Personality Functioning in Obesity and Binge Eating Disorder: Combining a Psychodynamic and Trait Perspective

Abstract

Objective: There is preliminary evidence for an association between personality traits and binge eating disorder (BED) in obese patients. In addition, recent studies have shown impaired psychodynamic personality functioning in BED. However, these results are partly inconsistent. The goal of this study was to explore and evaluate personality traits and personality functioning in obese patients with BED or subthreshold BED. Moreover, we aimed to explore the additional value of combined assessment of personality traits and personality functioning. Methods: Treatment-seeking obese female patients with BED (n=129) or subthreshold BED (n=91) were compared with obese (n=107) and nonobese (n=90) female community controls in terms of personality traits (using the Temperament and Character Inventory) and personality functioning (using the Developmental Profile Inventory) in univariate and multivariate analyses. Results: Harm Avoidance was higher and Self-Directedness was lower in obese patients with BED or subthreshold BED compared with obese and nonobese community controls. In addition, obese patients with BED or subthreshold BED presented more maladaptive and less adaptive personality functioning than controls. Although univariate analyses did not find significant differences in personality traits or personality functioning between obese patients with BED and those with subthreshold BED, when both personality traits and personality functioning were combined in multivariate analysis (data from both the Temperament and Character Inventory and Developmental Profile Inventory), obese patients with BED showed greater vulnerabilities in personality traits and functioning than obese patients with subthreshold BED. Conclusions: Obese patients with BED or subthreshold BED had specific impairments in personality traits and personality functioning. Combined assessment indicated that patients with BED had the most vulnerable personality profile of the 4 groups. The results support the added value of assessment of both personality traits and psychodynamic personality functioning, in line with the alternative Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) model for personality disorders.

Exploring effectiveness of CBT in obese patients with binge eating disorder: personality functioning is associated with clinically significant change

“…Moreover, we assessed personality traits using the TCI, a reliable questionnaire for the assessment of relevant personality traits in subjects with and without specific psychopathology [ 52 ]. These findings subsequent former study results, showing that obese patients with BED or subthreshold BED presented more maladaptive and less adaptive psychodynamic personality functioning as well impaired personality traits reflected by higher Temperament and Character Inventory (TCI) Harm avoidance and lower Self-directedness as compared to non-bingeing obese controls and normal weight controls [ 34 ].…”

“…This integrative perspective is in line with the current hybrid DSM-5 Alternative Model of Personality Disorders (AMPD) in which psychodynamically informed levels of personality functioning -as reflected by concepts of self and interpersonal functioning- are combined with personality traits [ 2 ]. A recent study exploring personality functioning and personality traits in patients with BED showed that patients with BED or subthreshold BED presented more maladaptive and less adaptive psychodynamic personality functioning as well as impaired personality traits, as compared to obese and normal weight community controls [ 34 ].…”

Exploring the Link between ADHD and Obesity: A Focus on Temperament

“…In comparison to the personality variables that influence later substance use, such as high NS and RD, low HA and negative affectivity, our patients with obesity have low NS and high HA, as well as prevalent internalizing disorders. In other words, both ADHD subjects with obesity and those with substance abuse may present high RD, but while subjects prone to substance abuse may present high NS and low HA (impulsive, quick-tempered, intolerant to frustration and rules, low dopaminergic activity, and typical ADHD features), patients with obesity are characterized by low NS and high HA (excessive worrying, pessimism, shyness, being fearful, doubtful, and easily fatigued), with neurotic introversion more closely related to the typical features of binge- and over-eating [ 44 , 45 ]. This is consistent with previous findings linking depression and negative affects to ADHD and the development of childhood obesity [ 12 ].…”

“…Consistent with these reports, according to Cloninger’s model of personality, obese individuals, compared with normal-weight subjects, should present a distinctive temperament profile, characterized by low SD and C and high NS and HA. In obese individuals with associated binge eating disorder, this profile is even more pronounced [ 44 , 45 ]. These temperamental dimensions may be related to psychopathological dimensions.…”

Assessment of personality functioning in psychosomatic medicine

“…Personality traits can be important risk or protective factors in the development of obesity. A recent study among obese women with binge eating disorder found impairments in both personality traits and personality functioning as compared to obese and non-obese community controls [ 35 ]. Obese patients with binge eating disorder had a significantly more vulnerable personality profile with impairments at almost all levels of maladaptive personality functioning.…”