The clinical relevance of personality disorder cognitions in the eating disorders

• Main Author: Butler, Emma
• Published: University of East London 2009
• Subjects: 150
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.532926

Although cognitive behavioural therapy (CBT) is recommended by the National Institute for Clinical Excellence (2004) as the treatment of choice for bulimia nervosa, it has only been found to be effective for 50-60% of individuals. In addition, the evidence base for the efficacy of CBT in the treatment of anorexia nervosa is weak. It is commonly recognised that there is a high comorbidity between personality disorders (and their associated traits) and eating disorders. The purpose of this study was therefore to examine the cognitions underpinning personality disorders in individuals with eating disorders, and to investigate whether those cognitions reduce the impact of CBT for eating disorders. Participants were 59 individuals with a diagnosed eating disorder presenting for CBT at a specialist eating disorder service. Each participant completed measures of personality disorder cognitions, eating disorder attitudes/dysfunctional assumptions and other psychological symptoms at session one of CBT. Participants were then asked to repeat the measures of eating disorder attitudes/dysfunctional assumptions at session six of CBT. Drop-out rates were recorded. Findings provided evidence of the rapid onset of action of CBT for eating disorders. There was a significant reduction in eating disorder attitudes over the first six sessions. Six personality disorder cognitions were significantly associated with eating disorder attitudes/dysfunctional assumptions and other psychological symptoms. These were avoidant, obsessive-compulsive, dependent, borderline, histrionic and paranoid personality disorder cognitions. Higher levels of dependent and narcissistic personality disorder cognitions were associated with dropping out of treatment before session seven of CBT, and higher levels of histrionic, avoidant and borderline personality disorder cognitions were associated with an improvement in eating disorder attitudes in the first six sessions of CBT. The limitations of the study and recommendations for future research are discussed. In addition, the clinical implications of the findings are considered.