Eating disorders and personality: A methodological and empirical review. Clinical Psychology Review, 26, 299-320

Department of Psychology, Georgia State University, Atlanta 30302-5010, USA.
Clinical Psychology Review (Impact Factor: 7.18). 06/2006; 26(3):299-320. DOI: 10.1016/j.cpr.2005.10.003
Source: PubMed

ABSTRACT 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.

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Available from: Lisa R R Lilenfeld, Jan 05, 2015
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    • "The remaining variance is typically explained by nonshared environmental factors. Given this, it is important to understand whether the relationship between personality traits and disordered eating is a result of common causal factors (as opposed to independent etiologic factors; Lilenfeld et al., 2006) and whether these common causal factors are primarily genetic or environmental in origin. Such findings can point researchers in the direction of specific genetic/biological and/or environmental risk processes that account for both phenotypes and can inform our understanding of transactional risk processes between genetic and environmental factors in the etiology of eating pathology. "
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    ABSTRACT: Eating disorders are severe psychiatric disorders with a complex etiology involving transactions among sociocultural, psychological, and biological influences. Most research and reviews, however, focus on only one level of analysis. To address this gap, we provide a qualitative review and summary using an integrative biopsychosocial approach. We selected variables for which there were available data using integrative methodologies (e.g., twin studies, gene-environment interactions) and/or data at the biological and behavioral level (e.g., neuroimaging). Factors that met these inclusion criteria were idealization of thinness, negative emotionality, perfectionism, negative urgency, inhibitory control, cognitive inflexibility, serotonin, dopamine, ovarian hormones. Literature searches were conducted using PubMed. Variables were classified as risk factors or correlates of eating disorder diagnoses and disordered eating symptoms using Kraemer et al.'s (1997) criteria. Sociocultural idealization of thinness variables (media exposure, pressures for thinness, thin-ideal internalization, thinness expectancies) and personality traits (negative emotionality, perfectionism, negative urgency) attained 'risk status' for eating disorders and/or disordered eating symptoms. Other factors were identified as correlates of eating pathology or were not classified given limited data. Effect sizes for risk factors and correlates were generally small-to-moderate in magnitude. Multiple biopsychosocial influences are implicated in eating disorders and/or disordered eating symptoms and several can now be considered established risk factors. Data suggest that psychological and environmental factors interact with and influence the expression of genetic risk to cause eating pathology. Additional studies that examine risk variables across multiple levels of analysis and that consider specific transactional processes amongst variables are needed to further elucidate the intersection of sociocultural, psychological, and biological influences on eating disorders. © 2015 Association for Child and Adolescent Mental Health.
    Journal of Child Psychology and Psychiatry 06/2015; DOI:10.1111/jcpp.12441 · 6.46 Impact Factor
    • "The specific role of interoceptive awareness (identifying and differentiating between somatic and affective cues), or what Merwin et al. (2010) refer to as clarity, has received less attention in the IE literature, yet it is a core element of emotion awareness, which is a principle of behavior change that has received more attention and empirical support in recent years (Boswell, 2013; Kircanski, Lieberman , & Craske, 2012). As described above, many individuals with eating disorders evidence impaired perceptions of interoceptive cues (Brown et al., 2010; Kaye, Fudge, & Paulus, 2009; Lilenfeld et al., 2006; Pollatos et al., 2008). Therefore, IE may be a potent intervention strategy through its ability to both improve interoceptive clarity and modify interoceptive sensitivity marked by negative reactivity and nonacceptance of somatic signals (be it hunger and satiety or anxious arousal). "
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    ABSTRACT: Interoceptive exposure (IE) was originally developed for the treatment of panic disorder. The scope of IE has recently expanded, as the transdiagnostic relevance of interoceptive constructs has become increasingly recognized in diverse problem areas. Despite high comorbidity rates with anxiety and recent attention to interoceptive constructs, IE has received minimal explicit attention in eating disorders. The conceptual and empirical literature supports IE as a transdiagnostic intervention strategy that can be integrated into cognitive‐behavioral therapy (CBT) for eating disorders. In this article, we (a) summarize the relevant literature on interoceptive constructs in eating disorders, (b) review common approaches to exposure in eating disorder treatment, and (c) provide a rationale and concrete suggestions for beginning to integrate IE more explicitly in eating disorder treatment.
    Clinical Psychology Science and Practice 06/2015; 22(2). DOI:10.1111/cpsp.12103 · 2.92 Impact Factor
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    • "Candidate gene studies suggest common genetic liability between the two disorders (Mas et al., 2013). Comorbidity with obsessive–compulsive personality disorder (OCPD) is also high (Lilenfeld et al., 2006), and the excessive self-control (Pinto et al., 2014), perfectionism and rigidity seen in OCPD (Ansell et al., 2010) may parallel AN more closely. "
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    ABSTRACT: The compulsive nature of weight loss behaviors central to anorexia nervosa (AN), such as relentless self-starvation and over-exercise, has led to the suggestion of parallels between AN and other compulsive disorders such as obsessive-compulsive disorder (OCD) and addictions. There is a huge unmet need for effective treatments in AN, which has high rates of morbidity and the highest mortality rate of any psychiatric disorder, yet a grave paucity of effective treatments. Viewing compulsivity as a transdiagnostic concept, seen in various manifestations across disorders, may help delineate the mechanisms responsible for the persistence of AN, and aid treatment development. We explore models of compulsivity that suggest dysfunction in cortico-striatal circuitry underpins compulsive behavior, and consider evidence of aberrancies in this circuitry across disorders. Excessive habit formation is considered as a mechanism by which initially rewarding weight loss behavior in AN may become compulsive over time, and the complex balance between positive and negative reinforcement in this process is considered. The physiological effects of starvation in promoting compulsivity, positive reinforcement, and habit formation are also discussed. Further research in AN may benefit from a focus on processes potentially underlying the development of compulsivity, such as aberrant reward processing and habit formation. We discuss the implications of a transdiagnostic perspective on compulsivity, and how it may contribute to the development of novel treatments for AN.
    Frontiers in Psychology 07/2014; 5:778. DOI:10.3389/fpsyg.2014.00778 · 2.80 Impact Factor
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