Eating and Psychiatric Symptoms as a Function of Axis II Comorbidity in Bulimic Patients: Three-Month and Six-Month Responses After Therapy

Abstract

Using DSM-III-R criteria, the authors organized 61 bulimic patients into "Borderline," "Other Personality Disorder," and "No Personality Disorder" groups, and then examined eating and comorbid symptoms at 3-month intervals during 6 months of multimodal therapy. Personality-disorder classifications seemed to predict neither the severity nor responsiveness to treatment of bulimic symptoms; all groups showed reliable and clinically significant improvements in eating habits over time. Conversely, the borderline patients showed reliably more comorbid symptoms than did any other group; their scores on disorder-specific dimensions--like borderline "traits" and maladaptive defenses--remained distinctly elevated throughout treatment. Our findings indicate that 1) a "borderline/nonborderline" distinction predicts temporally stable--and theoretically meaningful--differences in comorbid profiles, and 2) there exists an intriguing degree of independence, at least during ongoing treatment, between severity of character pathology and degree of change obtained on eating symptoms. Theoretical and clinical implications are discussed.