The course of eating disorder not otherwise specified and its subtypes in patients with borderline personality disorder
Weingeroff, Jolie L.
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Research suggests that "eating disorder not otherwise specified" (EDNOS) is particularly prevalent among individuals with borderline personality disorder (BPD). However, longitudinal data concerning course and predictors of outcome among different subtypes of EDNOS are scarce, particularly with comorbid BPD. The purpose of this study was to examine the longitudinal course of ED NOS subtypes and baseline predictors of outcome of ED NOS over 1 0 years of prospective follow-up in borderline patients. Two hundred and ninety patients who met Revised Diagnostic Interview for Borderlines (DIB-R) and Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised (DSM-111-R) criteria for BPD were followed prospectively over 10 years. Five subtypes of Structured Clinical Interview for DSM-111-R Axis I Disorders (SCID-1) diagnosed EDNOS were identified: subthreshold anorexia nervosa (AN) above the low-weight cut-off; subthreshold AN without loss of menses, subthreshold bulimia nervosa (BN); binge eating disorder (BED); and purging disorder. At baseline, 20% of the sample met criteria for an EDNOS subtype. In the first study, generalized estimating equations were first conducted to determine the prevalence of EDNOS subtypes over time. We used Kaplan-Meier survival analyses to examine time-to-remission, recurrence, and new onsets of the EDNOS subtypes. In the second study, baseline body mass index (BMI), socioeconomic status (SES), global assessment of functioning (GAF), social security disability income (SSOI), polypharmacy, and severity of childhood neglect, sexual abuse, and "other abuse" (e.g., physical, verbal, emotional) were examined as predictors of the course of EDNOS. Findings from the first study indicate that over time, rates of EDNOS were observed to decrease, and remissions were common. Among the EDNOS subtypes, BED was observed to have a particularly slow rate of remission and moderate rates of new onsets. Subthreshold AN without low weight had high rates of recurrence and new onsets. Findings of the second study indicate that borderline patients with EDNOS who were receiving SSDI at baseline were less likely to experience a remission of EDNOS and more likely to experience a recurrence. Additionally, severity of childhood adversity predicted new onsets of EDNOS. Findings suggest that receiving SSOI and severity of childhood adversity importantly impact the course of EDNOS in BPD.
Thesis (Ph.D.)--Boston University