Hostname: page-component-7479d7b7d-wxhwt Total loading time: 0 Render date: 2024-07-08T17:45:11.811Z Has data issue: false hasContentIssue false

Anorexia and Depression: Depressive Comorbidity in Anorexic Adolescents

Published online by Cambridge University Press:  10 April 2014

Carmen García-Alba*
Affiliation:
José Germain Psychiatric Institute of Leganés, Madrid
*
Correspondence concerning this article should be addressed to Carmen Garcia-Alba, Ronda Delicias 21, Majadahonda, 28220 Madrid (Spain). Fax: 91 638 0243. E-mail: [email protected]

Abstract

Frequently, depression is a concomitant pathology in anorexia nervosa. To verify this, we carried out a comparative case/control study with 50 anorexic patients, restricting-type (ANP), 50 depressed patients (DP) and 50 non-patients (NP), aged between 13 and 16. We used the Rorschach Test and the Minnesota Multiphasic Personality Inventory (MMPI) and compared the results to parent's observations collected from the Achenbach Child Behavior Checklist (CBCL). Results showed two clearly different groups among participants: ANP with depression (36%) and ANP without depression (64%). This seems to indicate that depression is not a core element in anorexic disorders. However, we also observed a significant increase in the MMPI scale 2, which was probably related to starvation and weight loss. We confirmed the absence of general anxiety in the ANP group and obtained differences between depressive symptoms and those derived from coping deficit disorders. The discussion emphasizes the importance of using several tests to reduce bias in results and conclusions.

La depresión es, frecuentemente, una patología concomitante con la anorexia nerviosa. Para verificarlo, se diseñó un estudio comparativo con 50 pacientes anoréxicas, tipo restrictivo (ANP), 50 deprimidas (DP) y 50 no pacientes (NP), de edades comprendidas entre los 13 y 16 años. Se utilizaron el Test de Rorschach y el Minnesota Multiphasic Personality Inventory (MMPI), comparándose los resultados con las observaciones de los padres, recogidas de forma estandardizada a través del Child Behavior Checklist (CBCL). Los resultados obtenidos mostraron la existencia de dos grupos claramente diferenciados: ANP con depresión (36%) y ANP sin depresión (64%). Por lo tanto, parece que la depresión no es nuclear en la patología anoréxica. No obstante, se apreció un aumento significativo de la escala 2 del MMPI, probablemente consecutivo a la inanición y pérdida de peso. Además, en el grupo ANP se ha constatado la ausencia de ansiedad generalizada. También se encontraron diferencias entre el síndrome depresivo y las alteraciones derivadas de la indefensión social. Igualmente, se ha subrayado la importancia de investigar con distintos tests, para evitar sesgos en los resultados y conclusiones.

Type
Articles
Copyright
Copyright © Cambridge University Press 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abou-Saleh, M. T., Oleesky, D., Crisp, A. H., & Lacey, J. H. (1986). Dexamethasone suppression and energy balance in eating disorders. Acta Psychiatrica Scandinavica, 73, 242251.CrossRefGoogle ScholarPubMed
Achenbach, T. M. (1979). The child behavior profile: An empirically based system for assessing children's behavioral problems and competencies. International Journal of Mental Health, 7, 2442.CrossRefGoogle Scholar
Achenbach, T. M., & Edelbrock, C. S. (1983). Manual for the child behavior checklist and revised child behavior profile. Burlington, VT: University of Vermont.Google Scholar
Altshuler, K. Z., & Weiner, M. F. (1985). Anorexia nervosa and depression: A dissenting view. American Journal of Psychiatry, 142, 328332.Google ScholarPubMed
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., Rev. ed.). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association. (1993). Practice guideline for eating disorders. American Journal of Psychiatry, 150, 212228.CrossRefGoogle Scholar
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th. ed.). Washington, DC: American Psychiatric Association.Google Scholar
Archer, R. P. (1987). Using the MMPI with adolescents. Hillsdale, NJ: Erlbaum.Google ScholarPubMed
Archer, R. P. (1992). MMPI-A: Assessing adolescent psychopathology. Hillsdale, NJ: Erlbaum.Google Scholar
Berk, M., Kessa, K., Szabo, C. P., & Butkow, N. (1997). The augmented platelet intracellular calcium response to serotonin in anorexia nervosa but not bulimia may be due to subsyndromal depression. International Journal of Eating Disorders, 22, 5763.3.0.CO;2-1>CrossRefGoogle Scholar
Biederman, J., Habelow, W., Rivinus, T.Harmatz, J., & Wise, J. (1986). MMPI profiles in anorexia nervosa patients with and without major depression. Psychiatry Research, 19, 147154.CrossRefGoogle ScholarPubMed
Biederman, J., Rivinus, T. M., Herzog, D. B., Ferber, R. A., Harper, G. P., & Orsulak, P. J. (1984). Platelet MAO activity in anorexia nervosa patients with and without a major depressive disorder. American Journal of Psychiatry, 141, 12441247.Google ScholarPubMed
Bruch, H. (1962). Perceptual and conceptual disturbance in anorexia nervosa. Psychosomatic Medicine, 24, 187195.CrossRefGoogle ScholarPubMed
Cabetas, I. (1998). Anorexia nerviosa: la melancolía como sustrato psico-patológico de la enfermedad. Unpublished doctoral dissertation, University Complutense of Madrid, Spain.Google Scholar
Calderón, E. (2000). Trastornos de la personalidad en trastornos de la conducta alimentaría: anorexia nerviosa, bulimia nerviosa y trastorno de alimentación no especificado. Unpublished doctoral dissertation, University of Baleares Islands, Spain.Google Scholar
Cantwell, D. P., Sturzenberger, S., Burroughs, J., Salkin, B., & Green, J. K. (1977). Anorexia nervosa: An affective disorder? Archives of General Psychiatry, 34, 10871093.CrossRefGoogle ScholarPubMed
Cervera, S., & Gual, P. (1998). Trastornos de la conducta alimentaría: anorexia nerviosa y bulimia nerviosa. In Vázquez-Barquero, J. L. (Ed.), Psiquiatría en atención primaria (pp. 389405). Madrid: Grupo Aula Médica.Google Scholar
Cervera, S., & Quintanilla, M. (1995). Anorexia nerviosa: manifestaciones psicopatológicas fundamentales. Pamplona: Eunsa.Google Scholar
Chinchilla, A. (1995). Guía teórico-práctica de los trastornos de la conducta alimentaría: anorexia nerviosa y bulimia nerviosa. Barcelona: Masson.Google Scholar
Chinchilla, I. (1977). La anorexia nerviosa como equivalente depresivo. Unpublished doctoral dissertation, University of Salamanca, Spain.Google Scholar
Dana, R., & Bolton, B. (1982). Interrelationships between Rorschach and MMPI scores for female college students. Psychological Bulletin, 51, 12811282.Google Scholar
Dancyger, I. F., Sunday, S. R., & Halmi, K. A. (1997). Depression modulates non eating disordered psychopathology in eating disordered patients. Eating Disorders: The Journal of Treatment and Prevention, 5, 5968.CrossRefGoogle Scholar
Díaz, M. (1999). Psicobiología de los trastornos de la conducta alimentaría. Aula Médica Psiquiatría, 3, 219238.Google Scholar
Díaz, M., & Carrasco, J. L. (2001). La personalidad y sus trastornos en la anorexia y en la bulimia nerviosa. In García-Camba, E. (Ed.), Avances en trastornos de la conducta alimentaria. Anorexia nerviosa, bulimia nerviosa, obesidad (pp. 93106). Barcelona: Masson.Google Scholar
Dies, R. R. (1995). Subject variables in Rorschach research. In Exner, J. E. (Ed.), Issues and methods in Rorschach research (pp. 99121). Mahwah, NJ: Erlbaum.Google Scholar
Exner, J. E. (1986). The Rorschach: A Comprehensive System. Basic foundations (Vol. 1, 2nd ed.). New York: Wiley.Google Scholar
Exner, J. E. (1991). The Rorschach: A Comprehensive System. Interpretation (Vol. 2, 2nd ed.). New York: Wiley.Google Scholar
Exner, J. E. (1993). The Rorschach: A Comprehensive System. Basic foundations (Vol. 1, 3rd ed.). New York: Wiley.Google Scholar
Exner, J. E. (1995). Introduction. In Exner, J. E. (Ed.), Issues and methods in Rorschach research (pp. 124). Mahwah, NJ: Erlbaum.Google Scholar
Exner, J. E. (1997, July). Current research. Alumni Newsletter, 412.Google Scholar
Exner, J. E. (2001). A Rorschach workbook for the Comprehensive System (5th ed.). Asheville, NC: Rorschach Workshops.Google Scholar
Exner, J. E. (2003). The Rorschach. A Comprehensive System. Basic foundations and principles of interpretation (Vol. 1, 4th ed.). New York: Wiley.Google Scholar
Exner, J. E., Kinder, B. N., & Curtis, G. (1995). Reviewing basic design features. In Exner, J. E. (Ed.), Issues and methods in Rorschach research (pp. 145158). Mahwah, NJ: Erlbaum.Google Scholar
Exner, J. E., & Sendín, C. (1998). Manual de interpretación del Rorschach para el Sistema Comprehensivo ( ed.). Madrid: Psimática.Google Scholar
Exner, J. E., & Sendín, C. (1997). Some issues in Rorschach research. European Journal of Psychological Assessment, 13, 155163.CrossRefGoogle Scholar
Exner, J. E., & Weiner, I. B. (1995). The Rorschach: A Comprehensive System: Assessment of children and adolescents (Vol. 3, 2nd ed.). New York: Wiley.Google Scholar
Fitcher, M. M., Pirke, K. M., & Holsboer, F. (1986). Weight loss causes neuroendocrine disturbances: Experimental study in healthy starving subjects. Psychiatry Research, 17, 6172.Google Scholar
García Villamisar, D., & Polaino, A. (1988). Una revisión del concepto de depresión infantil desde la perspectiva clínica. In Polaino, A. (Ed.), Las depresiones infantiles (pp. 5470). Madrid: Morata.Google Scholar
Garfinkel, P. E., & Garner, D. M. (1982). Anorexia nervosa: A multidimensional perspective. New York: Brunner-Mazel.Google Scholar
Garner, D. M., & Garfinkel, P. E. (1985). Handbook of psychotherapy of anorexia and bulimia. New York: Guilford Press.Google Scholar
Gerner, R. H., & Gwirstman, H. E. (1981). Abnormalities of dexamethasone suppression test and urinary MHPG in anorexia nervosa. American Journal of Psychiatry, 138, 650.Google ScholarPubMed
Gershon, E. S., Schreiber, J. L., Guroff, J. J., Hamovit, J. R., Dibble, E. D., Kaye, W., Nurnberger, J. I., Andersen, A. E., & Ebert, M. (1984). Clinical findings in patients with anorexia nervosa and affective illness in their relatives. American Journal of Psychiatry, 141, 14191422.Google ScholarPubMed
Gough, H. G. (1950). The F minus K dissimulation index for the MMPI. Journal of Consulting Psychology, 14, 408413.CrossRefGoogle Scholar
Greene, R. L. (1980). The MMPI: An interpretative manual. New York: Grune & Stratton.Google Scholar
Halmi, K. A., Eckert, E., Marchi, P. A., Sampugnaro, V., Apple, R., & Cohen, J. (1991). Comorbility of psychiatric diagnoses in anorexia nervosa. Archives of General Psychiatry, 48, 712718.CrossRefGoogle Scholar
Hathaway, S. R, & McKinley, J. C. (1942). A multiphasic personality schedule (Minnesota): III. The measurement of symptomatic depression. Journal of Psychology, 14, 7384.CrossRefGoogle Scholar
Hathaway, S. R., & McKinley, J. C. (1951). Minnesota Multiphasic Personality Inventory manual (Rev. ed.). New York: The Psychological Corporation.Google Scholar
Hedges, L. V., & Olkin, I. (1985). Statistical methods for metaanalysis. Orlando, FL: Academic.Google Scholar
Heebink, D. M., Sunday, S. R., & Halmi, K. A. (1995). Anorexia nervosa and bulimia nervosa in adolescence: Effects of age and menstrual status on psychological variables. Journal of American Academy of Child and Adolescent Psychiatry, 34, 378382.CrossRefGoogle ScholarPubMed
Horiguchi, T., & Sasaki, T. (1998). Rorschach study of borderline personality disorder: Construction of borderline personality index. Journal of Mental Health, 44, 6974.Google Scholar
Hudson, J. I., Pope, H. G., Jonas, J. M., & Yurgelun-Tood, D. (1983). Phenomenological relationship of eating disorders to major affective disorder. Psychiatry Research, 9, 345354.CrossRefGoogle ScholarPubMed
Katz, J. L. (1987). Eating disorders and affective disorder: Relatives or merely chance acquaintances? Comprehensive Psychiatry, 28, 220228.CrossRefGoogle ScholarPubMed
Keppel, G. (1991). Design and analysis: A researcher's handbook (2nd ed.). Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
Keys, A., Brozek, J., Henschel, A., Mickelsen, O., & Taylor, H. L. (1950). The biology of human starvation. Minneapolis, MN: University of Minnesota Press.CrossRefGoogle Scholar
Klinefelter, D., Pancoast, D. L., Archer, R. P., & Pruitt, D. L. (1990). Recent adolescent MMPI norms: T-scores elevation comparisons to Marks and Briggs. Journal of Personality Assessment, 54, 379389.CrossRefGoogle Scholar
Lasa, L., & Canedo, C. (1997). Disfunciones fisiológicas relacionadas con factores mentales y del comportamiento: trastornos de la conducta alimentaria. In Cervera, S., Conde, V., Espino, A., Giner, J., Leal, C., & Torres, F. (Eds.), Manual del residente de psiquiatría (Vol.1, pp. 11211154). Madrid: Litofinter.Google Scholar
Lázaro, L., & Toro, J. (1999). Aspectos epidemiológicos, sociales y culturales de los trastornos del comportamiento alimentario. Aula Médica Psiquiatría, 3, 205218.Google Scholar
Levitt, E. E. (1989). The clinical application of MMPI special scales. Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
López Gómez, I. (2001). Comorbilidad en los trastornos de la conducta alimentaria. In García-Camba, E. (Ed.), Avances en trastornos de la conducta alimentaria. Anorexia nerviosa, bulimia nerviosa, obesidad (pp. 157169). Barcelona: Masson.Google Scholar
Marks, P. A., & Briggs, P. (1972). Adolescent norm tables for the MMPI. In Dahlstrom, W. G., Welsh, G. S., & Dahlstrom, L. E. (Eds.), An MMPI handbook: Clinical interpretation (Vol. 1, pp. 388399). Minneapolis, MN: University of Minnesota Press.Google Scholar
Meyer, G. J. (1997). On the integration of personality assessment methods: The Rorschach and MMPI. Journal of Personality Assessment, 68, 297330.CrossRefGoogle ScholarPubMed
Morandé, G., Casas, J., Calvo, R., Marcos, A., Hidalgo, I., Lareo, J.et al. (1995). Protocolo de trastornos del comportamiento alimentario. Madrid: Instituto Nacional de la Salud.Google Scholar
Mormont, Ch., Frankignoul, A., & Michel, A. (2001). Le transsexualisme et l'anorexie mentale: Emprise et tyrannie de la subjectivite. Practiques Psychologiques, 3, 2536.Google Scholar
Muttini, C. (2002). Bulimia e falso-se. Minerva Psichiatrica, 43, 110.Google Scholar
North, C., & Gowers, S. (1999). Anorexia nervosa, psychopathology and outcome. International Journal Eating Disorders, 26, 386389.3.0.CO;2-A>CrossRefGoogle ScholarPubMed
Parker, K. C., Hanson, R. K., & Hunsley, J. (1988). MMPI, Rorschach, and WAIS: A meta-analytic comparison of reliability, stability, and validity. Psychological Bulletin, 103, 367373.CrossRefGoogle Scholar
Polaino, A., & García Villamisar, D. A. (1988). Diagnóstico y evaluación de las depresiones infantiles. In Polaino-Lorente, A. (Ed.), Las depresiones infantiles (pp. 7196). Madrid: Morata.Google Scholar
Polaino Lorente, A., & Lizasoaín, O. (1990). Programas para la preparación a la hospitalización infantile. In Buceta, J. M. & Bueno, A. M. (Eds.), Modificación de conducta y salud (pp. 126150). Madrid: Endema.Google Scholar
Pollice, Ch., Kaye, W. H., Greeno, C. G., & Weltzin, T. E. (1997). Relationship of depression, anxiety, and obsession to state of illness in anorexia nervosa. International Journal of Eating Disorders, 21, 367376.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
Quay, H. C., & Peterson, D. R. (1983). Interim manual for the Revised Behavior Problem Checklist. Coral Glabes, FL: Applied Social Sciences.Google Scholar
Roberts, N., Vargo, B., & Ferguson, H. B. (1989). Measurement of anxiety and depression in children and adolescents. Psychiatric Clinics of North America, 12, 837860.Google ScholarPubMed
Salorio, P., Ruiz, M. E., Martínez-Moya, R., Gómez, R., Velo, E., & Oñate, A. (2003). Personalidad y trastornos alimentarios: un estudio mediante el test de Rorschach (Exner). Anales de Psiquiatría, 19, 14.Google Scholar
Sánchez Carrión, J. J. (1992). Análisis de tablas de contingencia (2nd ed.). Madrid: Centro de Investigaciones Sociológicas.Google Scholar
Sánchez Carrión, J. J. (1995). Manual de análisis de datos. Madrid: Alianza Editorial.Google Scholar
Sendín, C. (2000). Diagnóstico psicológico. Bases conceptuales y guía práctica en los contextos clínico y educativo. Madrid: Psimática.Google Scholar
Sendín, C., & García-Alba, C. (1995, November). Diagnóstico escolar: integración de Rorschach y Escala de Inteligencia de Wechsler para Niños (WISC) para la medida del desarrollo cognitivo. Paper presented at the 2nd International Congress on Psychology and Education, Madrid, Spain.Google Scholar
Szmukler, C., Dare, C., & Treasure, J. (1995). Handbook of eating disorders. Theory, treatment and research. New York: Wiley.Google Scholar
Toro, J. (1995). Los trastornos oroalimentarios. In Sacristán, J. Rodríguez (Ed.), Psicopatología del niño y del adolescente (Vol. 1, pp. 429454). Sevilla: Publicaciones de la Universidad de Manuales Universitarios.Google Scholar
Toro, J. (2001). Anorexia nerviosa. Medicina Clínica, 117, 334335.CrossRefGoogle Scholar
Turón, V. (1997). Trastornos de la alimentación: Anorexia nerviosa, bulimia y obesidad. Barcelona: Masson.Google Scholar
Vallejo, J. (1997). Prólogo. In Turón, V. (Ed.), Trastornos de la alimentación (p. IX). Barcelona: Masson.Google Scholar
Varela, M., Martíni, A. M., Ponce, M., & Rubio, X. (1994). Anorexia nerviosa: estudio clínico-fenomenológico de siete casos. Revista de Psiquiatría Clínica, 31, 2534.Google Scholar
Viglione, D. J. (1997). Problems in Rorschach research and what to do about them. Journal of Personality Assessment, 68, 590599.CrossRefGoogle Scholar
Weiner, I. B. (1993). Clinical considerations in the conjoint use of the Rorschach and the MMPI. Journal of Personality Assessment, 60, 148152.CrossRefGoogle ScholarPubMed
Weiner, I. B. (1997). Current status of the Rorschach inkblot method. Journal of Personality Assessment, 68, 519.CrossRefGoogle ScholarPubMed
Winokur, A., March, V., & Mendels, J. (1980). Primary affective disorder in relatives of patients with anorexia nervosa. American Journal of Psychiatry, 137, 695698.Google ScholarPubMed
Yellowless, A. J. (1985). Anorexia and bulimia in anorexia nervosa: A study of psychosocial functioning and associated psychiatric symptomatology. British Journal of Psychiatry, 146, 648652.CrossRefGoogle Scholar