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Are eating disorders linked to specific personality traits?

24 January 2012 Journal of Psychotherapy and Psychosomatics

This study analyzes the occurrence of specific personality traits and psychiatric disorders in a population of patients with eating disorders (ED). Patients with major depression (MD) reported higher scores on all Eating Disorder scales than did those without this diagnosis. Patients with ED and MD were characterized by more pathological personality profiles on the Temperament and Character Inventory than patients with ED alone.  ED patients with this personality profile match the subgroup as avoidant/depressed patients.

A report in the 5th 2011 issue of Psychotherapy and Psychosomatics by a group of Italian investigators analyzes the occurrence of specific personality traits and psychiatric disorders in a population of patients with eating disorders.

The lifetime prevalence of mood disorders in anorexia nervosa (AN) varies between 64.1 and 96%, and between 50 and 90% in bulimia nervosa (BN). Moreover, the prevalence of comorbid mood disorders among patients diagnosed with eating disorders (ED) is also high, between 12.7 and 68% among those with AN and 40% among those with BN.

The severity of depressive symptomatology seems to correlate with the severity of the ED. Other factors that should be addressed are depressive personality traits. Instability and emotional liability, avoidant behaviors and depressive traits have been frequently found in ED patients.

This study aimed to (a) assess the prevalence of current major depression (MD) in a clinical sample of female patients with ED, (b) confirm the correlation between ED severity and diagnosis of MD, and (c) assess the differences in personality traits between ED patients with and without MD.

The sample consisted of 693 patients admitted to the outpatient service of the ED Program of Turin University between January 1, 2003, and October 30, 2007. All subjects were diagnosed with an ED: AN, restricting type, n = 151; AN, binge-eating/purging type, n = 75; BN, purging type, n = 188; ED not otherwise specified, n = 279. Diagnoses of ED and MD were based on the Structured Clinical Interview for DSM-IV.

The first two assessment interviews were conducted by psychiatrists experienced in the diagnosis and treatment of ED. Between the first and the second interviews, patients completed some self-report questionnaires: Eating Disorder Inventory 2, Beck Depression Inventory (BDI) and Temperament and Character Inventory. Subjects with MD represented 17.4% (n = 121) of the sample, with the following ED subtypes: 13.2% restricting type of AN (n = 20), 24% binge-eating/purging type of AN (n = 18), 21.2% BN (n = 40) and 15.4% ED not otherwise specified (n = 43).

Patients with MD reported more frequent episodes of binge eating than patients without MD (p<0.004) after controlling for BMI, age, duration of the disorder and ED diagnosis (clinical variables). Moreover, subjects with MD more often reported self-induced vomiting ( p<0.015), after controlling for age and clinical variables.

The BDI scores of subjects with MD were significantly different from those without MD (p<0.001), after controlling for age and clinical variables. In addition, the BDI scores of 306 patients (44.1% of the sample) who were not diagnosed with MD were higher than 10; there were no statistically significant differences among diagnostic subtypes, respectively (p< 0.215). Patients with MD reported higher scores on all Eating Disorder Inventory 2 scales than did those without this diagnosis.

Low BMI, as a global malnutrition index, plays a modest role in the association between ED and MD; it cannot independently correlate with depression. Indeed, patients with MD reported significantly more episodes of binge eating and vomiting. This association might depend on the greater severity and higher rates of comorbidity characterizing patients with purging behaviors.

Patients with ED and MD were characterized by more pathological personality profiles on the Temperament and Character Inventory than patients with ED alone. ED patients with this personality profile match the subgroup as avoidant/depressed patients. In other words, depression can influence the development of altered personality traits or vice versa. It cannot be excluded that underlying common features could influence both personality traits and depression. Future research should include longitudinal studies in the general population in order to compare premorbid personality traits with those associated with the development of ED and depression in adolescence.

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