The question of subgroups in eating disorders was addressed in this study. According to the Diagnostic and Statistical Manual of Mental Disorders, IV, the two subtypes for anorexia nervosa are restricting and binge-eating/purging. For bulimia nervosa, the subtypes are purging and nonpurging. An attempt was made here to examine alternative ways to create meaningful subgroups in the eating-disordered patient group. A cluster analysis was performed in a group of 52 female patients (AN=21, BN=31). Fifty-five undergraduate students served as a control group. Three self-report instruments were used: the Eating Disorder Inventory-2, Karolinska Scales of Personality, and Tennessee Self-Concept Scale.
The results reveal three different groups of patients. Factors like poor interoceptive ability and high degree of somatization differentiate between the groups, and contribute to severity of pathology, as well as to lower levels of self-concept.
Ever since bulimia nervosa was introduced in the third edition of the Diagnostic and Statistical Manual of Mental Disorders 1980 (DSM: American Psychiatric Association, 1980), there has been a great interest in differences versus similarities between patients suffering from anorexia nervosa and bulimia nervosa. The anorectic personality has been described as rigid, obsessive, conformist, achievement oriented, constricted, and conscientious (Bruch, 1978; Casper, Hedeker & McClough, 1992; Vitousek & Manke, 1994). The bulimic personality, on the other hand, has been described as more impulsive, affectively unstable, compulsive, and more prone to depression and suicide (Johnsson, 1993; Johnson & Connors, 1987; Mizes, 1988; Vitousek & Manke, 1994).
Several studies have addressed the importance and significance of subcategories in both diagnoses. In the late seventies binging behavior was considered the main contributing factor to a meaningful division between subgroups (DaCosta & Halmi, 1992). More recent studies have shown that purging behavior seems to be a more relevant measure for distinction. In the DSM-IV manual, a distinction was made between the restricting and the binge-eating/purging type of anorexia nervosa. For bulimia nervosa, the subtypes are purging and nonpurging.
Purging behavior has been shown to indicate more severe pathologies, including depression, somatization, anxiety, and suicide attempts (Cachelin & Maher, 1998; Garner, 1999; Garner, Garner & Rosen, 1993). McCann, Rossiter, King and Agras (1991) found in a sample of bulimics that those who used purging behavior were more likely to suffer from a past or present depression or panic disorder. Purging bulimics also scored higher on narcissistic, masochistic and borderline scales of Personality Disorders Examination compared to nonpurging subjects. Further, purging behavior has shown a worse prognosis for both anorexia and bulimia (DaCosta & Halmi, 1992; Garner et al.). This behavior also seems to be related to chronicity of the illness (Garner et al.; Norring & Sohlberg, 1993). The research consequently indicates that purging behavior signals more psychological distress among both anorexics and bulimics.
We were interested in examining other possible ways to divide the eating-disordered patient group. The traditional subcategories, as mentioned above, are evaluated on behavioral measures. We wanted to know if personality-related variables and variables of self-image also could distinguish between groups in a meaningful way. In other words, we wanted to study some of the psychological factors that underlie the patient group, and see whether these possibly contribute to degree of severity. Further, we wondered how closely associated to diagnostic groups and subgroups such factors would be.
Many eating-disordered patients suffer from poor interoceptive awareness (alexithymia). Alexithymia has been cited as a potential contributor to the …