William J. Swift

DSM-III-R personality disorders in eating-disorder subtypes

The authors interviewed 46 eating-disordered individuals with the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) to assess the prevalence of personality disorders in four eating disorder subtypes. The findings suggest that eating disorder subtypes vary in prevalence of concurrent personality disorder diagnoses. Obsessive-compulsive personality disorder was common in restricting anorexics, but not bulimic anorexics. Normal-weight bulimia was associated with histrionic personality disorder. Regardless of eating-disorder subtype, self-reported depression was highest in individuals meeting criteria for borderline and dependent personality disorder.

Five-year outcome from eating disorders: Relevance of personality disorders

In order to assess the relationship of personality disorder and eating disorder outcome 30 eating disordered patients were followed up 4-5 years after taking part in a study examining the prevalence of personality disorders in eating disordered individuals. Subjects with personality disorders did not differ from those without personality disorders in the amount of symptomatic change over time, although their psychopathology generally remained more severe. The relationship of personality disorder and clinical outcome ratings varied depending on the personality measure. SCID-II personality disorder diagnoses were not significantly associated with outcome ratings, but were related to a greater likelihood to be hospitalized and treated with psychotropic medications. Results with a new personality measure, the Wisconsin Personality Inventory, did display an association between personality disturbance and eating disorder outcome ratings and also suggested that borderline personality was a significant predictor of outcome.

Borderline versus other personality disorders in the eating disorders : clinical description

The authors compared eating-disordered patients with borderline personality disorder to those patients with other personality disorders or none at all. Borderline subjects differed from other personality disorders in several ways; most notably their histories of sexual abuse, self-mutilation, suicide gestures, and perceived hostile parental relationships

The Long-Term Outcome of Early Onset Anorexia Nervosa: A Critical Review

Abstract Anorexia nervosa is a serious psychosomatic disorder which most typically begins between 16 and 18 years of age. Clinicians have often held that early age of onset (e.g. age 11 to 15) is associated with a better outcome. This paper reviews the long-term outcome studies on anorexia nervosa and concludes that this contention is not supported by available data. The methodologies of 7 outcome studies which focus on an early onset population are critiqued, and it is concluded that 2 are strong. Because of the increasing prevalence of anorexia nervosa, this once rare disorder can now be more easily investigated, and consequently better follow-up studies which examine potential prognostic factors, including age of onset, should be forthcoming.

The psychodynamic diversity of anorexia nervosa

This paper proposes that anorexia nervosa patients are a psychodynamically heterogeneous group and can be usefully divided into three subtypes — the borderline; the empty, understructured; and the emotionally-conflicted, identity-confused. Clinical experience and the long-term outcome literature challenge any uniformity assumptions about anorexia nervosa. It is noted that anorexia nervosa appears to be a “spectrum disorder” with presentations ranging from normative adolescent concern about weight, dieting, appearance, etc. to severe psychopathology and classical anorexic symptomatology among those predisposed.

Sugar, opioids and binge eating

There is evidence that endogenous opiates are involved in the control of feeding in experimental animals. Several types of experimental obesity are associated with increased opiate production and/or increased numbers and sensitivity of opiate receptors. Research with experimental animals suggests that nutrients, particularly sugar, have an effect on feeding behavior that is mediated by opiates. For instance, the obesity-producing effect of a palatable diet in rodents is blocked by opiate antagonists. Stress induced feeding in rodents leads to preferential sucrose ingestion and is blocked by opiate antagonists and beta-endorphin. The effect of nutrients on the endogenous opiate system of humans is less clear. Clinical experience suggest that carbohydrates (sugar in particular) play a role in binge eating and obesity. Many binge eaters preferentially eat sweets during a binge. Many obese individuals consume more than half of their total daily calories as carbohydrates. Sweet snacking is a frequent behavior at times of stress. Recent evidence suggests that sugar can lead to increased beta-endorphin production in obese subjects.

Bulimia and the Basic Fault: A Psychoanalytic Interpretation of the Binging‐Vomiting Syndrome

A psychoanalytic formulation of bulimia based on the work of Balint and Kohut is presented. Its central thesis is that severe bulimics demonstrate a “basic fault” in their ego, specifically an impairment in functions which regulate tension. Because of this deficiency they are subjected to intolerable internal tension which enfeebles their sense of self. The typical bulimic sequence of dieting, binging, vomiting, relaxation, and repudiation is seen as a defensive reparative device which attempts to alleviate internal tension and to bridge the underlying fault. Illustrative case material is included.

Plasma immunoreactive beta-endorphin in bulimics.

The plasma beta-endorphin response to glucose ingestion was compared in 8 bulimics and 8 controls. The bulimics demonstrated a sustained elevation of plasma beta-endorphin unrelated to glucose ingestion throughout the 5-hour study period. It is hypothesized that such an elevation of beta-endorphin is the result of stress and that it may play an important role in the perpetuation of the binge-vomiting cycle.

Self‐Concept in Adolescent Anorexics

Two measures of self-concept, the Offer Self-image Questionnaire (OSIQ) and the Structural Analysis of Social Behavior (SASB)-Introject, were administered to 30 hospitalized female adolescent anorexics. The OSIQ responses yielded a “mixed pattern” of self-concept as compared to normal subjects with good adjustment in some areas (e.g., morals, impulse control, educational goals) and very poor adjustment in others (e.g., emotional tone, body and self-image, sexual attitudes). This unusual OSIQ pattern appears to be unique to anorexics. The SASB-Introject found the anorexics to be self-restraining and self-attacking. However, what separated the anorexics from a normal reference group was not the level of self-restraint (both groups were high in this respect) but the intense intrapunitiveness of the anorexics. Comparing the two measures, good adjustment on the OSIQ scales was highly correlated with low self-attack on the SASB-Introject. Clinical and research implications of these findings are discussed.

Immunoreactive beta-endorphin increases after IV glucose in obese human subjects

The plasma beta-endorphin of obese human subjects and non-obese controls was compared following the intravenous infusion of 25 grams of glucose. The plasma beta-endorphin of the obese subjects was significantly higher than controls one hour and four and one half hours after glucose infusion. The increased beta-endorphin of the obese subjects was associated with falling blood sugar.