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Outcome of anorexia nervosa: eating attitudes, personality, and parental bonding
C M Bulik1, P F Sullivan, J L Fear
1Virginia Commonwealth University, Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, Virginia 23298-0126, USA. cbulik@hsc.vcu.edu
Background:
We examined eating attitudes, personality, and parental bonding in women with a history of anorexia nervosa stratified by degree of recovery in comparison to randomly selected controls. We were interested in the distinguishing characteristics of recovery and of chronic anorexia nervosa.
Method:
All female new referrals to an eating disorders service between January 1, 1981 and December 31, 1984 with probable or definite anorexia nervosa were eligible for inclusion. 86.4% of these women ("cases") were located and agreed to participate. The control group was a random community sample. All subjects were interviewed with a structured diagnostic instrument and completed a battery of psychological inventories including the Eating Disorder Inventory (EDI), the Three-Factor Eating Questionnaire (TFEQ), the Temperament and Character Inventory (TCI), and the Parental Bonding Instrument (PBI).
Results:
We divided the anorexia follow-up sample into full recovery (n = 21), partial recovery (n = 34), and chronically ill (n = 15) and compared them to community controls (n = 98). The chronically ill group was distinguished by a lower desired body mass index (BMI), higher cognitive restraint on the TFEQ, higher Drive for Thinness and Bulimia on the EDI, lower maternal and paternal care on the PBI, and high harm avoidance and low self-directedness on the TCI. The full recovery group scored high on self-directedness and cooperativeness on the TCI.
Conclusions:
The domains of personality, character, and parental bonding differ among categories of recovery in anorexia nervosa. Whether these differences contribute to recovery or emerge during recovery or lack thereof remains an unanswered question.