Mixture Modeling to Characterize Anorexia Nervosa: Integrating Personality and Eating Disorder Psychopathology

Abstract

<b>BACKGROUND:</b> Efforts to examine alternative classifications (e.g., personality) of anorexia nervosa (AN) using empirical techniques are crucial to elucidate diverse symptom presentations, personality traits, and psychiatric comorbidities. <b>AIMS:</b> The purpose of this study was to use an empirical approach (mixture modeling) to test an alternative classification of AN as categorical, dimensional, or hybrid categorical-dimensional construct based on the co-occurrence of personality psychopathology and eating disorder clinical presentation. <b>METHODS:</b> Patients with AN (<i>N</i> = 194) completed interviews and questionnaires at treatment admission and 3-month follow-up. Mixture modeling was used to test whether indicators best classified AN as categorical, dimensional, or hybrid. <b>RESULTS:</b> A four-latent class, one-latent dimension mixture model that was variant across groups provided the best fit to the data. Results suggest that all classes were characterized by low self-esteem and self-harming and suicidality tendencies. Individuals assigned to Latent Class 2 (LC2; <i>n</i> = 21) had a greater tendency toward being impulsive and easily angered and having difficulties controlling anger compared with those in LC1 (<i>n</i> = 84) and LC3 (<i>n</i> = 66). Moreover, individuals assigned to LC1 and LC3 were more likely to have a poor outcome from intensive treatment compared with those in LC4 (<i>n</i> = 21). Findings indicate that the dimensional aspect within each class measured frequency of specific eating disorder behaviors but did not predict treatment outcomes. <b>CONCLUSIONS:</b> These results emphasize the complexity of AN and the importance of considering how facets of clinical presentation beyond eating disorder behaviors may have different treatment and prognostic implications.