To examine the effectiveness of an Internet Based Therapy (IBT) for Bulimia Nervosa (BN), when compared to a brief psychoeducational group therapy (PET) or a waiting list (WL).

93 female BN patients, diagnosed according to DSM-IV criteria. An experimental group (31 IBT patients) was compared to two groups (31 PET and 31 WL). PET and WL were matched to the IBT group in terms of age, disorder duration, previous treatments and severity. All patients completed assesment, prior and after treatment.

Considering IBT, mean scores were lower at the end of treatment for some EDI scales and BITE symptoms scale, while the mean BMI was higher at post-therapy. Main predictors of good IBT outcome were higher scores in EDI perfectionism and higher scores on reward dependence. Drop-out was related to higher SCL-obsessive/compulsive (p=0.045) and novelty seeking (p=0.044) scores and lower reward dependence (p=0.018). At the end of the treatment bingeing and vomiting abstinence rates (22.6% for IBT, 33.3% for PET, and 0.0% for WL; p=0.003) and drop-out rates (35.5% IBT, 12.9% PET and 0% WL; p= 0.001) differed significantly between groups. While the concrete comparison between the two treatments (IBT and PET) did not evidence significant differences for success proportions (p=0.375), statistical differences for drop-out rates (p=0.038) were obtained.

The results of this study suggest that an online self-help approach appears to be a valid treatment option for BN, especially for people who present lower severity of their eating disorder (ED) symptomatology and some specific personality traits.

To assess the differences in comorbid lifetime substance use (tobacco, alcohol and drug use) between eating disorder (ED) patients and healthy controls.

Participants were a consecutive series of 779 ED cases, who had been referred to specialised ED units in five European countries. The ED cases were compared to a balanced control group of 785 healthy individuals. Assessment: Participants completed the Substance Use Subscale of the Cross Cultural Questionnaire (CCQ), a measure of lifetime tobacco, alcohol and drug use. In the control group, also the GHQ-28, the SCID-I interview and the EAT-26 were used.

ED patients had higher lifetime consumption of tobacco and drugs (p <0.01). The only insignificant result was obtained for alcohol (OR= 1.29; δ =0.157; N.S.) and cannabis use (OR= 1.21; δ = 0.037, N.S.). Significant differences across ED sub diagnoses also emerged for all of the assessed variables (p<0.01), with the BN and AN-BP patients generally presenting the highest prevalence rates. The only exception was detected for alcohol consumption where EDNOS patients demonstrated the highest values (p=0.008). Only a few cultural differences between countries emerged (p<0.05).

Lifetime tobacco and drug use but not alcohol consumption are more prevalent in ED patients than healthy controls. While alcohol appears to be more common in EDNOS, smoking and drug use are more frequent in patients with bulimic symptomatology. The differential risk observed in patients with bulimic features might be related to differences in temperament or might be the result of increased sensitivity to reward.

To explore gender differences on personality and clinical features in patients with eating disorders (ED) and a healthy control sample.

60 ED males and 60 ED females, consecutively admitted to our Hospital and diagnosed according to DSM-IV-R criteria, were matched for age and diagnosis. A comparison group of 120 non clinical people (60 males, 60 females) were also collected. Measures: TCI-R, SCL-90-R, EDI-2.

Female ED patients scored significantly higher than males on Drive for Thinness, Body Dissatisfaction, Interoceptive Awareness and total EDI (p < 0.002). However, these differences were not significant when compared with controls. ED women exhibited higher SCL-90-R Somatization, Interpersonal Sensitivity, Depression, Anxiety, Hostility, GSI, PSDI and PST scores (p<0.002). Regarding personality traits, high Harm Avoidance, Persistence, Cooperativeness (p<0.018) and low Self- Directedness (p=0.001) were associated with an ED diagnosis in males. Significant differences across ED subdiagnoses were also observed. Lifetime obesity was significantly associated with ED in males (p=0.008). However, when specific ED diagnosis was entered, the gender effect of obesity disappeared (p=0.081).

Although gender specific differences in clinical and psychopathological features across ED patients have been observed, there are important similarities in current ED features between ED males and females, suggesting that, in spite of having some gender-specific associated traits, EDs are not different with regard to gender. These data encourage our continued efforts toward using similar strategies to detect and treat EDs among men and women.

Cross-sectional studies show that neuroticism is strongly associated with affective disorders. We investigated whether neuroticism and affective disorders mutually reinforce each other over time, setting off a potential downward spiral.

A total of 2981 adults aged 18–65 years, consisting of healthy controls, persons with a prior history of affective disorders and persons with a current affective disorder were assessed at baseline (T1) and 2 (T2) and 4 years (T3) later. At each wave, affective disorders according to DSM-IV criteria were assessed with the Composite Interview Diagnostic Instrument (CIDI) version 2.1 and neuroticism with the Neuroticism–Extraversion–Openness Five Factor Inventory (NEO-FFI).

Using structural equation models the association of distress disorders (i.e. dysthymia, depressive disorder, generalized anxiety disorder) and fear disorders (i.e. social anxiety disorder, panic disorder, agoraphobia without panic) with neuroticism could be attributed to three components: (a) a strong correlation of the stable components of distress and fear disorders with the stable trait component of neuroticism; (b) a modest contemporaneous association of change in distress and fear disorders with change in neuroticism; (c) a small to modest delayed effect of change in distress and fear disorders on change in neuroticism. Moreover, neuroticism scores in participants newly affected at T2 but remitted at T3 did not differ from their pre-morbid scores at T1.

Our results do not support a positive feedback cycle of changes in psychopathology and changes in neuroticism. In the context of a relative stability of neuroticism and affective disorders, only modest contemporaneous and small to modest delayed effects of psychopathology on neuroticism were observed.