Clinical Correlates of Anorexia Nervosa in Adolescent Inpatient Populations
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Authors
Norton, Jerome
Issue Date
2000
Type
Dissertation
Language
en
Keywords
Alternative Title
Abstract
Anorexia Nervosa often presents with a series of adjunctive diagnoses and symptom patterns. Previous research has commonly focused on the psychiatric comorbidity of eating disorders at large, most commonly depression and anxiety-related disorders. Little research, however, has compared DSM-IV subtypes of anorexia (Restricting Type and Binge-eating/purging Type). Behavioral problems often associated with Anorexia Nervosa, such as self-injurious behavior, suicidality, and substance abuse, have been addressed with regard to subtype differences. However, most samples in the current literature have not distinguished patient status (inpatient vs. outpatient) or age (adolescent vs. adult) as potential confounds. The present study focuses on adolescent anorexic inpatients (n = 58) ages 12-18 treated by the adolescent inpatient psychiatry unit at Alta Bates Medical Center in Berkeley, California between 1996 and 1999. A retrospective chart review was used in comparing Restricting Type anorectics (n = 34) and Binge-eating/Purging Type anorectics (n=24) in terms of comorbid Axis I disorders and behavioral impulsivity. Axis I disorders included DSM-IV disorders of anxiety and depression, and obsessive-compulsiveness (as indicated by diagnoses of Obsessive Compulsive Disorder or Obsessive Compulsive Personality Disorder features.) Measures of behavioral impulsivity included histories of self-mutilating behavior, suicidality, and substance use. Both groups presented with high proportions of anxiety and depression. Results indicate, however, that Binge-eating/Purging Type anorectics are more likely than Restricting type anorectics (100% vs. 61.7%) to have comorbid anxiety disorders. The two groups did not differ in terms of relative proportions of obsessive-compulsiveness (28.6% vs. 19.4%) or depression (87.5% vs. 70.6%). Binge- eating/Purging Type anorectics were much more likely than Restricting Type anorectics to have histories of self-injurious behavior (54.2% vs. 11.8%), suicidality (33.3% vs. 2.9%), and substance use (41.7% vs. 14.7%), indicating a group difference with regard to behavioral impulsivity. Results suggest that the use of subtypes in Anorexia Nervosa diagnosis is of clinical utility. Group differences in terms of behavioral impulsivity and comorbid anxiety are discussed in relation to the results of past research concerning Anorexia Nervosa subtypes and Borderline Personality Disorder.