Mediation models of anxiety and depression between temperament and drive for thinness and body dissatisfaction in anorexia nervosa

Abstract

Purpose Anorexia nervosa (AN) is a life-threatening condition in which temperament, anxiety, depression, and core AN body-related psychopathology (drive for thinness, DT, and body dissatisfaction, BD) are intertwined. This relationship has not been to date disentangled; therefore, we performed a multiple mediation analysis aiming to quantify the effect of each component. Methods An innovative multiple mediation statistical method has been applied to data from 184 inpatients with AN completing: Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire, Eating Disorders Inventory-2, State-Trait Anxiety Inventory, and Beck Depression Inventory. Results All affective temperaments but the hyperthymic one were involved in the relationship with DT and BD. Only the anxious temperament had a significant unmediated direct effect on DT after the strictest correction for multiple comparisons, while the depressive temperament had a significant direct effect on DT at a less strict significance level. State anxiety was the strongest mediator of the link between affective temperament and core AN body-related psychopathology. Depression showed intermediate results while trait anxiety was not a significant mediator at all. Conclusion Affective temperaments had a relevant impact on body-related core components of AN; however, a clear direct effect could be identified only for the anxious and depressive temperaments. Also, state anxiety was the strongest mediator thus entailing interesting implications in clinical practice. Level of evidence V, cross-sectional study.

Perfectionism in anorexia nervosa: Associations with clinical picture and personality traits

“…As we highlighted, perfectionism has displayed a direct correlation with the drive for thinness and the anxious temperament. This evidence is further intriguing as in previous studies, the anxious temperament has been shown to have a significant unmediated effect on the drive for thinness and body dissatisfaction (Jérolon et al, 2022) and on the eating psychopathology and BMI (Marzola et al, 2017(Marzola et al, , 2020. Many possible explanations could be behind these data.…”

“…To the best of our knowledge, literature did not address this association. We found that the high‐perfectionism group displayed depressive, cyclothymic, irritable and anxious temperaments, which are the temperaments with the highest impact on eating‐related symptoms, especially regarding the anxious and depressive one (Jérolon et al, 2022; Marzola et al, 2020). The clarification of the relationship between perfectionism and affectivity could be relevant in the treatment of patients with AN.…”

“…Affective temperaments correlated with low body mass index (BMI) and severity of eating psychopathology but not with the duration of illness. Finally, a study (Jérolon et al, 2022) displayed that all affective temperaments, but the hyperthymic one, were involved in the relationship with the drive for thinness and body dissatisfaction in patients with AN. The strongest relationship concerned the anxious and the depressive temperaments.…”

Abnormal sense of agency in eating disorders

“…An individual who feels unable to initiate any kind of action, suffering from depressive symptoms, is very different from an individual who suffers from a high level of impulsivity. Therefore, subjective experience of the sense of agency combined with temperamental and symptomatic aspects may be both important contributors to the experiential aspects of the body image disturbance in EDs 55 . In terms of states that can be related to EDs, we measured in the present study depression, anxiety, dissociation, non-suicidal self-injurious behaviours, while in terms of traits, we analysed impulsivity, emotion dysregulation, identity representation, and history of traumatic experiences.…”