Eating disorders subtypes in a sample of young females using the OPD system : Preliminary results

Objectives: Clinical experience with patients suffering from eating disorders (EDs) shows that the same symptom can cover different types of mental functioning, with very different prognosis. This study aims to investigate the existence of recurrent diagnostic configurations on an adolescent sample normalized for the DSM-IV diagnosis of ED, using the Operationalized Psychodynamic Diagnosis system (OPD-Task-Force 2008: Operationalized Psychodynamic Diagnosis OPD-2 Manual of Diagnosis and Treatment Planning in order to improve the therapeutic strategies. In a previous study we found that OPD can show different recurrent psychodynamic configurations independently from the DSM-IV diagnosis. In subsequent research we found that OPD can also show different psychodynamic configurations in a population affected by eating disorder and different configurations for each personality disorder. Method: The sample is made up of 50 consecutive non-selected young women (age between 16-25 years) coming to a nutritional day hospital at the Department of Clinical Nutrition of the H. Niguarda-Milan and visited by an OPD-II trained interviewer of the psychiatric university unit of the same hospital. We present the preliminary results of a study with a 300 patient sample, in which there will be three evaluations (T0 - T1 18 months - T2 36 months follow up) using the following tools: OPD-2, SCL-90, EDI-2, BUT, suited clinical anamnestic schedule. We performed two different factor analyses with the Varimax rotation, the first one using OPD Axis I (Experience of Illness) variables, the second one among the factors extracted in Axis I and the Axis III (Conflicts) and Axis IV (Structure) variables. Results: We obtained in the first step of analysis four different recurrent psychodynamic configurations, that we called Configurations, that represent the patient psychological, somatic and social theory of illness. In the second step we've found two recurrent psychodynamic configurations, that we called Organizations, that represent more stable organizations of illness that could contribute to create the high outcome variability in this disorder. Conclusions: These results suggest the existence of different subtypes of patients with EDs, that differ not only with respect to the symptomatology, but also with respect to underlying psychodynamic features. Our hypotheses are that patients with different configurations and organizations need different therapeutic approaches, and that the frequent treatment failures with patients with EDs are due to the lack of an appropriate differential diagnosis