Eating disorders and personality: A methodological and empirical review (original) (raw)
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Personality and eating disorders: A decade in review
Clinical Psychology Review, 2005
Personality traits have been implicated in the onset, symptomatic expression, and maintenance of eating disorders (EDs). The present article reviews literature examining the link between personality and EDs published within the past decade, and presents a meta-analysis evaluating the prevalence of personality disorders (PDs) in anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) as assessed by self-report instruments versus diagnostic interviews. AN and BN are both consistently characterized by perfectionism, obsessive-compulsiveness, neuroticism, negative emotionality, harm avoidance, low selfdirectedness, low cooperativeness, and traits associated with avoidant PD. Consistent differences that emerge between ED groups are high constraint and persistence and low novelty seeking in AN and high impulsivity, sensation seeking, novelty seeking, and traits associated with borderline PD in BN. The meta-analysis, which found PD rates of 0 to 58 percent among individuals with AN and BN, documented that self-report instruments greatly overestimate the prevalence of every PD.
Personality Profiles in Eating Disorders: Rethinking the Distinction Between Axis I and Axis II
American Journal of Psychiatry, 2001
Objective: Like other DSM-IV axis I syndromes, eating disorders are diagnosed without respect to personality, which is coded on axis II. The authors assessed the utility of segregating eating disorders and personality pathology and examined the extent to which personality patterns account for meaningful variation within axis I eating disorder diagnoses. Method: One hundred three experienced psychiatrists and psychologists used a Qsort procedure (the Shedler-Westen Assessment Procedure-200) that assesses personality and personality pathology to describe a patient they were currently treating for bulimia or anorexia. Data were subjected to a cluster-analytic procedure (Q-analysis) to determine whether patients clustered into coherent groupings on the basis of their personality profiles. Categorical and dimensional personality diagnoses were then used to predict measures relevant to adaptation and etiology, controlling for axis I diagnosis. Results: Three categories of patients emerged: a high-functioning/perfectionis-tic group, a constricted/overcontrolled group, and an emotionally dysregulated/ undercontrolled group. This categorization demonstrated substantial incremental validity beyond axis I diagnosis in predicting eating disorder symptoms, adaptive functioning (Global Assessment of Functioning scores and history of psychiatric hospitalization), and etiological variables (sexual abuse history). Conclusions: Axis I symptoms are a useful component, but only one component, in the accurate diagnosis of eating disorders. Classifying patients with eating disorders by eating symptoms alone groups together patients with anorexic symptoms who are high functioning and self-critical with those who are highly disturbed, constricted, and avoidant, and groups together patients with bulimic symptoms who are high functioning and self-critical with those who are highly disturbed, impulsive, and emotionally dysregulated. These distinctions may be relevant to etiology, prognosis, and treatment.
International Journal of Eating Disorders, 2022
Objective: This study aimed to report the presence of categorical and dimensional personality disorders (PD) in adults with longstanding eating disorders (ED) over a period of 17 years and to investigate whether changes in PD predict changes in ED symptoms or vice versa. Methods: In total, 62 of the 80 living patients (78% response rate) with anorexia nervosa (n = 23), bulimia nervosa (n = 25), or other specified feeding or ED (n = 14) at baseline were evaluated during hospital treatment and at 1-year, 2-year, 5-year, and 17-year follow-up. PD were assessed using the Structured Clinical Interview for DSM-IV Axis II disorders, and the eating disorder examination (EDE) interview was used to assess ED. Data were analyzed using multilevel modeling. Results: From baseline to the 17-year follow-up, the number of patients with any PD decreased significantly from 74.2% to 24.2%, and the total number of PD diagnoses declined from 80 to 22. Mean EDE score was significantly reduced from 4.2 (SD: 1.1) to 2.0 (SD: 1.6). There was a positive association between ED and PD where the initial level of either disorder was followed by similar levels of the other disorder throughout the entire follow-up period. High baseline levels of borderline PD predicted less decrease in ED symptoms. No significant within-person effects were found. Conclusions: Both ED and PD significantly declined over time. As the severity of either disorder seems to be associated with the other, thorough assessment and treatment that incorporates both the ED psychopathology and the personality disturbances are advisable. Public Significance Statement: While personality disorders were highly prevalent in the sample of patients with longstanding eating disorders, both disorders were significantly reduced at the 17-year follow-up. The disorders are related in the sense that an initial high level of either disorder is associated with a high level of the other over time. A thorough assessment and attention to both illnesses are advisable in therapy.
Personality prototype as a risk factor for eating disorders
Revista Brasileira de Psiquiatria, 2015
Objective: To establish whether the risk of suffering from an eating disorder (ED) is associated with the high-functioning, undercontrolled, or overcontrolled personality prototype groups. Method: The Revised NEO Personality Inventory (NEO-PI-R) and the Eating Disorder Inventory 2 (EDI-2) were administered to 69 patients diagnosed as suffering from EDs (cases) and 89 people free of any ED symptoms (control group). A cluster analysis was carried out to divide the participants into three groups based on their scores in the Big Five personality dimensions. A logistic regression model was then created. Results: Participants in the undercontrolled group had a risk of suffering from an ED 6.517 times higher than those in the high-functioning group (p = 0.019; odds ratio [OR] = 6.517), while those in the overcontrolled subgroup had a risk of ED 15.972 times higher than those in the high-functioning group. Conclusions: Two personality subtypes were identified in which the risk of EDs was six times higher (the undercontrolled group) and almost 16 times higher (the overcontrolled group). Prevention and treatment programs for ED could benefit from focusing on the abovementioned personality profiles.
Dimensional assessment of personality pathology in patients with eating disorders
Psychiatry Research, 1999
This study examined patients with eating disorders on personality pathology using a dimensional method. Female Ž . subjects who met DSM-IV diagnostic criteria for eating disorder n s 136 were evaluated and compared to an Ž . age-controlled general population sample n s 68 . We assessed 18 features of personality disorder with the Ž . Dimensional Assessment of Personality Pathology ᎏ Basic Questionnaire DAPP-BQ . Factor analysis and cluster analysis were used to derive three clusters of patients. A five-factor solution was obtained with limited intercorrelation between factors. Cluster analysis produced three clusters with the following characteristics: Cluster 1 members Ž . constituting 49.3% of the sample and labelled 'rigid' had higher mean scores on factors denoting compulsivity and Ž . interpersonal difficulties; Cluster 2 18.4% of the sample showed highest scores in factors denoting psychopathy, Ž neuroticism and impulsive features, and appeared to constitute a borderline psychopathology group; Cluster 3 32.4%
Psychological Medicine, 2009
Background. Aetiological studies of eating disorders would benefit from a solution to the problem of instability of eating disorder symptoms. We present an approach to defining an eating disorders phenotype based on the retrospective assessment of lifetime eating disorders symptoms to define a lifetime pattern of illness. We further validate this approach by testing the most common lifetime categories for differences in the prevalence of specific childhood personality traits.
Psychiatry Research, 2014
Despite recent modifications to the DSM-V diagnostic criteria for Eating Disorders (ED; American Psychiatric Association, 2013), sources of variability in the clinical presentation of ED patients remain poorly understood. Consistent with previous research that has used underlying personality dimensions to identify distinct subgroups of ED patients, the present study examined (1) whether we could identify clinically meaningful subgroups of patients based on temperamental factors including Behavioral Inhibition (BIS), Behavioral Activation (BAS) and Effortful Control (EC), and (2) whether the identified subgroups would also differ with respect to ED, Axis-I and Axis-II psychopathology. One hundred and forty five ED inpatients participated in this study. Results of a k-means analysis identified three distinct groups of patients: an Overcontrolled/Inhibited group (n ¼53), an Undercontrolled/Dysregulated group (n ¼58) and a Resilient group (n ¼34). Further, group comparisons revealed that patients in the Undercontrolled/Dysregulated group demonstrated more severe symptoms of bulimia, hostility and Cluster B Personality Disorders compared to the other groups, while patients in the Resilient group demonstrated the least severe psychopathology. These findings have important implications for understanding how individual differences in personality may impact patterns of ED symptoms and cooccurring psychopathology in patients with ED.
Prevalence of personality disorders in patients with eating disorders: a pilot study using the IPDE
European Eating Disorders Review, 2004
Objective: The present study aims to determine the comorbidity of personality disorders (PD) with anorexia and bulimia nervosa, and to establish the major personality characteristics of eating disorders subtypes. Method: Using the International Personality Disorders Examination (IPDE), the study investigated the personality profiles of 66 outpatients with eating disorders. Statistical analyses were carried out using non-parametric methods such as the Kruskal-Wallis H test and Mann-Whitney U. Results: 51.5% of the overall sample met criteria for at least one personality disorder. Purging anorexia nervosa patients were the most affected. The most common personality disorders were obsessive-compulsive, avoidant, dependent, borderline and not otherwise specified. Discussion: More than half of the subjects with AN and BN met the criteria for at least one PD. This finding is a challenge for clinical practice. Implications for further research in this area are commented on.