BOOK REVIEWS: Personality Disorders and Eating Disorders
Reprinted from Eating Disorders Review
September/October 2007 Volume 18, Number 5
©2007 Gürze Books
Given the importance of developmental psychopathology and personality disorders in the phenomenology and possibly in the pathogenesis of eating disorders, too little attention has been paid to the specific intersections of these conditions. Happily, the current volume brings together an authoritative group to focus on theoretical and clinical issues of how personality, personality disorders and eating disorders influence each others' appearance and course, and the implications of the various permutations and combinations of personality types, cluster types, and multiple disorders on treatment. In addition to Drs. Sansone and Levitt, a psychiatrist and psychologist who are highly experienced clinicians and scholars, 18 other prominent American and international experts contribute succinct and informative chapters covering the essentials in excellent fashion.
Following an eloquent first-person account of a struggle toward recovery by a patient identified only by her initials, the book consists of 15 chapters organized around seven suitable sections: personality conceptualization, epidemiology, etiology, assessment, personality disorders most relevant to eating disorders, treatment approaches (four chapters), and outcome. Each chapter contains highlighted "practice points" to aid clinical thinking, and pedagogically useful clinical vignettes, tables and schematic figures appear in many of the chapters.
Although space precludes reviewing each chapter in depth, several particularly valuable for clinical thinking include the two in the section on etiology: Favaro and Santonastaso's discussion of "Impulsivity versus compulsivity in patients with eating disorders," a lucid attempt to distinguish these clinical features and place them in perspective, and Sansone and Sansone's chapter on how childhood trauma may influence both personality and eating disorder development. Vitousek and Stumpf's chapter on difficulties in the assessment of personality traits and disorders in patients with eating disorders is intelligent and nuanced.
The personality disorders singled out as most relevant for patients with eating disorders are obsessive-compulsive personality disorder, borderline personality disorder and avoidant personality disorder. While no one would argue that these are not among the most important, I missed reading discussions of other cluster A, B, and C disorders and traits–narcissism, schizotypal, and schizoid for example, and of features that are not in the DSM's current pantheon, such as self-defeating and masochistic personality dimensions. Perhaps the editors will provide greater discussions of these matters in a subsequent edition.
In line with their list of the most relevant personality disorders, the treatment chapters focus on obsessive-compulsive disorder and obsessive-compulsive personality disorder and avoidant personality, and two chapters consider the treatment of patients with both borderline personality disorders and eating disorders. In one, Levitt lays out a detailed scheme for a specific self-regulation approach that I found to be particularly instructive, and in the other the Sansones describe a more eclectic approach. An excellent review of psychotropic medication use in these patients concludes the section. The outcome chapter examines prognostic factors in eating disorder patients who also bear prominent personality disorders, and summarizes key points from previous sections.
Overall, this book will benefit a range of clinicians and researchers who want to update their knowledge about how eating disorders and personality disorders meld into one another, how these co-morbidities affect course and outcomes, and what current treatment strategies may yield the greatest odds of obtaining therapeutic benefit in the care of these vexing, difficult, and suffering patients.