Redefining phenotypes in eating disorders based on personality: A latent profile analysis (original) (raw)
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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.
Comprehensive Psychiatry, 2004
The current study sought to examine differences in personality-related characteristics between restricting anorexia nervosa (RAN), binging/purging anorexia (BPAN), and purging bulimia nervosa (BN) patients. Scores on the Temperament and Character Inventory (TCI) and on the Dutch Eating Behaviour Questionnaire (DEBQ) were compared for 166 RAN, 78 BPAN, and 151 BN patients. Bingers/purgers showed a higher score for restrained, external and emotional eating and a lower score for a subscale of "self-directedness" compared to patients who never binge and purge. Personality differences were most marked between RAN and BN patients, while personality char-acteristics of BPAN patients tended to be similar to those of BN patients. BN patients showed higher scores on "novelty seeking" and the subscales "exploratory excitability," "impulsivity," and "extravagance," and lower scores on "self-directedness," compared to restricting patients. Moreover RAN patients also showed higher scores on subscales of character dimensions, compared to BN patients. The higher the scores on novelty seeking, the lower the scores on several character scales, which has important implications for the reinforcement of behavior and the treatment of eating disorders.
Comparing the Personality Traits of Patients with an Eating Disorder versus a Dual Diagnosis
Journal of Dual Diagnosis, 2020
Objectives: This cross-sectional study explored personality traits of individuals receiving treatment in a private clinic for an eating disorder (ED) compared to those receiving treatment for a dual diagnosis (DD; defined as an addiction to illegal drugs and/or alcohol along with a mental illness, in this case an ED). The aims of this study were to: (a) assess the personality profiles and differentiating traits between the ED and DD groups, (b) analyze differences in personality traits of restrictive ED versus bingeing ED profiles, and lastly (c) compare the individuals Temperament and Character Inventory-Revised (TCI-R) results to their personality clusters as per the Diagnostic and Statistical Manual of Mental Disorders-5 th edition (DSM-5). Methods: The TCI-R is a self-report questionnaire consisting of seven scales, each with their own subscales, which provide a fuller understanding of each temperament and character trait evaluated. This questionnaire was given to patients (n ¼ 67) receiving treatment at a private institute specialized in eating disorders in Barcelona, Spain and the surrounding areas, along with the State-Trait Anxiety Inventory (STAI), Beck Depression Inventory-II (BDI-II), and the Barratt Impulsiveness Scale-11 (BIS-11). These subsequent questionnaires were given as they are often found to be comorbidities of ED. Results: The ED group (n ¼ 41), regarding the TCI-R scales, showed higher scores in harm avoidance (HA), reward dependence (RD), persistence (P), cooperativeness (C) and selfdirectedness (SD). Whereas, the DD (n ¼ 26) group, showed higher scores in novelty seeking (NS) and self-transcendence (ST). Also, there was a significant positive correlation between the DD group and the extravagance (NS3) subscale of novelty seeking across models. When comparing the two ED groups, the restrictive profile (RP) to the bingeing profile (BP), there were significant negative correlations in the TCI-R subscales of dependence (RD4) and perfectionism (P4) whereas there were positive correlations in the TCI-R subscale of responsibility (SD1). Conclusions: These results support previous studies and help to appraise differences in personality traits between specific groups in a clinical setting.
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.
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%
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.
Eating disorders and personality: A methodological and empirical review
Clinical Psychology Review, 2006
Methodological approaches utilized to evaluate models of the relationship between personality and eating disorders, as well as empirical support for each model, are reviewed. Limited prospective research suggests that negative emotionality, perfectionism, drive for thinness, poor interoceptive awareness, ineffectiveness, and obsessive-compulsive personality traits are likely predisposing factors. Limited family study research suggests that obsessive-compulsive personality disorder (OCPD) and anorexia nervosa share a common familial liability. Potential pathoplastic personality factors include Cluster B personality disorders and OCPD, which predict a poorer course and/or outcome, and histrionic personality traits and self-directedness, which predict a more favorable course and/or outcome. Future research should focus upon sophisticated prospective and family study research in order to best evaluate competing models of the eating disorder-personality relationship. D
Personality in non-clinical adolescents with eating disorders
European Eating Disorders Review, 2008
Objective: The aim of this study was to examine whether personality-related differences also exist in non-clinical adolescents with any given type of eating disorder (ED) and whether personality characteristics are associated with changes in the course of the diagnosis. Method: An initial sample of 1336 boys and girls (mean age: 11.37, SD ¼ 0.62) was assessed in a two-phase long-term study. A total of 258 subjects were selected from the initial sample (T1) and contacted again 2 years later (T2) (n ¼ 200). These subjects comprise the sample group of this study. Of these, 51 were diagnosed with ED (37 with diagnosis type anorexia (DTA) and 14 with diagnosis type bulimia (DTB)). An experimental version of the Junior Temperament and Character Inventory (JTCI) was applied. Results: Subjects with DTA had significantly higher scores on Reward Dependence and Self-Directedness factors than subjects with no diagnosis or DTB, respectively. Subjects with DTB had higher scores on Novelty Seeking, Harm Avoidance and Spirituality factors than subjects with forms of anorexia or without diagnosed ED. Subjects with ED remission had significantly lower scores on Persistence and Self-Directedness scales. ED incident subjects had significantly higher scores on Harm Avoidance. Conclusions: Subjects without full-blown syndromes have similar temperament characteristics to subjects with full eating disorders. These results support the theory that non-full-blown syndromes differ from full syndromes only in pathological severity.