King's College London

Eating disorders, including anorexia nervosa and bulimia nervosa, are serious and potentially life-threatening mental illnesses that affect around 1.25 million people in the UK. Characterised by intense fears surrounding eating, weight and body shape, these disorders can cause a significant amount of psychological distress and often co-occur alongside other conditions such as anxiety and addiction. Anorexia alone has the highest death rate of any psychiatric disorder, but little is known about what causes it, meaning treatment options are limited and not always effective.

A new study from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, funded by the Medical Research Foundation, Medical Research Council and National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre (BRC), reveals further insight into the links between personality traits and the onset of eating disorder symptoms. These findings could help to design more personalised treatments.

The study, published in the Journal of Affective Disorders, uses a comprehensive approach to look at how combinations of different personality traits are linked with the co-development and co-occurrence of eating disorders, depression, anxiety and suicidal risk.

The researchers identified personality profiles that could indicate both the future risk and current diagnoses of eating disorders and several co-occurring conditions. They found that neuroticism – an individual's tendency to experience negative emotion – and impulsivity are two key personality traits that could serve as early risk factors for future anxiety and dieting behaviours.

According to the findings, interventions and therapies that focus on personality traits like neuroticism could be key to preventing the development of eating disorders among those at risk.

The team analysed data from three samples with overlapping measures of psychopathology (i.e. symptoms) and personality: a longitudinal adolescent sample involving repeated observations over ~10 years (IMAGEN), and clinical samples of young adults with eating disorders (ESTRA ), major depression or alcohol use disorder (STRATIFY).

Neuroticism was found to be a diagnostic marker for both anorexia and bulimia, while impulsivity had specific links to bulimia. As well as this, findings suggest that hopelessness is a key diagnostic marker of depression, anxiety and suicidal risk occurring alongside eating disorders, while extraversion was found to have potential protective factors linked with lower depressive risks in patients with bulimia.

The study could play a key role in informing the design of new eating disorder treatments that target specific personality traits.

Dr Zhang added "[Our findings] suggest that interventions targeting hopelessness and introversion may improve clinical outcomes. For people who are feeling hopeless, therapies can focus on challenging negative beliefs and thoughts, teaching coping skills to manage stress and setbacks, and setting achievable goals to foster a sense of hope and agency. For more introverted people, therapies can include strategies to improve social skills, increase assertiveness, and build confidence in social interactions."

By understanding the mechanisms and risk factors of eating disorders and co-occurring mental health conditions, we can get closer to developing more personalised intervention and prevention strategies – improving outcomes for both at-risk individuals and those already living with these devastating illnesses.

'Distinct personality profiles associated with disease risk and diagnostic status in eating disorders' was published in Journal of Affective Disorders. DOI: 10.1016/j.jad.2024.05.132.