A dark past, a restrained present, and an apocalyptic future: time perspective, personality, and life satisfaction among anorexia nervosa patients

Introduction

“[. . .] and in addition to the feeling of being full there was another more terrifying one, as if a hundred appetites were raging out of control within her. She couldn’t explain it, but she felt as if everything was in chaos and something awful was going to happen. She had eaten and now something terrible would occur.”

In ‘The Best Little Girl in the World’ by Steven Levenkron (Levenkron, 1978).

Eating disorders present a serious and potentially life-threatening condition. This is especially true for anorexia nervosa, which is characterized by episodes of self-starvation, the preference for being underweight, a distorted body image, and an intense fear of gaining weight (Lee, Cloninger & Chaea, 2015). This line of research shows that diet and eating behaviors are strongly associated with particular personality characteristics in clinical samples (e.g., Lee, Cloninger & Chaea, 2015; Anckarsäter et al., 2012), making personality a major factor of eating disorders in general (Lilenfeld et al., 2006; Cassin & Von Ranson, 2005). Eating disorder patients describe themselves as anxiety prone, with low self-esteem, and poor emotional self-regulation. Besides these self-descriptions, anorexia nervosa patients also describe themselves as rigid, industrious/persistent, and perfectionists (e.g., Akan & Grilo, 1995). These personality profile and their propensity to experience anxiety and negative affect (Harney et al., 2014; Spring & Bulik, 2014; Lundblad et al., 2015a; Lundblad et al., 2015b) might lead to cognitive-emotional dysfunctions, such as, intolerance of uncertainty (cf. Sternheim, Startup & Schmidt, 2011; Sternheim et al., 2011; Sternheim, Startup & Schmidt, 2015). This behavior is almost synonymous with neuroticism, but at the same time these patients present a picture of the self as conscientious and persistent. Paradoxically, conscientiousness and persistence have been linked to well-being and happiness (Garcia, 2011a; Garcia, 2012; Garcia et al., 2013), but eating disorder patients, especially anorexia nervosa patients, express an absence of positive emotions and lack of satisfaction in several planes of their lives (Kitsantas, Gilligan & Kamata, 2003; Phillipou et al., 2015; Dapelo et al., 2016; Brand-Gothelf et al., 2014; Lavender et al., 2016; Tomba et al., 2014). Thus, the question is if, as it is among individuals without eating disorders, these personality traits are predictors of life satisfaction among anorexia nervosa patients or if there are other aspects of the being that are associated with life satisfaction across healthy and unhealthy individuals.

In this context, the Science of Well-being suggests that individual differences in personality, influence the physical, psychological, and social aspects of health and well-being of all individuals (Cloninger, 2004; Garcia & Rosenberg, 2016). Nevertheless, instead of linking specific temperament traits, such as extraversion and neuroticism, to well-being, Cloninger’s Science of Well-Being focuses on self-awareness of the unity of being through sustainable personality development in three dimensions (Cloninger, 2004; Cloninger, 2006; Cloninger, 2007; Cloninger, 2013; Garcia & Rosenberg, 2016). In Cloninger’s paradigm, unity of being represents a complete, coherent and harmonious sense of the self, giving raise to feelings of hope in one self’s ability to cope and make decisions (i.e., Self-directedness), feelings of love and empathy towards others (i.e., Cooperativeness), and feelings of faith in that we are part of something beyond the self and others (i.e., Self-transcendence). In short, the ability to be self-aware and organize one’s life in a coherent manner is more important to well-being than specific temperament traits, such as, extraversion and persistence.

Indeed, in line with their personality characteristics (i.e., high levels of neuroticism and persistence), anorexia nervosa patients display an inability or difficulty to evaluate the future long-term outcomes of their actions/choices and also an incapacity or inflexibility to adapt their mindset/strategies to new information or novel environmental stimuli (Tenconi et al., 2016). Thus, perhaps explaining their intolerance of uncertainty (cf. Sternheim et al., 2011; Sternheim, Startup & Schmidt, 2011). The cognitive ability to organize the past, present, and future (i.e., a person’s time perspective) in a coherent manner is indeed an important aspect of an individual who can make self-directed choices for her/his own well-being and flexible adapt to new situations (Cloninger, 2004; Garcia et al., 2016). As a matter of fact, a balanced organization of the flow of time seems to influence life satisfaction beyond temperament traits (Zhang & Howell, 2011).

A balanced or coherent time perspective may be described as: a sentimental and positive view of the past (i.e., high past positive), a less pessimistic attitude toward the past (i.e., low past negative), the desire to experience pleasure without concern for future consequences (i.e., high present hedonistic), a less fatalistic and hopeless view of the future (i.e., low present fatalistic), and the ability to find reward in achieving specific long-term goals (i.e., high future) (Zimbardo & Boyd, 1999; Zimbardo, Keough & Boyd, 1997). Individuals’ perspective of time predicts the reported use of alcohol, drug, and tobacco (Keough, Zimbardo & Boyd, 1999), risky driving (Zimbardo, Keough & Boyd, 1997; Boyd & Zimbardo, 2005), indecision and avoidant procrastinations (Díaz-Morales, Ferrari & Cohen, 2008), environmental engagement (Milfont, Wilson & Diniz, 2012), the choice of food and of partner, educational achievement, and the distinctness of future goals (Zimbardo & Boyd, 1999). Time perspective is also related to well-being–negative views of the past have been reported to be associated with depression, whereas positive views of the past have been reported to be associated with happiness and life satisfaction (Bruehlman-Senecal & Ayduk, 2015; Zimbardo & Boyd, 1999; see also Stolarski et al., 2014; Sailer et al., 2014; Garcia et al., 2016). In relation to anorexia patients, however, if positive information of the present, or past for that matter (e.g., they have become thinner), is not well adjusted into their mindset (e.g., “I’m still overweight”), then even if long-term goals are future oriented, these goals might not be healthy in nature (e.g., “I need to eat less”).

Methods

Results

We first conducted a t-test to compare if anorexia patients differed in the five time perspective dimensions, the Big Five traits, and temporal life satisfaction. In short, anorexia patients scored higher in the past negative, the present fatalistic, and the future dimensions and higher in conscientiousness, extraversion, and agreeableness. Controls scored higher in both the past positive and the present hedonistic dimensions and also higher in temporal satisfaction with life (see Table 1).

Next, we conducted multiple regression analyses in which temporal satisfaction with life was the outcome variable and personality was the predictor in the first model and time perspective the predictor in the second model. These analyses were conducted separately for each participant group in order to investigate if the personality traits and the outlook on time associated to positive levels of life satisfaction among controls, also predicted anorexia patients’ life satisfaction. Additionally, these regressions aimed to investigated if time perspective dimensions predicted life satisfaction beyond personality traits.

For anorexia patients, the multiple regression revealed that at step one, personality contributed significantly to the regression model (F(5, 68) = 3.69, p < .01) and accounted for 23% of the variation in temporal satisfaction with life. In this first step, emotional stability (positively) was the only significant predictor of temporal satisfaction with life among anorexia patients (see Table 2). Introducing the time perspective dimensions explained an additional 23% of variation in temporal satisfaction with life. This change in R² was significant (F(10, 68) = 4.82, p < .001). In this second step, emotional stability was no longer a significant predictor of temporal satisfaction with life. Instead, both the past positive (positively) and the present hedonistic (positively) time perspective dimensions predicted significantly temporal satisfaction with life among anorexia patients (see Table 2).

For participants in the control group, the multiple regression revealed that at step one, personality contributed significantly to the regression model (F(5, 98) = 5.12, p < .001) and accounted for 21% of the variation in temporal satisfaction with life. In this first step, openness to experience (negatively) and emotional stability (positively) were the significant predictors of temporal satisfaction with life among controls (see Table 2). Introducing the time perspective dimensions explained an additional 46% of variation in temporal satisfaction with life. This change in R² was significant (F(10, 93) = 18.47, p < .001). In this second step, emotional stability (positively) and both the past negative (negatively) and past positive (positively) time perspective dimensions predicted significantly temporal satisfaction with life among controls (see Table 2).

Discussion

We investigated differences in time perspective dimensions, personality traits, and life satisfaction between anorexia nervosa patients and matched controls. We also investigated if the personality traits and the outlook on time associated to positive levels of life satisfaction among controls, also predicted anorexia patients’ life satisfaction. Additionally, we investigated if time perspective dimensions predicted life satisfaction beyond personality traits among both patients and controls. Our results showed that anorexia patients had a darker and less sentimental view of the past (i.e., high past negative and low past positive), a higher reluctance to experience pleasure (i.e., low present hedonistic), a more fatalistic and hopeless view of the future (i.e., high present fatalistic), and at the same time a higher tendency to find reward in achieving specific long-term goals (i.e., high future). Moreover, the patients were higher in conscientiousness, extraversion, agreeableness, and lower in life satisfaction. In other words, patients’ time-awareness is placed in a dark past, an extremely restrained present, and an apocalyptic future, while their self-awareness is focused on them as hard-workers (i.e., conscientiousness), external positive stimuli (i.e., extroversion), and pleasing and being kind to other people (i.e., agreeableness). In other words, presenting a personality usually associated with happiness and well-being, but an unbalanced time perspective or an unhappy outlook on time. In essence, the personality traits measured here seem to be necessary for high levels of life satisfaction but not sufficient (cf. Cloninger, 2004). Instead, individuals level of self-awareness is probably what helps individuals to adapt to internal and external conditions (Cloninger, 2004; Ruini, 2017).

This picture of the self in time (i.e., time perspective) and space (i.e., personality) that the patients present goes in line with earlier studies in which anorexia patients describe themselves as rigid, industrious, and perfectionists (e.g., Akan & Grilo, 1995). In the present study, however, our results also suggest that these time-space characteristics might lead to cognitive-emotional-social dysfunctions in anorexia nervosa patients (cf. Sternheim et al., 2011; Sternheim, Startup & Schmidt, 2011; Cardi et al., 2015). For instance, a focus of the self in relation to external positive stimuli (i.e., high extraversion) in conjunction with a extremely restrictive present (i.e., low present hedonistic) and focus on future reward (i.e., high future) might lead to a persistent attitude towards self-starving in an already highly conscientious individual with an apocalyptic view of the future (i.e., high present fatalistic). This description suggests a persistent striving for future reward from and individual without hope for the future which might explain why anorexia nervosa patients display an inability or difficulty to evaluate the future long-term outcomes of their actions/choices and also an incapacity or inflexibility to adapt their mindset/strategies to new information or novel environmental stimuli (cf. Tenconi et al., 2016).

Unsurprisingly, for patients, a better view of the past and a more hedonistic present (i.e., a less restrictive attitude towards the present) seems to increase their life satisfaction. When it comes to the controls, the past positive dimension and the past negative dimensions together with emotional stability were the main predictors. Suggesting that the cultivation of a sentimental and positive view of the past (i.e., high past positive) would lead to increases in life satisfaction for both patients and individuals without eating disorders, but that increases in the desire to experience pleasure without concern for future consequences (i.e., high present hedonistic) would lead to increases in life satisfaction only among anorexia nervosa patients. Moreover, personality did not seem to play the same kind of role for patients as for controls. This is against most studies on life satisfaction, which show that emotional stability or low neuroticism, along extraversion, is one of the major predictors of life satisfaction (Pavot, Diener & Suh, 1998). Again, temperament traits might help to define the type of disorder, but not if a person would develop a disorder (Cloninger, 2004). In this study, not only did patients present what the literature would partially define as a happy personality, but also these traits were not even associated with patients’ life satisfaction when time perspective was introduced as a predictor. Hence, we argue that temperament traits do not define who the happy people are and that focusing on the cultivation of specific time dimension would lead to higher well-being among patients. This effect seems to go beyond the patients’ temperamental dispositions. That being said, although we stated that emotionally stability played a role for controls’ life satisfaction but not for patients, we cannot rule out that this difference was rather because the relationship between personality traits-life satisfaction was less strong for patients to begin with.

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