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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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Adler L. & Prendergast P. (1992). Eating disorder patients with a history of sexual abuse.Paper presented at the 5th International Conference on Eating Disorders,New York,24–26 April, 1992.
American Psychiatric Association (1980). Diagnostic and Statistical Manual for Mental Disorders (3rd edn). American Psychiatric Association: Washington, DC.
American Psychiatric Association (1987). Diagnostic and Statistical Manual for Mental Disorders (3rd edn – Revised). American Psychiatric Association: Washington, DC.
American Psychiatric Association (1991). DSM-IV Options Book: work in progress. Task Force on DSM-IV. American Psychiatric Association, Washington, DC.
Beck A. T., Ward C. H., Mendelson M., Mock J. & Erbaugh J. (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561571.
Blashfield R. K. & Breen M. J. (1989). Face validity of the DSM-III-R personality disorders. American Journal of Psychiatry 146, 15751579.
Brisman J. & Segal M. (1984). Bulimia and alcoholism: two sides of the same coin? Journal of Substance Abuse Treatment 1, 113118.
Casper R. C., Eckert E. D., Halmi K. A., Goldberg S. C. & Davis J. M. (1980). Bulimia. Its incidence and clinical importance in patients with anorexia nervosa. Archives of General Psychiatry 37, 10301035.
Coid J., Allollio B. & Rees L. H. (1983). Raised plasma metenkephalin in patients who habitually mutilate themselves. Lancet ii, 545546.
Derogatis L. R., Liberman R. S., Rickels K., Uhlenhutz E. H. & Cori L. (1974). The Hopkins Symptom Checklist (HSCL). A self-report-symptom inventory. Behavioural Sciences 19, 14.
Dohrenwend B. P., Shrout P. E., Egri G. & Mendelsohn F. S. (1980). Nonspecific psychological distress and other dimensions of psychopathology. Archives of General Psychiatry 37, 11291236.
Esquirol J. E. D. (1838). Des Maladies Mentales. Baillère: Paris.
Fahrenberg J., Selg H. & Hampel R. (1973). Das Freiburger Persönlichkeitsinventar. Hogrefe: Göttingen.
Fahrenberg J., Hampel R. & Selg H. (1984). Das Freiburger Persönlichkeitsinventar, Revidierte Fassung FPI-R. Hogrefe: Göttingen.
Fahy T. & Eisler I. (1993). Impulsivity and eating disorders. British Journal of Psychiatry 162, 193197.
Fichter M. M. & Haberger R. (1990). Bulimia nervosa: psycho-sexuelle entwicklungsstörungen. In Praktische Sexualmedizin (ed. Vogt H. J., Eichner W. and Herms V.), pp. 155174. Medical Tribune Verlagsgesellschaft mbH: Wiesbaden.
Fichter M. M., Elton M., Engel K., Meyer A. E., Poustka F., Mall H. & van der Heydte S. (1990). The Structured Interview for Anorexia and Bulimia Nervosa (SIAB): development and characteristics of a (semi-)standardized instrument. In Bulimia Nervosa: Basic Research, Diagnosis and Therapy (ed. Fichter M. M.), pp. 5770. John Wiley: Chichester.
Fichter M. M., Elton M., Engel K., Meyer A. E., Mall H. & Poustka F. (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.
Fichter M. M., Quadflieg N. & Rief W. (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. Herzog W., Deter H. C. and Vandereycken W.), pp. 133149. Springer: Berlin.
Frances A. J., Widiger T. A. & Pincus H. A. (1989). The development of DSM-IV. Archives of General Psychiatry 46, 373375.
Garfinkel P. E., Moldofsky H. & Garner D. M. (1980). The heterogeneity of anorexia nervosa. Bulimia as a distinct subgroup. Archives of General Psychiatry 37, 10361040.
Garner D. M., Olmstead M. P. & Polivy J. (1983). Development and validation of a multidimensional eating disorder inventory of anorexia nervosa and bulimia. International Journal of Eating Disorders 2, 1434.
Gartner A. F., Marcus R. N., Halmi K. & Loranger A. W. (1989). DSM-III-R personality disorders in patients with eating disorders. American Journal of Psychiatry 146, 15851591.
Goldstein W. N. (1981). A study of impulse control in the borderline patient. Psychiatric Clinics 14, 8187.
Greenspan G. S. & Samuel S. E. (1989). Self-cutting after rape. American Journal of Psychiatry 146, 789790.
Hatsukami D., Eckert E., Mitchell J. E. & Pyle R. (1984). Affective disorder and substance abuse in women with bulimia. Psychological Medicine 14, 701704.
Herzog D. B., Keller M. B., Lavori Ph. W., Bradburn I. S. & Ott I. L. (1990). Course and outcome of bulimia nervosa. In Bulimia Nervosa: Basic Research, Diagnosis and Therapy (ed. Fichter M. M.), pp. 126141. John Wiley: Chichester.
Herzog D. B. (1990). Predictors in eating disorders.Paper presented at the 4th International Conference on Eating Disorders,27–29 April,New York.
Hiller W., Zaudig M. & Mombour W. (1989). Münchner Diagnosen Checklisten für DSM-III-R. Logomed Verlag: München.
Hiller W. & Zaudig M. (1992). MDCL – Münchner Diagnosen. Checklisten für DSM-III-R und ICD-10. Handbuch und 30 Checklisten. Huber: Bern.
Johnson C., Tobin D. & Enright A. (1989). Prevalence and clinical characteristics of borderline patients in an eating-disordered population. Journal of Clinical Psychiatry 50, 915.
Johnson C., Tobin D. L. & Dennis A. (1990). Differences in treatment outcome between borderline and non-borderline bulimics at one-year follow-up. International Journal of Eating Disorders 9, 617627.
Lacey J. H. & Moureli E. (1986). Bulimic alcoholics: some features of a clinical sub-group. British Journal of Addiction 81, 389393.
Lacey J. H. & Evans C. D. H. (1986). The impulsivist: a multi-impulsive personality disorder. British Journal of Addiction 81, 641649.
Lacey H. (1990 a). Multi-impulsive bulimia. In Psychosomatische und sexualmedizinische Probleme in der ärztlichen Praxis (ed. Söllner W., Harrer M., Fischer H., Loewit K. and Wesiack W.), pp. 91103. Institut für Medizinische Psychologie und Psychotherapie der Universität Innsbruck und Arbeitskreis für Vorsorgemedizin in Tirol.
Lacey J. H. (1990 b). Incest, incestuous fantasy and indecency. A clinical catchment area study of normal-weight bulimic women. British Journal of Psychiatry 157, 399403.
Lacey J. H. (1993). Self-damaging and addictive behaviour in bulimia nervosa. British Journal of Psychiatry 163, 190194.
Levine A. P. & Hyler S. E. (1986). DSM-III personality diagnosis in bulimia. Comprehensive Psychiatry 27, 4753.
Mundt Ch. (1986). Kleptomanie. In Lexikon der Psychiatrie (ed. Müller Ch.), pp. 393396. Springer: Heidelberg.
Parker G., Tulping H. & Brown L. B. (1979). A parental bonding instrument. British Journal of Medical Psychology 52, 110.
Pepplinkhuizen L. & Verhoeven W. M. A. (1991). Destructive Drives and Impulse Control. CIP-Gegevens Koninklijke Bibliotheek: Den Haag.
Peveler R. & Fairburn C. (1990). Eating disorders in women who abuse alcohol. British Journal of Addiction 85, 16331638.
Root M. P. P. (1989). Treatment failures: the role of sexual victimization in women's addictive behaviour. American Journal of Orthopsychiatry 59, 542549.
Russell G. (1979). Bulimia nervosa: an ominous variant of anorexia nervosa. Psychological Medicine 9, 429448.
Sansone R. A., Fine M. A., Seuferer S. & Bovenzi J. (1989). The prevalence of borderline personality symptomatology among women with eating disorders. Journal of Clinical Psychology 45, 603610.
Scott D. W. (1983). Alcohol and food abuse: some comparisons. British Journal of Addiction 78, 339349.
Shearer S. L., Peters C. P., Quaytman M. S. & Ogden R. L. (1990). Frequency and correlates of childhood sexual and physical abuse histories in adult female borderline inpatients. American Journal of Psychiatry 147, 214216.
Sohlberg S., Norring C., Holmgren S. & Rosmark B. (1989). Impulsivity and long-term prognosis of psychiatric patients with anorexia nervosa/bulimia nervosa. Journal of Nervous and Mental Disease 177, 249258.
Striegel-Moore R. H., Cronan S., Goebel A., Pena L., Scheibe K. (1992). Disordered eating in female in-patients with psychoactive substance use disorders.Paper presented at the 5th International Conference on Eating Disorders,New York,24–26 April 1992.
van Praag M. M. (1991). Serotonergic dysfunction and aggression control. Psychological Medicine 21, 1519.
Virkkunen M., Nuttila A., Goodwin F. K. & Linnoila M. (1987). Cerebrospinal fluid monoamine metabolite levels in male arsonists. Archives of General Psychiatry 44, 241–27.
Virkkunen M., DeJong J., Bartko J. & Linnoila M. (1989). Psychobiological concomitants of history of suicide attempts among violent offenders and impulsive fire setters. Archives of General Psychiatry 46, 604606.
von Zerssen D. (1976). Klinische Selbstbeurteilungs-Skalen (KS) aus dem Münchner Psychiatrischen Informationssystem. Beltz: Weinheim.
Wonderlich S., Donaldson M. A., Staton R. D., Carson D., Gertz L. & Johnson M. (1992). Eating disturbance in incest victims: a controlled study.Paper presented at the 5th International Conference on Eating Disorders,New York,24–26 April, 1992.
World Health Organization (1989). International Classification of Diseases, draft of 10th revision (ICD-10). WHO: Geneva.
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