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Course of multi-impulsive bulimia

  • M. M. Fichter (a1), N. Quadflieg (a1) and W. Rief (a1)

Thirty-two consecutively admitted females with bulimia nervosa (purging type) according to DSM-IV and additional impulsive behaviours (multi-impulsive bulimia (MIB)) and 32 age-matched female controls with DSM-IV bulimia nervosa (purging type) (uni-impulsive bulimia (UIB)) were assessed longitudinally on admission and at discharge following in-patient therapy and at a 2-year follow-up. Multi-impulsive bulimics were defined as presenting at least three of the six of the following impulsive behaviours in their life-time in addition to their bulimic symptoms at admission: (a) suicidal attempts, (b) severe autoaggression, (c) shop lifting (other than food), (d) alcohol abuse, (e) drug abuse, or (f) sexual promiscuity. Multi-impulsive bulimics were more frequently separated or divorced, had less schooling and held less-skilled jobs. Except for interoceptive awareness (EDI), which was more disturbed in multi-impulsive bulimics, there were no differences concerning scales measuring eating disturbances and related areas. Multi-impulsive bulimics showed more general psychopathology – anxiety, depression, anger and hostility, psychoticism – differed in several personality scales from uni-impulsive bulimics (e.g. increased excitability and anger/hostility) and had overall a less favourable course of illness. Multi-impulsive bulimics also received more in- and out-patient therapy previous to the index treatment and during the follow-up period. The data support the notion that ‘multi-impulsive bulimia’ or ‘multi-impulsive disorder’ should be classified as a distinct diagnostic group on axis I or that an ‘Impulsive Personality Disorder’ should be introduced on axis II. The development of more effective treatment for multi-impulsive bulimia is warranted.

Corresponding author
1Address for correspondence: Professor M. M. Fichter, Department of Psychiatry, University of Munich, Nussbaumstrasse 7, 80336 München, Germany
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A. T. Beck , C. H. Ward , M. Mendelson , J. Mock & J. Erbaugh (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561571.

J. Brisman & M. Segal (1984). Bulimia and alcoholism: two sides of the same coin? Journal of Substance Abuse Treatment 1, 113118.

R. C. Casper , E. D. Eckert , K. A. Halmi , S. C. Goldberg & J. M. Davis (1980). Bulimia. Its incidence and clinical importance in patients with anorexia nervosa. Archives of General Psychiatry 37, 10301035.

L. R. Derogatis , R. S. Liberman , K. Rickels , E. H. Uhlenhutz & L. Cori (1974). The Hopkins Symptom Checklist (HSCL). A self-report-symptom inventory. Behavioural Sciences 19, 14.

B. P. Dohrenwend , P. E. Shrout , G. Egri & F. S. Mendelsohn (1980). Nonspecific psychological distress and other dimensions of psychopathology. Archives of General Psychiatry 37, 11291236.

T. Fahy & I. Eisler (1993). Impulsivity and eating disorders. British Journal of Psychiatry 162, 193197.

M. M. Fichter , M. Elton , K. Engel , A. E. Meyer , H. Mall & F. Poustka (1991). Structured interview for Anorexia and Bulimia Nervosa (SIAB): development of a new instrument for the assessment of eating disorders. International Journal of Eating Disorders 10, 571592.

M. M. Fichter , N. Quadflieg & W. Rief (1992). The German longitudinal bulimia nervosa study 1. In the course of eating disorders: long-time follow-up studies of anorexia and bulimia nervosa (ed. W. Herzog , H. C. Deter and W. Vandereycken ), pp. 133149. Springer: Berlin.

A. J. Frances , T. A. Widiger & H. A. Pincus (1989). The development of DSM-IV. Archives of General Psychiatry 46, 373375.

P. E. Garfinkel , H. Moldofsky & D. M. Garner (1980). The heterogeneity of anorexia nervosa. Bulimia as a distinct subgroup. Archives of General Psychiatry 37, 10361040.

D. M. Garner , M. P. Olmstead & J. Polivy (1983). Development and validation of a multidimensional eating disorder inventory of anorexia nervosa and bulimia. International Journal of Eating Disorders 2, 1434.

C. Johnson , D. L. Tobin & A. Dennis (1990). Differences in treatment outcome between borderline and non-borderline bulimics at one-year follow-up. International Journal of Eating Disorders 9, 617627.

J. H. Lacey & E. Moureli (1986). Bulimic alcoholics: some features of a clinical sub-group. British Journal of Addiction 81, 389393.

J. H. Lacey & C. D. H. Evans (1986). The impulsivist: a multi-impulsive personality disorder. British Journal of Addiction 81, 641649.

J. H. Lacey (1990 b). Incest, incestuous fantasy and indecency. A clinical catchment area study of normal-weight bulimic women. British Journal of Psychiatry 157, 399403.

J. H. Lacey (1993). Self-damaging and addictive behaviour in bulimia nervosa. British Journal of Psychiatry 163, 190194.

A. P. Levine & S. E. Hyler (1986). DSM-III personality diagnosis in bulimia. Comprehensive Psychiatry 27, 4753.

G. Parker , H. Tulping & L. B. Brown (1979). A parental bonding instrument. British Journal of Medical Psychology 52, 110.

R. Peveler & C. Fairburn (1990). Eating disorders in women who abuse alcohol. British Journal of Addiction 85, 16331638.

M. P. P. Root (1989). Treatment failures: the role of sexual victimization in women's addictive behaviour. American Journal of Orthopsychiatry 59, 542549.

R. A. Sansone , M. A. Fine , S. Seuferer & J. Bovenzi (1989). The prevalence of borderline personality symptomatology among women with eating disorders. Journal of Clinical Psychology 45, 603610.

D. W. Scott (1983). Alcohol and food abuse: some comparisons. British Journal of Addiction 78, 339349.

S. Sohlberg , C. Norring , S. Holmgren & B. Rosmark (1989). Impulsivity and long-term prognosis of psychiatric patients with anorexia nervosa/bulimia nervosa. Journal of Nervous and Mental Disease 177, 249258.

M. Virkkunen , A. Nuttila , F. K. Goodwin & M. Linnoila (1987). Cerebrospinal fluid monoamine metabolite levels in male arsonists. Archives of General Psychiatry 44, 241–27.

M. Virkkunen , J. DeJong , J. Bartko & M. Linnoila (1989). Psychobiological concomitants of history of suicide attempts among violent offenders and impulsive fire setters. Archives of General Psychiatry 46, 604606.

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Psychological Medicine
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