article  PubMed  CAS  Google Scholar 

  35. Rossiter EM, Agras WS, Telch CF, Schneider JA: Cluster B personality disorder characteristics predict outcomes in the treatment of bulimia nervosa. Int J Eat Disord 1993, 13:349–357.

    PubMed  CAS  Google Scholar 

  36. Waller G: Dropout and failure to engage in individual outpatient cognitive-behavior therapy for bulimic disorders. Int J Eat Disord 1997, 22:35–41.

    Article  PubMed  CAS  Google Scholar 

  37. Ames-Frankel J, Devlin MJ, Walsh BT, et al.: Personality disorder diagnoses in patients with bulimia nervosa: clinical correlates and changes with treatment. J Clin Psychiatry 1992, 53:90–96.

    PubMed  CAS  Google Scholar 

  38. Davis R, Olmsted MP, Rockert W: Brief group psychoeducation for bulimia nervosa: II. Prediction of clinical outcome. Int J Eat Disord 1992, 11:205–211.

    Google Scholar 

  39. Agras WS, Crow SJ, Halmi KA, et al.: Outcome predictors for the cognitive behavioral treatment of bulimia nervosa: data from a multisite study. Am J Psychiatry 2000, 157:1302–1308.

    Article  PubMed  CAS  Google Scholar 

  40. Wonderlich SA, Fullerton D, Swift WJ, Klein MH: Five-year outcome from eating disorders: Relevance of personality disorders. Int J Eat Disord 1994, 15:233–244.

    Article  PubMed  CAS  Google Scholar 

  41. Steiger H, Leung F, Thibaudeau J, et al.: Comorbid features in bulimics before and after therapy: are they explained by Axis-II diagnoses, secondary effects of bulimia, or both? Compr Psychiatry 1993, 34:45–53.

    Article  PubMed  CAS  Google Scholar 

  42. Steiger H, Stotland S, Houle L: Prognostic implications of stable versus transient borderline features in bulimic patients. J Clin Psychiatry 1994, 55:206–214.

    PubMed  CAS  Google Scholar 

  43. Steiger H, Stotland S: Prospective study of outcome in bulimics as a function of axis-II comorbidity: long-term responses on eating and psychiatric symptoms. Int J Eating Disord 1996, 20:149–161.

    Article  CAS  Google Scholar 

  44. Gleaves DH, Williamson DA, Barker SE: Confirmatory factor analysis of a multidimensional model of bulimia nervosa. J Abn Psychol 1993, 102:173–176.

    Article  CAS  Google Scholar 

  45. Herzog DB, Dorer DJ, Keel PK, et al.: Recovery and relapse in anorexia and bulimia nervosa: a 7.5-year follow-up study. J Am Acad Child Adolesc Psychiatry 1999, 38:829–837. A major and exemplary study characterizing the course of AN and BN and their predictors.

    Article  PubMed  CAS  Google Scholar 

  46. Herzog DB, Sacks NR, Keller MB, et al.: Patterns and predictors of recovery in anorexia nervosa and bulimia nervosa. J Am Acad Child Adolesc Psychiatry 1993, 32:835–842.

    Article  PubMed  CAS  Google Scholar 

  47. Nilsson EW, Gillberg C, Gillberg IC, Rastam M: Ten-year follow-up of adolescent-onset anorexia nervosa: personality disorders. J Am Acad Child Adolesc Psychiatry 1999, 38:1389–1395.

    Article  PubMed  CAS  Google Scholar 

  48. Matsunaga H, Kaye WH, McConaha C, et al.: Personality disorders among subjects recovered from eating disorders. Int J Eating Disord 2000, 27:353–357.

    Article  CAS  Google Scholar 

  49. Francis AJ: Categorical and dimensional systems of personality diagnosis: a comparison. Compr Psychiatry 1982, 23:1198.

    Google Scholar 

  50. Widiger TA: Categorical versus dimensional classifications: implications from and for research. J Personal Disord 1992, 6:287–300.

    Google Scholar 

  51. Ball SA: Reconceptualizing personality disorder categories using personality trait dimensions: introduction to special section. J Personal 2001, 69:147–153.

    Article  CAS  Google Scholar 

  52. Clark LA, Watson D: Personality, disorder, and personality disorder: toward a more rational conceptualization. J Personal Disord 1999, 13:142–151.

    PubMed  CAS  Google Scholar 

  53. Fairburn CG, Cooper Z, Doll HA, Welch SL: Risk factors for anorexia nervosa: three integrated case-control comparisons. Arch Gen Psychiatry 1999, 56:468–476.

    Article  PubMed  CAS  Google Scholar 

  54. Srinivasagam NM, Kaye WH, Plotnicov KH, et al.: Persistent perfectionism, symmetry, and exactness after long-term recovery from anorexia nervosa. Am J Psychiatry 1995, 152:1630–1634.

    PubMed  CAS  Google Scholar 

  55. Pollice C, Kaye WH, Greeno CG, Weltzin TE: Relationship of depression, anxiety, and obsessionality to state of illness in anorexia nervosa. Int J Eat Disord 1997, 21:367–376.

    Article  PubMed  CAS  Google Scholar 

  56. Kaye WH, Greeno CG, Moss H, et al.: Alterations in serotonin activity and psychiatric symptomatology after recovery from bulimia nervosa. Arch Gen Psychiatry 1998, 55:927–935.

    Article  PubMed  CAS  Google Scholar 

  57. Lilenfeld LR, Stein D, Bulik CM, et al.: Personality traits among currently eating disordered, recovered and never ill first-degree relatives of bulimic and control women. Psychol Med 2000, 30:1399–1410. An excellent combination design (family study and "recovered" patients) and important contribution to the literature.

    Article  PubMed  CAS  Google Scholar 

  58. Lilenfeld LR, Kaye WH, Greeno CG, et al.: A controlled family study of anorexia nervosa and bulimia nervosa: psychiatric disorders in first-degree relatives and effects of proband comorbidity. Arch Gen Psychiatry 1998, 55:603–610.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Yale Psychiatric Research at Congress Place, Yale University School of Medicine, 301 Cedar Street, PO Box 208098, 06520, New Haven, CT, USA

    Carlos M. Grilo PhD

Authors
  1. Carlos M. Grilo PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Grilo, C.M. Recent research of relationships among eating disorders and personality disorders. Curr Psychiatry Rep 4, 18–24 (2002). https://doi.org/10.1007/s11920-002-0007-8

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-002-0007-8

Keywords

Search

Navigation