[Anorexia nervosa. A clinical and psychometric study]

Psychiatric symptoms and psychometric variables were assessed in thirty three female inpatients with anorexia nervosa. Our sample was a relatively "severe" group. All of the patients were still in treatment at the time of the study and had fulfilled the strict diagnostic criteria clearly defined by Crisp, Bruch, Russell, Dally and Gomez. Since the initial descriptions of anorexia nervosa were made, there has been a great confusion about whether it is a homogeneous illness or not. Our findings bear consistently with the clinical observation that there are distinct diagnostic sub-groups within the anorexia nervosa syndrome. Objective psychological measures lend support to the clinical evaluation that neurotic mechanisms (hysterical, phobic or obsessionnal features) are unusual in anorexia nervosa. Within the primary anorectics, the major clinical predictors of a poor outcome were: age (greater than 20 years), persistant amenorrhea and importance of weight loss. Within the 33 patients, the other predictors of a poor outcome were: small weight gain during treatment, absence of manifest distress (denial or satisfaction) and bulimia associated with self-induced vomiting. On the other hand, anxiety, depression and premorbid personality traits were not systematically associated with a poor prognosis. The population studied was heterogeneous in terms of MMPI profiles and Rorschach scores. The extent to which all our patients deviated from the norm on the Rorschach scores was not negligeable. The Rorschach variables linked to a clinical severity were the percentage of responses F (Form) and F + (form quality). The combination of these scores with the MMPI Anxiety Index (WELSH) lead to identify different sub-groups with a poor prognosis. According to H. Bruch theories, cognitive and perceptual difficulties, disturbance of body image of internal sensations as well as deficiency in identifying emotional states were very common. Rorschach responses of anorectic patients were compared with those of schizophrenic and depressed control groups of F% and F + % mean scores. The results showed that the anorectic group was closer to the schizophrenic group than to the depressed one.