title: Psychological and weight-related characteristics of patients with anorexia nervosa-restricting type who later develop bulimia nervosa.
abstract: BACKGROUND
  Patients with anorexia nervosa-restricting type (AN-R) sometimes develop accompanying bulimic symptoms or the full syndrome of bulimia nervosa (BN). If clinicians could predict who might change into the bulimic sub-type or BN, preventative steps could be taken. Therefore, we investigated anthropometric and psychological factors possibly associated with such changes.
  
  
  METHODS
  All participants were from a study by the Japanese Genetic Research Group for Eating Disorders. Of 80 patients initially diagnosed with AN-R, 22 changed to the AN-Binge Eating/Purging Type (AN-BP) and 14 to BN for some period of time. The remaining 44 patients remained AN-R only from the onset to the investigation period. Variables compared by ANOVA included anthropometric measures, personality traits such as Multiple Perfectionism Scale scores and Temperament and Character Inventory scores, and Beck Depression Inventory-II scores.
  
  
  RESULTS
  In comparison with AN-R only patients, those who developed BN had significantly higher current BMI (p < 0.05) and maximum BMI in the past (p < 0.05). They also scored significantly higher for the psychological characteristic of parental criticism (p < 0.05) and lower in self-directedness (p < 0.05), which confirms previous reports, but these differences disappeared when the depression score was used as a co-variant. No significant differences were obtained for personality traits or depression among the AN-R only patients irrespective of their duration of illness.
  
  
  CONCLUSIONS
  The present findings suggest a tendency toward obesity among patients who cross over from AN-R to BN. Low self-directedness and high parental criticism may be associated with the development of BN by patients with AN-R, although the differences may also be associated with depression.
authors.affiliation: Department of Psychosomatic Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira-shi, Tokyo 187-8553, Japan.
authors.forename: Hiroki
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authors.lastname: Nishimura
authors.forename: Gen
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authors.lastname: Komaki
authors.forename: Tetsuya
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authors.lastname: Ando
authors.forename: Toshihiro
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authors.lastname: Nakahara
authors.forename: Takakazu
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authors.lastname: Oka
authors.forename: Keisuke
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authors.lastname: Kawai
authors.forename: Toshihiko
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authors.lastname: Nagata
authors.forename: Aya
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authors.lastname: Nishizono
authors.forename: Yuri
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authors.lastname: Okamoto
authors.forename: Kenjiro
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authors.lastname: Okabe
authors.forename: Masanori
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authors.lastname: Koide
authors.forename: Chikara
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authors.lastname: Yamaguchi
authors.forename: Satoshi
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authors.lastname: Saito
authors.forename: Kazuyoshi
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authors.lastname: Ohkuma
authors.forename: Katsutaro
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authors.lastname: Nagata
authors.forename: Tetsuro
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authors.lastname: Naruo
authors.forename: Masato
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authors.lastname: Takii
authors.forename: Nobuo
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authors.lastname: Kiriike
authors.forename: Toshio
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authors.lastname: Ishikawa