Emotional instability as a trait risk factor for eating disorder behaviors in adolescents: Sex differences in a large-scale prospective study

Abstract

Background Temperament and personality traits, including negative emotionality/neuroticism, may represent risk factors for eating disorders. Further, risk factors may differ by sex. We examined longitudinal temperament/personality pathways of risk for purging and binge eating in youth stratified by sex using data from a large-scale prospective study. Methods Temperament, borderline personality features, sensation seeking, ‘big five’ personality factors, and depressive symptoms were measured at five time points from early childhood to adolescence in 5812 adolescents (3215 females; 2597 males) in the Avon Longitudinal Study of Parents and Children. We conducted univariate analyses with these predictors of binge eating and purging at 14 and 16 years for total and sex-stratified samples. We used structural equation modeling (SEM) to fit data to a path analysis model of hypothesized associations. Results Of the total sample, 12.54% engaged in binge eating and 7.05% in purging by 16 years. Prevalence was much greater and increased dramatically for females from 14 years (7.50% binge eating; 2.40% purging) to 16 years (15.80% binge eating; 9.50% purging). For both sexes, borderline personality, depressive symptoms and lower emotional stability predicted eating disorder behaviors; sensation seeking and conscientiousness were also significant predictors for females. SEM identified an ‘emotional instability’ pathway for females from early childhood into adolescence (RMSEA = 0.025, TLI = 0.937 and CFI = 0.970). Conclusions Binge eating and purging are common in female and male adolescents. Early temperament/personality factors related to difficulty regulating emotions were predictive of later adolescent eating disorder behaviors. Results have important clinical implications for eating disorder prevention and intervention.

Temperament in preadolescence is associated with weight and eating pathology in young adulthood

“…In accordance with previous studies (Atiye et al, ; Brown et al, ; Martin et al, ; Sutin et al, ), we found an association of higher negative affectivity in early adolescence and the later development of eating pathology. Despite the low number of formal eating disorder diagnoses in our study, the associations were generally robust.…”

“…In comparison with the number of reports on temperament and weight problems, the literature on prospective studies of temperament and eating disorders (EDs) is scarce (Atiye et al, ; Brown, Hochman, & Micali, ; Stice, South, & Shaw, ). Higher negative affectivity was found to be associated with all EDs (anorexia nervosa [AN], bulimia nervosa [BN], binge‐eating disorder [BED], and eating disorders not otherwise specified [EDNOS]) in a 2015 meta‐analysis of cross‐sectional studies (Atiye et al, ).…”

“…Higher negative affectivity was found to be associated with all EDs (anorexia nervosa [AN], bulimia nervosa [BN], binge‐eating disorder [BED], and eating disorders not otherwise specified [EDNOS]) in a 2015 meta‐analysis of cross‐sectional studies (Atiye et al, ). Negative affectivity also predicted ED symptoms in longitudinal studies (age range 3–16 years), but it should be noted that these studies did not cover the whole age range of adolescence, did not evaluate ED diagnoses, and did not correct for initial symptoms (Brown et al, ; Martin et al, ; Sutin et al, ). This requires further research.…”

“…Currently, few large longitudinal studies have investigated whether preadolescent temperamental characteristics predict weight gain and/or disordered eating in later life (Atiye et al, ; Brown et al, ; Stice et al, ; Sutin et al, ). To extent the current knowledge base, we investigated the role of temperament in weight and eating pathology in a prospective population‐based cohort study covering preadolescence through young adulthood.…”

Anxiety disorder symptoms at age 10 predict eating disorder symptoms and diagnoses in adolescence

“…Physical symptoms such as restlessness, fatigue, tension, and irritability might either be diffuse, behavioral indicators of psychopathology, specific physical symptoms of anxiety, or, in some cases, might index parental misinterpretation of symptoms. Mechanisms behind this pattern of risk are unclear; it is possible that such symptoms represent early signs of difficulties with emotion regulation (Brown, Hochman, & Micali, ; Castellanos‐Ryan et al., ) or it may be that physical symptoms are more easily observable to parents and thus, more likely to be reported. There was some support for this interpretation in the current sample.…”