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OBJECTIVE
The present study examines the question of whether concomitant narcissistic self-disorders indicate a poorer prognosis in patients with anorexia nervosa (AN) and bulimia nervosa (BN).


METHODS
Ninety-one female inpatients who met the DSMIV criteria fo AN or BN were investigated during inpatient treatment by using: a semistructured diagnostic interview, the Eating Disorder Inventory (EDI), the Narcissism Inventory (NI), the Hamburg Obsession-Compulsion Inventory, and the Inventory of Interpersonal Problems (IIP). The patients were divided into two groups: those with and those without narcissistic self-disorders as measured by the NI. Seventy-five patients were assessed at follow-up thirty months after discharge.


RESULTS
Fifty-one percent of the follow-up group no longer fulfilled the DSM-IV criteria for AN or BN, and there was no significant correlation with the earlier presence of concomitant narcissistic self-disorders. At follow-up, patients with narcissistic self-disorders had significantly more pathological mean scores than patients without such disorders on four of the eight EDI scales and on four of the eight IIP scales. ANOVA for repeated measures revealed significant improvement over time on seven of the eight EDI scales in both groups. However, significant group-by-time interactions demonstrated that patients with narcissistic self-disorders had improved more over time than patients without selfdisturbances. Furthermore, the obsessive-compulsive Symptoms of those patients with narcissistic self-disorders who no longer fulfilled DSM-IV criteria for AN or BN had significantly decreased.


CONCLUSIONS
Our findings indicate that the improvement of eating disorder Symptoms corresponds to a decrease in obsessive-compulsive Symptoms. In addition, there is a certain degree of independence between the severity of narcissistic self-disorders and the outcome of AN or BN. The results suggest that concomitant narcissistic self-disorders do not indicate a significantly poorer prognosis in patients with AN and BN.
Thiel
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Klinik für Psychiatrie und Psychotherapie, Diakoniekrankenhaus Rotenburg, Elise-Averdieck-Straße, D-27356 Rotenburg (Wümme).
Welche Bedeutung haben narzißtische Selbst-Störungen für die Prognose der Anorexia und Bulimia nervosa?