Effects of personality disorder on outcome in short-term group therapy for bulimia nervosa

Dale Wendy Sokoloff (1990)

This dissertation explored the relationship between personality functioning and outcome in a short-term group therapy for bulimia nervosa. The study was designed to test the hypothesis that personality disordered bulimic subjects would have a poorer outcome following a twelve-week group therapy intervention than non-personality disordered subjects. Forty-five female outpatients meeting DSM-III-R criteria for bulimia nervosa were assigned to one of eight consecutive groups. All of these subjects were found to meet criteria for personality disorder on clinician ratings and MCMI scores, with over 60% in the severe range. As expected, limited efficacy was found for the group intervention. Significant improvement at post-treatment was found for depression, ineffectiveness, and number of vomiting-free days per week. A factor analysis of the MCMI produced four oblique factors: Psychological Maladjustment, Extroverted Acting Out, Somatization, and Paranoia. Psychological Maladjustment and Somatization were shown to have a strong relationship to the psychological variables associated with bulimia nervosa. Somatization was found to contribute to less change in loneliness and ineffectiveness. Extroverted Acting Out was related to lower levels of reported loneliness, ineffectiveness, and interpersonal distrust overall and contributed to less change in depression and perfectionism. Extroverted Acting Out was also associated with a greater propensity for change, in both positive and negative directions, in purge-free days, particularly in regard to vomiting. Follow-up interviews were conducted with 14 subjects who completed treatment to assess personal experience of outcome. Subjects reported notable improvement in mood and self-esteem, in conjunction with a greater sense of control over binge/purge behavior, although frequency of bulimic episodes was largely unchanged. Minimal improvement in social adjustment was reported. The subjects identified group process variables as the most helpful aspects of the treatment. Cognitive-behavioral interventions were experienced as less salient to change. Overall, the findings suggest that short-term group therapy is a less effective treatment for personality disordered patients than has been previously demonstrated with other bulimic patients. Treatment interventions aimed principally at bulimic symptoms are less effective with personality disordered patients than interventions aimed specifically at personality development. It is concluded that a process oriented group treatment is useful for these patients in reducing depression, enhancing self-esteem, and promoting a connection to further treatment.