Outcome in patients with anorexia and bulimia nervosa and concomitant narcissistic self-disorders

Objective: The present study examines the question of whether concomitant n arcissistic self-disorders indicate a poorer prognosis in patients with ano rexia nervosa (AN) and bulimia nervosa (BN). Method: Ninety-one female inpa tients who met the DSM-IV criteria fo AN or BN were investigated during inp atient treatment by using: a semistructured diagnostic interview, the Eatin g Disorder Inventory (EDI), the Narcissism Inventory (NI), the Hamburg Obse ssion-Compulsion Inventory, and the Inventory of Interpersonal Problems (LI P). The patients were divided into two groups: those with and those without narcissistic self-disorders as measured by the NI. Seventy-five patients w ere assessed at follow-up thirty months after discharge. Results: Fifty-one percent of the follow-up group no longer fulfilled the DSM-IV criteria for AN or BN, and there was no significant correlation with the earlier presen ce of concomitant narcissistic self-disorders. At follow-up, patients with narcissistic self- disorders had significantly more pathological mean score s than patients without such disorders on four of the eight EDI scales and on four of the eight IIP scales. ANOVA for repeated measures revealed signi ficant improvement over time on seven of the eight EDI scales in both group s. However, significant group-by-time interactions demonstrated that patien ts with narcissistic self-disorders had improved more over time than patien ts without self-disturbances. Furthermore, the obsessive-compulsive symptom s of those patients with narcissistic self-disorders who no longer fulfille d DSM-IV criteria for AN or BN had significantly decreased. Conclusion: Our findings indicate that the improvement of eating disorder symptoms corresp onds to a decrease in obsessive-compulsive symptoms. In addition, there is a certain degree of independence between the severity of narcissistic self- disorders and the outcome of AN or BN. The results suggest that concomitant narcissistic self-disorders do not indicate a significantly poorer prognos is in patients with AN and BN.