Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BioPsychoSocial Medicine
Published in: BioPsychoSocial Medicine 1/2008

Open Access 01-12-2008 | Research

Psychological and weight-related characteristics of patients with anorexia nervosa-restricting type who later develop bulimia nervosa

Authors: Hiroki Nishimura, Gen Komaki, Tetsuya Ando, Toshihiro Nakahara, Takakazu Oka, Keisuke Kawai, Toshihiko Nagata, Aya Nishizono, Yuri Okamoto, Kenjiro Okabe, Masanori Koide, Chikara Yamaguchi, Satoshi Saito, Kazuyoshi Ohkuma, Katsutaro Nagata, Tetsuro Naruo, Masato Takii, Nobuo Kiriike, Toshio Ishikawa, Japanese Genetic Research Group for Eating Disorders

Published in: BioPsychoSocial Medicine | Issue 1/2008

Login to get access

Abstract

Background

Patients with anorexia nervosa-restricting type (AN-R) sometimes develop accompanying bulimic symptoms or the full syndrome of bulimia nervosa (BN). If clinicians could predict who might change into the bulimic sub-type or BN, preventative steps could be taken. Therefore, we investigated anthropometric and psychological factors possibly associated with such changes.

Method

All participants were from a study by the Japanese Genetic Research Group for Eating Disorders. Of 80 patients initially diagnosed with AN-R, 22 changed to the AN-Binge Eating/Purging Type (AN-BP) and 14 to BN for some period of time. The remaining 44 patients remained AN-R only from the onset to the investigation period. Variables compared by ANOVA included anthropometric measures, personality traits such as Multiple Perfectionism Scale scores and Temperament and Character Inventory scores, and Beck Depression Inventory-II scores.

Results

In comparison with AN-R only patients, those who developed BN had significantly higher current BMI (p < 0.05) and maximum BMI in the past (p < 0.05). They also scored significantly higher for the psychological characteristic of parental criticism (p < 0.05) and lower in self-directedness (p < 0.05), which confirms previous reports, but these differences disappeared when the depression score was used as a co-variant. No significant differences were obtained for personality traits or depression among the AN-R only patients irrespective of their duration of illness.

Conclusion

The present findings suggest a tendency toward obesity among patients who cross over from AN-R to BN. Low self-directedness and high parental criticism may be associated with the development of BN by patients with AN-R, although the differences may also be associated with depression.
Appendix
Available only for authorised users
Literature
1.
Fairburn CG, Harrison PJ: Eating disorders. Lancet. 2003, 361 (9355): 407-416. 10.1016/S0140-6736(03)12378-1.CrossRefPubMed
2.
Milos G, Spindler A, Schnyder U, Fairburn CG: Instability of eating disorder diagnoses: prospective study. Br J Psychiatry. 2005, 187: 573-578. 10.1192/bjp.187.6.573.CrossRefPubMedPubMedCentral
3.
Bulik CM, Sullivan PF, Fear J, Pickering A: Predictors of the development of bulimia nervosa in women with anorexia nervosa. J Nerv Ment Dis. 1997, 185 (11): 704-707. 10.1097/00005053-199711000-00009.CrossRefPubMed
4.
Eddy KT, Keel PK, Dorer DJ, Delinsky SS, Franko DL, Herzog DB: Longitudinal comparison of anorexia nervosa subtypes. Int J Eat Disord. 2002, 31 (2): 191-201. 10.1002/eat.10016.CrossRefPubMed
5.
Strober M, Freeman R, Morrell W: The long-term course of severe anorexia nervosa in adolescents: survival analysis of recovery, relapse, and outcome predictors over 10–15 years in a prospective study. Int J Eat Disord. 1997, 22 (4): 339-360. 10.1002/(SICI)1098-108X(199712)22:4<339::AID-EAT1>3.0.CO;2-N.CrossRefPubMed
6.
Tozzi F, Thornton LM, Klump KL, Fichter MM, Halmi KA, Kaplan AS, Strober M, Woodside DB, Crow S, Mitchell J, Rotondo A, Mauri M, Cassano G, Keel P, Plotnicov KH, Pollice C, Lilenfeld LR, Berrettini WH, Bulik CM, Kaye WH: Symptom fluctuation in eating disorders: correlates of diagnostic crossover. Am J Psychiatry. 2005, 162 (4): 732-740. 10.1176/appi.ajp.162.4.732.CrossRefPubMed
7.
Fichter MM, Quadflieg N, Hedlund S: Twelve-year course and outcome predictors of anorexia nervosa. Int J Eat Disord. 2006, 39 (2): 87-100. 10.1002/eat.20215.CrossRefPubMed
8.
Deter HC, Herzog W: Anorexia nervosa in a long-term perspective: results of the Heidelberg-Mannheim Study. Psychosom Med. 1994, 56 (1): 20-27.CrossRefPubMed
9.
Steinhausen HC: The outcome of anorexia nervosa in the 20th century. Am J Psychiatry. 2002, 159 (8): 1284-1293. 10.1176/appi.ajp.159.8.1284.CrossRefPubMed
10.
Kitagawa N, Asakura S, Kusumi I, Denda K, Koyama T: Temperament and Character of patients with eating disorders: an association between personality and clinical manifestations (in Japanese). Seishin Igaku. 2002, 44 (4): 381-389.
11.
Enns MW, Cox BJ: Perfectionism and depression symptom severity in major depressive disorder. Behav Res Ther. 1999, 37 (8): 783-794. 10.1016/S0005-7967(98)00188-0.CrossRefPubMed
12.
Bydlowski S, Corcos M, Jeammet P, Paterniti S, Berthoz S, Laurier C, Chambry J, Consoli SM: Emotion-processing deficits in eating disorders. Int J Eat Disord. 2005, 37 (4): 321-329. 10.1002/eat.20132.CrossRefPubMed
13.
Nagata T, Oshima J, Wada A, Yamada H, Iketani T, Kiriike N: Temperament and character of Japanese eating disorder patients. Compr Psychiatry. 2003, 44 (2): 142-145. 10.1053/comp.2003.50023.CrossRefPubMed
14.
Ruuska J, Kaltiala-Heino R, Rantanen P, Koivisto AM: Psychopathological distress predicts suicidal ideation and self-harm in adolescent eating disorder outpatients. Eur Child Adolesc Psychiatry. 2005, 14 (5): 276-281. 10.1007/s00787-005-0473-8.CrossRefPubMed
15.
Kleifield EI, Sunday S, Hurt S, Halmi KA: The effects of depression and treatment on the Tridimensional Personality Questionnaire. Biol Psychiatry. 1994, 36 (1): 68-70. 10.1016/0006-3223(94)90066-3.CrossRefPubMed
16.
Vervaet M, van Heeringen C, Audenaert K: Personality-related characteristics in restricting versus binging and purging eating disordered patients. Compr Psychiatry. 2004, 45 (1): 37-43. 10.1016/j.comppsych.2003.09.008.CrossRefPubMed
17.
Vervaet M, Audenaert K, van Heeringen C: Cognitive and behavioural characteristics are associated with personality dimensions in patients with eating disorders. Eur Eat Disorders Rev. 2003, 11 (5): 363-378. 10.1002/erv.532.CrossRef
18.
Ando T, Komaki G, Naruo T, Okabe K, Takii M, Kawai K, Konjiki F, Takei M, Oka T, Takeuchi K, Masuda A, Ozaki N, Suematsu H, Denda K, Kurokawa N, Itakura K, Yamaguchi C, Kono M, Suzuki T, Nakai Y, Nishizono-Maher A, Koide M, Murakami K, Nagamine K, Tomita Y, Ookuma K, Tomita K, Tonai E, Ooshima A, Ishikawa T, Ichimaru Y: Possible role of preproghrelin gene polymorphisms in susceptibility to bulimia nervosa. Am J Med Genet B Neuropsychiatr Genet. 2006, 141 (8): 929-934.CrossRef
19.
Frost RO, Marten P, Lahart C, Rosenblate R: The dimensions of perfectionism. Cognit Ther Res. 1990, 14 (5): 449-468. 10.1007/BF01172967.CrossRef
20.
Tanaka H, Nagata T, Kiriike N, Kawarada Y, Matsunaga H, Yamagami S: Perfectionism in patients with Eating Disorders (in Japanese). Seishin Igaku. 1999, 41 (8): 847-853.
21.
Cloninger CR, Svrakic DM, Przybeck TR: A psychobiological model of temperament and character. Arch Gen Psychiatry. 1993, 50 (12): 975-990.CrossRefPubMed
22.
Kijima N, Saito R, Takeuchi M, Yoshino A, Ono Y, Kato M, Kitamura T: Cloninger's seven-factor model of temperament and character and Japanese version of Temperament and Character Inventory (TCI) (in Japanese). Seishinkashindangaku. 1996, 7 (3): 379-399.
23.
Kojima M, Furukawa TA, Takahashi H, Kawai M, Nagaya T, Tokudome S: Cross-cultural validation of the Beck Depression Inventory-II in Japan. Psychiatry Res. 2002, 110 (3): 291-299. 10.1016/S0165-1781(02)00106-3.CrossRefPubMed
24.
Bulik CM, Devlin B, Bacanu SA, Thornton L, Klump KL, Fichter MM, Halmi KA, Kaplan AS, Strober M, Woodside DB, Bergen AW, Ganjei JK, Crow S, Mitchell J, Rotondo A, Mauri M, Cassano G, Keel P, Berrettini WH, Kaye WH: Significant linkage on chromosome 10p in families with bulimia nervosa. Am J Hum Genet. 2003, 72 (1): 200-207. 10.1086/345801.CrossRefPubMed
25.
Ando T, Ichimaru Y, Konjiki F, Shoji M, Komaki G: Variations in the preproghrelin gene correlate with higher body mass index, fat mass, and body dissatisfaction in young Japanese women. Am J Clin Nutr. 2007, 86 (1): 25-32.PubMed
26.
Humphrey LL: Structural analysis of parent-child relationships in eating disorders. J Abnorm Psychol. 1986, 95 (4): 395-402. 10.1037/0021-843X.95.4.395.CrossRefPubMed
27.
Sassaroli S, Ruggiero GM: The role of stress in the association between low self-esteem, perfectionism, and worry, and eating disorders. Int J Eat Disord. 2005, 37 (2): 135-141. 10.1002/eat.20079.CrossRefPubMed
28.
van Furth EF, van Strien DC, Martina LM, van Son MJ, Hendrickx JJ, van Engeland H: Expressed emotion and the prediction of outcome in adolescent eating disorders. Int J Eat Disord. 1996, 20 (1): 19-31. 10.1002/(SICI)1098-108X(199607)20:1<19::AID-EAT3>3.0.CO;2-7.CrossRefPubMed
29.
Bulik CM, Sullivan PF, Fear JL, Pickering A: Outcome of anorexia nervosa: eating attitudes, personality, and parental bonding. Int J Eat Disord. 2000, 28 (2): 139-147. 10.1002/1098-108X(200009)28:2<139::AID-EAT2>3.0.CO;2-G.CrossRefPubMed
30.
Fassino S, Abbate-Daga G, Amianto F, Leombruni P, Boggio S, Rovera GG: Temperament and character profile of eating disorders: a controlled study with the Temperament and Character Inventory. Int J Eat Disord. 2002, 32 (4): 412-425. 10.1002/eat.10099.CrossRefPubMed
31.
Halvorsen I, Heyerdahl S: Girls with anorexia nervosa as young adults: personality, self-esteem, and life satisfaction. Int J Eat Disord. 2006, 39 (4): 285-293. 10.1002/eat.20248.CrossRefPubMed
32.
Spoor STP, Stice E, Bekker MHJ, Van Strien T, Croon MA, Van Heck GL: Relations between dietary restraint, depressive symptoms, and binge eating: a longitudinal study. Int J Eat Disord. 2006, 39 (8): 700-707. 10.1002/eat.20283.CrossRefPubMed
33.
Gilbert N, Meyer C: Fear of negative evaluation and the development of eating psychopathology: a longitudinal study among nonclinical women. Int J Eat Disord. 2005, 37 (4): 307-312. 10.1002/eat.20105.CrossRefPubMed
34.
Young EA, Clopton JR, Bleckley MK: Perfectionism, low self-esteem, and family factors as predictors of bulimic behavior. Eat Behav. 2004, 5 (4): 273-283. 10.1016/j.eatbeh.2003.12.001.CrossRefPubMed
35.
Stice E: Risk and maintenance factors for eating pathology: a meta-analytic review. Psychol Bull. 2002, 128 (5): 825-848. 10.1037/0033-2909.128.5.825.CrossRefPubMed
36.
Tenconi E, Lunardi N, Zanetti T, Santonastaso P, Favaro A: Predictors of binge eating in restrictive anorexia nervosa patients in Italy. J Nerv Ment Dis. 2006, 194 (9): 712-715. 10.1097/01.nmd.0000235783.29257.b1.CrossRefPubMed
37.
Stice E, Hayward C, Cameron RP, Killen JD, Taylor CB: Body-image and eating disturbances predict onset of depression among female adolescents: a longitudinal study. J Abnorm Psychol. 2000, 109 (3): 438-444. 10.1037/0021-843X.109.3.438.CrossRefPubMed
38.
Naito M, Kijima N, Kitamura T: Temperament and Character Inventory (TCI) as predictors of depression among Japanese college students. J Clin Psychol. 2000, 56 (12): 1579-1585. 10.1002/1097-4679(200012)56:12<1579::AID-8>3.0.CO;2-K.CrossRefPubMed
39.
Dancyger I, Fornari V, Scionti L, Wisotsky W, Sunday S: Do daughters with eating disorders agree with their parents' perception of family functioning?. Compr Psychiatry. 2005, 46 (2): 135-139. 10.1016/j.comppsych.2004.07.024.CrossRefPubMed
40.
Halmi KA, Sunday SR, Strober M, Kaplan A, Woodside DB, Fichter M, Treasure J, Berrettini WH, Kaye WH: Perfectionism in anorexia nervosa: variation by clinical subtype, obsessionality, and pathological eating behavior. Am J Psychiatry. 2000, 157 (11): 1799-1805. 10.1176/appi.ajp.157.11.1799.CrossRefPubMed
41.
Klump KL, Bulik CM, Pollice C, Halmi KA, Fichter MM, Berrettini WH, Devlin B, Strober M, Kaplan A, Woodside DB, Treasure J, Shabbout M, Lilenfeld LR, Plotnicov KH, Kaye WH: Temperament and character in women with anorexia nervosa. J Nerv Ment Dis. 2000, 188 (9): 559-567. 10.1097/00005053-200009000-00001.CrossRefPubMed
42.
Fassino S, Piero A, Gramaglia C, Daga GA, Gandione M, Rovera GG, Bartocci G: Clinical, psychological, and personality correlates of asceticism in anorexia nervosa: from saint anorexia to pathologic perfectionism. Transcult Psychiatry. 2006, 43 (4): 600-614. 10.1177/1363461506070785.CrossRefPubMed
43.
Mulder RT, Joyce PR, Sullivan PF, Bulik CM, Carter FA: The relationship among three models of personality psychopathology: DSM-III-R personality disorder, TCI scores and DSQ defences. Psychol Med. 1999, 29 (4): 943-951. 10.1017/S0033291799008533.CrossRefPubMed
44.
Svrakic DM, Draganic S, Hill K, Bayon C, Przybeck TR, Cloninger CR: Temperament, character, and personality disorders: etiologic, diagnostic, treatment issues. Acta Psychiatr Scand. 2002, 106 (3): 189-195. 10.1034/j.1600-0447.2002.02196.x.CrossRefPubMed
45.
Grucza RA, Przybeck TR, Spitznagel EL, Cloninger CR: Personality and depressive symptoms: a multi-dimensional analysis. J Affect Disord. 2003, 74 (2): 123-130. 10.1016/S0165-0327(02)00303-8.CrossRefPubMed
46.
Klump KL, Strober M, Bulik CM, Thornton L, Johnson C, Devlin B, Fichter MM, Halmi KA, Kaplan AS, Woodside DB, Crow S, Mitchell J, Rotondo A, Keel PK, Berrettini WH, Plotnicov K, Pollice C, Lilenfeld LR, Kaye WH: Personality characteristics of women before and after recovery from an eating disorder. Psychol Med. 2004, 34 (8): 1407-1418. 10.1017/S0033291704002442.CrossRefPubMed
47.
Vitousek K, Manke F: Personality variables and disorders in anorexia nervosa and bulimia nervosa. J Abnorm Psychol. 1994, 103 (1): 137-147. 10.1037/0021-843X.103.1.137.CrossRefPubMed
48.
Conley J: Longitudinal stability of personality traits: A multitrait-multimethod-multioccasion analysis. J Pers Soc Psychol. 1985, 49 (5): 1266-1282. 10.1037/0022-3514.49.5.1266.CrossRefPubMed
49.
Roberts B, DelVecchio W: The rank-order consistency of personality traits from childhood to old age: A quantitative review of longitudinal studies. Psychol Bull. 2000, 126 (1): 3-25. 10.1037/0033-2909.126.1.3.CrossRefPubMed
Metadata
Title
Psychological and weight-related characteristics of patients with anorexia nervosa-restricting type who later develop bulimia nervosa
Authors
Hiroki Nishimura
Gen Komaki
Tetsuya Ando
Toshihiro Nakahara
Takakazu Oka
Keisuke Kawai
Toshihiko Nagata
Aya Nishizono
Yuri Okamoto
Kenjiro Okabe
Masanori Koide
Chikara Yamaguchi
Satoshi Saito
Kazuyoshi Ohkuma
Katsutaro Nagata
Tetsuro Naruo
Masato Takii
Nobuo Kiriike
Toshio Ishikawa
Japanese Genetic Research Group for Eating Disorders
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BioPsychoSocial Medicine / Issue 1/2008
Electronic ISSN: 1751-0759
DOI
https://doi.org/10.1186/1751-0759-2-5

Other articles of this Issue 1/2008

BioPsychoSocial Medicine 1/2008 Go to the issue

Research

A prospective study of the psychobehavioral factors responsible for a change from non-patient irritable bowel syndrome to IBS patient status

Review

The ventro-medial prefrontal cortex: a major link between the autonomic nervous system, regulation of emotion, and stress reactivity?

Research

Panic disorder and locomotor activity

Research

The reliability and validity of a Japanese version of symptom checklist 90 revised

Editorial

Towards a new strategy to implement psychosomatic knowledge in medical practice

Case report

Case report: a case of intractable Meniere's disease treated with autogenic training