Empirically derived personality subtyping for predicting clinical symptoms and treatment response in bulimia nervosa.
Evidence suggests that eating disorder subtypes reflecting under-controlled, over-controlled, and low psychopathology personality traits constitute reliable phenotypes that differentiate treatment response. This study is the first to use statistical analyses to identify these subtypes within treatment-seeking individuals with bulimia nervosa (BN) and to use these statistically derived clusters to predict clinical outcomes.



Using variables from the Dimensional Assessment of Personality Pathology-Basic Questionnaire, K-means cluster analyses identified under-controlled, over-controlled, and low psychopathology subtypes within BN patients (n = 80) enrolled in a treatment trial. Generalized linear models examined the impact of personality subtypes on Eating Disorder Examination global score, binge eating frequency, and purging frequency cross-sectionally at baseline and longitudinally at end of treatment (EOT) and follow-up. In the longitudinal models, secondary analyses were conducted to examine personality subtype as a potential moderator of response to Cognitive Behavioral Therapy-Enhanced (CBT-E) or Integrative Cognitive-Affective Therapy for BN (ICAT-BN).



There were no baseline clinical differences between groups. In the longitudinal models, personality subtype predicted binge eating (p = 0.03) and purging (p = 0.01) frequency at EOT and binge eating frequency at follow-up (p = 0.045). The over-controlled group demonstrated the best outcomes on these variables. In secondary analyses, there was a treatment by subtype interaction for purging at follow-up (p = 0.04), which indicated a superiority of CBT-E over ICAT-BN for reducing purging among the over-controlled group.



Empirically derived personality subtyping appears to be a valid classification system with potential to guide eating disorder treatment decisions. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:506-514).
Department of Psychiatry, University of Minnesota Medical Center, Minneapolis, Minnesota.
Ann F
AF
Haynos
Department of Psychiatry, University of Minnesota Medical Center, Minneapolis, Minnesota.
Carolyn M
CM
Pearson
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
Linsey M
LM
Utzinger
Neuropsychiatric Research Institute, Fargo, North Dakota.|Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota.
Stephen A
SA
Wonderlich
Neuropsychiatric Research Institute, Fargo, North Dakota.|Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota.
Ross D
RD
Crosby
Neuropsychiatric Research Institute, Fargo, North Dakota.|Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota.
James E
JE
Mitchell
Department of Psychiatry, University of Minnesota Medical Center, Minneapolis, Minnesota.|The Emily Program, Minneapolis, Minnesota.
Scott J
SJ
Crow
Department of Psychiatry, University of Minnesota Medical Center, Minneapolis, Minnesota.|The Emily Program, Minneapolis, Minnesota.
Carol B
CB
Peterson
D000328:Adult; D052018:Bulimia Nervosa / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D010551:Personality / Q000502:physiology*; D011795:Surveys and Questionnaires
affect regulation; bulimia nervosa; classification; personality; treatment