**10. Main conclusions of the chapter**


#### **11. References**

140 New Insights into the Prevention and Treatment of Bulimia Nervosa

punctuations are greater in the trustful, convincing and impulsive scales. The comparison between two groups of patients (eating disorders and other mental disorders) did not reveal the existence of differences in coping styles except at self-criticism, style in which patients' scores with eating disorders were relevantly greater than those obtained in other mental disorders. Regarding personality styles, punctuations at inhibited and impulsive personalities were greater in the patients with other mental disorders than in the group of

Comparing patients with anorexia and bulimia, patients with anorexia nervosa obtained higher scores at self-criticism, and also at convincing, respectful and sensitive personality.

In the same study, a cluster analysis revealed the existence of two groups of patients. One group showed greater self-criticism, wishful thinking, social withdrawal, inadequate control centred upon emotions and inadequate control in general. In this group introversion, inhibition, sensitivity and impulsivity prevailed. In this group, 53.1% of the patients suffered from bulimia and 69% suffered from anorexia. In the other group, scores were higher in problem solving, social support, perceived self-efficacy, adequate control centred upon problems and adequate control in general. In this group scores at sociable, trustful, convincing and respectful personality were higher. In this group, 46.5% of the patients

With respect to personality features, this study confirmed what has been highlighted by other authors (Cano, Rodríguez, et al., 2007) in the sense that stability-extroversion is associated to more adequate coping strategies, while unstable-introvert people present greater inadequacy. However, studies on personality and eating disorders have proven controversial because they have serious methodological deficiencies (Echeburúa & Marañón, 2001). For the future, coping strategies studies could be proposed as something more operative than the idea of associating eating disorders to this or that personality style and making prognostic inferences on the basis of it. In fact, the result of the cluster analysis executed, using the dispositional (personality) as well as the contextual (coping strategies) ratify such findings as those of other authors (Strober, Salkin, et al., 1982; Westen & Harnden-Fischer, 2001) in the sense that there is presence of subgroups of patients with eating disorders with worse coping strategies and prevailing of introversion-instability.

 Research has often found bulimic patients to be extroverted, histrionic, and affectively unstable. It is possible that both, anorexia nervosa and bulimia nervosa may be linked to personality factors heterogeneously. So that, more than one type of personality could

 Despite the fact that the dimension impulsivity-compulsivity seems to be a useful tool to represent the two main eating disorders, it is difficult to explain the concurrence of bulimia nervosa and obsessiveness, or how an eating disorder as anorexia nervosa

Up to now, the multi-impulsive bulimia is not accepted as a different type of bulimia

 Some results on the association between symptoms of bulimia nervosa and substance abuse/dependence have lead to the hypothesis of bulimia nervosa as an addictive

cause or contribute to the symptoms of the eating disorders.

nervosa despite many authors state its undoubted clinical presence.

Patients with bulimia nervosa scored more at impulsive personality.

suffered from bulimia and 31% suffered from anorexia.

**10. Main conclusions of the chapter** 

becomes another one as bulimia nervosa.

disorder.

eating disorders.


Fedorowicz, VJ.; Falissard, B.; Foulon, C.; Dardennes, R.; Divac, SM.; Guelfi, JD. & Rouillon,

Fernández Aranda F. (2006). Poblaciones especiales: bulimia multi-impulsiva. In: *Bulimia* 

Fichter, MM.; Quadflieg, N. & Rief, W. (1994). Course of multi-impulsive bulimia.

Foa, E. & Wilson, R. (1991). *Stop obsessing: How to overcome your obsessions and compulsions*.

Folkman, S. & Moskowitz, JT. (2004). Coping: Pitfalls and promise. *Annual Review of* 

Franko, DL. & Keel, PK. (2006). Suicidality in eating disorders: Occurrence, correlates, and

Franko, DL.; Keel, PK.; Dorer, DJ.; Blais, MA.; Delinsky, SS.; Eddy, KT.; Charat, V.; Renn, R.

Gartner, AF.; Marcus, RN.; Halmi, K. & Loranger, AW. (1989). DSM-III-R Personality

Grucza, RA.; Przybeck, TR. & Cloninger, CR. (2007). Prevalence and correlates of binge

Herzog DB.; Keller, MB.; Sacks, NR.; Yeh, CJ. & Lavori, PW. (1992). Psychiatric morbidity in

Herzog, DB.; Keller, MB.; Lavori, PW.; Kenny, GM. & Sacks, NR. (1992). The Prevalence of

Holderness, CC.; Brooks-Gunn, J. & Warren, MP. (1994). Co-morbidity of eating disorders

Jáuregui Lobera, I.; Estébanez, S.; Santiago Fernández, MJ.; Alvarez Bautista, E. & Garrido,

Jáuregui Lobera, I.; Santiago Fernández, MJ. & Estébanez Humanes, S. (2009). Eating

Johnson, C.; Tobin, D. & Enright, A. (1989). Prevalence and clinical characteristics of

disorders? *Psychological Medicine*, Vol 34., pp. 843-853. ISSN 0033-2917. Gargallo, M.; Fernández Aranda, F. & Raich, RM. (2003) Bulimia nerviosa y trastornos de la

*and Health Psychology*, Vol 3., pp. 335-349. ISSN 1697-2600.

*and Adolescent Psychiatry,* Vol 31., pp. 810-818. ISSN 021-9630.

*Psychiatry,* Vol *53.*, pp. 147-152. ISSN 0160-6689.

clinical implications. *Clinical Psychology Review*, Vol 26., pp. 769–782. ISSN 0272-

& Herzog, DB. (2004). What predicts suicide attempts in women with eating

personalidad. Una revisión teórica de la literatura. *International Journal of Clinical* 

Disorders in Patients with Eating Disorders*. American Journal of Psychiatry,* Vol 146.,

eating disorder in a community sample. *Comprehensive Psychiatry*, Vol 48., pp. 124–

treatment seeking anorexics and bulimics. *Journal of the American Academy of Child* 

Personality Disorders in 210 women with Eating Disorders. *Journal of Clinical* 

and substance abuse review of the literature. *Interantional Journal of Eating Disorders*,

O. (2009). Coping strategies in eating disorders*. European Eating Disorders Review*,

behaviour disorders and personality. A study using MCMI-II. *Atención Primaria*,

borderline patients in an eating-disordered population. *Journal of Clinical Psychiatry,* 

*Psychological Medicine*, Vol 24., pp. 591–604. ISSN 0033-2917.

Bantam Books, ISBN 978-0553381177, New York.

*Psychology,* Vol 55., pp. 745-774. ISSN 0066-4308.

589–595, ISSN 0276-3478.

84-8473-416-1, Madrid.

pp. 1585-1591, ISSN 0002-953X.

Vol 16., pp. 1–34, ISSN 0276-3478.

Vol 17., pp. 220-226. ISSN 1072-4133.

Vol 41., pp. 201-206. ISSN 0212-6567.

Vol 50., pp. 9-15. ISSN 0160-6689.

131. ISSN 0010-440X.

7358.

F. (2007). Factors associated with suicidal behaviors in a large French sample of inpatients with eating disorders. *International Journal of Eating Disorders*, Vol 40., pp.

*nerviosa. Perspectivas clínicas actuales*, FJ. Vaz (Coord), pp. 241-247. Ergon, ISBN 978-


Cano García, FJ.; Rodríguez Franco, L. & García Martínez, J. (2007). Spanish version of the

Casper, R. (1990) Personality features of women with good outcome from restricting anorexia nervosa. *Psychosomatic Medicine*, Vol 52., pp. 156–170. ISSN 0033-3174. Clinton, DN. & Glant, R. (1992). The eating disorders spectrum of DSM-III-R. Clinical

Cook Myers, T.; Wonderlich, SA.; Crosby, R.; Mitchell, JE.; Steffen, KJ.; Smyth, J. &

Corcos, M.; Taïeb, O.; Benoit-Lamy, S.; Paterniti, S.; Jeammet, P. & Flament, MF. (2002).

Díaz, M.; Carrasco, JL.; Prieto, R. & Saiz, J. (1999). El papel de la personalidad en los

Dohm, FA.; Striegel-Moore, RH.; Wilfley, DE.; Pike, KM.; Hook, J. & Fairburn, CG. (2002).

Dolan, B.; Evans, C. & Norton, K. (1994). Disordered eating behaviour and attitudes in

Echeburúa, E. & Corral, P. (1999). Avances en el tratamiento, cognitivo-conductual de los

Echeburúa, E. & Marañón, I. (2001). Comorbilidad de las alteraciones de la conducta

Fahy, T. & Eisler, I. (1993). Impulsivity and eating disorders. *British Journal of Psychiatry,* Vol

Favaro, A. & Santonastaso, P. (1996). Purging behaviors, suicide attempts, and psychiatric

Favaro, A. & Santonastaso, P. (2000). Self-injurious behavior in anorexia nervosa. *The Journal of Nervous and Mental Disease*, Vol 188., pp. 537-542, ISSN 0022-3018.

trastornos de la conducta alimentaria. *Actas Españolas de Psiquiatría*, Vol 27., pp. 43-

Self-harm and substance use in a community sample of Black and White women with binge eating disorder or bulimia nervosa. *International Journal of Eating* 

Female and Male Patients with Personality Disorders*. Journal of Personality* 

trastornos de personalidad. *Análisis y Modificación de Conducta*, Vol 25., pp. 585-614,

alimentaria con los trastornos de personalidad. *Psicología Conductual*, Vol 9., pp.

symptoms in 398 eating disordered subjects. *International Journal of Eating Disorders*,

*Acta Psychiatrica Scandinavica*, Vol 106., pp. 381-386. ISSN 0001-690X. Corstorphine, E.; Mountford, V.; Tomlinson, S.; Waller, G. & Meyer, C. (2007). Distress tolerance in the eating disorders. *Eating Behaviors*, Vol 8., pp. 91-97. ISSN 471-0153. David, JP. & Suls, J. (1999). Coping efforts in daily life: role of big five traits and problem appraisals. *Journal of Personality*, Vol 67., pp. 265-94. ISSN 1467-6494. Diaz Marsá, M. (1999). Psicobiología de los trastornos alimentarios. *Aula Médica Psiquiatría*,

*Disorders*, Vol 39., pp. 655-661, ISSN 0276-3478.

*Disorders*, Vol 32., pp. 389-400, ISSN 0276-3478.

*Disorders,* Vol 8., pp. 17-27. ISSN 0021-843X.

1139-9287.

ISSN 0022-3018.

Vol 1., pp. 219-238.

50. ISSN 1139-9287.

ISSN 211-7339.

162., pp. 193-197.

513-525. ISSN 1132-9483.

Vol 20., pp. 99-103, ISSN 0276-3478.

Coping Strategies Inventory. *Actas Españolas de Psiquiatría*, Vol 35., pp. 29–39. ISSN

features and psychosocial concomitants of 86 consecutive cases from a Swedish urban catchment area *The Journal of Nervous and Mental Disease*, Vol 180., pp. 244-50,

Miltenberger, R. (2006). Is multi-impulsive bulimia a distinct type of bulimia nervosa: Psychopathology and EMA findings. *International Journal of Eating* 

Suicide attempts in women with bulimia nervosa: frequency and characteristics.


Ponce de León, C. (2006). Bulimia nerviosa y personalidad. In: *Bulimia nerviosa. Perspectivas* 

Rossiter, EM.; Agras, WS.; Telch, CF. & Schneider JA. (1993). Cluster B personality disorder

Sarason, IG. & Sarason, BR. (1996). *Psicología anormal*. Prentice-Hall, ISBN 968-880-538-6,

Schmidt, U.; Hodes, M. & Treasure, J. (1992). Early onset bulimia nervosa: who is at risk? A

Skodol, AE.; Oldham, JM.; Hyler, SE.; Kellman, HD.; Doidge, N. & Dacies, M. (1993).

Sohlberg, S. & Strober, M. (1994). Personality in anorexia nervosa: an update and a

Spitzer, RL.; Williams, JB.; Gibbon, M. & First, MB. (1992). *The Structured Clinical Interview for* 

Steiger, H. & Stotland, S. (1996). Prospective study of outcome in bulimics as a function of

*International Journal of Eating Disorders,* Vol 20.*,* pp. 149-161*,* ISSN 0276-3478. Steiger, H. & Stotland, S. (1996). Prospective study of outcome in bulimics as a function of

*International Journal of Eating Disorders,* Vol 20.*,* pp. 149-161*,* ISSN 0276-3478. Steiger, H.; Leung, F.; Thibaudeau, J. & Houle, L. (1993). Prognostic utility subcomponents

Steiger, H.; Liquornik, K.; Chapman, J. & Hussain N. (1991). Personality and family

Steiger, H.; Young, SN.; Ng Ying Kin, NMK.; Koerner, N.; Israel, M.; Lageix, P. & Paris, J.

bulimia nervosa. *Psychological Medicine*, Vol 31., pp. 85-95. ISSN 0033-2917. Strober, M.; Salkin, B.; Burroughs, J. & Morrell, W. (1982). Validity of the bulimia-restricter

Suzuki, K.; Takeda, A. & Matsushita, S. (1995). Coprevalence of bulimia with alcohol abuse

Svirko, E. & Hawton, K. (2007). Self-injurious behavior and eating disorders: The extent and

*Psychology,* Vol *32.,* pp. 187-197. ISSN 0144-6657.

*Journal of Eating Disorders*, Vol 13., pp. 349-357, ISSN 0276-3478.

*Journal of Eating Disorders,* Vol 14., pp. 403-416, ISSN 0276-3478.

México.

0033-2917.

690X.

990X.

ISSN 0276-3478.

51, ISSN 0022-3018.

ISSN 0363-0234.

90., pp. 971-975. ISSN 1360-0443.

*clínicas actuales,* FJ. Vaz (Coord), pp. 49-56. Ergon, ISBN 978-84-8473-416-1, Madrid.

characteristics predict outcome in the treatment of bulimia nervosa. *International* 

retrospective case-control study. *Psychological Medicine*, Vol 22., pp 623-628. ISSN

Comorbidity of DSM-III-R Eating Disorders and Personality Disorders. *International*

theoretical integration. *Acta Psychiatrica Scandinavica*, Vol 89., pp. 1–15. ISSN 0001-

*DSM-III-R (SCID).* Archives of General Psychiatry, Vol 49., pp. 624-629, ISSN 0003-

Axis-II comorbidity: Long-term responses on eating and Psychiatric symptoms.

Axis-II comorbidity: Long-term responses on eating and Psychiatric symptoms.

of the borderline personality construct in bulimia nervosa. *British Journal of Clinical* 

disturbances in eating-disorder patients: comparison of "restricters" and "bingers" to normal controls. *International Journal of Eating Disorders*, Vol 10., pp. 501–512,

(2001). Implications of impulsive and affective symptoms for serotonin function in

distinction in anorexia nervosa. Parental personality characteristics and family psychiatric morbidity. *The Journal of Nervous and Mental Disease*, Vol 170., pp. 345-

and smoking among Japanese male and female high school students. *Addiction*, Vol

nature of the association. *Suicide and Life-Threatening Behavior*, Vol 37., pp. 409–421.


Kaye, WH.; Lilenfeld, LR.; Plotnicov, K.; Merikangas, KR.; Nagy, L.; Strober M, Bulik CM.;

Kennedy, SH.; McVey, G. & Kata, R. (1990). Personality Disorders in Anorexia Nervosa and

Lacey, JH. & Evans, CDH. (1986). The impulsivist: a multi-impulsive personality disorder.

Levitt, JL.; Sansone, RA. & Cohn, L. (2004). *Self-harm behavior and eating disorders*. Brunner-

Loranger, AW. (1995). *International Personality Disorder Examination (IPDE)*. Organización

Marino, MF. & Zanarini, MC. (2001). Relationship between EDNOS and its subtypes and

Matsunaga, H.; Kiriike, N.; Nagata, T. & Yamagami, S. (1998). Personality disorders in

Medina, A. & Moreno, MJ. (1998). *Los trastornos de la personalidad. Un estudio médico-filosófico*.

Millon, T. & Ávila, A. (1998). *Inventario clínico multiaxial de Millon-II: manual*. TEA Ediciones,

Mitchell, JE.; Hatsukami, D.; Pyle, R. % Eckert, E. (1988). Bulimia with and without a family history of drug abuse. *Addictive Behaviors*, Vol 13., pp. 245-51. ISSN 0306-4603. Nagata, T.; Kawarada, Y.; Kiriike, N. & Iketani, T. (2000). Multi-impulsivity of Japanese

Nagata, T.; Matsuyama, M.; Kiriike, N.; Iketani, T. & Oshima, J. (2000). Stress coping

Newton, JR.; Freeman, CP. & Munro, J. (1993). Impulsivity and dyscontrol in bulimia

Peñas Lledó, EM. (2006). Impulsividad y bulimia nerviosa. In: Bulimia nerviosa.

Peñas-Lledó, E. & Waller, G. (2001). Bulimic psychopathology and impulsive behaviors

Peterson, CB.; Wonderlich, SA.; Mitchell, JE. & Crow, SJ. (2004). Integrative cognitive

*Psychiatrica Scandinavica*, Vol 87., pp. 389-394. ISSN 0001-690X.

Borderline Personality Disorder. *International Journal of Eating Disorders,* Vol 29., pp.

patients with eating disorders in Japan. *International Journal of Eating Disorders,* Vol

patients with eating disorders: primary and secondary impulsivity. *Psychiatry* 

strategy in Japanese patients with eating disorders: relationship with bulimic and impulsive behaviors. *The Journal of Nervous and Mental Disease*, Vol 188., pp. 280-286,

nervosa: is impulsivity an independent phenomenon or a marker of severity? *Acta* 

Perspectivas clínicas actuals, FJ. Vaz (Coord), pp. 63-69. Ergon, ISBN 978-84-8473-

among nonclinical women. *International Journal of Eating Disorders*, Vol 29., pp. 71-

therapy for bulimia nervosa. In: Handbook of eating disorders and obesity, JK. Thompson (Ed.), pp. 245–262. John Wiley & Sons, ISBN 78-0-471-23073-1, Hoboken,

*British Journal of Addiction*, Vol 81., pp. 641–649. ISSN 0952-0481.

Vol 20., pp. 878–881. ISSN 0145-6008.

Routledge, ISBN 9780415946988, New York.

349-353, ISSN 0276-3478.

23., pp. 399-408*.,* ISSN 0276-3478.

ISBN 84-7174-491-0, Madrid.

ISSN 0022-3018.

416-1, Madrid.

New Jersey.

75, ISSN 0276-3478.

Nanuk, ISBN 978-84-923902-0-5, Córdoba.

*Research*, Vol 94., pp. 239–250. ISSN 0165-1781.

Mundial de la Salud, ISBN 978-0880489171, Ginebra:

3956.

Moss, H. & Greeno, CG. (1996). Bulimia nervosa and substance dependence: Association and family transmission. *Alcoholism: Clinical and Experimental Research*,

Bulimia Nervosa. *Journal of Psychiatry Research,* Vol 24., pp. 259-269. ISSN 0022-


**10** 

*Poland* 

Bernadetta Izydorczyk

**A Psychological Profile of the** 

**Suffering from Bulimia Nervosa** 

**Body Self Characteristics in Women** 

*Department of Clinical and Forensic Psychology, University of Silesia in Katowice,* 

Bulimia nervosa appears to be a significant medical condition and a serious social problem since it requires long term and multi-dimensional treatment, and its incidence rates among young generation (predominantly women), has incresed significantly in recent years. The results of scientific research described in psychological and psychiatric literature point to a variety of factors that contribute to development of this eating disorder [Fairburn, Harrison, Lacey, Evans, Thompson, Cash, Pruzinsky, Garner, Józefik, Głębocka, Rabe Jabłońska, Dunajska, Mikołajczyk, Samochowiec, Schier]. The most significant underlying factors include: biological disturbance of hunger and satiety sensing, familial factors (early childhood emotional deficits and traumatic experiences), socio-cultural factors (body image disturbances which develop as a consequence of the "terror" of a slim body, which is being promoted as the only way to success in life), as well as some individual factors such as impulse regulation disturbances, impulsivity, low frustration tolerance, neuroticism, perfectionism, obsessive-compulsive, borderline or histrionic personality disorders [Lacey, Mikołajczyk, Samochowiec]. Lacey and Evan, who defined the concept of Multi Impulsive

Personality Disorder, included bulimia nervosa among its major symptoms [Lacey].

self structure, and determine effective therapy for bulimia nervosa.

with bulimic and anorectic patients [Izydorczyk, Bieńkowska, Klimczyk].

In the light of the recent psychological literature, cognitive and emotional body image disturbances are regarded as significant factors behind development of anorexia and bulimia nervosa [Thompson, Cash, Głębocka, Kulbat, Rabe Jabłońska, Schier]. However, far less scientific research is devoted to body image and the body self distortions in individuals suffering from bulimia nervosa [Rabe-Jabłońska, Dunajska]. The recently observed higher incidence of bulimia nervosa (especially among women), compared to anorexia nervosa, seems to point to a multitude of factors that determine development of this disorder. It also indicates the spread of the cultural cult of "ideal and perfect" body image, and the tendency to conform to social norms regarding physical appearance ("what I should look like") and to disapprove of one's current body shape, which is being promoted as a key to success in life. Thus it can be stated that adequate medical care as well as the quality of family, professional and social roles performed in life significantly support a psychological diagnosis of the body

It is a psychological diagnosis of body experiences and body image in anorexia and bulimia nervosa that I have focused on in my many years of scientific research and therapeutic work

**1. Introduction** 

