Characteristics of self‐regulation in adolescent patients with anorexia nervosa

Abstract

The purpose of the study was to investigate the different modes of self-regulation in adolescent anorexia nervosa (AN). A self-system questionnaire, the Narcissism Inventory, was given to 61 adolescent females with AN and 61 controls. Patients with AN reported higher overall disturbances in self-regulation than controls. In particular, a highly unstable self-system, a tendency to use idealization as modus of regulation, and high narcissistic gain from their illness was found in the patient group; however, the patients did not report a 'classic narcissistic self'. Furthermore, we were able to differentiate between two clusters of patients, one with high (n = 34) and one with low (n = 27) disturbance in self-regulation; the latter reported a shorter duration of illness and lower oral control but did not differ on any other clinical variables. Stronger relationships were found between the dimension 'endangered self' and the overall scores of the Eating Attitudes Test (EAT) and the Eating Disorder Inventory (EDI) as well as two subscales of the EAT and five of the EDI. Our study in anorexic adolescents demonstrated that the self-system is experienced as highly unstable, that idealization is used as mode of regulation, and that the dimension of the 'classic narcissistic self' is less important in this patient group. It is important to evaluate the system of self-regulation for planning treatment in the individual patient according to their needs.

Emotion generation and regulation in anorexia nervosa: A systematic review and meta-analysis of self-report data

“…This corroborates individual studies which report that people with EDs are more aware than HCs of social presentation and comparison (public self-consciousness) and reflect more in private on how they compare with others (private self-consciousness; Cardi et al, 2014;Forbush & Watson, 2006;Ille et al, 2014). People with AN judge themselves by high external standards which they feel that they do not successfully attain (Gunnard et al, 2012;Karwautz et al, 2001aKarwautz et al, ,2001b. This predicts body dissatisfaction and drive for thinness (Buchholz et al, 2007).…”

“…Nine studies measured avoidance of emotion-provoking situations. All studies found greater reported avoidance by people with EDs relative to HCs, with meta-analysis of six studies supporting this conclusion within samples of people with AN [d = 1.00 (95% CI: 0.56, 1.45), p b 0.000] (Holliday, Tchanturia, Landau, Collier, & Treasure, 2005;Karwautz et al, 2001aKarwautz et al, , 2001b; see Appendix A for metaanalyses references). Experiential avoidance is associated with ED and AN symptomatology (Corstorphine, Mountford, Tomlinson, Waller, & Meyer, 2007;Lampard, Byrne, McLean, & Fursland, 2011;Rawal, Park & Williams, 2010;Raykos, Byrne, & Watson, 2009).…”

“…Perhaps because of such factors, there can be discrepancy in the fit between environment and the individual, and people with AN experience their social environments as invalidating or demanding (Haynos & Fruzzetti, 2011;Karwautz et al, 2001aKarwautz et al, ,2001bMountford et al, 2007). They have underdeveloped social cognitive abilities, including poor emotion recognition and difficulty developing 'theory of mind' , which may further contribute to the experience of others as invalidating.…”

Pre‐morbid psychiatric morbidity, comorbidity and personality in patients with anorexia nervosa compared to their healthy sisters

“…Comparison with previous work on temperament, character, and personality traits It was Strober (1991) who first integrated the organismic approach to temperament by Cloninger into a model of aetiology for AN focusing on self-development (Karwautz et al, 2001b). In terms of these dimensions of personality (temperament and character) the women with AN differed markedly from their sisters, scoring lower in novelty seeking, self-directedness, and cooperativeness, and higher in harm avoidance, persistence, and self-transcendence and higher in all the dimensions of the EDI-2.…”

What is the relationship between facets of narcissism and women's body image?

“…Early studies reported that higher narcissism was associated with more positive body image (Jackson, Ervin, & Hodge, 1992) and lower incidence of disordered eating in women (e.g., Karwautz et al, 2001;Steinberg & Shaw, 1997), although relationships among men have been more equivocal (Brown & Graham, 2008;Davis, Karvinen, & McCreary, 2005). A limitation of these studies, however, is in their treatment of narcissism as a homogeneous concept.…”