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Emotional instability as a trait risk factor for eating disorder behaviors in adolescents: Sex differences in a large-scale prospective study

Published online by Cambridge University Press:  05 August 2019

Melanie Brown Open the ORCID record for Melanie Brown [Opens in a new window] ,
Ayelet Hochman  and
Nadia Micali Open the ORCID record for Nadia Micali [Opens in a new window]
Melanie Brown
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, NY, USA
Ayelet Hochman
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, NY, USA
Nadia Micali*
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, NY, USA Department of Psychiatry, University of Geneva, Geneva, Switzerland Department of Women's, Child and Adolescent Health, University of Geneva, Geneva, Switzerland Institute of Child Health, University College, London, London, UK
*
Author for correspondence: Nadia Micali, E-mail: nadia.micali@unige.ch
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Abstract

Background

Temperament and personality traits, including negative emotionality/neuroticism, may represent risk factors for eating disorders. Further, risk factors may differ by sex. We examined longitudinal temperament/personality pathways of risk for purging and binge eating in youth stratified by sex using data from a large-scale prospective study.

Methods

Temperament, borderline personality features, sensation seeking, ‘big five’ personality factors, and depressive symptoms were measured at five time points from early childhood to adolescence in 5812 adolescents (3215 females; 2597 males) in the Avon Longitudinal Study of Parents and Children. We conducted univariate analyses with these predictors of binge eating and purging at 14 and 16 years for total and sex-stratified samples. We used structural equation modeling (SEM) to fit data to a path analysis model of hypothesized associations.

Results

Of the total sample, 12.54% engaged in binge eating and 7.05% in purging by 16 years. Prevalence was much greater and increased dramatically for females from 14 years (7.50% binge eating; 2.40% purging) to 16 years (15.80% binge eating; 9.50% purging). For both sexes, borderline personality, depressive symptoms and lower emotional stability predicted eating disorder behaviors; sensation seeking and conscientiousness were also significant predictors for females. SEM identified an ‘emotional instability’ pathway for females from early childhood into adolescence (RMSEA = 0.025, TLI = 0.937 and CFI = 0.970).

Conclusions

Binge eating and purging are common in female and male adolescents. Early temperament/personality factors related to difficulty regulating emotions were predictive of later adolescent eating disorder behaviors. Results have important clinical implications for eating disorder prevention and intervention.

Keywords

AdolescentsALSPACbinge eatingborderline personality disorderdepressioneating disordersemotional instabilitypersonalitypurgingtemperament
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 11 , August 2020 , pp. 1783 - 1794
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Copyright
Copyright © Cambridge University Press 2019

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References

Allen, KL, Byrne, SM and McLean, NJ (2012) The dual-pathway and cognitive-behavioural models of binge eating: prospective evaluation and comparison. European Child & Adolescent Psychiatry 21, 51–62.CrossRefGoogle ScholarPubMed
Allison, PD (2001) Missing Data: Sage University Papers Series on Quantitative Applications in the Social Sciences (07–136). Thousand Oaks, CA: Sage Publications.Google Scholar
Angold, A, Costello, EJ, Messer, SC, Pickles, A, Winder, F and Silver, D (1995) Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research 5, 1–12.Google Scholar
Arnett, J (1994) Sensation seeking: a new conceptualization and a new scale. Personality and Individual Differences 16, 289–296.CrossRefGoogle Scholar
Bastiani, AM, Rao, R, Weltzin, T and Kaye, WH (1995) Perfectionism in anorexia nervosa. International Journal of Eating Disorders 17, 147–152.3.0.CO;2-X>CrossRefGoogle ScholarPubMed
Boyd, A, Golding, J, Macleod, J, Lawlor, DA, Fraser, A, Henderson, J, Molloy, L, Ness, A, Ring, S and Davey Smith, G (2013) Cohort profile: the ‘children of the 90s’ – the index offspring of the Avon Longitudinal Study of Parents and Children. International Journal of Epidemiology 42, 111–127.CrossRefGoogle ScholarPubMed
Bulik, CM, Sullivan, PF, Weltzin, TE and Kaye, WH (1995) Temperament in eating disorders. International Journal of Eating Disorders 17, 251–261.3.0.CO;2-V>CrossRefGoogle ScholarPubMed
Buss, A and Plomin, R (1984) Temperament: Early Developing Personality Traits. Hillsdale, NJ: Lawrence Erlbaum.Google Scholar
Cassin, SE and von Ranson, KM (2005) Personality and eating disorders: a decade in review. Clinical Psychology Review 25, 895–916.CrossRefGoogle Scholar
Cervone, D and Pervin, LA (2015) Personality, Binder Ready Version: Theory and Research, 13th Edn.Hoboken, NJ: John Wiley & Sons.Google Scholar
Cloninger, CR (1994) Temperament and personality. Current Opinion in Neurobiology 4, 266–273.CrossRefGoogle Scholar
Cossrow, N, Pawaskar, M, Witt, EA, Ming, EE, Victor, TW, Herman, BK, Wadden, TA and Erder, MH (2016) Estimating the prevalence of binge eating disorder in a community sample from the United States: comparing DSM-IV-TR and DSM-5 criteria. The Journal of Clinical Psychiatry 77, e968–e974.CrossRefGoogle Scholar
Costa, PT and MacCrae, RR (1992a) Revised NEO Personality Inventory (NEO PI-R) and NEO Five-Factor Inventory (NEO-FFI): Professional Manual. Odessa, FL: Psychological Assessment Resources, Incorporated.Google Scholar
Costa, PT and MacCrae, RR (1992b) Normal personality assessment in clinical practice: The NEO Personality Inventory. Psychological Assessment 4, 5–13.CrossRefGoogle Scholar
Culbert, KM, Racine, SE and Klump, KL (2015) Research review: what we have learned about the causes of eating disorders – a synthesis of sociocultural, psychological, and biological research. Journal of Child Psychology and Psychiatry 56, 1141–1164.CrossRefGoogle ScholarPubMed
Ehrhart, KH, Roesch, SC, Ehrhart, MG and Kilian, B (2008) A test of the factor structure equivalence of the 50-item IPIP Five-factor model measure across gender and ethnic groups. Journal of Personality Assessment 90, 507–516.CrossRefGoogle ScholarPubMed
Farstad, SM, McGeown, LM and von Ranson, KM (2016) Eating disorders and personality, 2004–2016: a systematic review and meta-analysis. Clinical Psychology Review 46, 91–105.CrossRefGoogle Scholar
Field, AE, Taylor, CB, Celio, A and Colditz, GA (2004) Comparison of self-report to interview assessment of bulimic behaviors among preadolescent and adolescent girls and boys. International Journal of Eating Disorders 35, 86–92.CrossRefGoogle ScholarPubMed
Fraser, A, Macdonald-Wallis, C, Tilling, K, Boyd, A, Golding, J, Davey Smith, G, Henderson, J, Macleod, J, Molloy, L, Ness, A, Ring, S, Nelson, SM and Lawlor, DA (2013) Cohort profile: the Avon Longitudinal Study of Parents and Children: ALSPAC mothers cohort. International Journal of Epidemiology 42, 97–110.CrossRefGoogle ScholarPubMed
Goldberg, LR (1999) A broad-bandwidth, public domain, personality inventory measuring the lower-level facets of several five-factor models. Personality Psychology in Europe 7, 7–28.Google Scholar
Hudson, JI, Hiripi, E, Pope, HG Jr and Kessler, RC (2007) The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry 61, 348–358.CrossRefGoogle ScholarPubMed
Johnson, JG, Cohen, P, Gould, MS, Kasen, S, Brown, J and Brook, JS (2002) Childhood adversities, interpersonal difficulties, and risk for suicide attempts during late adolescence and early adulthood. Archives of General Psychiatry 59, 741–749.CrossRefGoogle ScholarPubMed
Kann, L, Warren, CW, Harris, WA, Collins, JL, Williams, BI, Ross, JG and Kolbe, LJ (1996) Youth risk behavior surveillance – United States, 1995. Journal of School Health 66, 365–377.CrossRefGoogle ScholarPubMed
Kaye, WH, Wierenga, CE, Knatz, S, Liang, J, Boutelle, K, Hill, L and Eisler, I (2015) Temperament-based Treatment for Anorexia Nervosa. European Eating Disorders Review 23, 12–18.CrossRefGoogle ScholarPubMed
Keel, PK and Forney, KJ (2013) Psychosocial risk factors for eating disorders. International Journal of Eating Disorders 46, 433–439.CrossRefGoogle ScholarPubMed
Keel, PK, Fichter, M, Quadflieg, N, Bulik, CM, Baxter, MG, Thornton, L, Halmi, KA, Kaplan, AS, Strober, M and Woodside, DB (2004) Application of a latent class analysis to empirically define eating disorder phenotypes. Archives of General Psychiatry 61, 192–200.CrossRefGoogle ScholarPubMed
Maples, JL, Guan, L, Carter, NT and Miller, JD (2014) A test of the international personality item pool representation of the revised NEO personality inventory and development of a 120-item IPIP-based measure of the five-factor model. Psychological Assessment 26, 1070.CrossRefGoogle ScholarPubMed
McCrae, RR and Costa, PT (1987) Validation of the five-factor model of personality across instruments and observers. Journal of Personality and Social Psychology 52, 81–90.CrossRefGoogle ScholarPubMed
Messer, SC (1995) Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents: factor composition and structure across development. International Journal of Methods in Psychiatric Research 5, 251–262.Google Scholar
Micali, N, Solmi, F, Horton, NJ, Crosby, RD, Eddy, KT, Calzo, JP, Sonneville, KR, Swanson, SA and Field, AE (2015) Adolescent eating disorders predict psychiatric, high-risk behaviors and weight outcomes in young adulthood. Journal of the American Academy of Child & Adolescent Psychiatry 54, 652–659, e1.CrossRefGoogle ScholarPubMed
Mistry, S, Zammit, S, Price, VE, Jones, HJ and Smith, DJ (2017) Borderline personality and attention-deficit hyperactivity traits in childhood are associated with hypomanic features in early adulthood. Journal of Affective Disorders 221, 246–253.CrossRefGoogle ScholarPubMed
Nagl, M, Jacobi, C, Paul, M, Beesdo-Baum, K, Höfler, M, Lieb, R and Wittchen, H-U (2016) Prevalence, incidence, and natural course of anorexia and bulimia nervosa among adolescents and young adults. European Child & Adolescent Psychiatry 25, 903–918.CrossRefGoogle ScholarPubMed
Rothbart, MK, Ahadi, SA and Evans, DE (2000) Temperament and personality: origins and outcomes. Journal of Personality and Social Psychology 78, 122.CrossRefGoogle ScholarPubMed
Sansone, RA and Sansone, LA (2011) Personality pathology and its influence on eating disorders. Innovations in Clinical Neuroscience 8, 14.Google ScholarPubMed
Sansone, RA, Levitt, JL and Sansone, LA (2006) The prevalence of personality disorders in those with eating disorders. In Sansone, RA and Levitt, JL (eds), Personality Disorders and Eating Disorders: Exploring the Frontier. New York: Routledge, pp. 23–39.Google Scholar
Sharp, C, Goodyer, IM and Croudace, TJ (2006) The Short Mood and Feelings Questionnaire (SMFQ): a unidimensional item response theory and categorical data factor analysis of self-report ratings from a community sample of 7- through 11-year-old children. Journal of Abnormal Child Psychology 34, 365–377.CrossRefGoogle ScholarPubMed
Stice, E (2001) A prospective test of the dual-pathway model of bulimic pathology: mediating effects of dieting and negative affect. Journal of Abnormal Psychology 110, 124.CrossRefGoogle ScholarPubMed
Stice, E, Shaw, H and Nemeroff, C (1998) Dual pathway model of bulimia nervosa: longitudinal support for dietary restraint and affect-regulation mechanisms. Journal of Social and Clinical Psychology 17, 129–149.CrossRefGoogle Scholar
Striegel-Moore, RH, Rosselli, F, Perrin, N, DeBar, L, Wilson, GT, May, A and Kraemer, HC (2009) Gender difference in the prevalence of eating disorder symptoms. International Journal of Eating Disorders 42, 471–474.CrossRefGoogle ScholarPubMed
Stringaris, A, Maughan, B and Goodman, R (2010) What's in a disruptive disorder? Temperamental antecedents of oppositional defiant disorder: findings from the Avon longitudinal study. Journal of the American Academy of Child & Adolescent Psychiatry 49, 474–483.Google Scholar
Strother, E, Lemberg, R, Stanford, SC and Turberville, D (2012) Eating disorders in men: underdiagnosed, undertreated, and misunderstood. Eating Disorders 20, 346–355.CrossRefGoogle ScholarPubMed
Sweeting, H, Walker, L, MacLean, A, Patterson, C, Räisänen, U and Hunt, K (2015) Prevalence of eating disorders in males: a review of rates reported in academic research and UK mass media. International Journal of Men's Health 14.Google ScholarPubMed
Thomas, A and Chess, S (1977) Temperament and Development. Oxford, UK: Brunner/Mazel.Google Scholar
Winsper, C, Zanarini, M and Wolke, D (2012) Prospective study of family adversity and maladaptive parenting in childhood and borderline personality disorder symptoms in a non-clinical population at 11 years. Psychological Medicine 42, 2405–2420.CrossRefGoogle Scholar
Zanarini, M, Horwood, J, Waylen, A and Wolke, D (2004) The UK version of the childhood interview for DSM-IV borderline personality disorder (UK-CI-BPD). Unpublished Manuscript, University of Bristol, Department of Community Medicine, Unit of Perinatal and Pediatric Epidemiology, Bristol.Google Scholar
Zuckerman, M (1979) Sensation Seeking: Beyond the Level of Optimal Arousal. Hillsdale, NJ: Lawrence Erlbaum.Google Scholar