Hessler Johannes Baltasar, Heuser Jörg, Schlegl Sandra, Bauman Tabea, Greetfeld Martin, Voderholzer Ulrich
Schoen Clinic Roseneck, Am Roseneck 6, D-83209, Prien am Chiemsee, Germany.
2Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Munich, Germany.
Borderline Personal Disord Emot Dysregul. 2019 Jan 16;6:1. doi: 10.1186/s40479-018-0098-4. eCollection 2019.
A substantial rate of patients with bulimia nervosa (BN) also suffer from Borderline personality disorder (BN + BPD). It is widely unknown how these comorbid patients with BN + BPD present and respond to inpatient treatment. Aims of the study were to examine (1) specific characteristics of patients with BN + BPD at admission, discharge, and during treatment, and (2) differential effects of inpatient treatment for BN vs. BN + BPD.
We analyzed routine data of inpatients admitted for the treatment of BN between 2013 and 2017 in a specialized hospital for eating disorders. (1) Cross-sectional differences were examined with independent -tests and χ-tests and (2) treatment effects pertaining to eating disorders symptoms, depression, psychosocial functioning and general psychopathology with repeated measures analysis of variance.
Of 1298 inpatients (96% female), 13.2% also had a diagnosis of BPD. (1) Patients with BN + BPD had more previous inpatient treatments ( = 0.001), had a longer length of stay ( = 0.003), gained more weight during treatment ( = 0.006), and were more often irregularly discharged ( = 0.018) as well as rated as unfit to work at discharge ( = 0.003). (2) Both groups improved in all examined variables (all main effects treatment < 0.001). Patients with BN + BPD showed worse symptoms aggregated across admission and discharge (all main effects diagnosis < 0.05). Patients with BN + BPD showed smaller improvements (interaction treatment×discharge) in depressive symptoms ( = 0.018), perfectionism ( = 0.009), and asceticism ( = 0.035) and discharge scores mostly lay in the range of the admission scores of the BN-only group.
Patients with BN + BPD improve during intense and specialized inpatient treatment, yet, retain pronounced impairment at discharge despite longer treatment. Treatment needs to be improved and should focus on transdiagnostic symptoms of BN and BPD.
相当一部分神经性贪食症（BN）患者同时患有边缘型人格障碍（BN + BPD）。目前人们对这些合并BN + BPD的患者的表现以及对住院治疗的反应知之甚少。本研究的目的是检查：（1）BN + BPD患者在入院、出院及治疗期间的具体特征；（2）针对BN与BN + BPD的住院治疗的不同效果。
我们分析了2013年至2017年期间在一家专门的饮食失调医院接受BN治疗的住院患者的常规数据。（1）采用独立样本t检验和卡方检验检查横断面差异；（2）使用重复测量方差分析来研究饮食失调症状、抑郁、心理社会功能和一般精神病理学方面的治疗效果。
在1298名住院患者中（96%为女性），13.2%的患者同时被诊断为BPD。（1）BN + BPD患者既往住院治疗次数更多（P = 0.001），住院时间更长（P = 0.003），治疗期间体重增加更多（P = 0.006），更常非正规出院（P = 0.018），且出院时被评定为不适合工作（P = 0.003）。（2）两组在所有检查变量上均有改善（所有主要效应治疗P < 0.001）。BN + BPD患者在入院和出院时综合症状更严重（所有主要效应诊断P < 0.05）BN + BPD患者在抑郁症状（P = ）、完美主义（P = 0.009）和禁欲主义（P = 0.035）方面的改善较小（治疗×出院交互作用），出院评分大多处于仅患BN组入院评分范围内。
BN + BPD患者在强化和专门的住院治疗期间有所改善，但尽管治疗时间更长，出院时仍存在明显损害。治疗需要改进，应关注BN和BPD的跨诊断症状。
