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Personality subtypes in eating disorders: validation of a classification in a naturalistic sample

Center for Anxiety and Related Disorders, Department of Psychology, Boston University, Boston, Massachusetts

DREW WESTEN, PhD

Departments of Psychology and Psychiatry and Behavioral Science, Emory University, Atlanta, Georgia, USA

Correspondence: Dr Heather Thompson-Brenner, Center for Anxiety and Related Disorders, Department of Psychology, Boston University, 648 Beacon Street, Boston, MA 02215, USA. Tel: +1 617 353 9236; fax: +1 617 353 9609; e-mail: ht141{at}hotmail.com

Declaration of interest None. Funding detailed in Acknowledgements.

Background Research has identified three personality subtypes in patients with eating disorders: emotionally dysregulated, constricted and high-functioning/perfectionistic.

Aims To see whether the subtypes are distinguished in ways indicative of valid classification, notably in patterns of adaptive functioning, comorbidity, treatment response and therapeutic interventions.

Method A random sample of experienced clinicians provided data on 145 patients with bulimic symptoms, including data on eating disorder symptoms, DSM-IV comorbidity, personality pathology, treatment response and treatment interventions.

Results Patients categorised as dysregulated had the poorest functioning, most comorbidity and worst outcome, followed by patients in the constricted and high-functioning groups. The three subtypes elicited different therapeutic interventions and accounted for substantial incremental variance in outcome, holding constant the severity of eating disorder symptoms and presence of other Axis I disorders.

Conclusions The data provide accumulating evidence for the validity of three personality subtypes in patients with eating disorders.

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