Objective: To assess the outcome for patients receiving specialist democratic therapeutic community treatment for personality disorder (PD) when they also have eating disturbance.Method: Prospective, naturalistic study. Personality psychopathology and disturbed eating attitudes of 135 male and female referrals to tertiary treatment for PD were assessed at referral. Seventy-five referrals were admitted for treatment and 60 were not. Participants were reassessed at 1-year follow-up.Results: There was a significant effect of treatment on dieting but not other aspects of eating disturbance. However, patients with eating disturbance were not more likely than those without to terminate treatment early or to have poorer outcome in terms of their personality pathology. Severity of baseline personality pathology did not predict treatment response.Conclusion: Clients with comorbidity should be considered for treatment of the personality disorder prior to treatment for the eating disorder. Copyright (c) 2006 John Wiley & Sons, Ltd and Eating Disorders Association.

Some recent case-reports in the psychiatric literature have presented patients who bloodlet and suggested that theirs is a rare pathological behaviour which is part of the purgative psychopathology associated with bulimia nervosa. Other reports have construed bloodletting as a self-mutilative behaviour and indicative of severe personality disorder. We review the literature to ascertain whether it supports either of the above claims or whether there are patients who conform to both or neither stereotype. We present two further cases, which highlight the importance of (1) eliciting Axis I and Axis II psychopathology in the assessment of all patients and (2) eliciting the patient’s view of the motivation and meaning of the behaviour. There is strong evidence to suggest that bloodletting is not solely a feature of eating disorders and that it may be more generally related to personality disorder, where, even in the absence of Axis-I pathology, it may be an indicator of severity of psychopathology. * c 1998 John Wiley

The desiderata for cross-cultural research are reviewed showing how this is dominated by the presumption of transcultural equivalence hidden by the technical problems of translation. This model requires intensive translation work on measures to preserve "equivalence". This work can be prohibitively intensive, might lead to spurious evidence of "equivalence" and has not produced much evidence of equivalence to date. A psychometric axiom--that a measure with low reliability cannot have validity--suggests a pragmatic way to explore these issues and current statistical software and personal computers make this feasible. We recommend that all cross-cultural research should present the internal reliability of the data as this will expose all but one theoretical problem in the detection of "equivalence". We also suggest that non-equivalence may indicate cross-cultural differences in the dimensionality of eating and body image concerns rather than just a problem to be exorcised by more translation work or to be hidden by not reporting reliability. These issues are not specific to work across languages but also apply to comparisons between any social groups within cultures. This is shown using data from questionnaires in their original English with respondents who were fluent in that language.

Background. Simultaneous diagnosis of more than one personality disorder (PD) has been termed 'comorbidity' or 'co-occurrence' implying that single diagnoses are the norm and multiple diagnoses interesting exceptions. Surveys of PD subjects in fact show 1.5-5.6 diagnoses per subject. Our study explores the hypothesis that multiple PD diagnosis is common and increases with increasingly personality disordered populations.Method. The PDQ-R questionnaire was administered to three UK samples: referrals for specialist PD in-patient treatment (n = 275); high tariff offenders attending a probation centre (n = 57); and undergraduate students (n = 274).Results. Means of 6.0 (95% CI 5.7-6.3), 4.0 (3.1-5.0) and 3.4 (3.0-3.8) PDQ-R diagnoses per subject were found respectively. High rates of PD diagnosis in individual subjects suggest that multiple diagnosis is the norm rather than the exception.Conclusions. Multiple diagnosis of PD is better construed as 'breadth' of psychopathology rather than comorbidity and is a function of sampling frame. High rates of multiple diagnoses question the interpretation of studies of any single PD. The graded construct of 'breadth' of axis-ii pathology may further our understanding of PD.

Information is presented on 40 funded and 52 unfunded extra-contractual referrals (ECRs) to Henderson Hospital. There were no significant differences between the groups on measures of motivation, self-esteem, personality disorder and dysthymia made blind to funding status. The only discriminating variable was being on probation at referral which was more common in those refused funding. These results complement earlier work suggesting that the internal market funding of referrals to specialist services is made on financial not clinical grounds and reinforce the view that offender patients are less likely to get treatment despite the recent recommendations of the Reed Committee (Department of Health and Home Office, 1992). Although the recent revision of ECR arrangements to give automatic funding for teritary referrals may ameliorate such problems, we argue that the simultaneous devolution of budgets to individual clinical teams will prevent proper assessment of costs and benefits of teritary treatment and reduce ECRs further.

The literature on the links between the eating disorders and both personality and overt personality disorders has been largely case report data or group studies of patients presenting with eating disorders. We present a brief review of this literature and note the rarity of studies reporting on the prevalence of eating disorder symptoms in samples selected for the presence of personality problems or in male samples. We report a survey of eating disorder symptoms among 130 patients referred to a therapeutic community specializing in the treatment of adults with severe personality disorder. This revealed high rates of both previously diagnosed and unrecognized eating disorder symptoms.

The 34-item Body Shape Questionnaire (BSQ) has demonstrated sound psychometric properties in all samples reported to date (including this study). However, the unidimensional nature of the 34 items suggests that the BSQ may be unnecessarily long for use in studies when body disparagement is not the main focus of investigation. This study of 342 adult women presents two 16-item "alternate forms" of the BSQ which showed equivalent means and excellent internal consistency in both derivation and replication samples. Two 8-item scales were also derived. The 34-, 16-, and 8-item versions showed equivalent convergent and discriminant validation against the Eating Attitudes Test (EAT)-26 and other parameters. We suggest that use of these 16-item versions may be more efficient than the original BSQ where body disparagement is not the sole focus of a study, or where a repeated measures design is employed. Furthermore, the 8-item versions are sufficiently robust to be used as "alternate forms" where speed of completion and economy are of the essence.

This paper reports a survey of the natural history of eating behavior and attitudes to weight and shape in British women attending a family planning clinic. Sixty-two women completed a battery of standardized tests, followed by a second questionnaire 18 months later. This rescreening represents the first report of an adult sample not self-defined as ill. The Eating Attitudes Test (EAT)-26 total score showed stability over time (r = .68) but also showed a nonsignificant increase in the number of "cases." The self-reported weight and desired weight increased slightly but statistically over the whole sample in the follow-up period. Analysis of group variances showed evidence of a heterogeneity of variance which was more marked than evidence of group mean effects between responders and nonresponders. The self-reported heights were stable but self-report of historical weight limits showed impossible inconsistencies such that any data related to these must be interpreted with caution. We recommend that future follow-up studies report analysis of loss to follow-up both by group means and variances, that inconsistent responses be counted and explored, and that both group mean changes over time and correlations be reported since they convey different information.

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Attitudes towards eating, weight and shape were examined in 479 Caucasian, Afro-Caribbean and Asian British women. The Asian women were found to have significantly more disordered eating attitudes than the Caucasian women, but no difference was found between the three groups in their concern with their body weight and shape. However, while in the Caucasian group disordered eating attitudes were significantly positively correlated with feelings of anxiety and depression, this was not true in the other two groups. Although the concerns of British Afro-Caribbean and Asian women are similar to those of the Caucasian women, there may be ethnic differences in the relationship between feelings about eating, weight and shape and mood.

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