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Women with personality disorders revealed trends for eating disorders

Eating disorders appear more likely among women with personality disorders, according to new study data.

“Clinicians have long observed associations between bulimia nervosa and traits such as impulsivity and emotional dysregulation and similarly, between anorexia nervosa and traits such as obsessive-compulsiveness and perfectionism,” Deborah Lynn Reas, PhD, of the Division of Mental Health and Addiction at Oslo University Hospital in Norway, said in an interview. “Our study, which included more than 3,000 men and women consecutively admitted for treatment for personality disorders, lends empirical support to these observations.”

 

Deborah Lynn Reas

The multicenter study demonstrated that bulimia nervosa was more common in female patients with borderline personality disorder, whereas women with obsessive-compulsive personality disorder (OCPD) were more likely to have anorexia nervosa.

Reas and colleagues evaluated data from 3,266 patients who had been treated in the Norwegian Network of Psychotherapeutic Day Hospitals from 1993 to 2009. The patients were aged 18 to 65 years, and 73% were women.

Major depressive disorder without a personality disorder was diagnosed in 11.6% (n=379) of the total sample, and these patients comprised the psychiatric comparison group. Of the remaining 2,887 patients, 35% were diagnosed with avoidant, 25.5% with borderline, 9.5% with paranoid, 4.1% with dependant and 4% with OCPDs, based on DSM-III-R and DSM-IV criteria. Personality disorder not otherwise specified was identified in 21.7% of the patients, and 28.4% of patients had more than one personality disorder.

Overall, 13.3% of individuals with a personality disorder met Mini International Neuropsychiatric Interview for Axis I eating disorders (anorexia nervosa, 0.7%; bulimia nervosa, 5.1%; eating disorder not otherwise specified, 7.6%). Five percent of patients diagnosed with major depressive disorder only were diagnosed with an eating disorder. A total of 15% of the group diagnosed with more than one personality disorder had an eating disorder.

More women than men (17.1% vs. 3.4%) were identified with any eating disorder (P<.001). The rates for eating disorders in men with personality disorders were comparable to those in the general population (3.4% vs. 2.8%), although the rates for women with personality disorders were nearly three times higher (17.1% vs. 5.9%), according to the researchers.

Across the female study population, the frequency of any eating disorder spanned from 6% of women with major depressive disorder to 23.5% of women with borderline personality disorder.

Data revealed a significant association between bulimia nervosa and borderline personality disorder (OR=3.57; 95% CI, 1.55-8.23) and avoidant personality disorder (OR=2.64; 95% CI, 1.15-6.06) in female patients. Meanwhile, anorexia nervosa was significantly linked to OCPD (OR=4.48; 95% CI, 1.22-18.48).

Reas and colleagues found no significant trends in the male population.

“We found a robust and differential association between specific eating disorders and personality disorders among women, which is likely to represent a meaningful pattern of comorbidity and is unlikely to constitute random co-occurrence,” the researchers concluded. “Our findings … lend empirical support to a coalescing literature regarding the significance of personality traits among individuals with eating disorders.”

Disclosure: See the study for a full list of relevant financial disclosures.