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Patients (n = 55) seeking treatment for eating disorders were evaluated for eating attitudes and behaviors, weight history, psychiatric symptoms, and presence of borderline personality organization. Patients were divided into borderline (n = 21) and nonborderline (n = 19) subgroups and were compared on the above dimensions after 1 year. There were relatively few differences between borderline and nonborderline bulimics in severity of symptomatic eating behavior and attitudes at the initial evaluation. However, the borderline patients were significantly more disturbed on a number of relevant dimensions, including general psychiatric symptoms. Follow‐up assessment showed that although most patients in the nonborderline group remitted their symptoms, patients in the borderline group continued to demonstrate clinically significant levels of disturbed eating patterns, Drive‐for‐Thinness, Body Dissatisfaction, and depression. The clinical and research implications for these findings are discussed.

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We investigated a multifactorial approach to the assessment of bulimia nervosa by means of hierarchical factor analysis. Two hundred forty-five bulimia nervosa patients and 68 patients with either anorexia nervosa or eating disorders not otherwise specified were administered a self-report battery that was organized into 21 dimensions relevant to eating disorder patients. When dimensions from this battery were subjected to hierarchical factor analysis, support for bulimia nervosa as a unique diagnostic category was obtained. However, the emergence of 3 secondary factors and 6 primary factors suggests that bulimia nervosa can also be described more complexly. The emergence of a multifactorial model of bulimia nervosa that incorporates several existing undimensional models suggests the potential for both divergent and complicated clinical presentation in bulimia nervosa patients.

Currently, there are no evidence-based treatments or established treatment protocols for patients that present with both eating disorders and substance use disorders/addictions. The lack of available integrated treatment programs, at all levels of care, has left the dually diagnosed patient vacillating between these two disorders. Eating disorder treatment programs frequently exclude patients with active substance use disorders, and addiction programs regularly exclude or do not effectively treat patients with eating disorders. Often, these patients are referred to addiction treatment programs prior to entering into eating disorder treatment. This approach is problematic, as both disorders are associated with high rates of relapse following treatment. Sequential treatments focus on the most acute disorder first, often utilizing multiple providers in different locations, with different theoretical orientations, staff training, and treatment protocols, which can make continuity of care quite difficult. Developing a comprehensive integrated approach to the treatment of comorbid patients will improve treatment delivery, reduce time in treatment, lower overall treatment costs, improve treatment outcome, and lessen consumer confusion. This chapter will provide