The eating disorders iceberg: Emotional deregulation and impulsivity lay below

Abstract

Introduction

Eating disorders (ED) and personality disorders (PD) are often interplayed in every-day clinical practice. Less is known on patient's emotional deregulation and impulsivity.

Aims

To investigate whether clinical features of ED and PD correspond to a specific impulsivity and emotional background pattern.

Objective

ED, PD, impulsivity and emotional regulation.

Methods

A group of outpatients with ED (n = 39) was compared to a group of healthy controls (n = 40) by means of semi-structured interviews and standardized questionnaires (BIS-11, DERS, Eat-26, SCID-II and STAI), in order to evaluate association between clinical features (ED and PD) and altered impulsivity or/and emotion regulation.

Results

Seventy-five percent of ED cases matched also diagnostic criteria for PD. Cluster B diagnoses occurred more frequently in Bulimia Nervosa (BN) and Binge eating disorders (BED) whereas Cluster C PD was strongly associated with restrictive anorexia (AN-R) (P < 0.001). BIS-11 scores were significantly higher in cluster B as compared to cluster C PD (P = 0.019). People with PD have a significantly higher DERS score compared to people without (P < 0.001). Mean DERS scores were similar in BN, BED and AN Binge purging (AN-BP) but lower in AN-R (P < 0.001).

Conclusions

ED is an iceberg top, of a three-step ladder. The intermediate step is built of personality traits and disorders forging the variety of ED clinical expressions. The hidden base of iceberg is represented by both the emotional (de)regulation and the level of impulsivity. Therapies focused on the base of this iceberg are needed for a clinical resolution of eating symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.