Johanna Levallius

Who Do You Think You Are? - Personality in Eating Disordered Patients

BackgroundThe Five-Factor Model of personality is strongly linked to common mental disorders. Yet the relationship between the lower order personality traits (facets) of the model and eating disorder (ED) features remains unclear. The aim of the study was to explore how patients with non-anorexic ED differ from controls in personality and to examine the ability of personality facets to explain psychopathology.MethodsFemale patients with non-anorexic ED (N = 208) were assessed on general psychopathology, ED symptoms and personality as measured by the NEO PI-R; and were compared on personality to age-matched female controls (N = 94).ResultsCompared to controls, patients were characterised by experiencing pervasive negative affectivity and vulnerability, with little in the way of positive emotions such as joy, warmth and love. Patients were also significantly less warm and sociable, and exhibited less trust, competence, and self-discipline. Finally, they were less open to feelings, ideas and new experiences, yet more open in their values. Among patients, personality facets explained up to 25% of the variance in ED and general psychopathology.ConclusionsED patients have distinct patterns of personality. Identifying and focusing on personality traits may aid in understanding ED, help therapists enhance the treatment alliance, address underlying problems, and improve outcome.

Now you see it, Now you don’t: compulsive exercise in adolescents with an eating disorder

BackgroundCompulsive exercise (CE) has been proposed as significant in the etiology, development and maintenance of eating disorders (EDs), resulting in more severe and enduring pathology. However, few studies have investigated CE longitudinally in adolescents with EDs. We aimed to test if adolescents show the same associations between CE and other clinical variables as previous research has found in adults.MethodsThree thousand one hundred sixteen girls and 139 boys from a clinical ED database were investigated regarding prevalence and frequency of CE and its relation to psychiatric symptoms, associated features and outcome. Denial of illness is common among adolescents and was therefore adjusted for.ResultsAdjusted CE prevalence in girls was 44%, and CE was most prevalent in bulimia nervosa. As previously found in adults, those with CE scored significantly higher than non-CE on total ED severity, level of restriction and negative perfectionism. However, there were only minor differences between CE and non-CE patients on emotional distress, hyperactivity, suicidality and self-esteem. Among boys, adjusted CE prevalence was 38%, and CE boys scored significantly higher than non-CE on total ED severity. Initial CE did not influence 1-year outcome, although cessation of CE was associated with remission.ConclusionsCE is a common clinical feature in adolescents with EDs and cessation is associated with remission. When controlling for denial of illness, CE had less detrimental impact than predicted. We recommend controlling for denial in studies on ED adolescents and further exploration of classification and treatment implications of CE.

Take charge: Personality as predictor of recovery from eating disorder

Many treatments for eating disorders (ED) have demonstrated success. However, not all patients respond the same to interventions nor achieve full recovery, and obvious candidates like ED diagnosis and symptoms have generally failed to explain this variability. The current study investigated the predictive utility of personality for outcome in ED treatment. One hundred and thirty adult patients with bulimia nervosa or eating disorder not otherwise specified enrolled in an intensive multimodal treatment for 16 weeks. Personality was assessed with the NEO Personality Inventory Revised (NEO PI-R). Outcome was defined as recovered versus still ill and also as symptom score at termination with the Eating Disorder Inventory-2 (EDI-2). Personality significantly predicted both recovery (70% of patients) and symptom improvement. Patients who recovered reported significantly higher levels of Extraversion at baseline than the still ill, and Assertiveness emerged as the personality trait best predicting variance in outcome. This study indicates that personality might hold promise as predictor of recovery after treatment for ED. Future research might investigate if adding interventions to address personality features improves outcome for ED patients.

Personality predicts drop-out from therapist-guided internet-based cognitive behavioural therapy for eating disorders. Results from a randomized controlled trial

Internet-based guided self-help cognitive behavioural therapy (ICBT) seems a promising way of delivering eating disorder treatment. However, treatment drop-out is a common problem and little is known about the correlates, especially in clinical settings. The study aimed to explore prediction of drop-out in the context of a randomized controlled trial within specialized eating disorder care in terms of eating disorder symptomatology, personality traits, comorbidity, and demographic characteristics. 109 outpatients diagnosed with bulimia nervosa or similar eating disorder were randomized to two types of ICBT. Participants were assessed with several clinical- and self-ratings. The average drop-out rate was 36%. Drop-out was predicted by lower scores in the personality traits Dutifulness and Assertiveness as measured by the NEO Personality Inventory Revised, and by higher scores in Self-affirm as measured by the Structural Analysis of Social Behaviour. Drop-out was also predicted by therapist factors: one therapist had significantly more drop-outs (82%) than the other three (M = 30%). Theoretical and clinical implications of the impact of the predictors are discussed.

Running on empty – a nationwide large-scale examination of compulsive exercise in eating disorders

BackgroundCompulsive exercise (CE) has been the neglected “Cinderella” among eating disorder (ED) symptoms, even though it seems to impact severity, treatment and outcome. This prompted a large-scale and systematic examination of the impact of CE in a representative ED sample.MethodsCE was examined in over 9000 female and male patients from a clinical ED database (covering out-patient, day and/or residential treatment) with respect to prevalence, ED diagnosis, ED symptoms, clinical features, patient characteristics, and outcome at 1-year follow-up. Relationships between changes in CE behavior and remission were also examined.ResultsCE was a transdiagnostic symptom, present in nearly half of all patients (48%). It was associated with greater overall ED pathology, particularly dietary restraint, and negative perfectionism. Initial CE did not impact remission rate, but patients continuing or starting CE during treatment had considerably lower remission rates compared to patients who never engaged in, or ceased with, CE. Results were comparable for females and males.ConclusionsAt baseline, there were few differences between patients with and without CE, except a somewhat higher symptom load for patients with CE, and CE did not predict ED outcome. However, how CE developed during treatment to 1-year follow-up considerably impacted remission rates. We strongly recommend CE to be systematically assessed, addressed, and continuously evaluated in all ED patients seeking treatment.

Exercise Caution: Questions to Ask Adolescents Who May Exercise Too Hard

When the primary goal of exercise is to compensate for food intake and to alter body shape and weight, it is considered compulsive and may be harmful. Compulsive exercise (CE) is important in the pathogenesis of eating disorders (EDs). Many healthy adolescents engage in CE too, and this may indicate a risk for EDs. Our aim was to learn more about ED risk factors tied to CE and to try to isolate questions to ask in order to probe for high ED risk in adolescents engaging in CE. Using two well-established instruments (the Structural Analysis of Social Behavior and the Eating Disorders Examination Questionnaire), we studied associations between ED variables and CE in healthy adolescent boys and girls. We examined gender-specific items to generate the best possible fit for each gender. Individuals with CE displayed significantly greater ED pathology and more self-criticism, and this pattern was stronger in girls than in boys. Risk factors for ED among individuals with CE differed slightly for boys and girls. We put forward a set of gender-specific questions that may be helpful when probing for ED risk among adolescents engaging in CE.

Maturation in patients with borderline personality disorder

Patients with borderline personality disorder have a characteristic and extreme personality associated with psychopathology. The aim was to investigate personality change in relation to suicidality following treatment. 21 patients were assessed before and after psychotherapy on personality (NEO PI-R) and suicidality (SUAS). At follow-up, Neuroticism and Conscientiousness normalized along with six lower-order facets; Depression, Impulsiveness, Competence, Achievement Striving, Self-Discipline and Deliberation. Thirteen patients showed a positive personality development paralleled by a lesser degree of suicidality.