Prospective study of outcome in bulimics as a function of Axis-II comorbidity: long-term responses on eating and...

We assessed prognostic implications of categorical personality disorder (PD) diagnoses at selected points during and following treatment for bulimic syndromes. Seventy-six bulimic cases were organized into Borderline PD, Other PD, or No PD groups, and then assessed at pretreatment, after 3 months of therapy, and at termination (after a modal 8 months). Results at 3- and 12-month posttreatment follow-ups (available in 43 and 38 cases, respectively) provided a reflection of status after therapy termination. On comorbid symptoms, borderline/ nonborderline differences were very striking: Borderlines showed more initial psychiatric symptoms than did nonborderlines, and despite improvements, retained disturbances of clinical magnitude to completion of therapy and into follow-up. On eating symptoms, borderline/ nonborderline differences were less dramatic, the overall pattern implying that borderlines showed only marginally poorer response in selected areas of disturbance. Results corroborate others linking Axis-II comorbidity to unfavorable outcome in the eating disorders, but suggest that character disturbance is more strongly linked to course of general psychiatric symptoms than it is to course of eating disturbances. We discuss clinical implications of differing strengths of association observed between eating and psychiatric symptoms, on the one hand, and Axis-II pathology, on the other.