State/trait distinctions in bulimic syndromes

This study compared 55 women with active bulimic symptoms, 18 in remission from a bulimic eating disorder, and 31 who showed no evidence of a past or present eating disorder, on selected personality and psychiatric features.

Discriminant function analyses were used to isolate dimensions that differentiated active patients from patients in remission, and controls (i.e., that would logically constitute "state"-related disturbances), and then dimensions that differentiated clinical cases (whether active or in remission) from non-eating-disordered controls (i.e., that might reflect stable trait pathology associated with bulimic syndromes, whether active or not).

Measures of depression, suicidality, and anxiety loaded significantly on the first function (differentiating active bingers from all other cases), whereas narcissism differentiated both clinical groups from non-eating-disordered controls.

In light of theoretical and empirical evidence stressing the etiological role of narcissistic disturbances in bulimic syndromes, we interpret our findings as suggesting that narcissim may be a common trait characteristic (persisting even after remission of bulimic symptoms) in those who develop bulimic eating syndromes. Alternatively, depression, suicidality, and anxiety appear to be state-dependent features that resolve in many cases, along with remission of bulimic symptoms. We discuss various clinical and theoretical implications of our findings.