Co-occurrence of ego function change and symptomatic change in bulimia nervosa: a six-year interview-based study

Low ego strength is theoretically thought of as causing difficulties in interpersonal relations and leading to the development of psychiatric symptomatology. Patients with bulimia nervosa were previously shown to have low ego strength and were studied to investigate whether gains in ego strength occur over time and are associated with improvement in symptoms. The average patient had an ego strength at a borderline level at index and at a neurotic level 6 years later. Less positive change in ego strength was associated with a low initial Eating Disorder Inventory (EDI) Symptom score a long Time in Treatment, and having been referred for specialist care. Positive changers significantly more often stopped vomiting/abusing laxatives and showed several non-significant tendencies to improve in other symptomatic aspects as well. Several methodological caveats are discussed, but these findings may contribute to the identification of mechanisms whereby long-term improvement occurs in bulimia nervosa.