Eating disorders, substance use disorders and multiple symptoms: three clinical vignettes
During the longitudinal study of three patients, referred to services at 3, 13, 15 years for eating disorders, reduced food intake and anorexia nervosa, other symptoms appeared depending on difficult development, relational and personality problems. The patients showed the interweaving of symptoms at different times: they were dealing with modified developmental needs and contexts, included new possibilities of attachment that might produce different internal organizations. These changes required different treatments. Anorexia started early in life for these girls, but presented different steps of organization. We wanted to start finding some aspects of a staging model to map the course of ED, because many patients arrived later in life, reported untreated early symptoms, actually personality traits. Mapping the evolution, could allow to take care of patients at the very early stage of problems when few symptoms are present, and better patients’ evolution might be possible.
Level of evidence
Level V opinions of respected authorities based on clinical experience.
KeywordsEating disorder Compulsive obsessional disorder Substance use disorder Depressive disorder Personality disorder
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.First M (2014) DSM V handbook of differential diagnosis. APA American Psychiatric Association. Dasha E. Nicholls, 2 https://doi.org/10.1176/appi.books.9781585629992.2
- 5.N.C.In.-To.Fam. (1994) Diagnostic classification: 0–3 Masson ed. Mi. 1995Google Scholar
- 6.Stern DN (1985) The interpersonal world of the infant. Basic books, NYGoogle Scholar
- 7.Stern DN (1995) The motherhood constellation Basic Books–Harper Collins, NYGoogle Scholar
- 8.Lingiardi V, Amedei G, Caviglia G, DeBei F (2011) La svolta relazionale R. Cortina ed. MiGoogle Scholar
- 10.Rizzolatti G, Gnoli A (2016) In te mi specchio Rizzoli ed. Mi. ISBN 978-88-17-08055-2Google Scholar
- 11.ICF—WHO | World Health Organization apps. http://who.int/iris/bitstream/10665/42417/4/9788879466288$4ita.pdf
- 12.Fava Vizziello G (2011) La partecipazione. Piccin, PdGoogle Scholar
- 14.Evans K, Sullivan MJ (2001) Dual diagnosis: counseling the mentally Ill substance abuser, 2nd edn. Guilford Press, UK, pp 75–76. ISBN 978-1-57230-446-8Google Scholar
- 15.Fava Vizziello G, Stern D, Cortina R (eds) (1992) Dalle cure materne all’interazione. MilanoGoogle Scholar
- 16.Mc Donough S (1992) L’aiuto all’interazione in G. Fava Vizziello, D. Stern Dalle cure materne all’interpretazione Raffaello Cortina ed. MiGoogle Scholar
- 17.Kernberg P (2000) Personality disorders in children and adolescents. Basic books, NY. https://doi.org/10.1080/080394800448183
- 18.Bleiberg E (2001) Treating personality disorders in children and adolescents. Guilford Press http://ajp.psychiatryonline.org/.doi/full/10.1176/appi.ajp.162.2.411-a
- 19.Cuzzolaro M, Piccolo F, Speranza AM (2009) Anoressia bulimia obesità. Carocci Faber, RomaGoogle Scholar
- 20.Ferrari P (2013) Troubles psychosomatiques du nousrrisson. In: Ferrari P, Bonnot O (eds) Traité de Psychopathologie de l’enfant et de l’adolescent. Lavoisier, Paris, pp 212–218Google Scholar
- 21.Kreisler L (1987) Le nouvel enfant du désordre psychosomatique. Privat, ToulouseGoogle Scholar
- 22.Jeanmet P (1980) Realité externe et realité interne à l’adolescence. Rev Fr Psychanalyse 44:481–521Google Scholar
- 24.Nizzoli U (2008) Disturbi dell’alimentazione e abuso di sostanze. Piccin, PDGoogle Scholar
- 26.Halmi KA, Tozzi F, Thornton LM, Crow S, Fichter MM, Kaplan AS, Keel P, Klump KL, Lilenfeld LR, Mitchell JE, Plotnicov KH, Pollice C, Rotondo A, Strober M, Woodside DB, Berrettini WH, Kaye WH, Bulik CM (2005) The relation among perfectionism, obsessive–compulsive personality disorder and obsessive–compulsive disorder in individuals with eating disorders. Int J Eat Disord 38(4):371–374CrossRefGoogle Scholar