Personality Profiles in Eating Disorders: Rethinking the Distinction Between Axis I and Axis II
2001/04/01 by Drew Westen, Jennifer Harnden-Fischer · 351 citations
Medicine · Psychology · #Anorexia #Anorexia nervosa #Clinical psychology #Eating Disorders and Behaviors #Eating disorders #Medical diagnosis #Medicine #Obsessive-Compulsive Spectrum Disorders #Pathology #Personality #Personality Disorders and Psychopathology #Personality disorders #Personality pathology #Psychiatry #Psychology
paper · doi:10.1176/appi.ajp.158.4.547
published in American Journal of Psychiatry 158(4), 547-562 (American Psychiatric Association)
openalex publication_date 2001/04/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/28
Abstract
OBJECTIVE: Like other DSM-IV axis I syndromes, eating disorders are diagnosed without respect to personality, which is coded on axis II. The authors assessed the utility of segregating eating disorders and personality pathology and examined the extent to which personality patterns account for meaningful variation within axis I eating disorder diagnoses. METHOD: One hundred three experienced psychiatrists and psychologists used a Q-sort procedure (the Shedler-Westen Assessment Procedure-200) that assesses personality and personality pathology to describe a patient they were currently treating for bulimia or anorexia. Data were subjected to a cluster-analytic procedure (Q-analysis) to determine whether patients clustered into coherent groupings on the basis of their personality profiles. Categorical and dimensional personality diagnoses were then used to predict measures relevant to adaptation and etiology, controlling for axis I diagnosis. RESULTS: Three categories of patients emerged: a high-functioning/perfectionistic group, a constricted/overcontrolled group, and an emotionally dysregulated/undercontrolled group. This categorization demonstrated substantial incremental validity beyond axis I diagnosis in predicting eating disorder symptoms, adaptive functioning (Global Assessment of Functioning scores and history of psychiatric hospitalization), and etiological variables (sexual abuse history). CONCLUSIONS: Axis I symptoms are a useful component, but only one component, in the accurate diagnosis of eating disorders. Classifying patients with eating disorders by eating symptoms alone groups together patients with anorexic symptoms who are high functioning and self-critical with those who are highly disturbed, constricted, and avoidant, and groups together patients with bulimic symptoms who are high functioning and self-critical with those who are highly disturbed, impulsive, and emotionally dysregulated. These distinctions may be relevant to etiology, prognosis, and treatment.
Cited by
- Some Limitations on the External Validity of Psychotherapy Efficacy Studies and Suggestions for Future Research
- An opportunity to bridge the gap between clinical research and clinical practice: Implications for clinical training.
- incorporating dimensions into the classification of eating disorders: Three models and their implications for research and clinical practice
- Perfectionism and impulsivity based risk profiles in eating disorders
- A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: An empirical examination of the status of empirically supported therapies.
- The genetic architecture of neuroticism in 3301 Dutch adolescent twins as a function of age and sex: a study from the Dutch twin register. [europepmc]
- Anorexia nervosa trios: behavioral profiles of individuals with anorexia nervosa and their parents. [europepmc]
- Daily mood patterns and bulimic behaviors in the natural environment. [europepmc]
- Countertransference reactions to adolescents with eating disorders: relationships to clinician and patient factors. [europepmc]
- Sexual functioning in women with eating disorders. [europepmc]
- The possible influence of impulsivity and dietary restraint on associations between serotonin genes and binge eating. [europepmc]
- Adult attachment, personality traits, and borderline personality disorder features in young adults. [europepmc]
- Molecular Genetic Studies of Eating Disorders: Current Status and Future Directions. [europepmc]
- The clinical utility of personality subtypes in patients with anorexia nervosa. [europepmc]
- Eating disorders and major depression: role of anger and personality. [europepmc]
- An opportunity to bridge the gap between clinical research and clinical practice: implications for clinical training. [europepmc]
- Psychosomatic syndromes and anorexia nervosa. [europepmc]
- Alternative methods of classifying eating disorders: models incorporating comorbid psychopathology and associated features. [europepmc]
- Incorporating dimensions into the classification of eating disorders: three models and their implications for research and clinical practice. [europepmc]
- Personality-based subtypes of anorexia nervosa: examining validity and utility using baseline clinical variables and ecological momentary assessment. [europepmc]
- Temperamental factors predict long-term modifications of eating disorders after treatment. [europepmc]
- Alcohol use disorder in women: Risks and consequences of an adolescent onset and persistent course. [europepmc]
- Are Extremes of Consumption in Eating Disorders Related to an Altered Balance between Reward and Inhibition? [europepmc]
- Associations of Neuroticism and Impulsivity with Binge Eating in a Nationally Representative Sample of Adolescents in the United States. [europepmc]
- Dimensions of impulsivity in relation to eating disorder recovery. [europepmc]
- Longitudinal Associations Among Bullying by Peers, Disordered Eating Behavior, and Symptoms of Depression During Adolescence. [europepmc]
- Reduced mentalizing in patients with bulimia nervosa and features of borderline personality disorder: A case-control study. [europepmc]
- Mentalizing Subtypes in Eating Disorders: A Latent Profile Analysis. [europepmc]
- Overcontrolled, undercontrolled, and resilient personality styles among patients with eating disorders. [europepmc]
- Associations Between Trauma, Early Maladaptive Schemas, Personality Traits, and Clinical Severity in Eating Disorder Patients: A Clinical Presentation and Mediation Analysis. [europepmc]
Related