A sizeable proportion of patients (30 per cent(lZ> and 32 per cent(2S) were said to have had a 'normal' personality during childhood before their illness. Nevertheless there is general agreement of a close relationship between obsessional personalities and the later development of anorexia nervosa. In fact Janet, who carefully described obsessions and psychasthenia, was dubious about the validity of the diagnostic concept of anorexia nervosa ( anorexie hystérique). He thought that the patient's fear of fatness was an elaborate obsessional idea. (51>
In a study of patients admitted for treatment they were classified into anorexia nervosa, bulimia nervosa, or a combination of the two disorders. (52) Personality disorders were identified through the Structured Clinical Interview for DSM-IIIR personality disorders (SCID-II). Seventy-two per cent of the patients met the criteria for at least one personality disorder. Anorectics were found to have a high rate of obsessive-compulsive personality disorder. On the other hand, bulimic patients with a history of anorexia nervosa showed high rates of borderline (40 per cent) and histrionic (40 per cent) personality disorder. (52)
There have been attempts to disentangle the features of premorbid personality and illness in order to clarify the personality characteristics predisposing to anorexia nervosa. Women who had recovered from restricting anorexia nervosa were tested at an 8- to 10-year follow-up, using a number of self-report instruments. (53) They were compared with two control groups: normal women and the sisters of the recovered anorexic patients. The women who had recovered from anorexia nervosa rated higher on risk avoidance and conforming to authority. In comparison with their sisters, the recovered women showed a greater degree of self-control and impulse control, and less enterprise and spontaneity.
In a study examining the close relationships between anorexia nervosa and obsessive-compulsive personality traits and disorder, 12 patients who had recovered from anorexia nervosa were examined and compared with normal controls.(54) They continued to exhibit obsessional traits in the weight-restored state and attained significantly higher scores on the Maudsley Obsessive-Compulsive Inventory and the Tridimensional Personality Questionnaire (harm avoidance and reward dependence).
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