Herzog D B, Keller M B, Lavori P W, Kenny G M, Sacks N R
Eating Disorders Unit, Massachusetts General Hospital, Boston 02114.
J Clin Psychiatry. 1992 May;53(5):147-52.
The purpose of this study was to assess the prevalence, reliability, and predictive value of comorbid personality disorders in a large sample of 210 women seeking treatment for anorexia nervosa (N = 31), bulimia nervosa (N = 91), or mixed disorder (N = 88).
All subjects were interviewed using the Structured Interview for DSM-III Personality Disorders as part of a longitudinal outcome study of eating disorders currently underway at Massachusetts General Hospital.
Of the 210 subjects, 27% had at least one personality disorder; the most commonly observed was borderline personality disorder in 18 subjects (9%). The highest prevalence of personality disorders was found in the anorexia nervosa/bulimia nervosa group at 39%, followed by 22% in the anorexics and 21% in the bulimic sample. We found statistically significant differences regarding the distribution of personality disorders across eating disorder groups. The dramatic personality disorder cluster was differentially distributed across groups; this finding was accounted for by higher rates of borderline personality disorder in the bulimia nervosa and anorexia nervosa/bulimia nervosa groups than in the anorexia nervosa group. The anxious personality disorder cluster was differentially distributed across groups with higher rates in the anorexia nervosa and anorexia nervosa/bulimia nervosa samples. Those subjects with a comorbid personality disorder had a significantly slower recovery rate than those without a comorbid personality disorder.
The prevalence of personality disorders is not high in treatment-seeking women with eating disorders compared with previously studied samples. The greatest frequency of comorbid personality disorders is in the anorexia nervosa/bulimia nervosa group; this subset also had longer duration of eating disorder illness and much greater comorbid Axis I psychopathology compared with the rest of the sample. Future studies should address whether personality disorders have predictive value in the long-term course and outcome of eating disorders.
本研究旨在评估210名寻求神经性厌食症（n = 31）、神经性贪食症（n = 91）或混合性饮食失调症（n = 88）治疗的女性大样本中共病性人格障碍的患病率、可靠性及预测价值。
作为麻省总医院目前正在进行的饮食失调纵向结局研究的一部分，所有受试者均接受了《精神疾病诊断与统计手册》第三版人格障碍结构化访谈。
在210名受试者中，27%至少患有一种人格障碍；最常观察到的是18名受试者（9%）患边缘型人格障碍。人格障碍患病率最高的是神经性厌食症/神经性贪食症组，为39%，其次是神经性厌食症患者中的22%和神经性贪食症样本中的21%。我们发现不同饮食失调组之间人格障碍的分布存在统计学显著差异。戏剧性人格障碍集群在各组中的分布存在差异；这一发现是由于神经性贪食症组和神经性厌食症/神经性贪食症组中边缘型人格障碍的发生率高于神经性厌食症组。焦虑性人格障碍集群在各组中的分布也存在差异，在神经性厌食症组和神经性厌食症/神经性贪食症样本中的发生率较高。那些共病性人格障碍的受试者恢复速度明显慢于无共病性人格障碍的受试者。
与先前研究的样本相比，寻求饮食失调治疗的女性中人格障碍的患病率并不高。共病性人格障碍最常见于神经性厌食症/神经性贪食症组；与样本中的其他部分相比，这一子集的饮食失调病程也更长，且共病的轴I精神病理学症状也更严重。未来的研究应探讨人格障碍在饮食失调的长期病程和结局中是否具有预测价值。
