Personality disorder diagnoses in patients with bulimia nervosa: clinical correlates and changes with treatment

In view of reports of a high incidence of Axis II disorders among patients with bulimia nervosa, we assessed personality diagnoses and traits in a sample of bulimic patients both preceding and following treatment for the eating disorder.

The Personality Disorder Examination, a structured interview to assess DSM-III-R personality disorders, was administered to 34 in-patients and 49 outpatients with bulimia nervosa entering treatment. Thirty of 49 outpatients were reassessed after 6 weeks of treatment with desipramine or placebo.

At initial assessment, 38% of inpatients (N = 13) and 29% of outpatients (N = 14) fulfilled criteria for at least one personality disorder, most frequently borderline personality disorder. There were significant correlations between Personality Disorder Examination trait scores and clinical measures of eating disorder and depressive symptoms. Of 30 outpatients who were reinterviewed following treatment, 3 of 9 patients lost one or more personality diagnoses at post-treatment assessment, and 2 of 21 patients without initial Personality Disorder Examination diagnoses received one or more diagnoses at the second interview. Changes in Personality Disorder Examination trait scores, but not diagnoses, were correlated with changes in some clinical measures.

These data suggest that the assessment of Axis II disorders in patients with bulimia nervosa is problematic and raise the possibility that personality features in this group may be influenced by the course of their Axis I disorder.