Patrick F. Sullivan

Temperament, character, and personality disorder in bulimia nervosa

In a sample of 76 women participating in a clinical treatment trial for bulimia nervosa, we examined the clinical differences between subjects with and without concurrent personality disorders and the ability of “self-directedness” (a character scale of Cloningers Temperament and Character Inventory) to predict the presence of personality disorder. Sixty-three percent of the sample had at least one personality disorder diagnosis. Fifty-one percent of personality disorders were in cluster C, 41% were in cluster B, and 33% were in cluster A. The presence of personality disorder was associated with greater depressive symptoms, worse global functioning, laxative use, greater body dissatisfaction, higher harm avoidance, and lower self-directedness. As hypothesized, low self-directedness scores were associated with a markedly increased probability of a personality disorder.

Abuse in Adult Relationships of Bulimic Women

The presence of abuse (repeated physical battery) was investigated in the adult relationships of 20 bulimic women and 17 control women. Significantly more bulimic women than controls reported having been in relationships in which repeated physical battery occurred. Both battered and nonbattered bulimic women scored significantly higher than controls on measures of eating and self-esteem-related pathology. Battered bulimic women were significantly more depressed than controls. Battery was also associated with self-blame. It is proposed that these women represent a more severely distressed subgroup of bulimic women. Further, similarities between these womens destructive relationship to both food and the batterer are considered. There has been substantial focus on childhood physical and sexual abuse in bulimic women, but in this study the focus is on the need for heightened sensitivity to the presence and implications of recurrent abusive experiences in their adult interpersonal relationships.

Substance use and sexual behavior among homosexual men at risk for HIV infection: Psychosocial moderators

Abstract Sexual practices continue to be the major mode of Human Immunodeficiency Virus (HIV) transmission within the homosexual population. Failure to use condoms consistently during anal intercourse has been directly associated with use of alcohol and other substances. We identify psychosocial cofactors that are not only related to sexual practices, but are also associated with an increased likelihood that substance users will engage in high-risk sex. Subjects were 525 men enrolled at the Pittsburgh site of the Multicenter AIDS Cohort Study in 1989. Alcohol use and popper use were each significantly associated with high-risk sexual practices (i.e., unprotected anal intercourse with multiple partners), even after a broad array of psychosocial characteristics were controlled. In addition, younger men, and those with greater family support and a higher sense of mastery, were more likely to engage in risky behavior. Not only did such “main effects” emerge, but the substance use-sexual practice relationship ...

The effect of a history of conduct disorder in adult major depression

This paper examines the impact of a history of conduct disorder on major depression in adulthood, including its symptomatology, comorbidity and response to tricyclic antidepressants. 103 subjects with DSM-III-R major depression were assessed for DSM-III-R axis I and II comorbidity, severity of depression, social functioning, general psychiatric symptomatology, early familial environment and family psychiatric history. 18 patients (17%) had a history of conduct disorder, 32 (31%) were subthreshold, and 53 (51%) had no childhood symptoms of conduct disorder. Depressed adults with a history of conduct disorder had significantly higher lifetime alcohol and drug dependence and virtually all (17/18, 94%) met criteria for a personality disorder. Despite this, the current episode of depression did not differ in severity, symptoms or response to treatment except that those with a history of conduct disorder were more likely to be agitated when depressed. The authors conclude that a history of conduct disorder is depressed patients predicts the presence of adult personality disorders and psychoactive substance dependence. In most other ways, depressed subjects with a history of conduct disorder were similar to other subjects.

Comorbidity of bulimia and substance abuse : perceptions of family of origin

Clinical characteristics and perceptions of family of origin were examined in 16 bulimic women with comorbid alcohol abuse or dependence, 17 women with bulimia alone, and 30 normal controls. Family Environment Scale self-report and Family Environment Q-sort analysis of taped semi-structured interviews about family environment revealed that while there were no differences across groups in global family environment items, differences existed in specific parental characteristics. Fathers of bulimic women (with or without alcohol abuse or dependence) were perceived as being significantly more seductive than fathers of normal controls. Bulimic women (with or without alcohol abuse or dependence) tended to view their mothers as more neurotic and to have experienced less enjoyment in their maternal role. Mothers of bulimic women with alcohol abuse tended to place the greatest emphasis on weight, exercise, and appearance.

Longitudinal Trends in the Use of Illicit Drugs and Alcohol in the Multicenter AIDS Cohort Study

Secular trends in illicit drug and alcohol use among gay men may reflect behavioral changes related to concerns about HIV1. These trends may also have public health ramifications to the extent that they measure the results of education about safer sexual practices. Using data from 1984-89 in the Multicenter AIDS Cohort Study, we investigated trends in use of illicit drugs and alcohol in HIV1 - men (N = 2,319), HIV1 + men without AIDS (N = 1,118), and HIVI + men who developed AIDS (N = 426). Illicit drug use was initially common, particularly in the HIV1 + groups, but declined substantially with time. Alcohol use declined considerably in the HIV1 + groups and to a lesser extent in HIV1 - men. Moderation in illicit drug and alcohol use was not robustly associated with demographic characteristics. While self-reported illicit drug and alcohol use decreased from 1984-89, such use persisted in most of each group.

Self-induced abortion in a bulimic woman

We report the case of a woman with bulimia nervosa, several personality disorders, and a past history of anorexia nervosa who deliberately induced an abortion via self-imposed starvation and vigorous exercise. Her history reveals severe obsessive-compulsive and narcissistic personality disorders as well as a lifelong pattern of denial of affect and illness.