PROSPECTIVE-STUDY OF OUTCOME IN BULIMICS AS A FUNCTION OF AXIS-II COMORBIDITY - LONG-TERM RESPONSES ON EATING AND PSYCHIATRIC-SYMPTOMS

We assessed prognostic implications of categorical personality disorde r (PD) diagnoses at selected points during and following treatment for bulimic syndromes. Seventy-six bulimic cases were organized into Bord erline PD, Other PD, or No PD groups, and then assessed at pretreatmen t, alter 3 months of therapy, and at termination (alter a modal 8 mont hs). Results at 3- and 12-month posttreatment follow-ups (available in 43 and 38 cases, respectively) provided a reflection of status after therapy termination. On comorbid symptoms, borderline/nonborderline di fferences were very striking: Borderlines showed more initial psychiat ric symptoms than did nonborderlines, and despite improvements, retain ed disturbances of clinical magnitude to completion of therapy and int o follow-up. On ea ting symptoms, borderline/nonborderline differences were less dramatic, the overall pattern implying that borderlines sho wed only marginally poorer response in selected areas of disturbance. Results corroborate others linking Axis-II comorbidity to unfavorable outcome in the eating disorders, but suggest that character disturbanc e is more strongly linked to course of general psychiatric symptoms th an it is to course of eating disturbances. We discuss clinical implica tions of differing strengths of association observed between eating an d psychiatric symptoms, on the one hand, and Axis-II pathology on the other. (C) 1996 by John Wiley & Sons, Inc.