Do illness characteristics and familial risk differ between women with anorexia nervosa grouped on the basis of personality pathology?

Abstract

Background. In view of the potential utility of personality-based groupings in eating disorders (EDs), and the lack of studies using this approach in large samples of individuals with anorexia nervosa (AN), this study set out to examine (i) the nature of personality-based clusters of women with lifetime AN and (ii) if these clusters are associated with either clinical symptoms or aetiological variables.

Method. The self-report Dimensional Assessment of Personality Pathology (DAPP) was completed by 153 women with a lifetime diagnosis of DSM-IV AN. A cluster analysis was used to identify personality-based subgroups. Clusters were then compared on clinical and aetiological variables.

Results. Three personality-based clusters were identified, defined by broad, avoidant and compulsive types of personality pathology. Dimensions of low dissocial behaviour, high inhibition and high compulsivity were common to all clusters, while dimensions related to emotional dysregulation appeared more heterogeneous. Clinical symptoms were not related to personality profile with the exception of a trend towards more fasting behaviour in the broad group. The compulsive cluster with the narrowest range of extreme personality traits reported the highest familial risk of eating pathology.

Conclusions. The three clusters identified in our AN sample were similar to those previously identified in broader eating disordered samples. Personality-based clusters did not correspond overall to clinical symptoms but aetiological differences supported their validity. Broader personality pathology indicative of emotional dysregulation, problems with identity and relationships, in addition to core traits, may increase vulnerability to AN in those with less familial risk.