Personality features and expressed concerns of adolescents with eating disorders

Adolescence, Summer, 1998 by Tamara Pryor, Michael W. Wiederman

Adolescence is a turbulent time, marked by intense physical and psychological changes, and it appears that females may experience particular stressors that are less often experienced by males. For example, during adolescence females are more likely than males to experience depression (Kandel & Davies, 1982), perhaps because self-esteem is more related to weight and body shape for females than it is for males (Tobin-Richards, Boxer, & Petersen, 1983). It is during adolescence that eating disorders, phenomena occurring almost exclusively among females, often first become apparent (American Psychiatric Association, 1994; Attie, Brooks-Gunn, & Petersen, 1990; Hsu, 1989).

Personality characteristics of women with eating disorders have been the focus of much research, with an emphasis on comparison of anorexia nervosa and bulimia nervosa (see Johnson & Wonderlich, 1992, and Vitousek & Manke, 1994, for reviews). In general, those with anorexia nervosa have been characterized as reticent, introversive, constricted, obsessional, and compulsive, whereas those with bulimia nervosa have been characterized as relatively more social, impulsive, and affectively labile. Most research on the personality features of individuals with eating disorders has dealt with adults. The descriptions of the adolescent anorexic presented in the professional literature usually have been based on clinical experience and observation; little empirical research on adolescents with anorexia nervosa or bulimia nervosa has been conducted (Attie et al., 1990).

In one of the few empirical personality studies conducted with a sample of adolescent anorexics, Strober (1981) compared three groups of female adolescents, each having received a different psychiatric diagnosis: anorexia nervosa, affective disorder (depression or anxiety), or conduct disorder. On an objective personality measure, Strober found that the females with anorexia nervosa were more self-regulating and less demonstrative of their emotional behavior, more socially conscientious and conforming, and more inhibited interpersonally when compared with the other groups of females (see Strober, 1980, for similar results). These findings suggest that personality features of adolescents and adults with anorexia nervosa may be similar.

The implication of personality factors in the etiology and maintenance of eating disorders (Johnson & Wonderlich, 1992; Vitousek & Manke, 1994) indicates the need for research using objective measures of personality among adolescents diagnosed with these disorders. One such measure is the Millon Adolescent Personality Inventory (MAPI; Millon, Green, & Meagher, 1982), the adolescent personality test most frequently used in clinical practice (Archer, Maruish, Imhof, & Pitrowski, 1991; Craig & Horowitz, 1990). The purpose of the present study was to explore MAPI response patterns among adolescents with either anorexia nervosa or bulimia nervosa (American Psychiatric Association, 1994). Further, differences between the two diagnostic groups with regard to MAPI scores were investigated. based on personality features demonstrated among adults with eating disorders (Johnson & Wonderlich, 1992; Vitousek & Manke, 1994), it was hypothesized that adolescents with anorexia nervosa would exhibit more inhibited, introversive personality traits, and would be more respectful and cooperative, when compared with peers with bulimia nervosa. Adolescents with bulimia nervosa were hypothesized to exhibit greater sociability, forcefulness, and affective sensitivity relative to adolescents with anorexia nervosa.

METHOD

Subjects

Research participants were 56 female adolescents, evaluated consecutively in the eating-disorders clinic at the University of Kansas School of Medicine-Wichita, who met diagnostic criteria (American Psychiatric Association, 1994) for either anorexia nervosa (restricting type, n = 21; binge/purge type, n = 5) or bulimia nervosa (purging type, n = 24; nonpurging type, n = 6). The patients ranged in age from 11 to 17 years (M = 14.63 years, SD = 1.37); the majority (75%) were between the ages of 14 and 16 years. All but two (3.6%) were white.

Measures

Personality features and expressed concerns. Participants completed the Millon Adolescent Personality Inventory (Millon et al., 1982), an instrument that has been well researched and widely used with adolescents in both inpatient and outpatient psychiatric settings (Cansler, 1986; Millon & Davis, 1993). It has 150 true-false items, constituting eight primary personality scales, eight scales indicative of the adolescent's expressed concerns, and four empirically derived scales indicative of behavioral correlates of the other scales (Millon et al., 1982). The psychometric properties of the MAPI generally are very good (Cansler, 1986; Millon & Davis, 1993).

The MAPI personality scales are: Introversive (Schizoid), Inhibited (Avoidant), Cooperative (Dependent), Sociable (Histrionic), Confident (Narcissistic), Forceful (Antisocial), Respectful (Compulsive), and Sensitive (Passive-Aggressive). The scales indicative of expressed concerns measure the extent to which respondents voice distress over particular areas of their lives (Self-Concept, Personal Esteem, Body Comfort, Sexual Acceptance, Peer Security, Social Tolerance, Family Rapport, and Academic Confidence). The behavioral correlates scales indicate the problems that may follow from the personality features and expressed concerns of the particular adolescent being considered; these empirically derived measures are: Impulse Control, Societal Conformity, Scholastic Achievement, and [School] Attendance Consistency.