Anorexia y depresión

The Spanish Journal of Psychology 2004, Vol. 7, No. 1, 40-52

Copyright 2004 by The Spanish Journal of Psychology 1138-7416

Anorexia and Depression: Depressive Comorbidity in Anorexic Adolescents
Carmen García-Alba
José Germain Psychiatric Institute of Leganés, Madrid

Frequently, depression is a concomitant pathology in anorexia nervosa. To verify this, we carried out a comparativecase/control study with 50 anorexic patients, restricting-type (ANP), 50 depressed patients (DP) and 50 non-patients (NP), aged between 13 and 16. We used the Rorschach Test and the Minnesota Multiphasic Personality Inventory (MMPI) and compared the results to parent’s observations collected from the Achenbach Child Behavior Checklist (CBCL). Results showed two clearly different groups amongparticipants: ANP with depression (36%) and ANP without depression (64%). This seems to indicate that depression is not a core element in anorexic disorders. However, we also observed a significant increase in the MMPI scale 2, which was probably related to starvation and weight loss. We confirmed the absence of general anxiety in the ANP group and obtained differences between depressive symptoms and thosederived from coping deficit disorders. The discussion emphasizes the importance of using several tests to reduce bias in results and conclusions. Keywords: anorexia nervosa, depression, assessment, adolescents, Rorschach Test, MMPI

La depresión es, frecuentemente, una patología concomitante con la anorexia nerviosa. Para verificarlo, se diseñó un estudio comparativo con 50 pacientesanoréxicas, tipo restrictivo (ANP), 50 deprimidas (DP) y 50 no pacientes (NP), de edades comprendidas entre los 13 y 16 años. Se utilizaron el Test de Rorschach y el Minnesota Multiphasic Personality Inventory (MMPI), comparándose los resultados con las observaciones de los padres, recogidas de forma estandardizada a través del Child Behavior Checklist (CBCL). Los resultados obtenidos mostraron la existenciade dos grupos claramente diferenciados: ANP con depresión (36%) y ANP sin depresión (64%). Por lo tanto, parece que la depresión no es nuclear en la patología anoréxica. No obstante, se apreció un aumento significativo de la escala 2 del MMPI, probablemente consecutivo a la inanición y pérdida de peso. Además, en el grupo ANP se ha constatado la ausencia de ansiedad generalizada. También seencontraron diferencias entre el síndrome depresivo y las alteraciones derivadas de la indefensión social. Igualmente, se ha subrayado la importancia de investigar con distintos tests, para evitar sesgos en los resultados y conclusiones. Palabras clave: anorexia nerviosa, depresión, evaluación, adolescentes, Test de Rorschach MMPI

This article is part of a wider research project that formed thebasis of a doctoral dissertation. (García-Alba, 2000). My sincere thanks to Dr. John Exner and Dr. Concepción Sendín, for their continuous help and support during this research. Their opinions on the results obtained have contributed substantially to my interest in publishing them. Correspondence concerning this article should be addressed to Carmen Garcia-Alba, Ronda Delicias 21, Majadahonda, 28220Madrid (Spain). Fax: 91 638 0243. E-mail: garciaalba@wanadoo.es

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ANOREXIA AND DEPRESSION

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The relationship between anorexia (AN) and depression (D) cannot be denied, since the two disorders share a series of biological anomalies such as: 1) hypercorticism associated with an excessive excretion of the corticotrophin-releasing hormone (CRH), 2) a dysfunction of the neurotransmitters(low noradrenalin and serotonin levels), and 3) an abnormal dexamethasone suppression test (Díaz, 1999). However, the precise nature of this relationship and the sequence in which it tends to develop still remain unclear (Cervera & Gual, 1998; Chinchilla, 1995). It was in 1977 when Cantwell, Sturzenberger, Burroughs, Salkin, and Green suggested the possibility of considering some AN cases as a...