Biomedical subjects

P F Sullivan

Publications and source records attributed to P F Sullivan.

At least 73 records · Page 4Linked to original sources

PubMed1996

Salivary reactivity in women with bulimia nervosa across treatment.

We examined salivary reactivity to a high-risk binge food in women with bulimia before and after cognitive-behavioral treatment. Prior to treatment, there was no change in salivation after presentation of high-risk food cues. After treatment, salivation increased significantly (p = .002) over baseline after presentation of the same foods. Salivary reactivity was negatively correlated with systolic blood pressure, but was unrelated to heart rate, self-report anxiety, or depression. Changes in salivary reactivity may be meaningful clinical index worthy of further investigation in this population.

Adolescent↗

PubMed1996

The effect of a history of conduct disorder in adult major depression.

This paper examines the impact of a history of conduct disorder on major depression in adulthood, including its symptomatology, comorbidity and response to tricyclic antidepressants. 103 subjects with DSM-III-R major depression were assessed for DSM-III-R axis I and II comorbidity, severity of depression, social functioning, general psychiatric symptomatology, early familial environment and family psychiatric history. 18 patients (17%) had a history of conduct disorder, 32 (31%) were subthreshold, and 53 (51%) had no childhood symptoms of conduct disorder. Depressed adults with a history of conduct disorder had significantly higher lifetime alcohol and drug dependence and virtually all (17/18, 94%) met criteria for a personality disorder. Despite this, the current episode of depression did not differ in severity, symptoms or response to treatment except that those with a history of conduct disorder were more likely to be agitated when depressed. The authors conclude that a history of conduct disorder is depressed patients predicts the presence of adult personality disorders and psychoactive substance dependence. In most other ways, depressed subjects with a history of conduct disorder were similar to other subjects.

Adolescent↗

PubMed1996

Effect of mood and food cues on body image in women with bulimia and controls.

OBJECTIVE: The present study evaluated body image assessment and cue reactivity in women with bulimia and controls in response to neutral, mood, and food cues in isolation, and mood and food cues in combination. METHOD: Subjects were 7 women with bulimia nervosa and 8 control women. Food cues were individualized high-risk/favorite foods. Low mood was elicited using the Musical Mood Induction Procedure. Order of cue presentation was random across subjects. Body image and cue reactivity were assessed using a computer version of the silhouette method and self-report ratings, respectively. RESULTS: Women with bulimia consistently rated their current body as being larger and their body image satisfaction as being lower than control women. In addition, women with bulimia differentially rated their current body and a picture of a healthy weight woman as being larger following exposure to food and/or mood cues. Ratings of ideal body were differentially affected by mood cues for control women. Ratings of body satisfaction were not affected by cue presentation. Mere presentation of high-risk foods in the absence of eating was sufficient to elicit urges to binge in women with bulimia. DISCUSSION: Body size estimation is not only affected by enduring characteristics (i.e., bulimia nervosa), but also more transient factors such as short-term exposure to salient food and mood cues.

Adolescent↗

PubMed1996

A case of comorbid anorexia nervosa, bulimia nervosa, and Munchausen's syndrome.

Reports of comorbid eating disorders and Munchausen's syndrome are rare. As part of a follow-up study of the outcome of anorexia nervosa, medical records and direct structured psychiatric interview data were collected on all women treated for anorexia nervosa in Christchurch, New Zealand between 1981-1984. On interview, one participant received diagnoses of anorexia nervosa, bulimia nervosa, and factitious disorder (Munchausen's syndrome). The subject interwove symptoms of her eating disorders with factitious presentations on several occasions. This diagnosis had not been apparent prior to compilation of all medical records.

Adult↗

PubMed1996

Correlates of severity in bulimia nervosa.

OBJECTIVE: We sought to clarify the correlates of severity in women with bulimia nervosa. METHOD: We studied 114 bulimic women at entry to a randomized clinical trial. We used eight definitions of severity that encompassed the DSM-III-R criteria set for bulimia nervosa (i.e., binging, purging, and body dissatisfaction in the current and worst lifetime time frames) and global functioning and symptomatology. We operationalized 28 possible correlates of severity that covered demographic, Axis I psychiatric, personality, family background, symptoms, and neuropsychological domains. We used regression techniques to investigate the associations between the correlates and severity indices. RESULTS: The regression models were all statistically significant and tended to account for a sizeable proportion of variance. In particular, earlier age of onset of bulimia and lower character scores (measured by the Temperament and Character Inventory) correlated with greater severity. Worse mean parental care (from the Parental Bonding Instrument), the absence of any lifetime anxiety disorder, and the presence of any lifetime mood disorder emerged as independent correlates in several models. CONCLUSIONS: As these were hypothesis-generating analyses, confirmation or refutation of these results awaits further study. In particular, age of onset of bulimia and personality traits related to character may be important modifiers of the severity of illness in bulimia nervosa.

Adolescent↗

PubMed1996

The significance of a prior history of anorexia in bulimia nervosa.

OBJECTIVE: Some authors stratify women with current, normal-weight bulimia nervosa into groups defined by the presence or absence of a past history of anorexia nervosa. Unlike the distinction between current anorexia nervosa with or without bulimic symptoms, fewer studies have investigated the significance of stratifying bulimic women by a past history of anorexia. METHOD: One hundred and fourteen women with bulimia nervosa in a clinical trial were studied via structured clinical interviews covering Axis I and II disorders and measures of personality and symptomatology. Prospective, 14-day dietary analysis was available for a subset of subjects. RESULTS: Bulimic women with a past history of anorexia nervosa were significantly more likely to have a lifetime anxiety disorder, lower current body mass index, increased cooperativeness on the Temperament and Character Inventory, and increased mature and neurotic scores on the Defense Style Questionnaire. These women also reported lower scores on the bulimia subscale of the Eating Disorders Inventory, but these self-report data were not consistent with the numbers of objective binges or reported energy intake. The prevalence of other Axis I disorders, Axis II personality disorders, and bulimic symptomatology was quite similar across groups. CONCLUSIONS: Although bulimic women with a prior history of anorexia nervosa differed in limited respects from those without such a history, the differences were outweighed by the similarities. A past history of anorexia nervosa did not appear to define particularly meaningful subgroups of women with current, normal-weight bulimia nervosa.

Adolescent↗

PubMed1996

Towards an understanding of defense style in terms of temperament and character.

The aim was to investigate the relationships between a model of personality based on the concept of defense mechanisms, as articulated by Vaillant, with the psychobiological model of personality, as developed by Cloninger. A total of 128 adults from 11 family pedigrees with at least two alcohol-dependent members completed the self-report Defense Style Questionnaire and the Temperament and Character Inventory. Immature defenses were largely explained by low character scores, while neurotic defenses were part temperament and part character. Cluster A, B and C defenses were related to low reward dependence, high novelty-seeking and high harm avoidance respectively. In a regression analysis, cluster B and C defenses were more related to low character scores than to temperament but, for cluster A defenses, temperament and character both contributed. The results suggest that it is possible to integrate an ego defense model of personality with a psychobiological model of personality, thereby enriching both approaches.

Adolescent↗

PubMed1995

Temperament in eating disorders.

This study examined dimensional personality and temperamental characteristics in women with eating disorders. Clinical symptoms, personality, and temperament were examined in 30 women with anorexia nervosa (AN), 32 women with bulimia nervosa with no history of anorexia nervosa (BN), and 20 women with comorbid anorexia and bulimia nervosa (AB). Temperament differed markedly across the groups on the Tridimensional Personality Questionnaire (TPQ) with AN women showing greater reward dependence, BN women scoring higher on novelty seeking subscales, and AB women showing high harm avoidance. The TPQ subscales also displayed higher classification accuracy than other personality and symptom measures. Temperamental features are distinct across eating disorder subtypes. Temperament could reflect differential vulnerabilities for the development of specific eating disorder symptom clusters.

Anorexia Nervosa↗

PubMed1995

Temperament, character, and personality disorder in bulimia nervosa.

In a sample of 76 women participating in a clinical treatment trial for bulimia nervosa, we examined the clinical differences between subjects with and without concurrent personality disorders and the ability of "self-directedness" (a character scale of Cloninger's Temperament and Character Inventory) to predict the presence of personality disorder. Sixty-three percent of the sample had at least one personality disorder diagnosis. Fifty-one percent of personality disorders were in cluster C, 41% were in cluster B, and 33% were in cluster A. The presence of personality disorder was associated with greater depressive symptoms, worse global functioning, laxative use, greater body dissatisfaction, higher harm avoidance, and lower self-directedness. As hypothesized, low self-directedness scores were associated with a markedly increased probability of a personality disorder.

Adult↗

PubMed1995

Adoption as a risk factor for mental disorders.

Although adoption has been viewed as a risk factor for mental disorders in children and adolescents, few studies have investigated this association in adults. To address this question, we analyzed data from a random community sample of adults where the presence of adoption in the first year of life was systematically noted and where the presence of lifetime mental disorders was determined by structured interview. In comparison to individuals raised by both biological parents, adoption was strongly associated with a history of childhood conduct disorder, antisocial personality and drug abuse or dependence. Adoption may thus be a risk factor for these mental disorders.

Adolescent↗

PubMed1995

Mortality in anorexia nervosa.

OBJECTIVE: The author's goal was to shed light on the debate regarding the mortality rate over time associated with anorexia nervosa. METHOD: He conducted a meta-analytic study using weighted linear regression to combine crude mortality proportions from 42 published studies to estimate the mortality associated with anorexia nervosa over time. RESULTS: The crude rate of mortality due to all causes of death for subjects with anorexia nervosa in these studies was 5.9% (178 deaths in 3,006 subjects). The aggregate mortality rate was estimated to be 0.56% per year, or approximately 5.6% per decade. CONCLUSIONS: The aggregate estimated mortality rate for subjects with anorexia nervosa is substantially greater than that reported for female psychiatric inpatients and for the general population.

Adolescent↗

PubMed1995

The significance of a history of childhood sexual abuse in bulimia nervosa.

BACKGROUND: Childhood sexual abuse (CSA) is found to have occurred to a substantial minority of women with bulimia nervosa. Its clinical significance is unclear. METHOD: We studied 87 bulimic women in a clinical trial. Structured interviews determined the presence of CSA, DSM-III-R disorders, global functioning, and depressive and bulimic symptoms. RESULTS: Forty-four per cent reported a history of CSA. Bulimic women with CSA reported earlier onset of bulimia, greater depressive symptoms, worse global functioning and more suicide attempts, and were more likely to meet criteria for bipolar II disorder, alcohol and drug dependence, conduct disorder and avoidant personality disorder. CONCLUSIONS: Although those with CSA had greater comorbidity, it was not an important modifier of bulimic symptoms.

Adolescent↗

PubMed1994

Total cholesterol and suicidality in depression.

There exists considerable controversy regarding an association between low total cholesterol and increased mortality from suicide. As suicide mortality is a crude marker for suicidal ideation and behavior, we investigated the association between total cholesterol and suicidality in a depressed sample. Ninety men and women meeting structured criteria for a major depressive episode of at least moderate severity participated in a study of predictors of treatment response. A three level variable codified the degree of suicidality in the previous month: no suicidal thoughts (39/90), suicidal ideation or plan (38/90), and a suicide attempt (13/90). There was a significant univariate association between lower cholesterol levels and increasing degrees of suicidality. In a multivariate analysis, this association was the only one that neared statistical significance (p = 0.068). Although it is premature to conclude that these variables are causally associated, data from a number of sources suggest that this association is worthy of further study.

Adult↗

PubMed1994

Self-induced abortion in a bulimic woman.

We report the case of a woman with bulimia nervosa, several personality disorders, and a past history of anorexia nervosa who deliberately induced an abortion via self-imposed starvation and vigorous exercise. Her history reveals severe obsessive-compulsive and narcissistic personality disorders as well as a lifelong pattern of denial of affect and illness.

Abortion, Induced↗

PubMed1994

Defense style in women with eating disorders.

A relatively new instrument, the Defense Style Questionnaire (DSQ), represents an efficient method by which to quantify an individual's psychological defense style. We administered the DSQ to 66 women hospitalized for anorexia nervosa, bulimia nervosa, or concurrent anorexia and bulimia nervosa. Contrary to our expectations, there were no consistent patterns of identifiable defense styles specific to these groups in qualitative, univariate, and multivariate analyses. The failure of the DSQ to demonstrate specificity across eating disorder subgroups suggests it is not informative in regard to the pathogenesis of these specific syndromes. In contrast, in a previous study, we found temperamental measures to be informative.

Adult↗

PubMed1994

Effects of exclusion criteria in depression treatment studies.

We investigated the effects of exclusion criteria in depression treatment studies by applying simulated exclusion criteria to a relatively unselected sample. The criteria were borderline personality disorder, drug/alcohol dependence, and exclusion criteria from the Treatment of Depression Collaborative Research Program and the Maintenance Therapies for Recurrent Depression Protocol. Each set of criteria substantially distorted demographic characteristics and Axis I and II comorbidity but did not yield higher rates of study completion or, in general, response to tricyclics. Excessive exclusion criteria in depression treatment studies have many adverse effects and should be applied only when overwhelmingly compelling reasons exist.

Adult↗

PubMed1994

Borderline personality disorder in major depression.

The precise interrelationship between borderline personality disorder (BPD) and major depression (MD) remains unclear. To elucidate this further, we studied the characteristics of BPD in an unselected sample of 103 depressed subjects. All subjects were evaluated with structured diagnostic instruments. We contrasted three groups (MD plus BPD, MD plus a non-BPD, and MD plus no personality disorder) across several domains (characteristics of the depressive disorder, psychometric scales, axes I and II comorbidity, early environmental indices, family psychiatric history, and treatment response). Depressed subjects with BPD had significantly earlier onset of depression, dense axes I and II comorbidity, and higher prevalence of conduct disorder, and were characterized by elevated psychoticism and anger-hostility scores. In most other respects, however, depressed subjects with BPD were not strikingly distinct from other groups of depressed subjects.

Adult↗

PubMed1994

Characteristics of bulimic women with and without alcohol abuse.

We compared the characteristics of hospitalized women with bulimia nervosa alone (N = 19) and with bulimia nervosa plus alcohol abuse (N = 13) using standard measures of depression, eating disorders, general psychiatric symptomatology, and temperament. Bulimic women with alcohol abuse had significantly higher lowest past weight, but did not differ from women with bulimia alone on age, age of onset of bulimia, current weight, and highest past weight. There were no differences in clinical symptoms of bulimia, depression, or general psychiatric symptomatology. On Cloninger's Tridimensional Personality Questionnaire (TPQ), bulimic women with alcohol abuse scored significantly higher on Total Novelty Seeking, on the Novelty Seeking Subscale Disorderliness, and on the Reward Dependence Subscale Attachment. Implications for understanding the relation between bulimia and substance abuse are discussed.

Adolescent↗