Personality subtypes in eating disorders: validation of a classification in a naturalistic sample.

BACKGROUND Research has identified three personality subtypes in patients with eating disorders: emotionally dysregulated, constricted and high-functioning/perfectionistic. AIMS To see whether the subtypes are distinguished in ways indicative of valid classification, notably in patterns of adaptive functioning, comorbidity, treatment response and therapeutic interventions. METHOD A random sample of experienced clinicians provided data on 145 patients with bulimic symptoms, including data on eating disorder symptoms, DSM-IV comorbidity, personality pathology, treatment response and treatment interventions. RESULTS Patients categorised as dysregulated had the poorest functioning, most comorbidity and worst outcome, followed by patients in the constricted and high-functioning groups. The three subtypes elicited different therapeutic interventions and accounted for substantial incremental variance in outcome, holding constant the severity of eating disorder symptoms and presence of other Axis I disorders. CONCLUSIONS The data provide accumulating evidence for the validity of three personality subtypes in patients with eating disorders.