We assessed the prospective association of risk factors for eating and body image disturbances after a 2-year follow-up in a community sample of Spanish adolescent girls. The participants included 128 Spanish girls aged 12–14, who took part in a 28-month prospective study. Aspects assessed were eating attitudes (Eating Attitudes Test), influence of the body shape model (questionnaire on influences of the aesthetic body shape model), extreme weight-control behaviors (Eating Disorder Examination-Questionnaire), body image (Body Image Questionnaire) and Body Mass Index (BMI). BMI, extreme weight-control behaviors and body image problems emerged as potential predictors of an increase in eating disturbances. An increased influence of the thinness model was significantly associated with reduced body satisfaction and body image problems. Preventive programs are needed to contribute reducing the impact of sociocultural influences with regard to thinness, the use of extreme weight-control behaviors and overweight in adolescents.
Personality characteristics have been hypothesized to be important variables in etiologic models of eating disorders and are potentially critical for both the development and maintenance of these symptoms [1], [2], [3], [4], [5], [6], [7] and [8]. Numerous studies have investigated the role of personality in eating disorders, with most reviews observing that eating disorder samples generally score higher than non–eating disorder comparison groups on measures of personality disorders, impulsivity, obsessive compulsive traits, and perfectionism [9], [10], [11] and [12]. The extent to which these results are due to underlying group differences, eating disorder maintenance factors, or a “scar” from the eating disorder symptoms is unclear.
In addition to comparisons between eating disorder and non–eating disorder samples, a number of studies have investigated personality differences between different eating disorder subgroups. These findings have been inconsistent with some observing differences among subgroups and others finding few or no such differences [9] and [11]. These inconsistencies may be due, in part, to different measurement strategies, definitions, and sampling procedures (eg, treatment-seeking vs community participants). Notably, most of these comparisons among eating disorder groups have been made between anorexia nervosa and bulimia nervosa (BN), or within subtypes of anorexia nervosa; few studies have examined personality differences using more broadly defined eating disorder and weight disorder samples including obesity, binge eating disorder (BED), and other types of eating disorders, not otherwise specified [9]. For this reason, personality differences among a wider range of eating and weight disorder subgroups are not well understood.
Another source of confusion in understanding the role of personality in eating disorders is the issue of whether personality is conceptualized dimensionally or categorically. Although many studies have examined the co-occurrence of categorically defined personality disorders in those with eating disorders [9] and [13], this literature is complicated by inconsistent definitions and measurement. Numerous problems are associated with the categorical classification of personality (especially personality disorders), including heterogeneity within categories, high rates of comorbidity, and longitudinal instability [14]. As a result of these limitations, the advantages of measuring personality dimensionally rather than categorically (or using a combination of both approaches) have been increasingly emphasized [6], [15] and [16]. In the context of the ongoing revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a number of researchers have argued for the adoption of a dimensional classification system of personality psychopathology as a way of increasing diagnostic validity [17] and [18].
Finally, personality studies of individuals with eating disorders have often neglected to examine the relationship between personality and mood disturbance, particularly depression. Given the high co-occurrence of mood disorders in eating disorders [19], investigating the relationship between depressive symptoms and personality is especially important for understanding both phenomena and their role in eating disorders. Although the complex interaction between depression and personality is unclear [20], the impact of depressive symptoms on self-report questionnaires including personality measures is an important consideration [21]. Of particular concern is the impact of depressive symptoms in biasing recall toward more negative global self-appraisals [22]. The potential impact of depressive symptoms in personality measurement may explain some of the inconsistent findings among previous studies of personality and eating disorders. In summary, several important issues remain unclear in the eating disorders and personality literature. The first issue is the extent to which personality characteristics differ among a wider range of eating and weight disorder subgroups including BED and obese individuals who do not binge eat. In addition, although many studies have evaluated personality disorders and personality disturbances in eating disorders using categorical definitions, fewer have measured personality dimensions using instruments that do not exclusively measure psychopathology. Finally, many studies have not examined measures of depression in the context of personality assessment.
The purpose of this investigation was to compare personality dimensions in eating and weight disorders among 4 groups of women: individuals with BN, individuals with BED, normal-weight control (NWC) participants, and obese participants without eating disorder symptoms. In addition, this study aimed to examine the impact of depression on personality dimensions by using depressive scores as a covariate.
