Axis II comorbidity and developmental adversity in bulimia nervosa

Using data from 61 bulimic patients, we evaluated associations among axis II disturbances, psychopathological traits, eating symptoms, and adverse developmental experiences (e.g., childhood sexual and physical abuse). Findings showed likelihood of childhood abuse to increase markedly in function of comorbid personality pathology. In addition, comorbid borderline personality disorder was found to be a better predictor of object-relations disturbances, primitive defenses, and hostility than developmental adversity was. Although marked trait disturbances were strongly associated with borderline personality disorder (more than with severity of childhood adversity), the converse seemed true of severity of bulimic symptoms (i.e., comorbid personality disorder had no predictive effects, whereas developmental variables had inconsistent effects). Bulimic and general psychopathological symptoms, thus, seemed to have intriguingly independent determinants. We interpret these findings as showing that the observed association between developmental adversity and bulimic syndromes may, in large part, be attributable to comorbid personality pathology.