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Cited by 317Eating Disorders and BehaviorsPersonality Disorders and PsychopathologyNutrition, Health and Food Behavior

Symptom fluctuation in eating disorders: correlates of diagnostic crossover

Tozzi, Federica, Thornton, Laura M., Klump, Kelly L., Fichter, Manfred M., Halmi, Katherine A., Kaplan, Allan S., Strober, Michael, Woodside, D. Blake +12 more·2005·American Journal of Psychiatry
DOI 10.1176/appi.ajp.162.4.732
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Abstract

OBJECTIVE: The course of anorexia nervosa often includes the emergence of bulimic symptoms and a crossover to the full syndrome of bulimia nervosa. However, clinicians' ability to predict who will develop bulimia nervosa is limited. The converse phenomenon, crossover from bulimia nervosa to anorexia nervosa, has not been investigated as thoroughly. The authors identified factors that are associated with crossover from anorexia nervosa to bulimia nervosa and from bulimia nervosa to anorexia nervosa. METHOD: All participants were from the International Price Foundation Genetic Study. Two groups were studied. The first comprised 88 individuals with an initial diagnosis of anorexia nervosa, of whom 32 developed bulimia nervosa. The second included 350 individuals with bulimia nervosa, of whom 93 developed anorexia nervosa. Several variables, including DSM-IV axis I and II disorders and personality traits, were evaluated as potential predictors of crossover. RESULTS: For the majority of affected individuals, crossover occurred by the fifth year of illness. A low level of self-directedness was associated with crossover in both directions. Other factors differed by diagnosis: high parental criticism was associated with crossover from anorexia nervosa to bulimia nervosa, whereas alcohol abuse/dependence and a low level of novelty seeking were associated with crossover from bulimia nervosa to anorexia nervosa. CONCLUSIONS: Low self-directedness may be associated with diagnostic instability in general, whereas other specific factors are related to the direction of diagnostic crossover. These results indicate that personality and family characteristics may influence the course of eating disorders and may be informative for planning interventions.

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  • Binge eating typically develops within the first three years after anorexia nervosa onset.

    “because binge eating typically develops within the first three years after AN onset (Bulik et al., 1997a, Tozzi et al., 2005).”

    From Factors associated with recovery from anorexia nervosa (2013) · cites this paper as Tozzi et al., 2005

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Authors
Tozzi, F., Thornton, L. M., Klump, K. L., Fichter, M. M., Halmi, K. A., Kaplan, A. S., Strober, M., Woodside, D. B., Crow, S., Mitchell, J., Rotondo, A., Mauri, M., Cassano, G., Keel, P., Plotnicov, K. H., Pollice, C., Lilenfeld, L. R., Berrettini, W. H., Bulik, C. M., & Kaye, W. H.
Affiliations
University of North Carolina at Chapel Hill (US)
ORCID
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
2005-04-01
Volume
162
Issue
4
Pages
732-740
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/appi.ajp.162.4.732
OpenAlex
W2130593434
Cited by
317
References
61
Citations by year
2026: 9 · 2025: 8 · 2024: 17 · 2023: 17 · 2022: 14 · 2021: 13 · 2020: 7 · 2019: 16 · 2018: 12 · 2017: 14 · 2016: 14 · 2015: 17 · 2014: 15 · 2013: 18 · 2012: 17
FWCI
20.83
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords
anorexia nervosa, bulimia nervosa, symptom fluctuation, self-direction, novelty seeking, parental criticism, alcohol abuse, personality traits, family factors
MeSH terms
Adolescent, Adult, Aged, Anorexia Nervosa, Feeding and Eating Disorders, Mental Disorders, Bulimia, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Personality Disorders, Personality Inventory, Psychiatric Status Rating Scales, Cohort Studies, Comorbidity, Logistic Models, Survival Analysis, Diagnosis, Dual (Psychiatry), Substance-Related Disorders

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