The clinical relevance of personality disorder cognitions in the eating disorders

Although cognitive behavioural therapy (CBT) is recommended by the National
Institute for Clinical Excellence (2004) as the treatment of choice for bulimia nervosa,
it has only been found to be effective for 50-60% of individuals. In addition, the
evidence base for the efficacy of CBT in the treatment of anorexia nervosa is weak.
It is commonly recognised that there is a high comorbidity between personality
disorders (and their associated traits) and eating disorders. The purpose of this study
was therefore to examine the cognitions underpinning personality disorders in
individuals with eating disorders, and to investigate whether those cognitions reduce
the impact of CBT for eating disorders.
Participants were 59 individuals with a diagnosed eating disorder presenting for CBT
at a specialist eating disorder service. Each participant completed measures of
personality disorder cognitions, eating disorder attitudes/dysfunctional assumptions
and other psychological symptoms at session one of CBT. Participants were then
asked to repeat the measures of eating disorder attitudes/dysfunctional assumptions
at session six of CBT. Drop-out rates were recorded.
Findings provided evidence of the rapid onset of action of CBT for eating disorders.
There was a significant reduction in eating disorder attitudes over the first six
sessions. Six personality disorder cognitions were significantly associated with
eating disorder attitudes/dysfunctional assumptions and other psychological
symptoms. These were avoidant, obsessive-compulsive, dependent, borderline,
histrionic and paranoid personality disorder cognitions. Higher levels of dependent
and narcissistic personality disorder cognitions were associated with dropping out of
treatment before session seven of CBT, and higher levels of histrionic, avoidant and
borderline personality disorder cognitions were associated with an improvement in
eating disorder attitudes in the first six sessions of CBT.
The limitations of the study and recommendations for future research are discussed.
In addition, the clinical implications of the findings are considered.

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