Academic journal article Journal of Eating Disorders

Association of Beck Depression Inventory Score and Temperament and Character Inventory-125 in Patients with Eating Disorders and Severe Malnutrition

Academic journal article Journal of Eating Disorders

Association of Beck Depression Inventory Score and Temperament and Character Inventory-125 in Patients with Eating Disorders and Severe Malnutrition

Article excerpt

Author(s): Satoshi Tanaka[sup.1], Keizo Yoshida[sup.2], Hiroto Katayama[sup.3], Kunihiro Kohmura[sup.4], Naoko Kawano[sup.5], Miho Imaeda[sup.6], Saki Kato[sup.7], Masahiko Ando[sup.8], Branko Aleksic[sup.6], Kazuo Nishioka[sup.6] and Norio Ozaki[sup.6]


Anorexia nervosa (AN) is a rare but debilitating eating disorder (ED) that affects 0.7 % of teenage females [1, 2]. A review on the prognosis of AN in the 20th century showed a mortality rate of 5.0 %. In addition, vomiting, bulimia, and purgative abuse are associated with poor outcomes and chronicity of the illness [3]. For severe and enduring cases, evidence of efficacy of treatment approaches is limited, and one review concluded that treatment trials need to move beyond targeting the core eating disorder pathology [4].

A malnourished state is also seen in patients diagnosed with other eating disorders. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) [5] has generated new diagnostic classifications including avoidant/restrictive food intake disorder (ARFID) and other specified feeding or eating disorder (OSFED). ARFID patients refuse adequate nourishment, but are not accompanied by AN-like psychopathology. OSFED patients do not fully meet the criteria of other specific eating disorders. These two diagnoses were formerly included in eating disorder, not otherwise specified (EDNOS) in DSM-IV-TR [6].

The personality of patients with AN has been examined in many studies with the use of a number of methods to measure personality. Among them, the Temperament and Character Inventory (TCI) theory [7] has been a lot utilized [8-11], but the results are inconsistent (Table 1). Few transdiagnostic studies have examined patients with EDs with malnutrition, including EDNOS [8].

Table 1: Past studies utilizing TCI to measure personality of AN patients: comparison with healthy controls [see PDF for image]

A previous study reported that in patients with major depression, the Hamilton Rating Scale for Depression [12] correlates positively with Harm Avoidance (HA) and negatively with Self-Directedness (SD) and Cooperativeness (CO) [13] on TCI. From other reports, in patients with postpartum depression, HA increases longitudinally and correlates positively with the Edinburgh Postnatal Depression Scale [14-16]. These findings present the possibility that one's personality measured via the TCI could be modulated by mental states, and this association could explain the inconsistency among TCI findings in patients with EDs (Table 1). We assumed that the personality of malnourished patients would be associated with their mental and physical states and sub-diagnosis, and used the TCI-125 [7, 17] to assess the personality of these patients and determine: 1) if the subscales of the TCI, especially HA, SD, and CO, are associated with findings on Beck's Depression Inventory (BDI) [18, 19], and 2) if the TCI subscales can be associated with malnourishment, as assessed by body mass index (BMI).

Participants and methods

All participants were Japanese women living in Japan. Among patients who met the criteria for ED of DSM-IV-TR, we excluded participants who were diagnosed with bulimia nervosa, younger than 17 years, or who did not consent to study participation. We recruited 46 patients with EDs (13 with AN, restricting type [AN-R], 22 with AN, binge-eating/purging type [AN-BP], 11 with EDNOS by DSM-IV-TR) from inpatients at Nagoya University Hospital, but we could not acquire enough life history from one patient with AN-BP, so only 45 cases were included in this study.

The 45 patients were retrospectively re-diagnosed by DSM-5 as follows: 14 patients with AN-R (13 formerly diagnosed as AN-R and one as EDNOS), 22 patients with AN-BP (21 formerly diagnosed as AN-BP and one as EDNOS), 4 patients with ARFID (formerly diagnosed as EDNOS), and 5 patients with OSFED (formerly diagnosed as EDNOS).

The BMI of patients ranged from 10. …

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