Exploring associations between personality trait facets and emotional, psychological and social well-being in eating disorder patients

Abstract

Purpose
Personality functioning is strongly linked to well-being in the general population. Yet, there is a lack of scientific knowledge about the pathways between personality trait facets and emotional, psychological and social well-being in ED patients. The general aim was to examine potential associations between maladaptive personality trait facets and the three main dimensions of well-being.

Methods
Participants were 1187 female eating disorder patients who were referred for specialized treatment. Patients were diagnosed with anorexia nervosa (31.7%), bulimia nervosa (21.7%), binge eating disorder (11%) and other specified eating disorders (35.5%). The Personality Inventory for the DSM 5 (PID-5) was used to measure 25 trait facets, and well-being was measured with the Mental Health Continuum Short Form (MHC-SF). Multiple hierarchical regression analyses were applied to examine potential associations between personality and well-being while controlling for background and illness characteristics.

Results
Personality trait facets led to a statistically significant increase of the explained variance in emotional (38%), psychological (39%), and social well-being (26%) in addition to the background and illness characteristics. The personality trait facets anhedonia and depression were strongly associated with all three well-being dimensions.

Conclusion
Personality traits may play an essential role in the experience of well-being among patients with EDs. To promote overall mental health, it may be critical for clinicians to address relevant personality trait facets, such as anhedonia and depression, associated with well-being in treatment.

Level of evidence
Level V, cross-sectional descriptive study.

Full text

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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
https://doi.org/10.1007/s40519-021-01107-6
BRIEF REPORT
Exploring associations betweenpersonality trait facets andemotional,
psychological andsocial well‑being ineating disorder patients
JanAlexanderdeVos1,2,3· MirjamRadstaak2,3· ErnstT.Bohlmeijer2,3· GerbenJ.Westerhof2,3
Received: 30 September 2020 / Accepted: 15 December 2020
© The Author(s) 2021
Abstract
Purpose Personality functioning is strongly linked to well-being in the general population. Yet, there is a lack of scientific
knowledge about the pathways between personality trait facets and emotional, psychological and social well-being in ED
patients. The general aim was to examine potential associations between maladaptive personality trait facets and the three
main dimensions of well-being.
Methods Participants were 1187 female eating disorder patients who were referred for specialized treatment. Patients were
diagnosed with anorexia nervosa (31.7%), bulimia nervosa (21.7%), binge eating disorder (11%) and other specified eating
disorders (35.5%). The Personality Inventory for the DSM 5 (PID-5) was used to measure 25 trait facets, and well-being
was measured with the Mental Health Continuum Short Form (MHC-SF). Multiple hierarchical regression analyses were
applied to examine potential associations between personality and well-being while controlling for background and illness
characteristics.
Results Personality trait facets led to a statistically significant increase of the explained variance in emotional (38%), psy-
chological (39%), and social well-being (26%) in addition to the background and illness characteristics. The personality trait
facets anhedonia and depression were strongly associated with all three well-being dimensions.
Conclusion Personality traits may play an essential role in the experience of well-being among patients with EDs. To pro-
mote overall mental health, it may be critical for clinicians to address relevant personality trait facets, such as anhedonia and
depression, associated with well-being in treatment.
Level of evidence Level V, cross-sectional descriptive study.
Introduction
Personality trait facets are relatively stable patterns of behav-
iors, cognitions, and emotions, which develop during child-
hood and adolescence. Traits can be placed on a continuum
from normality to pathology (dimensional), which means
that they can develop in a healthy way or become maladap-
tive [1].
Decades of research highlight that personality plays a
critical role in how people approach and appraise their lives
and experience well-being [2]. Personality traits are strongly
linked with the experience of subjective and psychological
well-being (PWB) in the general population [2]. Subjective
well-being, also described as emotional well-being (EWB),
consists of three dimensions, life satisfaction, positive, and
negative affect [3]. PWB or Eudaimonic well-being is about
living a good life and is conceptualized in six dimensions;
self-acceptance, positive relationships, autonomy, environ-
mental mastery, personal growth, and purpose in life [3].
* Jan Alexander de Vos
s.devos@humanconcern.nl
Mirjam Radstaak
m.radstaak@utwente.nl
Ernst T. Bohlmeijer
e.t.bohlmeijer@utwente.nl
Gerben J. Westerhof
g.j.westerhof@utwente.nl
1 University ofTwente, Department ofPsychology, Health,
andTechnology, Enschede, TheNetherlands
2 Stichting Human Concern, Centrum voor Eetstoornissen,
Amsterdam, TheNetherlands
3 Centre foreHealth andWell-Being Research, Enschede,
TheNetherlands

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Social well-being (SWB) has been proposed as a third main
factor of well-being, consisting of five dimensions, actual-
ization, coherence, integration, contribution, and acceptance
[3]. Well-being and psychopathology are considered as two
related, but distinct dimensions of mental health, with poten-
tially different determinants [4].
In a comprehensive meta-analysis, it was found that on a
domain level, neuroticism, extraversion and conscientious-
ness were strongly associated with EWB and PWB [2].
However, analysis on a trait facet level (i.e., a specific and
unique aspect of a broader personality domain) provided a
more detailed description of the relationships between per-
sonality and well-being and improved the incremental pre-
diction with 20% [2]. Multiple personality trait facets, such
as anxiety, hostility, depression, self-consciousness, vul-
nerability, warmth, assertiveness, positive emotions, trust,
competence, achievement striving, and self-discipline, were
moderately to strongly associated with EWB and PWB [2].
Studies examining personality functioning in patients
with eating disorders have primarily focused on explaining
ED pathology [5]. Personality is strongly linked to the onset
and maintenance of eating disorders (EDs), in particular per-
fectionism, neuroticism (i.e., depression, anxiety, anhedonia,
impulsiveness, and stress vulnerability), avoidance motiva-
tion, sensitivity (to social rewards), extraversion, and self-
directedness [5].
Knowledge concerning the role of personality functioning
for the experience of well-being in ED patients is sparse,
while they experience lower levels compared to the general
population [6]. Available studies have focused primarily on
specific aspects of personality such as resilience, or spe-
cific domains of Quality of Life (QoL) [7]. Although some
QoL domains have conceptual overlap with dimensions of
well-being (e.g., emotional and social functioning), PWB
is often neglected as a domain in QoL measures. Yet, PWB
has a strong theoretical background, dating back to Greek
philosophy, andis considered as one of the most influential
models of mental health [2, 3].
Well-being is also important to consider as a measure for
recovery in addition to symptom remission because people
who have recovered from an ED, consider the presence of
well-being essential for recovery [6]. Since personality trait
facets are strongly linked to the onset and maintenance of
EDs, and the experience of well-being in the general popu-
lations, it may function as an underlying maintaining factor
for overall mental health (i.e., the presence ofwell-being
andlow levels of psychopathology). To improve well-being,
as well as reduce ED pathology among patients, it may
therefore be crucial to promote the strengthening of adap-
tive personality trait facets in treatment. Examining which
specific personality trait facets are linked to the dimensions
of well-being in ED patients may provide clinicians with
knowledge on which trait facets to focus on in treatment.
This study, therefore, aimed to examine potential associa-
tions between maladaptive personality trait facets and the
three main dimensions of well-being (emotional, psycho-
logical, and social) on a trait facet level in a transdiagnostic
ED sample of patients with anorexia nervosa (AN), bulimia
nervosa (BN) binge eating disorders (BED), and other speci-
fied feeding and eating disorders (OSFED).
Methods
Participants andprocedure
Participants were Dutch ED patients, referred for treatment
at Stichting Human Concern, a specialized centre for the
treatment of EDs. General practitioners referred patients to
specialized care with a reference for further diagnosis or
treatment. The inclusion criteria were: (1) a minimum age
of 17years, (2) a primary ED diagnosis at intake, achieved
according to the criteria of the diagnostic and statistical
manual (DSM-5), (3) being able to understand and fill in
the questionnaires, and (4) consent to participate in the
research. A total of 1356 patients were screened between
January 2016 and March 2020 and received a written bro-
chure about the aim of the study and options for contacting
the researchers. Informed consent included that participants
were informed about the study and could withdraw their data
for scientific research at any time. The Behavioral, Manage-
ment and Social Sciences Ethics committee of the Univer-
sity of Twente approved the study protocol. One hundred
and thirty-two patients did not give consent, and 37 men
were excluded leading to a total of 1187 included patients.
Patients were diagnosed by a psychiatrist in collaboration
with an intake team, consisting of a family therapist, dieti-
cian, and a psychologist.
Data collection
The following background and illness characteristics were
collected during intake: age (M = 26.9years, SD = 8.9, range
17–66), start age ED (16.5years, SD = 5.6, range 4–55), ED
duration (9.6years, SD = 8.9, range 0.25–49), BMI kg/m2
(M = 22.5, SD = 7.4, range 10.2–59), ED diagnosis (32.1%
AN, 22.2% BN, 11% BED and 34.7% OSFED) and having
a comorbid personality disorder (11%), or other psychiatric
disorder (50.8%). Other psychiatric disorders were, mood
and anxiety, developmental, trauma-related, neurocognitive,
and addictive disorders.
Personality trait facets were measured with the Dutch
self-report Personality Inventory for DSM 5 (PID-5) [8]
according to the dimensional model of personality [1]. The
PID-5 is a 220-item self-report measure, designed to assess
personality domains (antagonism, detachment, disinhibition,

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
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negative affectivity, and psychoticism) and 25 underlying
trait facets, included in the DSM-5 alternative dimensional
model [8]. The items are evaluated on a 4-point Likert scale,
ranging from 0 (very false or often false) to 3 (very true or
often true). An example question from the personality trait
facet impulsivity is “I always do things on the spur of the
moment”. Higher scores are indicative of higher maladap-
tive personality functioning. The internal consistencies were
acceptable to excellent with excellent mean inter-item cor-
relations (see Table1).
Well-being was measured with the Dutch Mental Health
Continuum Short Form (MHC-SF) [3]. The MHC-SF con-
sists of 14 items and measures emotional (N = 3), psycholog-
ical (N = 6), social (N = 4), and overall well-being. The items
are rated on a 6-point Likert scale ranging from 0 “never”
to 5 “always,” and an example question from the dimension
PWB is “During the past month, how often did you feel
that you had warm and trusting relationships”. Higher scores
are indicative of higher levels of well-being. The internal
consistency of the scales was 0.83 for emotional, 0.82 for
psychological and 0.72 for social well-being.
The Dutch 36 item Eating Disorder Examination (EDE-
Q) was used to measure ED psychopathology (EDP) with
the global score [9]. The internal consistency of the global
scale was 0.92.
Analysis
Three multiple hierarchical regression analyses were run
with emotional, psychological, and social well-being as
dependent variables and the background and illness charac-
teristics and personality trait facets as independent variables.
A hierarchical model was tested in two steps and compared
on model fit, explained variance and stability of the asso-
ciations. In step 1, the background and illness character-
istics were entered, and in step 2, personality trait facets
were added. The assumptions for linearity, homoscedasticity,
and normality were met as inspected with QQ plots and his-
tograms. There was no multicollinearity between the inde-
pendent variables as inspected with the variance inflation
factor (highest VIF 4.4 for age). Regression analyses were
performed in SPSS, version 26. A post hoc power analysis
(power = 1—type II error) was performed in R statistics,
package PWR, v1.3–0. The test power was 0.72 to detect a
small effect size and 1 to detect a large effect size.
Results
Overall, the most severe maladaptive personality trait facets
(M ≥ 1.50) among ED patients were found for the following
trait facets (see also Table1): emotional lability submis-
siveness, anxiousness, rigid perfectionism, and distractibil-
ity. The mean well-being scores were M = 2.52 (SD = 1.07)
for emotional, M = 2.55 (SD = 0.99) for psychological and
M = 2.23 (SD = 0.99) for social well-being. The mean global
EDE-Q score was 4.12 (SD = 1.04). A correlation matrix of
the variables can be found in the supplements.
The model in step 1, with age, start age ED, BMI kg/m2,
ED diagnosis, personality disorder, and other psychiatric dis-
order as independent variables was statistically significant in
predicting EWB [R2 = 0.15, F (10, 1154) = 20.94, p < 0.001;
adjusted R2 = 0.15], PWB [R2 = 0.13, F (10, 11540) = 16.79,
p < 0.001; adjusted R2 = 0.12] and SWB [R2 = 0.06, F (10,
1154) = 7.00, p < 0.001; adjusted R2 = 0.05]. The full model
in step 2 with the addition of the personality trait facets led
to a statistically significant increase in the explained variance
Table 1 Mean scores of the PID-5 personality trait facets and scale
statistics
Percept. Dysreg. perceptual dysregulation, Restricted affect. restricted
affectivity, Separation ins. separation insecurity, UBE unusual beliefs
and expectations
Trait facet N questions M (SD) Cron-
bach’s
alpha (α)
Mean inter-
item cor-
relations
Anhedonia 8 1.26 (.60) .83 .37
Anxiousness 9 1.58 (.62) .85 .38
Attention seek-
ing
8 .78 (.60) .86 .44
Callousness 14 .19 (.23) .75 .23
Deceitfulness 10 .47 (.43) .82 .34
Depression 14 1.35 (.67) .92 .44
Distractibility 9 1.50 (.72) .90 .50
Eccentricity 13 .81 (.63) .92 .48
Emotional
lability
7 1.66 (.69) .87 .48
Grandiosity 6 .28 (.35) .69 .30
Hostility 10 .87 (.52) .83 .33
Impulsivity 6 .83 (.67) .89 .57
Intimacy avoid-
ance
6 .82 (.72) .84 .48
Irresponsibility 7 .56 (.50) .77 .33
Manipulative-
ness
5 .52 (.50) .72 .34
Percept. dysreg 12 .63 (.46) .78 .26
Perseveration 9 1.45 (.60) .82 .33
Restricted affec 7 .97 (.62) .81 .39
Rigid perfec-
tionism
10 1.52 (.68) .88 .43
Risk taking 14 1.15 (.50) .87 .32
Separation ins 7 1.12 (.64) .80 .36
Submissiveness 4 1.65 (.75) .86 .60
Suspiciousness 7 1.00 (.57) .78 .35
UBE 8 .37 (.44) .79 .33
Withdrawal 10 1.00 (.62) .90 .46

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for EWB [change in R2 = 0.38, F-change (25, 1129) = 37.04,
p < 0.001; adjusted R2 = 0.52], PWB [change in R2 = 0.39,
F-change (25, 1129) = 37.09, p < 0.001; adjusted R2 = 0.51]
and SWB [change in R2 = 0.26, F-change (25, 1129) = 17.51,
p < 0.001; adjusted R2 = 0.30].
Statistically significant variables associated with
well-being in step 2 can be found in Table 2. Anhedo-
nia (β = − 0.46, emotional; β = − 0.28, psychological;
β = −0.23, social), and depression (β = − 0.34, emotional;
β = −0.32, psychological; β = −0.16, social) were associ-
ated with all well-being dimensions over and beyond demo-
graphic and illness characteristics. Eccentricity (β = 0.07)
and submissiveness (β = 0.12) were associated with EWB,
in addition to EDP severity (β = −0.07). Distractibility
(β = 0.07), emotional lability (β = -0.08), and manipulative-
ness (β = 0.08) were associated with PWB, in addition to
BN (β = −0.09). Manipulativeness (β = 0.08), suspicious-
ness (β = −0.10), and withdrawal (β = −0.17) were associ-
ated with SWB, in addition to having a personality disorder
(β = −0.06).
Discussion
Decades of research have highlighted the critical role of
personality for the experience of well-being in the general
population [2]. Studies among ED patients have primarily
examined the role of personality in explaining ED pathol-
ogy [5]. Much less is known about its role for experiencing
well-being, while ED patients report lower functioning on
well-being compared to the general population. The addition
of personality trait facets, above patient background and ill-
ness characteristics, led to a statistically significant increase
of the explained variance in EWB(38%), PWB (39%), and
SWB (26%). Personality trait facets may play a critical role
in the experience of well-being among ED patients. Anhe-
donia and depression were strongly and negatively associ-
ated with all three well-being dimensions. These traits are
also well linked to ED symptomatology [5]. Personality may
function as an underlying mechanism maintaining both psy-
chopathological symptoms and the experience of well-being.
It may therefore be critical to focus on strengthening per-
sonality trait facets, especially depression and anhedonia, in
treatment to promote overall mental health (i.e., low levels
of psychopathology and adequate well-being). Farstad and
colleagues (2016) also concluded that it is important to capi-
talize on knowledge about personality in the treatment of
EDs, for instance, by tailoring treatments based on person-
ality dimensions. In addition, it may be fruitful to examine
the effectiveness of treatments on ED symptom remission
and well-being specifically targeting personality functioning,
such as dialectical behaviour therapy (DBT) and schema
therapy [10].
Several personality trait facets were associated with spe-
cific well-being dimensions that may be of interest for clini-
cians. Emotional lability and distractibility were negatively
associated with PWB. Studies have suggested that emotional
lability is also associated with EDs, particularly those that
involve binge eating [5]. Withdrawal and suspiciousness
were associated with lower EWB. Withdrawal is related to
avoidance motivation and lower levels of extraversion, which
are found to be frequently present in individuals with EDs,
as well as suspiciousness among individuals with BN [5].
The review of Farstad and colleagues (2016) suggests that
individuals with EDs consistently avoid situations associated
with punishment, which may be a pathway to lower societal
functioning and SWB.
Further relations were that eccentricity and submissive-
ness were associated with EWB, and manipulativeness with
PWB and SWB. There may be specific pathways to explain
these associations, which should be a topic for further inves-
tigation. For instance, a person who is anxious for situations
with punishment, for instance, for receiving criticism from
others, may not only avoid this (withdrawal) but may behave
submissive and with that experience adequate levels of EWB
as long as they can avoid criticism. Also, for manipulative-
ness, this may be a way to achieve things in one’s environ-
ment, such as getting things their way in treatment or in daily
life. Achieving things in the own environment is related to
environmental mastery (PWB) [3]. Third-wave behavior
therapies, such as acceptance and commitment therapy and
compassion focused therapy may be especially effective in
promoting mental health because they target these response-
focused emotion regulation strategies by fostering accept-
ance, mindfulness, metacognition, psychological flexibility,
and reducing experiential avoidance [10].
Overall, similar associations between personality trait fac-
ets and well-being were found in our sample as in the general
population [2]. Hostility and callousness were not related to
well-being in our sample, in contrary to the general popula-
tion [2]. Some personality traits are not measured by the
PID-5, such as trust, competence, achievement striving, and
self-discipline.
Limitations
It has been suggested that the measurement of stable
personality traits may lead to biased results in adoles-
cent samples because they are still in development [1].
In this sample, however, the average age of the patients
was 27years, and the majority of the sample were adult
patients. A major limitation is that this is a cross-sectional
study meaning that no causal inferences can be made. All
patients were females referred for specialized ED treat-
ment, so results may not be generalizable to other ED
patients in the community. No information was obtained

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Table 2 Results regression analysis: (standardized) beta’s of the independent variables for each dependent variable
Emotional well-being Psychological well-being Social well-being
Step 1 Step 2 Step 1 Step 2 Step 1 Step 2
BSE β BSE β BSE β BSE β BSE β BSE β
Background characteristics
Age 0.01 0.01 0.08 0.00 0.01 0.02 .01 .01 .08 0.00 0.01 0.01 0.01 0.01 0.05 0.00 0.01 0.01
Startage ED −0.00 0.01 −0.01 −0.00 0.01 −0.02 −.01 .01 −.03 −0.01 0.01 −0.05 −0.01 0.01 −0.03 −0.01 0.01 −0.05
ED duration −0.01 0.01 −0.05 0.00 0.01 −0.02 −.01 .01 −.10 −0.01 0.01 −0.06 −0.01 0.01 −0.07 −0.01 0.01 −0.06
BMI (kg/m2) 0.01 0.01 0.09* 0.01 0.01 0.04 .01 .01 .08 0.01 0.00 0.04 0.00 0.01 −0.01 0.00 0.00 −0.02
EDP severity −0.26 0.03 −0.26*** −0.08 0.02 −0.07** −.22 .03 −.23*** −0.01 0.02 −0.02 −0.15 0.03 −0.16*** 0.00 0.03 0.00
AN −0.25 0.08 −0.11** −0.09 0.06 −0.04 −.18 .07 −.09* −0.02 0.06 −0.00 −0.04 0.08 −0.02 0.09 0.07 0.04
BN −0.08 0.08 −0.03 −0.01 0.06 0.00 −.23 .07 −.10** −0.17 0.06 −0.09* −0.17 0.08 −0.07* −0.07 0.07 −0.03
BED −0.15 0.12 −0.04 −0.01 0.09 0.00 −.15 .11 −.05 −0.06 0.09 −0.07 0.00 0.12 0.00 0.09 0.10 0.03
Personality
disorder
−0.31 0.10 −0.09** −0.13 0.07 −0.04 −.24 .09 −.08** −0.10 0.07 −0.02 −0.25 0.09 −0.08** −0.17 0.08 −0.05*
Psychiatric
disorder
−0.40 0.06 −0.19*** −0.08 0.05 −0.04 −.35 .06 −.18*** −0.05 0.04 −0.03 −0.20 0.06 −0.10** 0.01 0.05 0.00
Personality trait facets
Anhedonia −0.82 0.07 −0.46*** −0.46 0.06 −0.28*** −0.38 0.07 −0.23***
Anxiousness 0.08 0.06 0.05 0.10 0.05 0.07 0.01 0.07 0.01
Attention seek-
ing
−0.03 0.05 −0.02 0.06 0.05 0.04 0.02 0.06 0.01
Callousness 0.21 0.13 0.04 0.04 0.12 0.01 −0.25 0.15 −0.06
Deceitfulness −0.13 0.08 −0.05 −0.13 0.08 −0.06 0.02 0.09 0.01
Depression −0.55 0.07 −0.34*** −0.47 0.06 −0.32*** −0.25 0.07 −0.16**
Distractibility −0.02 0.04 −0.01 −0.09 0.04 −0.07* 0.00 0.05 0.00
Eccentricity 0.12 0.05 0.07* −0.03 0.05 −0.02 −0.04 0.06 −0.02
Emotional
lability
−0.04 0.05 −0.03 −0.11 0.04 −0.08* −0.04 0.05 −0.03
Grandiosity −0.14 0.08 −0.05 0.09 0.08 0.03 0.06 0.05 0.03
Hostility −0.03 0.06 −0.02 0.09 0.06 0.05 −0.06 0.07 −0.03
Impulsivity 0.00 0.04 0.00 0.06 0.04 0.04 0.04 0.05 −0.03
Intimacy avoid-
ance
−0.07 0.04 −0.05 −0.02 0.03 −0.01 0.06 0.04 0.04
Irresponsibility 0.08 0.06 0.04 −0.09 0.06 −0.05 −0.10 0.07 −0.05

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Table 2 (continued)
Emotional well-being Psychological well-being Social well-being
Step 1 Step 2 Step 1 Step 2 Step 1 Step 2
BSE β BSE β BSE β BSE β BSE β BSE β
Manipulative-
ness
0.12 0.07 0.06 0.16 0.06 0.08* 0.15 0.07 0.08*
Percept. dysreg −0.11 0.08 −0.05 −0.01 0.08 0.00 −0.07 0.09 −0.03
Perseveration 0.10 0.06 0.05 0.02 0.06 0.01 0.07 0.07 0.04
Restricted affec 0.09 0.05 0.05 −0.02 0.05 −0.01 0.09 0.06 0.05
Rigid perfec-
tionism
−0.05 0.05 −0.03 0.00 0.04 0.00 0.00 0.05 0.00
Risk taking −0.01 0.06 −0.01 0.02 0.05 0.01 0.02 0.06 0.01
Separation ins 0.00 0.04 0.00 −0.04 0.04 −0.03 −0.03 0.05 −0.02
Submissive-
ness
0.17 0.04 0.12*** −0.05 0.03 −0.04 0.04 0.04 0.03
Suspiciousness −0.04 0.05 −0.02 −0.08 0.05 −0.05 −0.17 0.05 −0.10**
UBE 0.03 0.07 0.01 0.03 0.07 0.01 −0.08 0.08 −0.03
Withdrawal −0.02 0.06 −0.01 −0.08 0.05 −0.05 −0.27 0.06 −0.17***
R2.15 .54 .13 .52 .06 .32
F 20.94*** 37.12*** 16.71*** 35.00*** 7.00*** 15.22***
ΔR2– .38 – .39 – .26
ΔF– 37.04*** – 37.09*** – 17.51***
BMI body mass index, EDP severity eating disorder psychopathology severity, Psychiatric disorder other psychiatric disorders, except for personality disorders, Percept. Dysreg. perceptual dys-
regulation, Restricted affect. restricted affectivity, Separation ins. separation insecurity, UBE unusual beliefs and expectations
Emotional, psychological, and social well-being are the dependent variables, * = p value < .05, ** = p value < .01, *** = p value < .001. Step 1 = regression analysis with patient background char-
acteristics, Step 2 = regression analysis, with step 1 variables including the personality trait facets

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
1 3
from patients who did not give consent for this study. It
is unknown how this may have affected the results. Also,
there may be overlap in the constructs measuring well-
being and personality trait facets [2]. Another limitation
is that this study did not examine differences between ED
types, while it is suggested that different personality trait
facets may be linked to specific ED types [5], although
we did control for ED type in the analysis. At last, the
questionnaires were self-report measures, and results may
have been influenced by social desirability as reported by
Anglim and colleagues (2020).
Conclusions andimplications
In support of earlier studies in the general population, mala-
daptive personality trait facets may play a critical role in
the experience of well-being among patients with EDs. Cli-
nicians should be aware of potential associations between
maladaptive personality traits such as anhedonia and depres-
sion with well-being. A focus on these personality traits in
treatment may be critical to promote and improve well-being
and overall mental health in ED patients.
What isalready known onthis subject?
Multiple personality trait facets are well linked with the
experience of emotional, psychological, and social well-
being in the general population, while much less is known
about potential associations in ED patients.
What dowe now know asaresult ofthis
study thatwe did notknow before?
Several personality trait facets are moderately or strongly
linked with one or more well-being dimensions in patients
with EDs. Anhedonia and depression were strongly associ-
ated with all well-being dimensions. Personality functioning
may be important to focus on in treatment to improve overall
mental health.
Supplementary Information The online version contains supplemen-
tary material available at https ://doi.org/10.1007/s4051 9-021-01107 -6.
Funding This study was not funded by a funding agency.
Data availability The data that support the findings of this study are
available upon reasonable request. The data are not publicly available
due to ethical restrictions (e.g., although the data set was anonymized
before analysis, new technological procedures may compromise the
privacy of the patients).
Compliance with ethical standards
Conflict of interest The authors declare that they have no conflict of
interest.
Ethical approval All procedures performed in studies involving human
participants were in accordance with the ethical standards of the insti-
tutional research committee and with the 1964 Helsinki declaration and
its later amendments or comparable ethical standards. The Behavioral,
Management and Social Sciences Ethics committee of the University
Twente approved the study protocol.
Informed consent Patients were informed about the research and
signed an informed consent stating that they could withdraw the pos-
sibility to include their data for scientific research.
Open Access This article is licensed under a Creative Commons Attri-
bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and indicate if changes
were made. The images or other third party material in this article are
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permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit http://creat iveco mmons .org/licen ses/by/4.0/.
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