Personality and family features of adolescent girls with eating symptoms: Evidence for restricter/binger differences in a nonclinical population

doi:10.1016/0306-4603(91)90023-B

Addictive Behaviors

Volume 16, Issue 5, 1991, Pages 303-314

https://doi.org/10.1016/0306-4603(91)90023-B Get rights and content

Abstract

Conflicting evidence exists concerning a “restricter/binger” dichotomy aligned with personality traits of obsessionality versus impulsivity, and family traits of enmeshment versus incohesion. The present study explored relationships among reported personality and family traits, on the one hand, and subtypes of eating symptoms, on the other, in a sample of 715 high-school girls. Symptomatic eaters (most displaying subclinical eating problems) consistently displayed more Mood Problems, Body Concerns, and Self-Criticism than did asymptomatic girls. Differences were observed between restrictive eaters and binge eaters on other variables: Restrictive types were more Perfectionistic, whereas bingers were more Impulsive and rated their families as more Incohesive. Results were discussed in the light of two views on restricter/binger differences. That they reflect: (a) premorbid features acting in predisposition to the eating disorders (EDs). (b) state-dependent features associated either with restrictive or binging phases of eating disturbances.

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This study evaluated the extent to which personality disorder (PD) diagnoses drawn in active bulimics explained pretreatment and posttreatment comorbid features, once possible secondary effects of bulimia nervosa (BN) on the mental status were controlled. We used structured interviews to assign axis II diagnoses to 73 DSM-III-R bulimics, and then examined whether or not classification into borderline PD (BPD), other PD (OPD), or no PD (NPD) groups (a) predicted pretreatment and posttreatment differences in comorbid symptoms, and (b) explained the severity of comorbid symptoms independent of effects attributable to BN sequelae. Groups never differed on eating-symptom measures, with all showing satisfactory average improvements over 3 months. However, on pretreatment and posttreatment comorbid symptoms, BPD subjects displayed more depression, reliance on maladaptive defenses, and other pathological features than did other groups. More importantly, after controlling for the effects of possible sequelae of BN on comorbid symptoms at each point in time, a borderline/nonborderline distinction always explained significant residual proportions of variance in comorbid symptoms. These findings suggest that despite tendencies for BN to exacerbate concurrent symptoms, axis II diagnoses remain meaningful as indicators of comorbid features.
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The present study evaluated the utility of combining measures of body dissatisfaction and borderline personality features in screening high-school girls who may be at risk for bulimia nervosa. Two samples (777 high-school girls and 22 bulimic women in-treatment) completed scales assessing borderline traits, body dissatisfaction, eating symptoms, and associated psychiatric disturbances. Students were divided into four groups, respectively showing: (a) high body dissatisfaction and borderline traits. (b) high body dissatisfaction alone, (c) high borderline traits alone, or (d) neither vulnerability component. Clinical and nonclinical groups were then compared for severity of eating and psychiatric symptoms. Girls displaying the combination of high body dissatisfaction and borderline traits (our presumed “high-risk” group) showed an elevated profile of eating and associated disturbances, highly comparable to the bulimic group. They were also more likely to receive threshold and subthreshold diagnoses of bulimia nervosa (according to simulated diagnoses based on self-report items) than subjects in other high-school groups. Implications of these findings were discussed with reference to the “two-component” model of eating disorders.
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^☆: This research was supported by a grant from the Fonds de la Recherche en Santé du Quebec (no. 871398). The authors extend sincere thanks to the school boards and students, whose cooperation made this study possible.

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Personality and family features of adolescent girls with eating symptoms: Evidence for restricter/binger differences in a nonclinical population☆

Abstract

Comparative Psychiatry

Journal of Adolescent Health Care

Diagnostic and statistical manual of mental disorders

Diagnostic and statistical manual of mental disorders

Relevance of a standard measurement of undernutrition to the diagnosis of anorexia nervosa: Use of Quetelet's Body Mass Index

International Journal of Eating Disorders

Experiences of depression in normal young adults

Journal of Abnormal Psychology

Subclinical anorexia nervosa

Psychological Medicine

Eating attitudes as related to demographic and personality characteristics: A high-school survey

Canadian Journal of Psychiatry

Bulimic and non-bulimic college females' perceptions of family adaptability and family cohesion

Journal of Advanced Nursing

The prevalence of bulimia nervosa in the US college student population

American Journal of Public Health

The McMaster family assessment device

Journal of Martial and Family Therapy

The validity of the distinction between bulimia with and without anorexia nervosa

American Journal of Psychiatry

The eating attitudes test: Psychometric features and clinical correlates

International Journal of Eating Disorders

Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia

International Journal of Eating Disorders

Comparison between weight-preoccupied women and anorexia nervosa

Psychosomatic Medicine

The association between bulimic symptoms and reported psychopathology

International Journal of Eating Disorders

DSM-III-R personality disorders in patients with eating disorders

American Journal of Psychiatry

Observed family interactions among subtypes of eating disorders using structural analysis of social behavior

Journal of Consulting and Clinical Psychology

The etiology and treatment of bulimia nervosa: A biopsychosocial perspective