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Psychological Profiles of Women with a Past Or Present Diagnosis of Anorexia Nervosa R Bachner-Melman, a Zohar, I Kremer, R Ebstein

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Psychological Profiles of Women with a Past Or Present Diagnosis of Anorexia Nervosa R Bachner-Melman, a Zohar, I Kremer, R Ebstein The Internet Journal of Mental Health ISPUB.COM Volume 4 Number 2 Psychological Profiles of Women with a Past or Present Diagnosis of Anorexia Nervosa R Bachner-Melman, A Zohar, I Kremer, R Ebstein Citation R Bachner-Melman, A Zohar, I Kremer, R Ebstein. Psychological Profiles of Women with a Past or Present Diagnosis of Anorexia Nervosa. The Internet Journal of Mental Health. 2006 Volume 4 Number 2. Abstract Objective: To examine the relationship between anorexia nervosa (AN) subtype, recovery status, and personality profile. Methods: 195 women with lifetime AN (17 ill, 107 partially recovered, 71 recovered) and 242 controls completed measures of obsessiveness, perfectionism, fear of failure, endorsement of the thin ideal, self-esteem, harm avoidance, novelty seeking, persistence, and reward dependence. Results: Subtypes differed only on novelty seeking (lower for restricting AN). Controls differed significantly in the expected direction from all AN groups on almost all variables. Group scores (except persistence and novelty seeking) were ranked linearly from highest to lowest in the order of ill women, partially recovered, recovered, and then controls. Conclusion: Personality traits of women recovered from AN differ from those of controls (and may be premorbid risk factors), possibly predict prognosis, and may regress to the mean to some extent with recovery. Personality may both predict and correlate with AN; there is an urgent need for longitudinal research to confirm this. Note: Rachel Bachner-Melman and Ada H. Zohar have yield somewhat contradictory results. For example, whereas equal authorship. TPQ harm avoidance has been found in some studies to remain elevated after recovery from AN ( , , ), others have INTRODUCTION 7 8 9 found harm avoidance levels of women recovered from AN The association between personality and anorexia nervosa to be comparable to that of controls (10, 11). The number of (AN) has been the focus of a growing body of research individuals recovered from AN studied has generally been during recent years. Perhaps the most salient and robust small (up to n = 45), making it difficult to examine the effect personality characteristics of AN patients have been found to of subtype, and also the inclusion of a partially recovered be obsessiveness (1), perfectionism (2), harm avoidance (3), group is rare. endorsement of the thin ideal (4), and low self-esteem (5). In addition to elevated TPQ (Tridimensional Personality Perfectionism (12), obsessiveness (13) and low self-esteem (5) Questionnaire) harm avoidance, high persistence and low have consistently been shown to be robust characteristics novelty seeking and reward dependence have also been underlying AN. Less research attention has been focused on fear of failure in AN, although it has been found to reported (3). The results of scarce and limited prospective research point to negative emotionality, perfectionism, drive characterize AN patients (14). The TPQ (15) has been shown for thinness, poor interoceptive awareness, ineffectiveness, to characterize the personality structure of eating disorder and obsessive-compulsive personality traits as likely patients with higher classification accuracy than other predisposing factors for disordered eating and eating personality and symptom scales such as the MMPI and the SCL-90 (16). It measures four temperament dimensions, disorders in general (6), although little is known specifically about risk factors for AN. Most studies have focused on hypothesized to be mainly genetically influenced: Harm currently ill women and little is known about the personality Avoidance, a preference for safe routine and risk avoidance profiles of women recovering and recovered from AN. and a tendency to be pessimistic, shy and fatigable; Novelty Seeking, a tendency toward the activation of behavior such The few studies that have compared the personality features as exploratory activity in response to novelty, impulsive of women recovered from AN with those of control women decision making, extravagance, and quick loss of temper; 1 of 9 Psychological Profiles of Women with a Past or Present Diagnosis of Anorexia Nervosa Reward Dependence, a tendency to respond intensely to disorders section was used to determine recovery status signals of reward (especially social reward) and to maintain according to current AN symptomatology. Women were behaviors previously associated with reward or relief of excluded (n = 21) either because their recovery status was punishment; and Persistence, a tendency to be industrious difficult to determine (for example, women currently and perfectionist and to persevere despite frustration instead suffering from bulimia nervosa) or because of technical of becoming discouraged and giving up when expectations reasons (they had not completed all the questionnaires). The are not immediately satisfied. Previous research has shown remaining 195 women were stratified into three subgroups: women with AN to score high on Harm Avoidance (3,16,17,18) Women (n = 17) with a current diagnosis of AN. These and sometimes Persistence (3,19), and low on Novelty women strictly fulfilled all DSM-IV criteria for AN at the Seeking (particularly those with the restricting subtype) ( , ) 3 20 time of participation in the study. and sometimes low on Reward Dependence (3,20). Women (n = 107) partially recovered from AN. These The low prevalence of AN, 1–3% of adolescent females ( ), 21 women had a body mass index (BMI) value of above 17.5 makes prospective longitudinal studies arduous and and/or had been menstruating regularly for at least three expensive. Such studies conducted to date are few and months. However, they had excessive obsessions about food usually use broad outcome measures because of a lack of and weight and/or lingering bingeing/purging symptoms (but power to focus on AN. The contribution of cross-sectional not severe enough to warrant a diagnosis of bulimia studies examining women in various stages of recovery from nervosa). AN, such as this one, is therefore valuable. This cross- sectional study of a large sample of women in varying stages Women (n = 71) recovered from AN. Recovery was defined of illness with AN and recovery from the disorder aims to as BMI above 17.5, regular menstruation for at least three examine the relationship between a comprehensive range of months (unless birth control pills were taken), no regular personality characteristics, AN subtype and illness/recovery bingeing or purging symptoms for at least eight consecutive status. weeks, and no excessive obsessions about food. METHOD 2) The 242 control women with no history of an eating PARTICIPANTS disorder, mainly students, were recruited via announcements Women (n = 437) aged 14-36 participated in the study. They on college campuses and by word of mouth. These women were a subset of women participating in a larger study on the were screened for a possible history of an eating disorder. genetics of AN and comprised two groups: The following criteria were noted as possible indicators of eating disturbance: a BMI of under 17.5 or over 30 currently Women (n = 195) with a current or past DSM-IV diagnosis or since reaching current height, an ideal BMI of under 17.5, of AN, mostly students, were recruited from the community amenorrhea, an EAT-26 score of above 20 (24), and body via announcements in newspapers, on the internet, and on dissatisfaction scores in the highest 10% of all female college campuses. Initially 322 women were screened by participants in the original genetic study (N=1126; EDI body telephone for past or present symptoms of AN by the first dissatisfaction score > 38, items scored 0-5). Respondents author. Full DSM-IV criteria for a lifetime diagnosis of AN were also asked whether “eating has ever been problematic were subsequently confirmed for 219 of them by two or a source of distress for you” and the responses of those psychologists (first two authors), using the eating disorders replying positively were examined. Women who described section of the Structured Clinical Interview for DSM-IV symptoms compatible with eating disorders, or who fulfilled (SCID-IV) (22). The verbatim protocols of the interviews at least one of the other criteria above, were contacted and were read by a psychiatrist (third author) who re-interviewed interviewed with the SCID-IV. Those for whom a lifetime participants by phone when necessary; a lifetime diagnosis diagnosis of the full clinical syndrome of AN was confirmed of AN was confirmed in 216 women. We relied on self- (7 women; n = 5 recovered, n = 2 partially recovered) were reported clinical information, since medical records were excluded. Those with a lifetime diagnosis of bulimia nervosa generally not available and SCID-based current and lifetime or eating disorder not otherwise specified, including diagnoses of AN have been shown to be highly reliable (23). subthreshold AN (all AN criteria except amenorrhea or The SCID-IV was also used to determine other current and BMI<17.5) and subthreshold bulimia nervosa (BN) lifetime axis I diagnosis. An expanded version of the eating (frequency of bingeing and purging under twice a week for 2 of 9 Psychological Profiles of Women with a Past or Present Diagnosis of Anorexia Nervosa three months), and those who refused to be interviewed were about once a week = 3, between once a week and daily = 4, excluded. daily = 5. Scores for each method were summed for a total score. INSTRUMENTS The self-report instruments administered are listed in Table PROCEDURE 1. The study was approved by the Israeli Ministry of Health Helsinki Committee and the Ethics Committee of the Figure 1 Hebrew University of Jerusalem. All participants signed Table 1: Self-report measures administered informed consent forms, completed the self-report instruments (Table 1), and were screened and interviewed as described above. The data was collected during 2004 and 2005. DATA ANALYSIS To assess the effect of AN subtype on personality, both a multivariate analysis of variance (MANOVA) and a multivariate analysis of covariance (MANCOVA) were conducted.
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