Personality and Eating Disorders

Personality can play several major roles for those with eating disorders: as a risk factor, as a moderator of symptomatic expression, in choice of treatment, and also as a predictive factor in outcome. Some personality traits are common to all eating disorders, while others are strongly related only to certain types of eating disorders, such as high perfectionism in anorexia nervosa (AN) and increased sensation-seeking in binge eating disorder.

Researchers at Sweden’s largest eating disorder center, the Stockholm Centre for Eating Disorders, recently explored ways in which patients with non-anorexic eating disorders differ from controls in personality, and to examine whether facets of personality can be paired with psychopathology (J Eat Disord. 2015; 3:3). The Stockholm Centre admits about 700 patients each year to its inpatient, outpatient, day, and family units, and it also has a mobile acute treatment team.

Patients with non-anorexic eating disorders who were treated at the Stockholm Centre between 2010 and 2013 were enrolled in the study. This group had severe disease, as shown by mean scores on the Eating Disorder Examination (EDE) corresponding to the 95th percentile in young adult women. Potential participants had either been enrolled in a randomized control trial of Internet-based cognitive behavior therapy (n=150) or were enrolled in a multimodal day—patient treatment program (n=129). All patients were females and had a DSM-IV diagnosis of bulimia nervosa (BN) or eating disorder not otherwise specified (EDNOS). After eliminating 3 patients (2 who failed to complete the personality inventory and 1 who was diagnosed with AN), 208 persons were enrolled in the study.

The participants completed a series of online questionnaires, including the Eating Disorder Questionnaire (EDE-Q), the Comprehensive Psychiatric Rating Scale-Self-rating Scale for Affective Syndromes (CPRS), and the Structured Eating Disorder Interview, a 20- to 30-question instrument based directly on DSM-IV eating disorder criteria. They also completed the NEO Personality Inventory, Revised, a 240-item self-report measure designed to assess five dimensions and 30 facets of the Five Factor Model. The Five-Factor Model is comprised of five personality dimensions: openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism.

Personality differed between patients and controls

Compared to the controls, the patient group was characterized by pervasive negative affect and vulnerability, and displayed few positive emotions such as joy, warmth, or love. They were also significantly less sociable and showed less trust, competence, and self-discipline. While they were more closed to feelings, ideas and new experiences, they were more open in expressing their values. Patients also reported a tendency to doubt their own capacity to deal with life challengers, were self-effacing, and believed other people could not be trusted. They rated themselves as non-dogmatic and as less traditional than others. They also reported having a tendency to procrastinate and had trouble controlling their desires, which led to rash action, often followed by regret.

The authors stressed that knowledge of facets of personality, especially trust, striving to achieve, and neuroticism, can lead to better understanding of eating disorders. By identifying and focusing on personality traits, it might be possible to enhance the treatment alliance, address underlying problems, and improve outcomes.