The British Journal of Psychiatry (2006) 188: 87-88. doi: 10.1192/bjp.188.1.87-a
© 2006 The Royal College of Psychiatrists
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Correspondence

Personality subtypes and cognitive impairment in anorexia nervosa

A. J. Macdonald

North Dorset Primary Care Trust, Forston Clinic, Dorchester DT2 9TB, UK.

Correspondence: E-mail: ajmacdon{at}psychsft.freeserve.co.uk

I read with interest the article by Drs Thompson-Brenner and Westen (2005) about personality subtypes in eating disorders. Subnutrition from any cause is known to impair cognitive function and several workers have identified this in connection with anorexia nervosa (Macdonald, 1995).

The authors give no data on body mass index or weight. However, 38% of their sample had met criteria for anorexia nervosa at some point, 56% were fasting 4 days a week and half were exercising excessively. It is likely therefore that cognitive impairment was present in many. Hence the ‘personality subtypes’ identified may vanish on refeeding, or may be more pronounced, having been masked by cognitive blunting. It seems best to seek for personality subtypes in eating disorders during periods of adequate nutrition.

EDITED BY KIRIAKOS XENITIDIS and COLIN CAMPBELL

REFERENCES

  1. Macdonald, A. J. (1995) Eating disorders. Journal of Family Therapy, 17, 356.
  2. Thompson-Brenner, H. & Westen, D. (2005) Personality subtypes in eating disorders: validation of a classification in a naturalistic sample. British Journal of Psychiatry, 186, 516 -524.[Abstract/Free Full Text]
 

Authors' reply:

H. Thompson-Brenner

Eating Disorders Program, Center for Anxiety and Related Disorders, Psychology Department, Boston University, 648 Beacon Street, Boston, MA 02215, USA.

D. Westen

Eating Disorders Program, Center for Anxiety and Related Disorders, Psychology Department, Boston University, 648 Beacon Street, Boston, MA 02215, USA.

Correspondence: E-mail: ht141{at}hotmail.com

EDITED BY KIRIAKOS XENITIDIS and COLIN CAMPBELL

We appreciate Dr Macdonald's point that subnutrition may cause cognitive changes and other temporary conditions that may appear to affect personality. Data regarding personality in the context of adequate weight and nutrition are important for the accurate description of personality in eating disorders. It can be difficult, however, to ascertain whether shifts in personality functioning that take place through successful treatment or maturation precipitate positive nutritional changes or the reverse. Multiple studies do suggest that personality characteristics similar to those we describe in our report precede the development of eating disorders (Anderluh et al, 2003) and persist following remission of symptoms (Holtkamp et al, 2005). Although we did not report the data in detail, only 6.9% of those in our sample had a weight 15% below ideal, and the number of days of fasting was not correlated with either measure of personality pathology, suggesting this issue may not have compromised our data regarding personality to a significant extent.

REFERENCES

  1. Anderluh, M. B., Tchanturia, K., Rabe-Hesketh, S., et al (2003) Childhood obsessive-compulsive personality traits in adult women with eating disorders: defining a broader eating disorder phenotype. American Journal of Psychiatry, 160, 242 -247.[Abstract/Free Full Text]
  2. Holtkamp, K., Muller, B., Heussen, N., et al (2005) Depression, anxiety, and obsessionality in long-term recovered patients with adolescent-onset anorexia nervosa. European Child and Adolescent Psychiatry, 14, 106 -110.[Medline]




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