Dimensional assessment of personality pathology in patients with eating disorders

Borderline personality disorder and deliberate self-harm: does experiential avoidance play a role?

The theory that borderline personality disorder (BPD) is associated with experiential avoidance, and that experiential avoidance mediates the association between BPD and deliberate, nonsuicidal self-harm was examined. Female inmate participants (N = 105) were given structured diagnostic assessments of BPD, as well as several measures of experiential avoidance. There was a high lifetime prevalence of past self-harm (47.6%). Higher dimensional scores representing BPD severity were associated with higher self-harm frequency and greater experiential avoidance. Structural equation modeling analyses indicated that experiential avoidance did not mediate the association between BPD and self-harm, although thought suppression was associated with self-harm frequency.

Personality subtypes in eating disorders: validation of a classification in a naturalistic sample

BACKGROUND

Research has identified three personality subtypes in patients with eating disorders: emotionally dysregulated, constricted and high-functioning/perfectionistic.

AIMS

To see whether the subtypes are distinguished in ways indicative of valid classification, notably in patterns of adaptive functioning, comorbidity, treatment response and therapeutic interventions.

METHOD

A random sample of experienced clinicians provided data on 145 patients with bulimic symptoms, including data on eating disorder symptoms, DSM-IV comorbidity, personality pathology, treatment response and treatment interventions.

RESULTS

Patients categorised as dysregulated had the poorest functioning, most comorbidity and worst outcome, followed by patients in the constricted and high-functioning groups. The three subtypes elicited different therapeutic interventions and accounted for substantial incremental variance in outcome, holding constant the severity of eating disorder symptoms and presence of other Axis I disorders.

CONCLUSIONS

The data provide accumulating evidence for the validity of three personality subtypes in patients with eating disorders.

Categorical versus dimensional models of eating disorders: an examination of the evidence

OBJECTIVE

Eating disorders have been conceptualized as discrete syndromes or categories and as dimensions that differ in degree among individuals. Until recently, researchers have not directly addressed which of these models, categorical versus dimensional, is most valid.

METHODS

The primary objective of this review was to examine the evidence related to the validity of dimensional versus categorical models of eating disorders.

RESULTS

Findings from a series of taxometric studies have suggested that a conceptual representation of eating disorders may involve a latent taxon, related to binge eating (and possibly purging), and one or more dimensions. These studies found that binge eating was identified as a factor that does not occur on a continuum with anorexia nervosa, restricting subtype. Restricting subtype anorexia is continuous with normalcy, however.

DISCUSSION

These findings should be viewed as preliminary evidence that may have implications for the etiology, assessment, prevention, and treatment of eating disorders.

Personality and psychopathology: working toward the bigger picture

There are systematic and meaningful links among normal and abnormal personality traits and Axis I and II constructs from the DSM. Nevertheless, much research in this area focuses on pairs of constructs (e.g., the link between personality traits and a specific Axis I disorder), rather than on the broader multivariate structure of the personality-psychopathology domain. We underscore the need for this broader perspective, a perspective that would transcend largely artificial boundaries between current constructs (e.g., normal and abnormal personality). We outline our approach to research from this perspective and we emphasize the internalizing (mood and anxiety) and externalizing (substance use and antisocial behavior) spectra as promising foci for initial research on the joint structure of personality and psychopathology.

MCMI-II profiles of women with eating disorders: a cluster analytic investigation

A three-factor model of personality pathology was investigated in a clinical sample of 183 female patients in an outpatient eating disorders treatment program. Cluster analysis of MCMI-II personality scales (Millon, 1987) yielded three distinct personality profiles, which were consistent with previous studies. First, 16.9% of the sample comprised a High Functioning cluster, which manifested no clinical elevations on the MCMI-II and had significantly lower scores on the Eating Disorder Inventory (EDI; Garner; 1991) scales than the other two clusters. Second, 49.1% of the sample comprised an Undercontrolled/Dysregulated cluster. Finally, the remaining 34% of the sample comprised an Overcontrolled/Avoidant cluster. This final cluster had significantly higher EDI Ineffectiveness scale scores than the Undercontrolled/Dysregulated cluster group. Cluster membership was not associated with eating disorder subtype, suggesting that there is considerable variance in personality pathology within eating disorder diagnostic categories.

The role of personality in the onset of eating disorders and treatment implications

The relationship of personality and eating disorders is largely unclear. The development of well-specified conceptual models of this relationship, developments in family history, behavior genetic and prospective longitudinal research methodology, and careful consideration of how trait constructs may interact with state variables to produce or maintain eating disorders all will help to advance this area of research.