Background. Previous studies of personality characteristics in women with eating disorders primarily have focused on women who are acutely ill. This study compares personality characteristics among women who are ill with eating disorders, recovered from eating disorders, and those without eating or other Axis I disorder pathology.

Method. Female participants were assessed for personality characteristics using the Temperament and Character Inventory (TCI): 122 with anorexia nervosa (AN; 77 ill, 45 recovered), 279 with bulimia nervosa (BN; 194 ill, 85 recovered), 267 with lifetime histories of both anorexia and bulimia nervosa (AN+BN; 194 ill, 73 recovered), 63 with eating disorder not otherwise specified (EDNOS; 31 ill, 32 recovered), and 507 without eating or Axis I disorder pathology.

Results. Women ill with all types of eating disorders exhibited several TCI score differences from control women, particularly in the areas of novelty-seeking, harm avoidance, self-directedness, and cooperativeness. Interestingly, women recovered from eating disorders reported higher levels of harm avoidance and lower self-directedness and cooperativeness scores than did normal control women.

Conclusions. Women with eating disorders in both the ill and recovered state show higher levels of harm avoidance and lower self-directedness and cooperativeness scores than normal control women. Although findings suggest that disturbances may be trait-related and contribute to the disorders' pathogenesis, additional research with more representative community controls, rather than our pre-screened, normal controls, is needed to confirm these impressions.

Bulimic and non-bulimic anorexics were compared on psychological variables during a hospital treatment study. Although before treatment bulimic anorexics displayed more overall psychopathology than non-bulimics, many of the differences disappeared with treatment. There was no difference in severity of depression or body size estimation in these groups both before and with treatment. There was no difference in treatment response as measured by rate of weight gain. More expression of discomfort by bulimic anorexics during the acute phase of illness may in part account for some described differences in these two groups.

In three collaborating institutions 105 hospitalized female anorexia nervosa patients were assessed for depressive symptomatology periodically during treatment. As a whole, patients were mildly to moderately depressed, being as depressed as anxious neurotics and less depressed than depressed neurotics. The more depressed patients showed a variety of characteristics, many of which have previously been shown to be indicators of poor prognosis. Over the course of treatment patients became less depressed. Weight gain was correlated with a decrease in depression.

A survey of 355 college students was carried out to determine the prevalence of the psychiatric disorder bulimia (the binge-eating syndrome). Results of the survey indicate that, within the normal college population, 13% experienced all of the major symptoms of bulimia as outlined in the DSM-III. Within the bulimic population, 87% were females (19% of the female population) and 13% were males (5% of the male population). Although self-induced vomiting may accompany other symptoms of bulimia, the results suggest that self-induced vomiting is not a necessary symptom for diagnosis. A significant relationship between laxative use and self-induced vomiting was detected. These forms of behaviour, termed purging behaviour, occurred in an average of 10% of the students. Individuals who experienced the symptoms of bulimia had a history of being overweight or tended to be in the upper portion of their normal weight range (age, sex, and weight corrected) when compared with those individuals who had not experienced the symptoms of bulimia. No significant weight history differences were detected between vomiters and non-vomiters.

The relationship of selected pretreatment characteristics to weight gain during treatment was examined in 81 anorexia nervosa patients. Good prognostic indicators correlating positively with weight gain were: no previous hospitalizations for anorexia nervosa, a great amount of overactivity before treatment, less denial of illness, less psychosexual immaturity and the admission to feeling hunger. A perinatal history of delivery complications was associated with the poor outcome predictor of prior hospitalizations.

Body image distortion in 79 female anorexia nervosa patients were examined on a visual-size estimation apparatus during the emaciated stage of illness. Both they and an age-matched female control group overestimated their body widths, so this overestimation cannot be considered unique to anorexia nervosa. Among anorexia patients the degree of overestimation was associated with less weight gain during treatment, greater denial of illness, and several other pretreatment characteristics indicative of poor outcome.

In three hospitals 81 female patients satisfying rigorous diagnostic criteria for anorexia nervosa were randomly allocated to one of four treatment combinations of cyproheptadine and placebo with behaviour therapy and no behaviour therapy. Cyproheptadine was found to be effective in inducing weight gain in a subgroup of anorexia nervosa patients who (a) had a history of birth delivery complications, (b) had lost 41–52 per cent weight from norm and (c) had a history of prior outpatient treatment failure. This subgroup may represent a more severe form of anorexia nervosa.

In three collaborating hospitals, 81 anorexia nervosa patients were randomly assigned to behaviour modification or its absence and followed over 35 days. There was no overall significant difference in weight gain in the two groups except in a subset of patients: those with no prior out-patient treatments.

Body image estimations in 86 normal-weight adolescent girls showed (a) a tendency to overestimate body width and underestimate body length and (b) an association between the younger ages and the extent of overestimation of body width. In particular there is a sharp drop in overestimation between ages 10 and 11 and thereafter a more gradual and non-significant decline. These age-specific normative data are useful in assessing body image distortions in a variety of medical and psychiatric disorders.

The occurrence of anorexia nervosa in monozygotic twins discordant and concordant for this illness is reviewed. Two additional pairs of identical twins, one discordant and the other concordant for anorexia nervosa, are described.

Few studies have been published about psychiatric illness among relatives of patients with anorexia nervosa. Even less information is available concerning alcohol abuse in relatives of such patients. Theander (10) found a 2.5 per cent incidence of alcohol abuse among uncles and aunts of patients with anorexia nervosa. Six out of 94 fathers, 6.5 per cent, were alcohol abusers, whereas none of the 94 mothers so indulged. In a recent report of 13 male cases of anorexia nervosa Crisp and Toms (3) describe one father who was a severe alcoholic. Kay and Leigh (6), in a study of 38 patients with anorexia nervosa, noted alcoholism in four parents out of a total of 76 (5 per cent). Alcoholism in actual anorexia nervosa patients has been mentioned, but no incidence figures were given. Crisp (2) commented that ‘those chronic patients who have progressed to a state of overeating and vomiting not infrequently appear to become dominated by oral behaviour, and may sometimes present with alcoholism’. Toms and Crisp (11) hold that alcohol and drugs may be used as substitutes or diversions for the suppression of normal appetite.

Lindsten (5), Mellbin (7), and Pitts and Guze (8) have described a total of three cases of anorexia nervosa occurring in conjunction with gonosomal aneuploidy (Turner's syndrome or gonadal dysgenesis with XO sex chromosome pattern). The incidence of both conditions is low, and the small likelihood of their concurrent appearance in one individual by chance can be estimated from the following figures. According to Maclean et al. (6), the XO chromosome abnormality occurs in four out of 10,000 live births. Baikie et al. (1) have found that the incidence of the XO gonosome pattern in the general population is not significantly different from that at birth. Anorexia nervosa has an average annual incidence of 45 (Theander (9)) or 61 (Kidd and Wood (4)) cases per 10,000,000 people. On the assumption that the two conditions are independent, the probability of their occurring together would therefore be 0.18 to 0.24/100,000,000. Since the incidence data for the XO anomaly and for anorexia nervosa were obtained from different populations, it must be recognized that these figures are only order of magnitude estimates. Nevertheless, we considered it of interest to examine the available case records of anorexia nervosa patients seen at the University of Iowa Hospitals from 1920 to 1972 for Turner's syndrome and other anomalies of the urogenital tract.