Psychological and weight-related characteristics of patients with anorexia nervosa-restricting type who later develop bulimia nervosa

Hiroki Nishimura¹ , Gen Komaki¹ , Tetsuya Ando¹ , Toshihiro Nakahara² , Takakazu Oka³ , Keisuke Kawai⁴ , Toshihiko Nagata⁵ , Aya Nishizono⁶ , Yuri Okamoto⁷ , Kenjiro Okabe⁸ , Masanori Koide⁹ , Chikara Yamaguchi¹⁰ , Satoshi Saito¹¹ , Kazuyoshi Ohkuma¹² , Katsutaro Nagata¹³ , Tetsuro Naruo¹⁴ , Masato Takii⁴ , Nobuo Kiriike⁵ , Toshio Ishikawa¹⁵ and Japanese Genetic Research Group for Eating Disorders¹

¹Department of Psychosomatic Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira-shi, Tokyo 187-8553, Japan

²Department of Social Science and Medicine, Course for Health Science, Kagoshima University Graduate School of Medical and Dental Science, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima 890-8520, Japan

³Division of Psychosomatic Medicine, Department of Neurology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-Nishi-ku, Kitakyushu-shi, Fukuoka 807-8555, Japan

⁴Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka 812-8582, Japan

⁵Department of Neuropsychiatry, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka-shi, Osaka 545-8585, Japan

⁶Tokyo Institute of Psychiatry, 2-1-8 Kamikitazawa, Setagaya-ku, Tokyo 156-8585, Japan

⁷Health Service Center, Hiroshima University, 1-7-1 Kagamiyama, Higashihiroshima-shi, Hiroshima 739-8521, Japan

⁸Department of Psychosomatic Medicine, Tenri Hospital, 200 Mishima-cho, Tenri-shi, Nara 632-8552, Japan

⁹Department of Internal Medicine, Hoshigaoka Maternity Hospital, 27 Inoue-cho, Chikusa-ku, Nagoya-shi, Aichi 464-0026, Japan

¹⁰Division of General Medicine and Neuropsychiatry, Aichi Medical University Hospital, Nagakute, Aichi 480-1195, Japan

¹¹Department of Neuropsychiatry, School of Medicine, Sapporo Medical University, S-1, W-16, Chuo-ku, Sapporo-shi, Hokkaido 060-8543, Japan

¹²Department of Internal Medicine, Yufuin Kohseinenkin Hospital, 252 Kawaminami, Ufuin-cho, Ufu-shi, Oita, 879-5193, Japan

¹³Department of Psychosomatic Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayam, Hamamatsu-shi, Shizuoka 431-3192, Japan

¹⁴Department of Psychosomatic Medicine, Nogami Hospital, 1-4-1 Komatsubara, Kagoshima-shi, Kagoshima 891-0114, Japan

¹⁵Department of Psychosomatic Medicine, Kohnodai Hospital, National Center of Neurology and Psychiatry, 1-7-1 Kohnodai, Ichikawa-shi, Chiba 272-8516, Japan

author email corresponding author email

BioPsychoSocial Medicine 2008, 2:5doi:10.1186/1751-0759-2-5


Published:	12 February 2008

Abstract

Background

Patients with anorexia nervosa-restricting type (AN-R) sometimes develop accompanying bulimic symptoms or the full syndrome of bulimia nervosa (BN). If clinicians could predict who might change into the bulimic sub-type or BN, preventative steps could be taken. Therefore, we investigated anthropometric and psychological factors possibly associated with such changes.

Method

All participants were from a study by the Japanese Genetic Research Group for Eating Disorders. Of 80 patients initially diagnosed with AN-R, 22 changed to the AN-Binge Eating/Purging Type (AN-BP) and 14 to BN for some period of time. The remaining 44 patients remained AN-R only from the onset to the investigation period. Variables compared by ANOVA included anthropometric measures, personality traits such as Multiple Perfectionism Scale scores and Temperament and Character Inventory scores, and Beck Depression Inventory-II scores.

Results

In comparison with AN-R only patients, those who developed BN had significantly higher current BMI (p < 0.05) and maximum BMI in the past (p < 0.05). They also scored significantly higher for the psychological characteristic of parental criticism (p < 0.05) and lower in self-directedness (p < 0.05), which confirms previous reports, but these differences disappeared when the depression score was used as a co-variant. No significant differences were obtained for personality traits or depression among the AN-R only patients irrespective of their duration of illness.

Conclusion

The present findings suggest a tendency toward obesity among patients who cross over from AN-R to BN. Low self-directedness and high parental criticism may be associated with the development of BN by patients with AN-R, although the differences may also be associated with depression.