Abstract

Background: We believe that the frequent treatment failure with patients with eating disorders is in part due to the heterogeneity of patients with this diagnosis and to an incomplete understanding of psychopathological factors relevant to prognosis and treatment planning for subgroups of patients.

Goals: This ongoing study aimed to investigate the existence of psychopathologically significant dimensions in a sample of patients with Eating Disorders (EDs), using the Operationalized Psychodynamic Diagnosis (OPD-2) system (OPD Task Force, 2006).

Methods: The sample included 50 consecutive non-selected young women (mean age 19, [SD = 2,6] years old) attending a Nutrition Day Hospital at the Eating Disorder Unit of the Niguarda Hospital, Milan, who were evaluated by an OPD-2 trained interviewer. We performed two different factor analyses with the Oblimin rotation: the first one using OPD Axis I (Experience of Illness) variables, and the second using factors taken from Axis I and Axis III (Conflicts) and Axis IV (Structure) variables.

Conclusions: In the first analysis, we obtained four different psychodynamic dimensions, that we called Explicit Illness Configurations (EICs), that represent the patient’s psychological, somatic and social theory of illness and a symptomatic dimension. In the second analysis, we discovered three recurrent psychodynamic dimensions, which we called Implicit Functioning Profile (IFPs), representing more stable organizations of illness that may contribute to the high outcome variability in this disorder. These results suggest the existence of different subgroups of patients with EDs differing from each other with respect to psychodynamic features. These data suggest that tailoring therapeutic approaches to the patients’ individual profiles could improve outcomes.

Keywords: Eating disorders, OPD, subtypes, diagnosis, psychodynamic dimensions