اختلال شخصیت پیچیده در بولیمیا

Objective Recent research has suggested a move toward a dimensional system for the classification of personality disorders (PDs). Tyrer's dimensional model using severity as a form of categorizing PDs was used to compare eating disorder outcome in women with bulimia nervosa (BN) over 3 years. Method One hundred thirty-four women with BN were divided into 4 groups based on PD severity: no PD (n = 32), personality difficulty (n = 27), simple PD (n = 29), and complex PD (n = 46). Eating disorder symptoms and attitudes, general psychosocial functioning, and depressive symptoms were examined at pretreatment and at 1-year and 3-year follow-up (posttreatment). Results The complex PD group had greater Axis I comorbidity and psychopathology than the remaining 3 groups at pretreatment. At 1-year and 3-year follow-up, there were no differences in eating disorder outcome, general psychosocial functioning, and depressive symptoms across the 4 groups. Conclusion These results suggest that having an increased number of PDs comorbid with BN does not influence eating disorder outcome up to 3 years after treatment.

The categorical classification of personality disorders (PDs) has been the subject of considerable debate for some years [1], [2] and [3]. Limitations of the categorical model have been widely noted, and a number of authors have advocated dimensional models for the classification of PDs [4], [5] and [6]. One dimensional approach proposed by Tyrer and colleagues [7] and [8] uses severity as a means of categorizing PDs. In an attempt to reconcile the frequently overlapping PD diagnoses, this approach divides groups into a 4-point severity scale: no PD (does not meet criteria for actual or subthreshold PD), personality difficulty (meets subthreshold criteria for 1 or several PDs), simple PD (meets criteria for 1 or more PDs within the same PD cluster), and complex PD (meets criteria for 2 or more PDs across different clusters) [8]. This model of PD severity has been used to examine the impact on mental disability and outcome in substance use, mood, anxiety, and psychotic disorders [9] and [10]. However, to our knowledge, Tyrer's dimensional classification of PD severity has not previously been used to assess the impact on outcome in an eating-disordered group. The prevalence of PDs in bulimia nervosa (BN) is reported to range from 21% to 67% [11], [12] and [13]. The comorbidity of BN and PDs has been found to negatively impact clinical symptoms such as general psychiatric functioning, interpersonal skills, and social functioning [14] and [15]. In recent years, research has attempted to address the complexities of treating comorbid eating disorders and PDs by adapting psychotherapies such as dialectical behavior therapy [16], cognitive behavioral therapy [17], and interpersonal psychotherapy [18] to attend to the combination of eating disorder symptoms and personality pathology [15]. Mixed findings exist on the impact of personality pathology on eating disorder treatment outcome, with some studies reporting greater binge eating severity [19] and more disturbed psychiatric symptoms posttreatment in those with personality pathology [14] and [20]. In contrast, other studies report that the presence of a PD did not predict outcome [21], [22] and [23]. The use of Tyrer's dimensional personality classification attempts to address the issue of multiple personality diagnoses by considering severity in terms of both extent and breadth of personality dysfunction across personality clusters. The present study aims to evaluate the ability of Tyrer's dimensional approach to predict pathology and outcome in a sample of women with BN participating in a randomized controlled trial of cognitive behavior therapy [24]. This will be achieved by (1) comparing the pretreatment characteristics of women with BN among the dimensional personality groups and (2) examining the impact of PD severity on BN outcome at 1 and 3 years posttreatment.