Impulse control disorders in eating disorders: clinical and therapeutic implications

Abstract

Objective Few studies have explored impulse control disorders (ICDs) in women with bulimia nervosa (BN). We explored the prevalence of lifetime ICDs in women with BN, compared the severity of eating disorder symptoms in women with BN with and without ICD, and compared their personality profiles to females with one form of ICD, namely, pathologic gambling. Method A total sample of 269 female patients consecutively admitted to our unit participated in the current study (173 BN without comorbid ICD [BN − ICD]; 54 BN with comorbid ICD [BN + ICD]; and 42 pathologic gamblers [PG]). All participants were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Evaluation Assessment measures included the Symptom Checklist–90 revised and the Temperament and Character Inventory–revised, as well as a number of other clinical and psychopathologic indices. Results In BN, the observed lifetime prevalence of ICD was 23.8%. Lifetime compulsive buying (17.6%) and intermittent explosive disorder (13.2%) were the most frequently reported ICD. Bulimia nervosa subtype was not significantly associated with lifetime ICD ( P = .051) or with ICD subtype ( P = .253). After using multinomial regression models, we observed that BN + ICD and PG showed the highest scores on novelty seeking ( P < .0001). But BN + ICD women had the lowest scores on self-directedness ( P < .03) and higher scores on general psychopathology ( P < .01) and drug abuse ( P < .01). Conclusions Individuals with BN + lifetime ICD presented more extreme personality profiles, especially on novelty seeking and impulsivity, and general psychopathology than individuals with BN without ICD. On some personality traits, those BN + ICD more closely resembled individuals with PG than those with BN without ICD.