Personality Traits in Eating Disorders

Eating disorders are complex mental health conditions shaped by a combination of biological, psychological, cultural, and social influences. While emotional distress and societal pressures are commonly discussed, emerging research highlights the significant role of personality traits and skill deficits in the development, maintenance, and treatment of these disorders. Understanding these underlying psychological factors is critical for developing personalized, skill-based interventions that support lasting change and resilience.

What are Personality Traits?

The American Psychological Association defines a personality trait as “a relatively stable, consistent, and enduring internal characteristic inferred from a pattern of behaviors, attitudes, feelings, and habits in the individual.” Psychologists use this framework to understand better, predict, and explain individual behavior, including behavior related to health conditions and mental illness ^[1].

One of the most widely accepted models for categorizing personality traits is the Five-Factor Theory of Personality (also known as the Big Five). This model provides a valuable lens for examining how personality may influence the development and progression of eating disorders ^[2]. The five core traits include:

• Neuroticism: Characterized by emotional instability, irrational perfectionism, pessimism, and low self-esteem.
• Extraversion: Associated with sociability, interpersonal connection, and a preference for social engagement.
• Openness: Reflects curiosity, creativity, and a willingness to explore new experiences or ideas.
• Agreeableness: Marked by cooperation, trust, empathy, and a tendency toward forgiveness.
• Conscientiousness: Involves self-discipline, organization, and the pursuit of purposeful, goal-directed behavior.

By examining these traits, clinicians and researchers can gain deeper insight into how individual personality profiles may contribute to eating disorder risk, manifestation, and treatment response.

Personality Traits Linked to Eating Disorders

Research consistently shows that certain personality traits are closely associated with the development, maintenance, and severity of eating disorders. These traits shape how individuals regulate emotions, cope with stress, and engage with their social and physical environments.

Recognizing the role of personality can offer critical insight into why eating disorders develop in some individuals and persist over time. This understanding also helps inform more personalized and effective treatment approaches, allowing clinicians to tailor interventions based on a person’s unique psychological profile.

Emotional Regulation Difficulties

Emotion regulation refers to an individual’s ability to manage and respond to emotional experiences healthily and adaptively. People use a range of conscious and unconscious strategies to navigate intense emotions. When emotion regulation is impaired, individuals may resort to harmful behaviors to cope with distress.

Research consistently shows that individuals with eating disorders are more likely to experience difficulties in emotion regulation. Many struggle to identify, express, or manage negative emotions, often resorting to disordered behaviors as a means of emotional escape. For example, someone with bulimia nervosa may engage in binge eating to temporarily suppress feelings of anxiety, followed by purging and intense self-criticism ^[3].

While emotional dysregulation is a common feature among those with eating disorders, it is not the sole cause. Eating disorders are complex, multifactorial conditions influenced by a combination of biological, psychological, social, and cultural factors. Emotional regulation is just one crucial piece of a much broader puzzle.

Low Self-Esteem and Body Image Disturbance

From magazine covers to social media feeds, individuals are frequently exposed to unrealistic body standards that can negatively influence self-perception. While some may view these pressures as merely frustrating, others may internalize them, leading to ongoing struggles with self-worth and body image.

Distorted body image is a common feature in many eating disorders, particularly anorexia nervosa and bulimia nervosa, where individuals feel an overwhelming need to change their appearance, often at the expense of their health. This dissatisfaction can significantly impact physical and mental well-being and lower overall self-esteem ^[4].

Some individuals are more susceptible to these cultural and societal pressures. Research shows that those who score higher in neuroticism are more likely to experience low self-esteem and are at increased risk for developing eating disorders such as anorexia or bulimia ^[5].

Furthermore, studies have found a strong link between binge eating behaviors, body image dissatisfaction, and low self-esteem. Researchers suggest that disordered eating may serve as a coping mechanism, offering a temporary sense of control or self-worth in areas of life where these qualities may otherwise feel absent ^[6].

Perfectionism

Perfectionism can serve as both a motivator and a burden. While striving for excellence can be beneficial, for many individuals with eating disorders, the relentless pursuit of perfection, whether in academics, physical appearance, or self-control, can become psychologically damaging. Research shows that individuals with eating disorders frequently display perfectionistic tendencies, often chasing unrealistic standards or experiencing intense fear of failure, which leads to cycles of self-criticism and emotional distress ^[7].

Perfectionism is especially pronounced among individuals with anorexia nervosa. Studies have identified signs of perfectionistic behavior emerging in early childhood among those later diagnosed with anorexia. The persistent drive to achieve an unattainable body ideal may contribute directly to restrictive and harmful eating patterns. Moreover, higher levels of perfectionism are associated with longer illness duration and greater resistance to treatment, highlighting the need to address this trait as part of comprehensive care ^[8].

Obsessive-Compulsive Traits

Closely linked to perfectionism, obsessive-compulsive tendencies further reinforce rigid behaviors that sustain eating disorders ^[9]. For some people with eating disorders, food rituals and rigid behaviors aren’t just habits; they feel like necessities. 

Many individuals with anorexia, for example, experience obsessive-compulsive tendencies, whether it’s cutting food into exact portions, eating at specific times, or feeling an overwhelming need for symmetry on their plate. These behaviors can provide a temporary sense of control, but they also reinforce the eating disorder’s grip over their life ^[10]. 

Obsessive-Compulsive Personality Disorder (OCPD)

A separate pervasive condition, obsessive-compulsive personality disorder (OCPD), describes a broader set of personality traits influencing an individual’s general actions and behaviors. These traits include ^[11]: 

• A preoccupation with orderliness
• Perfectionism
• Control at the expense of flexibility, openness, and efficiency
• Reduced importance of the impact of these actions on others

Not all individuals with OCD will have OCPD. Equally, people with some obsessive-compulsive personality traits may not necessarily be diagnosed with OCPD ^[11]. However, studies have noted that many individuals with anorexia have concerns with symmetry, ordering, and arranging, shared by people with OCPD ^[12]. Additionally, close to 1 in 5 people with an eating disorder will also suffer from OCD at some point in their lives. This can largely be explained by the overlap of perfectionism and control personality traits in both conditions ^[13]. 

Neuroticism

Neuroticism is a personality trait characterized by heightened emotional sensitivity and a tendency to experience negative emotions more intensely and frequently. Individuals high in neuroticism often struggle with emotional regulation and may be more vulnerable to psychological distress. This trait is associated with several challenging emotional and behavioral responses, including:

• Increased anger and irritability
• Heightened anxiety and self-consciousness
• Emotional instability and mood swings
• Poor coping with everyday stressors
• Feelings of hopelessness in response to minor setbacks

Research consistently shows elevated levels of neuroticism among individuals with anorexia nervosa and bulimia nervosa ^[11]. For many, disordered eating behaviors may serve as maladaptive coping mechanisms in response to stress, internal conflict, or emotional overwhelm, which are everyday experiences for those with high neuroticism.

Understanding the connection between neuroticism and eating disorders is crucial for informing treatment approaches. It allows clinicians to tailor therapies and coping strategies that help individuals develop healthier ways of managing emotions and responding to stress. This insight should be viewed as a compassionate tool for healing, not a judgment or label.

Social Skills Deficits

Social functioning describes the ability of an individual to interact with people in their environment successfully. Social skill deficits arise when individuals struggle with the necessary skills needed to achieve this, like verbal and non-verbal communication.

A 2016 study identified social functioning concerns shared by young people with eating disorders who were interviewed. These include:

• Difficulty with group belonging
• Excessive awareness and self-monitoring of communication and behaviors
• Sensitivity to social judgment
• Limited social coping strategies

Many neurodevelopmental and mental health conditions have a social skill deficit component. Autism spectrum disorder is one condition commonly associated with social skill deficits. Indeed, people with autism are more likely to develop an eating disorder, and this may, in part, be due to the shared social skill deficits in these conditions. However, sensory difficulties related to food, obsessive behaviors, and a need for routine and control are also strongly implicated.

Cognitive Rigidity

Cognitive rigidity is a psychological concept that describes the tendency to persist in a behavior inappropriate to a current situation. This may be seen as a lack of flexibility or a concrete behavioral pattern.  

We can see this cognitive rigidity in eating disorders, where individuals persist in restrictive or purging behaviors despite the harmful effects of these actions. This pattern can also be seen in the unrealistic body image perceptions of individuals with anorexia. People with anorexia may be unable to accept their current body image, as rigid thinking leads to a continued perception that a greater level of thinness is still desirable and achievable.

Inflexibility and cognitive rigidity can also be seen in co-occurring conditions such as autism and OCD, increasing the overall risk of developing an eating disorder.

Impulsivity

Impulsivity involves more than simply acting without forethought; it often reflects an urgent, emotional reaction aimed at escaping psychological distress. For example, individuals with binge eating disorder may consume large amounts of food not due to hunger, but as a way to numb overwhelming emotions temporarily. This compulsion to quickly “fix” uncomfortable feelings, despite possible regret afterward, is a key way impulsivity contributes to the development and maintenance of eating disorders.

Although impulsivity has long been associated with bulimia nervosa, recent research suggests it also plays a significant role in restrictive-type anorexia, a condition historically characterized by control and rigidity. This evolving understanding highlights that individuals with anorexia may also engage in impulsive behaviors, particularly under emotional strain.

Impulsivity is also commonly linked to attention-deficit/hyperactivity disorder (ADHD). Notably, studies indicate that up to 1 in 5 young people with ADHD may develop an eating disorder, a prevalence similar to that seen in individuals with autism ^[13]. These overlapping traits underscore the importance of addressing impulsivity as part of comprehensive eating disorder assessment and treatment.

How Personality Affects Treatment Outcomes

In addition to influencing the development of eating disorders, personality traits also play a significant role in treatment outcomes and recovery. Research shows that individuals who score higher in extraversion, characterized by positive social relationships, high energy, and engagement, tend to have better recovery prospects. To a lesser extent, those with higher openness, a trait associated with curiosity and flexibility, also demonstrate more favorable treatment outcomes.

Awareness of personality traits can help clinicians develop individualized, targeted treatment plans that align with a person’s psychological profile. Several important considerations include:

• Emotion regulation: Therapeutic approaches like cognitive behavioral therapy (CBT) can help individuals identify and respond to difficult emotions in healthier ways, reducing reliance on disordered eating behaviors.
• Perfectionism: Therapists can guide clients in redirecting perfectionist tendencies toward realistic, constructive goals, rather than rigid or unattainable standards tied to weight or control.
• Obsessive-Compulsive traits and impulsivity: Recognizing the underlying psychological drivers of eating disorders ensures treatment does not unintentionally worsen symptoms such as bingeing or purging, which may serve as coping mechanisms.
• Social skill deficits: Group therapy and structured support programs can address feelings of isolation and help individuals build confidence in social interactions.
• Co-Occurring conditions: Certain personality traits may signal the presence of co-occurring disorders such as ADHD, anxiety, or autism spectrum conditions. Proper diagnosis and integrated treatment can significantly improve long-term outcomes.

Understanding how personality traits intersect with eating disorders not only enhances clinical insight but also empowers individuals on their journey toward recovery by honoring the complexity of their emotional and behavioral landscape.

A Path Forward 

Eating disorders cover a range of complex conditions influenced by a variety of personality traits, emotional regulation challenges, and skill deficits. Traits such as perfectionism, neuroticism, impulsivity, and obsessive-compulsive tendencies can significantly contribute to the onset and maintenance of these disorders.

Additionally, difficulties with social functioning, cognitive rigidity, and emotion regulation further exacerbate the struggle for individuals affected. Recognizing these patterns is crucial for understanding the root causes and tailoring treatment approaches to address specific personality-driven challenges effectively.

Professional help is essential in navigating the complexities of eating disorders. Individualized treatment plans considering personality traits can enhance recovery outcomes by promoting self-awareness, building resilience, and addressing co-occurring conditions. Seeking professional support increases the likelihood of recovery and provides individuals with the tools needed to rebuild their physical and emotional well-being.