A working assumption for many clinicians is that differences in personality functioning among eating‐disordered patients are crucial for treatment planning and prognosis. However, the empirical documentation is scarce. The present study used analyses of 13 objectively rated ego functions in a sample of 48 eating‐disordered patients to try to establish a firmer empirical basis in the area. The variation in ego functioning was great, and a cluster analysis identified four clusters. These were tentatively named “higher neurotic,” “lower neurotic,” “borderline,” and “borderline‐psychotic.” The clusters were unrelated to DSM‐III‐R eating disorder diagnoses and to the restricter/bulimic distinction and related markedly differently from those classifications to other clinical variables. The most interesting associations occurred between ego functioning and variables of possible prognostic value. Ego functioning thus constitutes a complementary diagnostic dimension of potential importance for prognosis.
This study evaluated the stability of performance on neuropsychological tests in a group of 14 schizophrenic patients. These patients were first tested as inpatients and later on as outpatients. The patients' results are also compared with matched normal controls and with standardized norms. The patients' test results were stable over time and no change in performance was found for the patients as a group, suggesting that these aspects of the patients' functioning were of a trait quality. The patient group had significantly poorer results on a majority of the tests compared with the controls. The variation of the level of cognitive functioning among the patients, however, was great. In clinical practice today, neuropsychological examinations are often included in the diagnostic procedure, and their results also have impact on treatment planning. However, the possibility to generalize the findings is reduced as a consequence of the low number of patients in the study.
The reported increase over the last decades in the incidence of eating disorders seems to be accompanied by a shift in the symptomatic spectrum, so that the clinician now more often comes in contact with individuals not matching the picture of the “typical” anorexia nervosa patient. Seventy‐nine patients assessed at the clinic over the last two and a half years were studied with respect to the differential diagnostic problems arising in this context. A considerable overlap in symptomatology was found between all sub‐ categories (anorexia nervosa, bulimia, double diagnosis of anorexia nervosa/bulimia according to the DSM‐III, and “anorexic‐like”). Furthermore, 49% had previously passed through at least one phase when a diagnosis other than that currently applicable would have been appropriate. These results, in combination with similar observations reported several times in the literature, imply the existence of some common feature among all the patients. In the ABC‐model, a conflict between anorectic and bulimic impulses is suggested as a concept capable of expressing this commonality while still representing a phenomenon identifiable at a clinical‐descriptive level. The possible difficulties in detecting the conflict in the everyday clinical work are discussed along with the practical and theoretical advantages associated with applying the ABC‐model to diagnosis, prognosis and treatment in eating disorders.
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