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

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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, Crow, Scott, Mitchell, James, Rotondo, Alessandro, Mauri, Mauro, Cassano, Giovanni, Keel, Pamela, Plotnicov, Katherine H., Pollice, Christine, Lilenfeld, Lisa R., Berrettini, Wade H., Bulik, Cynthia M., Kaye, Walter H.·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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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: Tozzi, Federica
Thornton, Laura M.
Klump, Kelly L.
Fichter, Manfred M.
Halmi, Katherine A.
Kaplan, Allan S.
Strober, Michael
Woodside, D. Blake
Crow, Scott
Mitchell, James
Keel, Pamela
Lilenfeld, Lisa R.
Bulik, Cynthia M.
Kaye, Walter H.
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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Symptom Fluctuation in Eating Disorders: Correlates of Diagnostic Crossover

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