ABSTRACT
Among the diverse clinical pictures seen in the eating disorder (ED) field, two case summaries make useful referents for a discussion of problems in assessing personality:
Patient A presented as a 15-year-old with a 3-year history of anorexia nervosa, restricting subtype. At interview, her BMI was 17.2 after partial weight restoration during her third inpatient admission. She denied any distress or dysfunction, with the exception of dismay about being “too fat”—a problem she was already working assiduously to correct. With pride, she characterized herself as strong willed and perfectionistic—the sort of person who accomplished every goal she set out to achieve. She outlined patterns of behavior, stretching back to childhood, that matched criteria for obsessive-compulsive personality disorder. Spontaneously, she articulated a close correspondence between her basic nature and her ED—she had always liked to do things “just right” and meant to apply those exacting standards to the control of eating and weight.
Patient B began treatment in our program at age 16. Her referral diagnoses from two previous therapists and five hospitalizations included anorexia nervosa, binge-purge subtype, major depressive disorder with psychotic features, borderline personality disorder (BPD), and narcissistic personality disorder. At presentation, she was alternately fasting and binge eating, vomiting several times a day, and abusing laxatives, diet pills, and psychotropic medication. She self-injured by cutting and burning, and she had made one serious suicide attempt. During the intake session, Patient B was emotionally labile and expressive, with bursts of anger and sobbing. She referred to herself as “evil” and “unworthy”; it was not difficult to see, she said bitterly, why her family and therapists had abandoned her as a hopeless case.
