1/10. methylphenidate treatment for bulimia nervosa associated with a cluster B personality disorder.OBJECTIVES: psychotherapy and antidepressant medication are helpful to many patients with bulimia nervosa (BN). However, a substantial number of bulimics respond poorly to such treatments. Recent studies suggest that many of the poor responders have cluster B personality disorders. In some ways, the symptomatology of bulimics who have a comorbid cluster B disorder resembles that of patients with attention deficit hyperactivity disorder (ADHD). In particular, individuals in both groups frequently have a high level of impulsivity. Such a resemblance raised the question of whether administration of methylphenidate (MPH), a drug used to treat ADHD, would have therapeutic effects in this subgroup of BN patients. methods: In a pilot study, we administered MPH to 2 patients with BN and cluster B traits and found beneficial effects. These patients had not responded to adequate trials of psychotherapy and selective serotonin reuptake inhibitors (SSRIs). RESULTS: MPH treatment was effective. Both patients had decreased binging and purging. DISCUSSION: MPH may be useful for bulimics with cluster B personality disorder who respond poorly to conventional treatment. Further studies of MPH administration may be worthwhile. Due to the potential risks, however, clinical treatment with this agent is not recommended at this time.- - - - - - - - - - ranking = 1keywords = personality disorder, personality (Clic here for more details about this article) |
2/10. bariatric surgery in a patient with possible psychiatric contraindications.Grade III obesity (BMI > 39.9 kg/m2) is considered a chronic disease where clinical and diet therapy show poor results, with high rates of relapse. The most consistent results are those obtained through surgical procedures. Several authors discuss the contraindications for the performance of anti-obesity operations. Psychiatric disorders are often considered contraindications to these operations, especially affective disorders, psychotic disorders and personality disorders. The authors report the case of a 37-year-old patient, with obesity history since the age of 12, and anorexiant abuse (amphetamine-derived substances) during 20 years, binge-eating episodes, purgative compensatory behaviors and recurrent depressive symptoms. She was submitted to anti-obesity surgery in August 2000 (BMI 40.2). The outcome is reported and a discussion of the possible psychiatric contraindications for the anti-obesity surgeries is proposed.- - - - - - - - - - ranking = 0.16666666666667keywords = personality disorder, personality (Clic here for more details about this article) |
3/10. An unusual case of pica.This paper presents the case of a 29 year old woman who compulsively ate rocks and pebbles, a habit developed in childhood. Extensive psychometric testing did not demonstrate phobias, obsessions, tendency to increased anxiety, depression or anorexic or bulimic disorder. The development of pica is partially explained by a childhood eating disorder, obsessive personality traits, cultural factors and specific (personality induced) stresses. Stress-reducing measures were successful in eliminating the eating disorder.- - - - - - - - - - ranking = 0.067447586273269keywords = personality (Clic here for more details about this article) |
4/10. Covert multiple personality underlying eating disorders.Frequently, MPD patients present themselves to the clinician with a variety of psychophysiological symptoms. Eating-disorder symptoms may be one of these, and may include the following: binge eating, self-induced vomiting, laxative abuse, excessive exercising, body image distortion, self-starvation, fluctuations in body weight, and nausea. Following are five cases in whom the pathological eating behavior was a manifestation of an underlying multiple personality disorder. The pathological eating behavior was so severe that some patients matched DSM-III-R diagnostic criteria for an eating disorder. Clinicians dealing with eating disorders should be aware that some patients may represent a subgroup in whom the underlying cause for the eating disorder may be MPD. These patients seldom respond to conventional treatment modalities used in eating-disorders programs, and only when the underlying multiplicity is identified and treated by a trained clinician, will the patient's eating-disorder symptoms improve.- - - - - - - - - - ranking = 0.3015618392132keywords = personality disorder, personality (Clic here for more details about this article) |
5/10. Long-term course in 14 bulimic patients treated with psychotherapy.Fourteen patients with bulimia were treated with group psychotherapy and with strategic use of antidepressants and individual psychotherapy as needed. The 12 who achieved sustained remission required an average of 21 months of treatment. patients with both an axis I and an axis II diagnosis did less well and required longer treatment than those who met criteria for bulimia only. Bulimic symptoms varied substantially with time, so that a definition of remission requiring that a patient be symptom-free for 6 months was more accurate than acute outcome data. patients with comorbid affective disorders, personality disorders, and bulimia had the poorest prognosis.- - - - - - - - - - ranking = 0.16666666666667keywords = personality disorder, personality (Clic here for more details about this article) |
6/10. Early trauma, dissociation, and late onset in the eating disorders.Although the majority of patients with anorexia nervosa and bulimia nervosa develop these disorders in their teens and 20s, some patients develop an eating disorder in their 30s, 40s, or 50s. We present a subgroup of patients with the following pattern of symptoms and historical detail: (1) severe sexual and physical abuse by family members; (2) relatively good premorbid professional and marital adjustment (considering later difficulties) though characterized by (3) hypomania, binge eating, and morbid obesity. A pronounced shift in eating behaviors follows (4) medical trauma (e.g., injury, cancer, surgery) that occurs after age 30, interrupts previous hypomanic adaptation, and leads to severe restriction, purging, and dramatic weight loss (e.g., 100 lb). Although only one patient met full criteria for anorexia nervosa, weight loss and starvation were serious enough to provoke further medical crises in all patients. Finally, (5) during both weight loss and weight restoration patients demonstrated significant dissociative disturbance, including dissociated mood and personality states (i.e., multiple personality disorder), self-destructive behavioral episodes repeating early trauma, and avoidance of food as a way to manage PTSD symptoms.- - - - - - - - - - ranking = 0.2003904598033keywords = personality disorder, personality (Clic here for more details about this article) |
7/10. Self-induced abortion in a bulimic woman.We report the case of a woman with bulimia nervosa, several personality disorders, and a past history of anorexia nervosa who deliberately induced an abortion via self-imposed starvation and vigorous exercise. Her history reveals severe obsessive-compulsive and narcissistic personality disorders as well as a lifelong pattern of denial of affect and illness.- - - - - - - - - - ranking = 0.33333333333333keywords = personality disorder, personality (Clic here for more details about this article) |
8/10. patients with bulimia nervosa who fail to engage in cognitive behavior therapy.Although cognitive behavioral treatment is the treatment of choice in bulimia nervosa, patients' response is variable. A minority of patients do not respond at all and some never engage in treatment. This paper concerns the latter group. A case series of six such patients with whom treatment could not be initiated is compared with a group who received a full course of treatment. The group with whom treatment could not begin were found to have a longer history of disorder, to report excessive laxative abuse, to have more severe depressed mood and a greater dissatisfaction with their body weight. In addition, they were more likely to have abused psychoactive substances, engaged in episodes of self-harm, and have a lower self-esteem. They were also more likely to be diagnosed as having borderline personality disorder. patients presenting with the wide range of difficulties characteristic of this group require a more intensive form of treatment than standard outpatient cognitive behavior therapy.- - - - - - - - - - ranking = 0.16666666666667keywords = personality disorder, personality (Clic here for more details about this article) |
9/10. Multiple personality in eating disorder patients.Although the overlap between childhood sexual and physical abuse and eating disorders is well known, little work has been done on the sequelae of childhood trauma in eating disorder patients. Dissociative phenomena are common in adult survivors of childhood abuse, with multiple personality disorder (MPD) being the most extreme form of dissociative disorder. We describe two women who presented for inpatient treatment of eating disorders who were subsequently found to have MPD. Because the eating pathology in these patients contained atypical features related to the MPD process, uncovering MPD was critical in the treatment of their eating behavior. MPD should be considered in any atypical or treatment-resistant eating disorder patient.- - - - - - - - - - ranking = 0.3015618392132keywords = personality disorder, personality (Clic here for more details about this article) |
10/10. diagnosis and treatment of bulimia nervosa.bulimia nervosa often has an obscure presentation that requires a high level of suspicion by physicians. awareness of subtle signs and knowledge of important questions to pursue are critical to a physician's ability to diagnose this disorder. Since bulimia nervosa may have several comorbid psychiatric disorders, such as depression, substance abuse, and personality disorders, it is important to refer patients for further evaluation and treatment. The treatment of bulimia nervosa is comprehensive and individualized and may include cognitive-behavioral therapy, group therapy, family therapy, individual psychotherapy, pharmacotherapy, or hospitalization. The comorbid disorders must also be addressed with appropriate treatment such as a drug or alcohol rehabilitation program for substance abusers. Although the prognosis can be variable, the majority of bulimic patients have a serious chronic illness with remissions and exacerbations.- - - - - - - - - - ranking = 0.16666666666667keywords = personality disorder, personality (Clic here for more details about this article) |
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