Impact of comorbid borderline personality disorder on inpatient treatment for bulimia nervosa: analysis of routine data

Abstract

BackgroundA substantial rate of patients with bulimia nervosa (BN) also suffer from Borderline personality disorder (BN + BPD). It is widely unknown how these comorbid patients with BN + BPD present and respond to inpatient treatment. Aims of the study were to examine (1) specific characteristics of patients with BN + BPD at admission, discharge, and during treatment, and (2) differential effects of inpatient treatment for BN vs. BN + BPD.MethodWe analyzed routine data of inpatients admitted for the treatment of BN between 2013 and 2017 in a specialized hospital for eating disorders. (1) Cross-sectional differences were examined with independent t-tests and χ2-tests; and (2) treatment effects pertaining to eating disorders symptoms, depression, psychosocial functioning and general psychopathology with repeated measures analysis of variance.ResultsOf 1298 inpatients (96% female), 13.2% also had a diagnosis of BPD. (1) Patients with BN + BPD had more previous inpatient treatments (p = 0.001), had a longer length of stay (p = 0.003), gained more weight during treatment (p = 0.006), and were more often irregularly discharged (p = 0.018) as well as rated as unfit to work at discharge (p = 0.003). (2) Both groups improved in all examined variables (all main effects treatment p < 0.001). Patients with BN + BPD showed worse symptoms aggregated across admission and discharge (all main effects diagnosis p < 0.05). Patients with BN + BPD showed smaller improvements (interaction treatment×discharge) in depressive symptoms (p = 0.018), perfectionism (p = 0.009), and asceticism (p = 0.035) and discharge scores mostly lay in the range of the admission scores of the BN-only group.ConclusionPatients with BN + BPD improve during intense and specialized inpatient treatment, yet, retain pronounced impairment at discharge despite longer treatment. Treatment needs to be improved and should focus on transdiagnostic symptoms of BN and BPD.Electronic supplementary materialThe online version of this article (10.1186/s40479-018-0098-4) contains supplementary material, which is available to authorized users.

Impact of comorbid borderline personality disorder on the outcome of inpatient treatment for anorexia nervosa: a retrospective chart review

“…Given the same average treatment duration for patients with AN and AN+BPD in our study, it remains to be investigated whether the comorbid patients would have benefitted from prolonged treatment. However, a similar investigation from our clinic examined the influence of BPD on inpatient treatment for bulimia nervosa found comparable patterns of symptom severity and outcome despite prolonged treatment for comorbid patients [ 9 ].…”

Emotion dysregulation acts in the relationship between vulnerable narcissism and suicidal ideation

“…Neacsiu, Fang, Rodriguez and Rosenthal ( 2018 ) evidenced that problems in emotion regulation are differentially connected to suicidal behaviors. Finally, Al‐Dajani, Uliaszek and Hamdullahpur ( 2019 ) showed that, cross‐sectionally, the relationship between emotion dysregulation and suicide ideation was significantly moderated by the belief of suicide as an escape, and longitudinally the latter moderated only the relationship between lack of clarity and suicide ideation.…”

The Mediator Effect of Personality on the Relationship Between Symptomatic Impairment and Treatment Outcome in Eating Disorders

“…interpersonal difficulties, unstable self-image and self-esteem, marked impulsivity, dysfunctional defense mechanisms, and emotion dysregulation might play a relevant role in determining response to ED treatment (Martinussen et al, 2017;Voderholzer et al, 2021). In line with previous empirical evidence, cooccurring Cluster B symptoms in an ED patient may mark greater severity, and thus potentially predict a poorer outcome and less symptomatic change (Steiger et al, 1993;Hessler et al, 2019). Cluster B personality characteristics have also been related to other therapeutic variables, such as a history of psychiatric hospitalization for an ED or other condition (Westen and Harnden-Fischer, 2001) and a greater risk of discharge against medical advice and re-admission following intensive ED treatment (Wildes et al, 2011).…”