The comorbidity of eating disorders and personality disorders: A metaanalytic review of studies published between 1983 and 1998

  • J. H. Rosenvinge
  • M. Martinussen
  • E. Østensen
Review Article


Comorbid personality disorders in eating disordered patients may seriously affect the treatment and course of their illness. Several studies show such a comorbidity, though with inconsistent findings. Qualitative reviews attribute this to methodological shortcomings, but the qualitative method may itself create new shortcomings. To circumvent this, the present, more extensive review applies a meta-analytic approach. Using the databases MEDLINE and PSYCHLIT, the 28 articles published between 1983 and 1998 that presented empirical evidence for an eating disorder and personality disorder comorbidity suitable for meta-analysis were included. We found a higher proportion of eating disordered patients with any personality disorder (average proportion =0.58) related to comparison groups (average proportion =0.28). Compared with anorexia nervosa patients, a higher proportion of patients with bulimia nervosa had a concurrent cluster B personality (average proportion =0.44 ) and a borderline personality disorder (average proportion =0.31). However, no differences between anorexia nervosa and bulimia nervosa patients in proportions of cluster C were found (average proportion =0.45 and 0.44 respectively). Patients with eating disorders and patients with bulimia nervosa in particular, should be routinely assessed for a concurrent personality disorder using structured clinical interviews. In future research, more stringent assessment procedures are highly recommended to address the question of causality between eating disorders and personality disorders, and how eating disorder symptoms and personality disorder symptoms are related to treatment effects.

Key words

Eating disorders personality disorders comorbidity meta-analysis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bruch H.: Four decades of eating disorders. In: Garner D., Garfinkel P. (Eds.), Handbook of psychotherapy for anorexia nervosa and bulimia. New York, Guilford Press, 1985, pp. 7–18.Google Scholar
  2. 2.
    Herzog D.B., Hamburg P., Brotman A.: Psychotherapy and eating disorders: An affirmative view. Int. J. Eating Disord., 62, 651–657, 1987.Google Scholar
  3. 3.
    Keel P.K., Mitchell J.E.: Outcome in bulimia nervosa. Am. J. Psychiatry, 154, 313–323, 1997.PubMedGoogle Scholar
  4. 4.
    Rossiter E.M., Agras W.S., Telch C.F., Schneider J.A.: Cluster B personality disorder characteristics predict outcome in the treatment of bulimia nervosa. Int. J. Eating Disord., 13, 349–357, 1993.CrossRefGoogle Scholar
  5. 5.
    Ames-Frankel J., Devlin M.J., Walsh T., Strasser T.J., Sadik C., Oldham J.M., Roose SP.: Personality disorder diagnoses in patients with bulimia nervosa: Clinical correlates and changes with treatment. J. Clin. Psychiatry, 53, 90–96, 1992.PubMedGoogle Scholar
  6. 6.
    Yates W.R., Sieleni B., Reich J., Brass C.: Comorbidity of bulimia nervosa and personality disorder. J. Clin. Psychiatry, 50, 57–59, 1989.PubMedGoogle Scholar
  7. 7.
    Löwenkopf E.I.: Bulimia: Concept and theory. Compr. Psychiatry, 24, 546–554, 1983.Google Scholar
  8. 8.
    Sours JA: Starving to death in a sea of objects. New York, Aronson, 1980.Google Scholar
  9. 9.
    Fornari V., Kaplan M., Sandberg D.E., Matthews M., Skolnick N., Katz J.L.: Depressive and anxiety disorders in anorexia nervosa and bulimia nervosa. Int. J. Eating Disord., 12, 21–29, 1992.CrossRefGoogle Scholar
  10. 10.
    Herzog D.B., Keller M.B., Lavori P.W., Kenny G.M., Sacks N.R.: The prevalence of personality disorders in 210 women with eating disorders. J. Clin. Psychiatry, 53, 147–152, 1992.PubMedGoogle Scholar
  11. 11.
    Toner B.B., Garfinkel P.E., Garner D.M.: Affective and anxiety disorders in the longterm follow-up of anorexia nervosa. Int. J. Psychiatry Med., 18, 357–364, 1988.PubMedCrossRefGoogle Scholar
  12. 12.
    Powers P.S., Coovert D.L., Brightwell D.R., Stevens B.A.: Other psychiatric disorders among bulimic patients. Compr. Psychiatry, 29, 503–508, 1988.PubMedCrossRefGoogle Scholar
  13. 13.
    Schwalberg M.D., Barlow D.H., Alger S.A., Howard L.J.: Comparisons of bulimics, obese binge eaters, social phobics, and individuals with panic disorder on comorbidity across DSM-III-R anxiety disorders. J. Abnorm. Psychol., 101, 675–681, 1992.PubMedCrossRefGoogle Scholar
  14. 14.
    Schneier F.R., Johnson J., Hornig C.D., Liebowitz M.R., Weissman M.M.: Social phobia: Comorbidity and morbidity in an epidemiologic sample. Arch. Gen. Psychiatry, 42, 282–288, 1992.CrossRefGoogle Scholar
  15. 15.
    Halmi K.A., Eckert E., Marchi P., Sampugnaro V., Apple R., Cohen J.: Comorbidity of psychiatric diagnoses in anorexia nervosa. Arch. Gen. Psychiatry, 48: 712–718Google Scholar
  16. 16.
    Corruble E., Ginestet D., Guelfi J.D.: Comorbidity of personality disorders and unipolar major depression: A review. J. Affect. Disord., 37, 157–170, 1996.PubMedCrossRefGoogle Scholar
  17. 17.
    Sanderson W.C., Wetzler S., Beck A.T, Betz F.: Prevalence of personality disorders among patients with anxiety disorders. Psychiatry Res., 51, 167–174, 1994.PubMedCrossRefGoogle Scholar
  18. 18.
    Braun D.L., Sunday S.R., Halmi K.A.: Psychiatric comorbidity in patients with eating disorders. Psychol. Med., 24, 859–867, 1994.PubMedCrossRefGoogle Scholar
  19. 19.
    Piran N., Lerner P., Garfinkel P.E., Kennedy S.H., Brouillette C.: Personality disorders in anorexic patients. Int. J. Eating Disord., 7, 589–599, 1988.CrossRefGoogle Scholar
  20. 20.
    Wonderlich S.A., Swift W.J., Slotnick H.B., Goodman S.: DSM-III-R personality disorders in eating-disorder subtypes. Int. J. Eating Disord., 9, 607–616, 1990.CrossRefGoogle Scholar
  21. 21.
    Norman D., Blais M.A., Herzog D.: Personality characteristics of eating-disordered patients as identified by the Millon Clinical Multiaxial Inventory. J. Person. Disord., 7, 1–9, 1993.CrossRefGoogle Scholar
  22. 22.
    Pope H.G., Frankenburg F.R., Hudson J.I., Jonas J.M., Yurgelun-Todd D.: Is bulimia associated with borderline personality disorder? A controlled study. J. Clin. Psychiatry, 48, 181–184, 1987.PubMedGoogle Scholar
  23. 23.
    Pope H.G, Hudson J.I.: Are eating disorders associated with borderline personality disorder? A critical review. Int. J. Eating Disord., 8, 1–9, 1989.CrossRefGoogle Scholar
  24. 24.
    Skodol A.E., Oldham J.M., Hyler S.E., Kellman H.D., Doidge N., Davies M.: Comorbidity of DSM-III-R eating disorders and personality disorders. Int. J. Eating Disord., 14, 403–416, 1993.CrossRefGoogle Scholar
  25. 25.
    Wonderlich S.A., Mitchell J.E.: Eating disorders and personality disorders. In: Yager Y., Gwirtsman H.E., Edelstein C.K. (Eds.), Special problems in managing eating disorders. Washington DC., American Psychiatric Press, 1992.Google Scholar
  26. 26.
    Streiner D.L.: Using meta-analysis in psychiatric research. Can. J. Psychiatry, 36, 357–362, 1991.PubMedGoogle Scholar
  27. 27.
    Fahy T.A., Eisler I., Russell G.F.M.: Personality disorder and treatment response in bulimia nervosa. Br. J. Psychiatry, 162, 765–770, 1993.PubMedCrossRefGoogle Scholar
  28. 28.
    Zerbe K.J., Marsh S.R., Coyne L.: Comorbidity in an inpatient eating disordered population: clinical characteristics and treatment implications. Psychiatric Hospital, 24, 3–7, 1993.PubMedGoogle Scholar
  29. 29.
    Thornton C., Russell J.: Obsessive-compulsive comorbidity in the dieting disorders. Int. J. Eating Disord., 21, 83–87, 1997.CrossRefGoogle Scholar
  30. 30.
    Martinussen M., Fjukstad B.: Metados: A computer program for meta-analysis calculations. University of Tromsø, Norway, 1995.Google Scholar
  31. 31.
    Martinussen M., Bjørnstad J.F.: Meta-analysis calculations based on independent and non-independent cases. Educational and Psychological Measurement, 59, 928–950, 1999.CrossRefGoogle Scholar
  32. 32.
    Hunter J.E., Schmidt F.L.: Methods of metaanalysis: Correcting error and bias in research findings. Newbury Park, CA, Sage, 1990.Google Scholar
  33. 33.
    Viswesvaran C., Schmidt F.L.: A Meta-analytic comparison of the effectiveness of smoking cessation methods. J. Appl. Psychol., 77, 554–561, 1992.PubMedCrossRefGoogle Scholar
  34. 34.
    Cooper J.L., Morrison T.L., Bigman O.L., Abramowitz S.I., Blunden D., Nassi A., Krener P.: Bulimia and borderline personality disorder. Int. J. Eating Disord., 7, 43–49, 1988.CrossRefGoogle Scholar
  35. 35.
    Gartner A.F., Marcus R.N., Halmi K., Loranger A.W.: DSM-III-R personality disorders in patients with eating disorders. Am. J. Psychiatry, 146, 1585–1591, 1989.PubMedGoogle Scholar
  36. 36.
    Gwirtsman H.E., Roy-Byrne P., Yager J., Gerner R.H.: Neuroendocrine abnormalities in bulimia. Am. J. Psychiatry, 140, 559–563, 1983.PubMedGoogle Scholar
  37. 37.
    Johnson C., Tobin D., Enright A.: Prevalence and clinical characteristics of borderline patients in an eating disordered population. J. Clin. Psychiatry, 50, 9–15, 1989.PubMedGoogle Scholar
  38. 38.
    Kennedy S.H., McVey G., Katz R.: Personality disorders in anorexia nervosa and bulimia nervosa. J. Psychiatr. Res., 24, 259–269, 1990.PubMedCrossRefGoogle Scholar
  39. 39.
    Levin A.P., Hyler S.E.: DSM-III personality diagnosis in bulimia. Compr. Psychiatry, 27, 47–53, 1986.PubMedCrossRefGoogle Scholar
  40. 40.
    Sansone R.A., Fine M.A., Seuferer S., Bovenzi J.: The prevalence of borderline personality symptomatology among women with eating disorders. J. Clin. Psychol., 45, 603–610, 1989.PubMedCrossRefGoogle Scholar
  41. 41.
    Schmidt N.B., Telch M.J.: Prevalence of personality disorders among bulimics, nonbulimic binge eaters, and normal controls. J. Psychopathol. Behav. Assess., 12, 169–185, 1990.CrossRefGoogle Scholar
  42. 42.
    Yager J., Landsverk J., Edelstein C.K., Hyler S.E.: Screening for axis II personality disorders in women with bulimic eating disorders. Psychosomatics, 30, 255–262, 1989.PubMedCrossRefGoogle Scholar
  43. 43.
    Zanarini M.C., Frankenburg F.R., Pope H.G., Hudson J.I., Yurgenlun-Todd D., Cicchetti C.J.: Axis II comorbidity of normal- weight bulimia. Compr. Psychiatry, 30, 20–24, 1990.CrossRefGoogle Scholar
  44. 44.
    Bossert-Zaudig S., Zaudig M., Junker M., Wiegand M., Krieg J.-C.: Psychiatric comorbidity of bulimia nervosa in patients: Relationship to clinical variables and treatment outcome. Eur. Psychiatry, 8, 15–23, 1993.Google Scholar
  45. 45.
    Bulik C.M., Sullivan P.F., Joyce P.R., Carter F.A.: Temperament, character, and personality disorder in bulimia nervosa. J. Nerv. Ment. Dis., 183, 593–598, 1995.PubMedCrossRefGoogle Scholar
  46. 46.
    Carroll J.M., Touyz S.W., Beumont P.J.V.: Specific comorbidity between bulimia nervosa and personality disorders. Int. J. Eating Disord., 19, 159–170, 1996.CrossRefGoogle Scholar
  47. 47.
    Gillberg I.C., Råstam M., Gillberg C.: Anorexia nervosa 6 years after onset: part I. personality disorders. Compr. Psychiatry, 36, 61–69, 1995.PubMedCrossRefGoogle Scholar
  48. 48.
    Matsunaga H., Kiriike N., Nagata T., Yamagami S.: Personality disorders in patients with eating disorders in Japan. Int. J. Eating Disord., 23, 399–408, 1998.CrossRefGoogle Scholar
  49. 49.
    Vaz Leal F., Salcedo S.: Trastornos de personalidad en pacientes con trastornos alimentarios: un estudio controlado. Actas Luso Esp. Neurol. Psiquiatr. Cienc. Afines, 21, 181–187, 1993.Google Scholar
  50. 50.
    Saccomani L., Savoini M., Cirrincione M., Vercellino F., Ravera G.: Long-term outcome of children and adolescents with anorexia nervosa: Study on comorbidity. J. Psychosom. Res., 44, 565–571, 1998.PubMedCrossRefGoogle Scholar
  51. 51.
    Samuels J.F., Nestadt G., Romanoski A.J., Folstein M.F., McHugh P.R.: DSM-III personality disorders in the community. Am. J. Psychiatry, 151, 1055–1062, 1994.PubMedGoogle Scholar
  52. 52.
    Bodlund O., Ekselsius L., Lindström E.: Personality traits and disorders among psychiatric outpatients and normal subjects on the basis of the screen questionnaire. Nordic Journal of Psychiatry, 47, 425–433, 1992.CrossRefGoogle Scholar
  53. 53.
    Maier W., Lichtermann D., Klinger T., Heun R., Hallmayer J.: Prevalence of personality disorders (DSM-III-R) in the community. J. Pers. Dis., 6, 187–196, 1992.CrossRefGoogle Scholar
  54. 54.
    Kennedy S.H., Katz R., Rockert W., Mendlowitz S., Ralevski E., Clewes J.: Assessment of personality disorders in anorexia nervosa and bulimia nervosa. A comparison of self-report and structured interview methods. J. Nerv. Ment. Dis., 183, 358–364, 1995.CrossRefGoogle Scholar
  55. 55.
    Duijsens I.J., Diekstra R.F.W.: DSM-III-R and ICD-10 personality disorders and their relationship with the big five dimensions of personality. Personality and Individual Differences, 21, 119–133, 1996.CrossRefGoogle Scholar
  56. 56.
    Dyce J.A.: The big five factors of personality and their relationship to personality disorders. J. Clin. Psychol., 53, 587–593, 1997.PubMedCrossRefGoogle Scholar
  57. 57.
    Troop N.A., Holbrey A., Treasure J.L.: Stress, coping and crisis support in eating disorders. Int. J. Eating Disord., 24, 157–166, 1998.CrossRefGoogle Scholar
  58. 58.
    Troop N.A., Treasure JL.: Psychosocial factors in the onset of eating disorders: response to life events and difficulties. Br. J. Med. Psychol., 70, 373–385, 1997.PubMedCrossRefGoogle Scholar
  59. 59.
    Leon G.A., Fulkerson C.L., Perry L., Cudek R.: Personality and behavioral vulnerabilities associated with risk status for eating disorders in adolescent girls. J. Abnorm. Psychol., 102, 438–444, 1993.PubMedCrossRefGoogle Scholar
  60. 60.
    Podar I., Hannus A., Allik J.: Personality and affectivity characteristics associated with eating disorders: A comparison between eating disordered, weight preoccupied and normal samples. J. Pers. Assess., 73, 133–147, 1999.PubMedCrossRefGoogle Scholar

Copyright information

© Editrice Kurtis 2000

Authors and Affiliations

  • J. H. Rosenvinge
    • 1
  • M. Martinussen
    • 1
  • E. Østensen
    • 1
  1. 1.Department of PsychologyUniversity of TromsøTromsøNorway

Personalised recommendations