Course of multi-impulsive bulimia

Manfred Maximilian Fichter · Norbert Quadflieg · Winfried Rief

208 citations0/0 files storedPsychological Medicine

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Eating Disorders and Behaviors Nutrition, Health and Food Behavior Personality Disorders and Psychopathology

Abstract

Thirty-two consecutively admitted females with bulimia nervosa (purging type) according to DSM-IV and additional impulsive behaviours (multi-impulsive bulimia (MIB)) and 32 age-matched female controls with DSM-IV bulimia nervosa (purging type) (uni-impulsive bulimia (UIB)) were assessed longitudinally on admission and at discharge following in-patient therapy and at a 2-year follow-up. Multi-impulsive bulimics were defined as presenting at least three of the six of the following impulsive behaviours in their life-time in addition to their bulimic symptoms at admission: (a) suicidal attempts, (b) severe autoaggression, (c) shop lifting (other than food), (d) alcohol abuse, (e) drug abuse, or (f) sexual promiscuity. Multi-impulsive bulimics were more frequently separated or divorced, had less schooling and held less-skilled jobs. Except for interoceptive awareness (EDI), which was more disturbed in multi-impulsive bulimics, there were no differences concerning scales measuring eating disturbances and related areas. Multi-impulsive bulimics showed more general psychopathology--anxiety, depression, anger and hostility, psychoticism--differed in several personality scales from uni-impulsive bulimics (e.g. increased excitability and anger/hostility) and had overall a less favourable course of illness. Multi-impulsive bulimics also received more in- and out-patient therapy previous to the index treatment and during the follow-up period. The data support the notion that 'multi-impulsive bulimia' or 'multi-impulsive disorder' should be classified as a distinct diagnostic group on axis I or that an 'Impulsive Personality Disorder' should be introduced on axis II. The development of more effective treatment for multi-impulsive bulimia is warranted.

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References

1961An Inventory for Measuring Depression 1974The Hopkins Symptom Checklist (HSCL): A self-report symptom inventory 1983Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia 1979A Parental Bonding Instrument 1979Bulimia nervosa: an ominous variant of anorexia nervosa 1980Nonspecific Psychological Distress and Other Dimensions of Psychopathology 1980The Heterogeneity of Anorexia Nervosa 1980Bulimia

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1996Impulsivity or Comorbidity in Bulimia Nervosa 2006Impulsiveness and lack of inhibitory control in eating disorders 1998Impulsive and Compulsive Self-Injurious Behavior in Bulimia Nervosa: Prevalence and Psychological Correlates 2001Eating disturbance and sexual trauma in childhood and adulthood 2008Suicide Attempts in Anorexia Nervosa 2000Multi-impulsivity of Japanese patients with eating disorders: primary and secondary impulsivity

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