Objective
This study examined evidence for personality variability in adolescents with eating disorder features in light of previous evidence that personality variability in adult women with eating disorder symptoms carries important clinical implications.
Method
Millon Adolescent Clinical Inventory personality data from adolescent girls with disturbed eating who were psychiatrically hospitalized were cluster analyzed, and resulting groups were compared in eating and comorbid psychopathology.
Results
Three subgroups were identified among the 153 patients with eating disorder features: high functioning, internalizing, and externalizing. The internalizing group was marked by eating-related and mood dysfunction; the externalizing group by elevated eating and mood psychopathology as well as impulsivity, aggression, and substance use; and the high-functioning group by lower levels of psychopathology and relatively high self-esteem.
Conclusions
These findings converge with previous research using different personality models in adult samples and highlight the clinical use of considering personality heterogeneity among adolescent and adult women with disturbed eating.
Women with disturbed eating or eating disorders (EDs) are not homogeneous with regard to clinical [1], [2], [3] and [4] or personality [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15] and [16] characteristics. This heterogeneity may represent an important source of information for understanding and predicting co-occurring disorders, etiologic factors, and effective treatment planning practices in women with eating disturbances. For example, in one study women with EDs who were otherwise high functioning tended to have relatively good prognoses, whereas other ED groups with different patterns of co-occurring disorders also varied in clinical course [12].
Most research that has taken a typological approach to understanding personality heterogeneity among women with eating-related psychopathology has identified 3 groups, as shown in Table 1. These groups can generally be characterized as high functioning, internalizing (ie, anxious, depressed, overcontrolled), and externalizing (ie, impulsive, dysregulated, stimulus seeking). Although some other studies have identified more than 3 groups using other measures, alternative models typically include the groups most commonly identified as well as others [12] or embed the assumption that personality subtypes should not vary in clinical severity in their analyses and recover the 2 commonly observed clusters that are not defined by high functioning [10].
Overall, results from this study build on the emerging literature demonstrating personality heterogeneity among women with eating disturbances, regardless of the developmental or diagnostic characteristics of the samples or the measurement models used to assess personality. Clinicians should regard this literature as suggesting that all patients with ED symptoms should not be treated similarly and that personality and personality pathology may represent important domains to consider when formulating and planning treatment. Given the potential importance of these findings and remaining questions regarding the optimal theoretical account of observed heterogeneity, ongoing research should continue to investigate this issue to further inform etiological theories of and clinical practice with patients with ED symptoms.
