A Study of Anorexia Nervosa, Especially on the Shifts of Its Subtypes and Psychiatric Comorbidity in the Clinical Course

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  • 神経性無食欲症の病型および合併精神障害の推移に関する研究
  • シンケイセイ ム ショクヨクショウ ノ ビョウガタ オヨビ ガッペイ セイシン ショウガイ ノ スイイ ニ カンスル ケンキュウ

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Abstract

We studied the shifts of diagnostic subtypes and psychiatric comorbidity, during the clinical course (average period : 34.9 M) in 25 anorexia nervosa patients who had inpatient treatment at the age of 18 and under. 17 patients met the DSM-IV criteria for anorexia nervosa restricting subtype and 8 met binge-eating/ purging subtytn on their first admission. In 3 of 8 patients with binge-eating subtype on admission had a history of restricting subtype. Patients with restricting subtype had significantly lower weight on admission and 4 of 17 restricting subtype patients changed their eating behaviors and shifted to another subtype such as binge-eating purging type, bulimia nervosa, eating disorder not otherwise specified during their follow-up periods. 9 patients were diagnosed to have psychiatric comorbidity at the end of follow-up period. The diagnoses included conduct disorder, borderline personality disorder, schizoid personality disorder and dependent personality disorder. They showed lower rate of returning to school life than the patients without psychiatric comorbidity. 7 of 9 patients with psychiatric comorbidity readmitted due to the symptoms and behaviors relating to the psychopathology of comorbidity. Their clinical courses were largely influenced by the type of personality disorder. The patients with psychiatric comorbidity showed some of the symptoms relating to the comorbidity before being diagnosed as having psychiatric comorbidity. Therefore careful assessment of psychiatric comorbidity and its psychopathology is indispensable for a long-term adequet treatment of anorexia nervosa.

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