Eating Disorders and Obesity: A Comprehensive Handbook

By Christopher G. Fairburn; Kelly D. Brownell | Go to book overview

36
Personality and Eating Disorders

STEPHEN A. WONDERLICH

Clinicians, theorists, and researchers have a long-standing interest in the relationship between personality and eating disorders. While early clinical descriptions emphasized the predispositional risk of personality traits for eating disorders, more recent conceptualization and research have examined how eating disorders may modify personality traits, whether certain mechanisms increase the risk of both eating disorders and certain personality characteristics, as well as the effect of personality on clinical presentation, course, and treatment of anorexia nervosa and bulimia nervosa. However, this literature continues to be plagued by conceptual and methodological problems, and debates about the nature and measurement of personality.


CONCEPTUAL AND METHODOLOGICAL DEBATE

The categorical approach to understanding personality, represented by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD), has come under increasing attack as a model of personality disturbance. The main criticisms include: (1) Most empirical data suggest that personality traits and disorders are continuously distributed as dimensions rather than bimodal categories; (2) cutoff points for “diagnoses” are arbitrary; (3) inadequate agreement between different personality measures (i.e., poor convergent validity); (4) poor discriminant validity between categories, resulting in marked comorbidity; (5) personality disorder categories typically do not show stability over time; and (6) extreme heterogeneity within polythetic diagnostic concepts (e.g., the 93 possible expressions of borderline personality disorder in DSM-III-R).

Although the debate continues, there is an increasing call for different approaches to the conceptualization and measurement of personality and its disorders. The most common recommendation is to move to a dimensional trait perspective. This offers numerous advantages: (1) The dimensional model is more consistent with empirical evidence sug-

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