title: An attempt to understand the paradox of anorexia nervosa without drive for thinness.
abstract: The "atypical" subgroup of women with anorexia nervosa not characterized by drive for thinness (DT) was studied. The study group comprised 151 anorectic patients (restrictor anorectics [AN-R], n=74; binge-purging anorectics [AN-BP], n=77). Subjects completed the following self-administered questionnaires: Eating Disorder Inventory-2 (EDI-2), Temperament and Character Inventory (TCI), State-Trait Anger Expression Inventory (STAXI), and Beck Depression Inventory (BDI). Patients were subdivided into three groups on the basis of body mass index (BMI) and DT score: AN-I with a BMI<15 and DT<7 (n=24); AN-II with a BMI>15 and DT<7 (n=34); and AN-III with a BMI<17.5 and DT>7 (n=93). Patients belonging to the AN-III group had a more severe disorder and form of psychopathology based on their scores on several scales. No association emerged between personality disorders and any single subgroup. Three hypotheses emerge: (1) some patients (about 38%) deny DT and provide negative answers on the questionnaires; (2) patients without DT (even when malnourished) seem to show less severe psychopathologic and personality traits; and (3) patients without DT answer questions honestly, but they have developed a character structure that enables them to feel negative and ego-dystonic emotions regarding their condition. Implications for treatment are discussed.
authors.affiliation: Department of Neurosciences, Section of Psychiatry, University of Turin, Turin, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Abbate-Daga
authors.forename: Andrea
authors.initials: A
authors.lastname: Pierò
authors.forename: Carla
authors.initials: C
authors.lastname: Gramaglia
authors.forename: Marina
authors.initials: M
authors.lastname: Gandione
authors.forename: Secondo
authors.initials: S
authors.lastname: Fassino
mesh_terms: D000328:Adult; D000786:Anger; D000856:Anorexia Nervosa / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D001290:Attitude; D001828:Body Image; D015992:Body Mass Index; D002605:Character; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology; D010555:Personality Inventory; D011795:Surveys and Questionnaires; D013694:Temperament