Trastornos de personalidad en pacientes con desórdenes de la conducta alimentaria

Vanesa Carina Góngora

Resumen


El interés por el estudio sistemático de los trastornos de personalidad en pacientes con desórdenes de la conducta alimentaria comienza con la aparición de la clasificación multiaxial del DSM III en 1980. Desde entonces numerosas publicaciones se han centrado principalmente en la prevalencia y efectos en el tratamiento de los trastornos de la personalidad en pacientes bulímicas y anoréxicas. Estos estudios han tenido resultados inconsistentes debidos, en buena medida, a divergencias conceptuales y metodológicas. En este artículo, se presentan las conclusiones más relevantes de dichas investigaciones, y se analizan las posibles fuentes de discrepancias. En términos generales, se puede afirmar que existe una comorbilidad moderada entre los trastornos de personalidad y los desórdenes de la conducta alimentaria. Los desórdenes más frecuentes son los trastornos borderline, histriónico, obsesivo- compulsivo, dependiente y evitativo de la personalidad. El trastorno borderline y el trastorno histriónico suelen presentarse con mayor frecuencia en la bulimia nerviosa, en tanto que el trastorno evitativo y el obsesivo compulsivo es más característico de la anorexia nerviosa. Sin embargo, el efecto de la relación entre trastornos de personalidad y de la conducta alimentaria en el tratamiento es aún poco clara, dando lugar a numerosas controversias e investigaciones. 


Palabras clave


trastornos de personalidad; trastornos de la conducta alimentaria; comorbilidad

Texto completo:

PDF XML

Referencias


American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American psychiatric Association.

Ames-Frankel, J., Devlin, M., Walsh, T, Strasser, T., Sadik, C., Oldham, J. & Roose, S. (1992). Personality disorder diagnoses in patients with bulimia nervosa: clinical correlates and changes with treatment. Journal of Clinical Psychiatry, 53, 90-96.

Benedek, T. (1936). Dominant ideas and their relation to morbid cravings. International Journal of Psychoanalysis, 17: 40-56.

Braun, D., Sunday, R., & Halmi, K. (1994). Psychiatric comorbidity in patients with eating disorders. Psychological Medicine, 24, 859-867.

Bruch, H. (1973). Eating Disorders: Obsesity, Anorexia and the Person Within. New York, Basic Books, 1973.

Bulik, C., Sullivan, P., Joyce, P., & Carter, F. (1995). Temperament, character and personality disorder in bulimia nervosa. The Journal of Nervous and Mental Disease, 183, 593-598.

Carrol, J., Touyz, S. & Beumont, P. (1996). Specific comorbidity between bulimia nervosa and personality disorders. International Journal of Eating Disorders, 19, 159-170.

Casper, R. (1990). Personality features of women with good outcome from restricting anorexia. Psychosomatic Medicien, 52: 156-170.

Casper, R., Hedeker, D & McClough, J. (1992). Personality dimensions in eating disorders and their relevance for subtyping. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 830-840.

Cooper, J., Morrison, T., Bigman, O., Abramowitz, S., Blunden, D., Nassi, A. & Krener, P. (1988). Bulimia and borderline personality disorder. International Journal of Eating Disorders, 7,43-49

Dennis, A. & Sansone, R. (1997). Treatment of patients with personality disorders in Garner, D & Garfinkel, P. (Eds). Handbook of Treatment for Eating Disorders, 2nd Edition, New York, The Guildford Press.

Fahy, T. (1991). Obsessive compulsive symptoms in eating disorders. Behavior Research and Therapy, 29, 113-116.

Fahy, T., Eiler, I., & Russell, G. (1993). Personality disorder and treatment response in bulimia nervosa. British Journal of Psychiatry, 163, 765-770.

Feinstein, A. (1970). The pre-therapeutic classification of comorbidity in chronic disease. Journal of Chronic Diseases, 23, 455-462.

Freud, S. (1895). Cartas a Fliess. Manuscristos. Manuscrito G: melancolía. Ed. Fernandez Ballesteros.

Garner, D., & Bemis, K. (1982). A cognitive-behavioral approach to anorexia nervosa. Cognitive Therapy and Research, 6, 123-150.

Garner, D.,Garfinkel, P & O0Shaughnessi, M. (1985). The validity of the distinction between bulimia with and without anorexia nervosa. American Journal of Psychiatry, 142, 581-587,

Garner, D., Olmstead, M. P., Davis, R., Rockert, W., Goldbloom, D. & Eagle, M. (1990). The association between bulimic symptoms and reported psychopathology. International Journal of Eating Disorders, 9, 1-16

Gartner, AF., Marcus, RN., Halmi K., & Loranger, AW. (1989). DSM-III-R personality disorders in patients with eating disorders. American Journal of Psychiatry, 146, 1585-1591.

Gunderson, J. & Elliot, G. (1985). The interface between borderline personality disorder and affective disorder. American Journal of Psychiatry, 142: 277-288.

Gwirstsman, H., Roy-Byrne, P., Yager, J. & Gerner, R. (1983). Neuroendocrine abnormalities in bulimia. American Journal of Psychiatry, 140, 559-563.

Herzog, D., Keller, M., Sacks, N., Yeh, C., & Lavori, P. (1992). Psychiatric comorbidity in treatment seeking anorexics and bulimics. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 810-818.

Herzog, D., Nussbaum, K & Marmor, A. (1996). Comorbidity and outcome in eating disorders. The Psychiatric Clinics of North America, 19, 843-859.

Herzog, D.B., Keller, MB., Lavori, P.W., Kenny, G.M., Sacks, N.R. (1992). The prevalence of personality disorders in 210 women with eating disorders. Journal of Clinical Psychiatry, 53, 147-152.

Janet, P. (1919). Las obsesiones y la psicastenia. Paris, Felix Alcan.

Johnson, C., Tobin, D.L. & Dennis, A. (1990). Differences in treatment outcome between borderline and nonborderline bulimics at one-year follow-up. International Journal of Eating Disorders, 9, 617-627.

Kennedy, S., McVey, G. & Katz, R. (1990). Personality disorders in anorexia nervosa and bulimia nervosa. Journal of psychiatric research, 24, 259-269.

Levin, AP & Hyler, SE. (1986). DSM-III personality diagnosis in bulimia. Comprehensive Psychiatry, 27, 47-53.

Millon, T. (1996). Disorders of personality: DSM-IV and Beyond. New York: Wiley

Norman, D., Blais, M., & Herzog, D. (1993). Personality characteristics of eating- disordered patients as identified by the Millon Clinical Multiaxial Inventory, Journal of Personality Disorders, 7, 1-9.

Piran, N., Lerner, P., Garfinkel, P., Kennedy, S., & Broullete, C. (1988). Personality disorders in anorexic patients. International Journal of Eating Disorders, 7, 589-599.

Pope, H. & Hudson, J. (1989). Are eating disorders associated with borderline personality disorder? a critical review. International Journal of Eating Disorders, 8, 1-9.

Pope, H., Frankenburg, F. & Hudson, J. (1987). Is bulimia associated with borderline personality disorder? a controlled study. Journal of Clinical Psychiatry, 48, 181-184.

Powers, P., Coovert, D. Brightwell, D. & Stevens, B. (1988). Other psychiatric disorders among bulimic patients. Comprehensive Psychiatry, 29, 502-508.

Rossiter, E. M., Agras, W. S., Telk , C.F. & Schneider, J.A. (1993). Cluster B personality disorder characteristics to predict outcome in the treatment of bulimia nervosa. International Journal of Eating Disorders, 13, 349-358.

Sansone, R. & Fine, M. (1992). Borderline personality as a predictor of outcome in

women with eating disorders. Journal of Personality Disorders, 6, 176-186.

Sansone, R., Fine, M., Seuferer, S. et al. (1989). The prevalence of borderline personality symptomatology among women with eating disordes, Journal of Clinical Psychology, 45, 603-610.

Schmidt, M. & Telch, M. (1990). Prevalence of personality disorders among bulimics, nonbulimic binge eater, and normal controls. Journal of Psychopathological Behavioral Assessment, 12, 169-185.

Selvini-Pallazoli, M. (1978). Self-starvation. New York, Jason Aronson.

Skodol, A., Oldham, J., Hyler, S., Kellman, H., Doidge, N., Davies, M. (1993). Comorbidity of DSM-III-R eating disorders and personality disorders. International Journal of Eating Disorders, 14, 403-416.

Steiger, H. & Stotland, S. (1996). Prospective study of outcome in bulimics as a function of Axis II comorbidity: long-term responses on eating and psychiatric symptoms. International Journal of Eating Disorders, 20 No 2, 149-161.

Steiger,H.Stotland,S.,&Houle,L.(1994).Prognosticimplicationsof “stable”versus “transient” borderline features in bulimic patients. Journal of Clinical Psychiatry, 55, 206-214.

Strober, M. (1985). Personality factors in anorexia nervosa. Pediatrician: International Journal of Child and Adolescent Health, 12: 134-138.

Swift, W.J. & Wonderlich, S.A. (1988). Borderline versus other personality disorders in the eating disorders clinical description. International Journal of Eating Disorders, 9, 629-638.

Tyrer, P. Gunderson, J., Lyons, M. & Tohen, M. (1997). Special feature: extent of comorbidity between mental state and personality disorders, Journal of Personality Disorders, 11, 242-259.

Van Strien, D., van der Ham, T., & van Engeland, H. (1992). Drop-out characteristics in a follow-up study of 90 eating-disordered patients. International Journal of Eating Disorders, 12, 341-343.

Vandereycken, W. & Pierloot, R. (1983). Long-term outcome research in anorexia nervosa. The problem of patient selection and follow-up duration. International Journal of Eating Disorders, 2, 237-242.

Vitousek, K &Ewald, L. (1993). Self-representation in eating disorders: a cognitive perspective. In. Segal, Z & Blatt (Eds), The self in emotional distress: congitive and psychodynamic perspectives (pp.221-257). New York: Guildford Press.

Vitousek, K. & Manke, F. (1994). Personality variables and disorders in anorexia nervosa and bulimia nervosa. Journal of Abnormal Psychology, 103, 137-147.

Waller, G. (1997). Drop-out and failure to engage in individual outpatient cognitive behavior therapy for bulimic disorders. International Journal of Eating Disorders, 22, 35-41.

Waller, J.V., Kaufman, M.R. & Deutsch, F. (1940). Anorexia nervosa: psychosomatic entity. Psychosomatic Medicine, 2, 3-16.

Widiger, T & Frances, A. (1989). Epidemiology, diagnosis and comorbidity of borderline personality disorders, in American Psychiatric Press Review of Psychiatry, Vol 8. Tasman, A; Hales; J, Frances, A (Eds). Washington, DC, American Psychiatric Press, pp-8-24.

Widiger, T. (1989). The categorical distinction between personality and affective disorders, Journal of Personality Disorders, 3, 77-91.

Wonderlich, S. & Mitchell, J. (1992). Eating disorders and personality disorders in Yager, J, Gwirtsman, H.& Edelstein, C (Eds), Special Problems in Managing Eating Disorders. American Psychiatric Press.

Wonderlich, S., & Mitchel, J. (1992). The comorbidity of personality disorders in the eating disorders. In J. Yager (Ed.), Special problems in managing eating disorders (pp. 51-86). Washington, DC: American Psychiatric Association Press.

Wonderlich, S.A., Fullerton, D., Swift, W.J. & Klein, M.H. (1994). Five-year outcome from eating disorders: relevance of personality disorders. International Journal of Eating Disorders, 15, 233-244.

Wonderlich, SA., Swift, WJ., Slotnick, HB. & Goodman, S. (1990). DSM-III-R personality disorders in eating disorders. International Journal of Eating Disorders, 9, 607-616.

Yager, J. Landsverk, J., Edelstein, C. & Hyler, S. (1989). Screening for axis II personality disorders. Psychosomatics, 30, 255-262.

Yates, W., Sieleni, B., Reich, J., & Brass, C. (1989). Comorbidity of bulimia nervosa and personality disorder. Journal of Clinical Psychiatry, 50, 57-59.

Zanarini, M., Frankenburg, F., Pope, H. (1990). Axis II comorbidity of normal- weight bulimia. Comprenhensive Psychiatry, 30, 20-24.




DOI: http://dx.doi.org/10.18682/pd.v2i0.512

Enlaces refback

  • No hay ningún enlace refback.


Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.

Licencia Creative Commons
La revista Psicodebate Psicología, Cultura y Sociedad de la Facultad de Ciencias Sociales. Universidad de Palermo se distribuye bajo una Licencia Creative Commons Atribución 4.0 Internacional.

https://dspace.palermo.edu/ojs/index.php/psicodebate/index

psicodebate@palermo.edu

ISSN: 1515-2251 e-ISSN: 2451-6600