Major Depression and Avoidant Personality Traits in Eating Disorders

Statistical analyses were carried out using SPSS software, version 13.0 for Windows. Categorical data were compared using the 2 test, and continuous data were analyzed using a two-tailed independent t test. Subjects with MD represented 17.4% (n = 121) of the sample, with the following ED subtypes: 13.2% restricting type of AN (n = 20), 24% binge-eating/purging type of AN (n = 18), 21.2% BN (n = 40) and 15.4% ED not otherwise specified (n = 43). No significant differences were found among ED subtypes ( 2 : 7.162; p ! 0.067), but patients with MD reported more frequent episodes of binge eating than patients without MD (5.6 8 8.2 vs. 3.51 8 5.9 episodes/week; F: 8.46; p ! 0.004) after controlling for BMI (based on investigators’ measurements), age, duration of the disorder and ED diagnosis (clinical variables). Moreover, subjects with MD more often reported self-induced vomiting (5.1 8 8.8 vs. 3.3 8 6.2; F: 5.89; p ! 0.015), after controlling for age and clinical variables. Patients with MD did not differ from those without MD with regard to age, age of onset of the disorder, duration of the disorder and BMI (data not shown). The BMI in the binge-eating/purging AN subgroup was lower in patients with MD than in those without MD (data not shown). The BDI scores of subjects with MD were significantly different from those without MD (35.1 8 3.3 vs. 10.9 8 5.8; F: 550.5; p ! 0.001), after controlling for age and clinical variables. In addition, the BDI scores of 306 patients (44.1% of the sample) who were not diagnosed with MD were The lifetime prevalence of mood disorders in anorexia nervosa (AN) varies between 64.1 and 96%, and between 50 and 90% in bulimia nervosa (BN). Moreover, the prevalence of comorbid mood disorders among patients diagnosed with eating disorders (ED) is also high, between 12.7 and 68% among those with AN and 40% among those with BN [1] . The severity of depressive symptomatology seems to correlate with the severity of the ED [2–4] . Unfortunately, previous studies showed several limitations. Other factors that should be addressed are depressive personality traits. Instability and emotional liability, avoidant behaviors and depressive traits have been frequently found in ED patients [5, 6] . Some studies [7–9] have identified groups of patients with comorbid avoidant behaviors, depressed mood and constricted affect. This study aimed to (a) assess the prevalence of current major depression (MD) in a clinical sample of female patients with ED, (b) confirm the correlation between ED severity and diagnosis of MD, and (c) assess the differences in personality traits between ED patients with and without MD. The sample consisted of 693 patients admitted to the outpatient service of the ED Program of Turin University between January 1, 2003, and October 30, 2007. All subjects were diagnosed with an ED: AN, restricting type, n = 151; AN, binge-eating/purging type, n = 75; BN, purging type, n = 188; ED not otherwise specified, n = 279. Diagnoses of ED and MD were based on the Structured Clinical Interview for DSM-IV [10] . Exclusion criteria were (a) severe medical comorbidity (e.g. epilepsy or diabetes), (b) current drug abuse and (c) male gender. The first two assessment interviews were conducted by psychiatrists experienced in the diagnosis and treatment of ED. Between the first and the second interviews, patients completed some self-report questionnaires: Eating Disorder Inventory 2 [11] , Beck Depression Inventory (BDI) [12] and Temperament and Character Inventory [13] . After complete description of the study to the subjects, written informed consent was obtained. Received: February 3, 2009 Accepted after revision: February 1, 2011 Published online: June 30, 2011