Eating Disorders - Risk Factors

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Personality Disorders

A 2000 study reported that people with eating disorders tended to share similar personality traits, including low self-esteem, dependency, and problems with self-direction. Researchers have been attempting to determine specific personality disorders or behavioral characteristics that might put people at higher risk for one or both of the eating disorders. Some studies have reported the following personality disorders linked to particular eating disorders:

• Avoidant personalities, mostly seen in anorexia. Such people are generally high functioning, persistent, and perfectionists.
• Dependent personalities, mostly seen in anorexia. This group is usually over-controlled and withdrawn.
• Borderline and histrionic personalities, mostly seen in bulimia. Such individuals are emotionally uncontrolled and impulsive.
• Narcissism is seen in both anorexia and bulimia.

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Any of these personality traits can appear in patients with either bulimia or anorexia. Some experts believe that the patient's specific personality disorder, rather than whether they are anorexic or bulimic, may be the more important factor in determining treatment choice.

Avoidant Personalities. Some studies indicate that as many as a third of anorexic restrictors have avoidant personalities. This personality disorder is characterized by:

• Being a perfectionist
• Being emotionally and sexually inhibited
• Having less of a fantasy life than people with bulimia or those without an eating disorder
• Not being rebellious, or being perceived as always being "good”
• Being terrified of being ridiculed or criticized or of feeling humiliated

People with anorexia are extremely sensitive to failure, and any criticism, no matter how slight, reinforces their own belief that they are "no good.”

The person with both anorexia and an avoidant personality disorder may develop a behavioral and eating pattern as follows:

• For such individuals, achieving perfection is the only way they believe they can obtain love.
• Part of the drive for perfection and love is being trouble-free and attaining some ideal image of thinness. Eating is also associated with lower animal drives, so fasting has been linked historically to saintliness. The individual is driven to demand nothing, including food.
• Failure is inevitable, since being loved has nothing to do with being perfect. (In fact, people who are always seeking perfection often alienate others around them.)
• This failure to achieve love is followed by a sense of being even more imperfect (which is equivalent to being fat) and a renewed sense of striving for perfection -- becoming even thinner.