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The level and direction of hostility in patients with bulimia nervosa, anorexia nervosa and a comparison group were measured using the the Hostility and Direction of Hostility Questionnaire. A semistructured interview developed by Harris, Brown, and Bifulco (Psychological Medicine, 16, 641-659, 1986) was used to assess childhood care to examine whether a link exists between childhood exposure to aggression or parental neglect and adult hostility. Patients with eating disorders had significantly higher hostility levels and were significantly more intropunitive than the comparison group. Patients with bulimia nervosa were significantly more intropunitive than the comparison group. Patients with bulimia nervosa were significantly more hostile than patients with anorexia nervosa. Anorexia nervosa patients were more likely to direct hostility inwardly, rather than outwardly, when compared with bulimia nervosa patients. Impulsivity was associated with extrapunitiveness whereas intropunitiveness was associated with depression. Although some measures of poor childhood care correlated with adult hostility levels no clear pattern emerged.
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PMID:Patterns of punitiveness in women with eating disorders. 762 Apr 76

The present study reports findings concerning the hypothesis whether patients with narcissistic self-system disturbances show more obsessive-compulsive (OC) symptoms as compared to patients without such disturbances. Ninety-one patients meeting DSM-III-R criteria for anorexia nervosa (AN) or bulimia nervosa (BN) were investigated using the Narzissmusinventar (NI), the Hamburger-Zwangsinventar (HZI), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Eating Disorder Inventory (EDI). The NI-data demonstrated a great variance of self-system disturbances in AN and BN; a cluster analysis identified two different clinical features. In comparison to eating disorder patients without concomitant disturbances of the self-system (n = 34) the patient group with such narcissistic deficits (n = 57) showed significantly higher Y-BOCS and HZI-scores indicating more and severer OC symptoms. These patients also had significantly higher and hence pathologic means on seven of eight EDI scales. The results suggest that OC behaviour may be an unconscious attempt to stabilize the self-system equilibrium, i.e. counteracting narcisstic desintegration. Regulatory processes of the self-system and OC symptoms may present additional prognostic factors and lead to new approaches in psychotherapy research.
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PMID:[Obsessive-compulsive symptoms in structural ego defects--a study exemplified by anorexia and bulimia nervosa]. 770 58

The aims of the study were (1) to compare the defence style of patients with anorexia nervosa with that of patients with bulimia nervosa and of female controls; (2) to establish whether a link exists between childhood adversity and adult defence style in eating disorder patients. Twenty-six patients with restricting anorexia nervosa (RAN), 61 patients with bulimia nervosa (BN), 37 patients with bulimic anorexia nervosa or bulimia nervosa with a history of anorexia nervosa (BAN/BN-HistAN) and 88 female controls were given the short Defense Style questionnaire (Andrews, Pollock & Stewart, 1989). Eating disorder patients were asked about their childhood care using a semi-structured interview (Harris, Brown & Bifulco, 1986). Bulimia nervosa patients had a significantly less mature defence style than the other groups and like the BAN/BN-HistAN group more immature defences than the control group. In the RAN group no childhood predictors of adult defence style were found, whereas in bulimia nervosa, excessive parental control during childhood was a negative predictor of mature defences and physical abuse a positive predictor of immature defence style. These results provide some evidence that childhood adversity may constitute a vulnerability factor for the later development of bulimia nervosa, mediated by personality development.
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PMID:Childhood adversity and adult defence style in eating disorder patients--a controlled study. 812 3

This study examined the frequency of eating disorders in women with obsessive compulsive disorder (OCD). Letters were sent to area psychiatrists asking them to refer patients diagnosed with OCD to a research study. Subjects completed the Yale Brown Obsessive Compulsive Scale and a survey including history of eating disorders. Thirty-one women participated in the study. Forty-two percent (N = 13) had a past or current history of an eating disorder: 26% anorexia nervosa alone (N = 8); 3% bulimia nervosa alone (N = 1); and 13% both anorexia and bulimia (N = 4). Our study found a higher percentage of history of eating disorders than expected. Perhaps specifically asking about history of weight loss, binging, and vomiting allowed for fuller disclosure of eating disorders than other studies that relied on retrospective chart review or limited the survey to current eating symptoms. A past history of eating disorder may be more common than previously believed and may frequently precede the diagnosis of OCD.
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PMID:Eating disorder history in women with obsessive compulsive disorder. 813 42

30 girls aged 13-19 who met criteria DSM-IV for anorexia nervosa were investigated by using a semistructured diagnostic interview assessing general psychopathology as well as anorectic and bulimic behavior, The Yale-Brown Obsessive-Compulsive Scale. The Eating Disorder Inventory, The Anxiety Hamilton Scale, The Depression Hamilton Scale. The comparison group consisted of 30 healthy girls aged 13-19. 1/3 of the girls with anorexia nervosa met the DSM-IV criteria for OCD, 1/10 subjects had OCD and depressive disorder. The comorbidity of eating disorder and OCD or OCD and depressive disorder worsened the course of anorexia nervosa and prognosis.
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PMID:[Obsessive-compulsive disorder in girls with eating disorders]. 865 Feb 81

Patients with anorexia nervosa (n = 18) and patients with obsessive-compulsive disorder (OCD) (n = 16) had similar scores on the Yale-Brown Obsessive Compulsive Scale (19 + or - 9 vs. 22 + or - 6). This suggests that these disorders have similar magnitude of impairment from obsessions and compulsions; however, OCD patients endorsed a wide variety of obsessions and compulsions, whereas anorexics tended to endorse symptoms that were related to symmetry and order.
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PMID:Comparison of obsessions and compulsions in patients with anorexia nervosa and obsessive compulsive disorder. 916 9

Clinicians working with contemporary women with anorexia nervosa have commented on the ascetic component in anorexia, meaning their self-denial, heightened morality, opposition between body and spirit, asexuality, and denial of bodily death (Mogul, 1980; Palazzoli, 1978; Rampling, 1985; Sabom, 1985; Turner, 1984). While these clinicians have commented on the asceticism in contemporary anorexia nervosa, they have little to say about the role of culture in subjective experiences of this asceticism. As we have seen, Jane and Margaret used notions of asceticism about food and the body that are a part of their religious beliefs to create a personal meaning system through which they expressed their self-starvation. These cases, while supporting clinical studies that point to an ascetic component in modern anorexia, go further to suggest that in some cases, this asceticism may be encoded in religion. Religious anorectics like Jane and Margaret challenge models of anorexia nervosa that understand the condition exclusively in terms of cultural foci on "dieting" and secular ideals of beauty and bodily thinness for women (Bemporad, Hoffman, & Herzog, 1989; Chernin, 1985; Garner et al., 1980; Orbach, 1986; Rost, Newhaus, & Florian, 1982). They also suggest a continuing persistence into the twentieth century of an association between religiosity and self-starvation noted by historians during the early Christian, medieval, and late-Victorian periods in the West (Bell, 1985; Brown, 1988; Brumberg, 1985, 1988; Bynum, 1987). The above discussion points to the new directions in psychological anthropology which challenge a strict and opposing dichotomy between the conscious and unconscious, between culture (seen as "public") and the individual mind (seen as "private" and idiosyncratic). Obeyesekere's concept of "the work of culture," (Obeyesekere, 1990) and Stephen's concept of the "autonomous imagination" are especially useful in understanding how persons like Jane and Margaret use in imaginative ways cultural symbols, such as notions of asceticism about food and the body that are a part of religion, to give meaning to their personal concerns with growth, separation, and sexuality. We saw how Jane and Margaret transform cultural symbols and language to express their starvation and deep anxieties. These cases lend support to views that culture and religion, as symbolic systems, have underpinnings in deep motivation (Obeyesekere, 1981, 1990; Spiro, 1965, 1987). They also suggest that the relations between culture and the individual mind (and between culture and "illness," between "normal" and "abnormal") must be viewed as a moving continuum, with culture constantly worked and reworked by the individual imagination in innovative and creative ways.
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PMID:The imaginative use of religious symbols in subjective experiences of anorexia nervosa. 921 86

The aim of the present study is to investigate smooth pursuit eye movement and saccadic performance in anorexia nervosa during a restored weight period and to determine if functional links can be made between eye movement performance and clinical features. SPEM parameters were recorded for 28 female anorectic out-patients (DSM IV), who had a body weight loss of up to 20% of ideal body weight. Twenty-eight comparison subjects were also tested. Clinically, each patient was assessed using the Eating Disorder Inventory (EDI), the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Structured Interview for Personality Disorders (SCID II), the Symptom Checklist-90-Revised (SCL-90-R) and the Hamilton Scale for Depression (HRSD). The anorectic patients performed slightly worse than the comparison subjects on a number of SPEM measures. No relationship was found between SPEM impairment and a global severity index of psychopathology (SCL 90-R GSI) or depressive symptoms. Moreover, OCD symptoms and scores on some EDI scales (such as perfectionism) appear related to the severity of the eye movement alterations. The evidence of SPEM abnormalities in a subgroup of anorectic patients during the remitted state and the relationship of the abnormalities to obsessive-compulsive symptoms are discussed. Results are in agreement with the hypothesis regarding the persistence of neurophysiological as well as psychopathological traits of disorder in anorectic patients.
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PMID:Eye movement abnormalities in anorexia nervosa. 957 3

This study sought to assess the prevalence and symptomatology of comorbid obsessive-compulsive disorder (OCD) among Japanese subjects who met the DSM-III-R criteria for bulimia nervosa (BN). The Structured Clinical Interview for DSM-III-R Patient Version was used to distinguish 26 BN patients with concurrent OCD from 52 BN patients without OCD. Obsessive-compulsive symptoms in BN subjects with concurrent OCD were evaluated using the Japanese version of the Yale-Brown Obsessive-Compulsive Scale. There were no differences in the prevalence of concurrent OCD between BN subjects with and without a lifetime history of anorexia nervosa. Among BN subjects with concurrent OCD, symptoms related to symmetry and order were most frequently identified, followed by contamination and aggressive obsessions, and checking and cleaning/washing compulsions. Bulimia nervosa subjects with concurrent OCD were more likely than subjects without OCD to have more severe mood and core eating disorder psychopathology. Comorbid OCD is a common phenomenon in Japanese bulimics (33%) similar to that suggested in BN subjects in the Western countries. Obsessive-compulsive symptoms related to symmetry and order were most frequently observed in BN subjects with concurrent OCD, which was a similar finding to that reported among restricting anorexic subjects.
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PMID:Prevalence and symptomatology of comorbid obsessive-compulsive disorder among bulimic patients. 1068 47

Obsessive-compulsive symptoms have been related to severity in the clinical presentation of eating disorders, whereas the impact of depression on the correlations between their severity and the severity of eating disorders has not been investigated. This paper assesses the effects of depression in 42 adolescent patients who met DSM-IV criteria for anorexia nervosa or bulimia nervosa by using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Eating Disorder Inventory (EDI) and the Beck Depression Inventory (BDI). The results indicate that patients who show elevated obsessionality and compulsivity on the Y-BOCS display a significantly higher degree of disturbed attitudes and behaviours concerning eating than patients with limited obsessionality and compulsivity. However, when the effects of depression are considered, all the differences found disappear. Our study suggests that depression is more directly associated with the severity of eating disorders than obsessive-compulsive symptoms and that the intensity of obsessive-compulsive symptoms in eating disorders is influenced by the intensity of depression. The relations between obsessive-compulsive symptoms, depression and eating disorders are not known. Even so this study highlights the importance of assessing depression when using obsessive and compulsive symptoms as a correlate of severity in the clinical presentation of eating disorders.
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PMID:Obsessive-compulsive symptoms as a correlate of severity in the clinical presentation of eating disorders: measuring the effects of depression. 1123 40


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