Eating Disorders - Risk Factors

It should be noted that any of these personality traits can appear in either patients with bulimia or anorexia. Some experts believe that the patient's specific personality disorder, rather than whether they are anorexic or bulimic, may be the more important factor in determining treatment choice.

text continues below

Avoidant Personalities. Some studies indicate that as many as a third of anorexic restrictors have avoidant personalities. This personality disorder is characterized by:

Being a perfectionist
Being emotionally and sexually inhibited
Having less of a fantasy life than people with bulimia or those without an eating disorder
Not being rebellious, or being perceived as always being "good?
Being terrified of being ridiculed or criticized or of feeling humiliated

People with anorexia are extremely sensitive to failure, and any criticism, no matter how slight, reinforces their own belief that they are "no good.?

The person with both anorexia and an avoidant personality disorder may develop a behavioral and eating pattern as follows:

For such individuals, achieving perfection, with all that that involves, is the only way they believe they can obtain love.
Part of the drive for perfection and love is being trouble-free and attaining some ideal image of thinness. Eating is also associated with lower animal drives, so fasting has been linked historically to saintliness. The individual is driven to demand nothing, including food.
Failure is inevitable, since being loved has nothing to do with being perfect. (In fact, people who are always seeking perfection often alienate others around them.)
This failure to achieve love is followed by a sense of being even more imperfect (which is equivalent to being fat) and a renewed sense of striving for perfection (i.e., becoming even thinner).

In keeping with the avoidant personality, one expert described her anorexic patients as having a total lack of self, well beyond having low self-esteem. In support of this, a 2002 study reported that women with eating disorders were less likely to attend to their own needs and to care for themselves. In other words, they felt "self-less" and experienced guilt if they felt they were promoting their own self-interest.

The process of not eating may become an act of passive revenge on those whose love is always out of reach: "See? I am slowly disappearing, and you will be very sad when I am gone."

Obsessive-Compulsive Personality. Obsessive-compulsive personality defines certain character traits (e.g., being a perfectionist, morally rigid, or preoccupied with rules and order). This personality disorder has been strongly associated with a higher risk for anorexia. These traits should not be confused with the anxiety disorder called obsessive-compulsive disorder (OCD), although they may increase the risk for this disorder.