Anorexia

REGULAR ARTICLE

Girls with Anorexia Nervosa as Young Adults: Personality,
Self-Esteem, and Life Satisfaction
Inger Halvorsen, MD1,2* Sonja Heyerdahl, PhD2
ABSTRACT Objective: The current study evaluated personality, self-esteem, and life satisfaction in former patients with different outcomes of childhood and adolescentonset anorexia nervosa (AN). Methods: Forty-four female patients with ANwere assessed 8.5 6 SD 3.4 years after treatment start with a clinical interview and questionnaires including the Temperament and Character Inventory (TCI) and the Rosenberg Self-Esteem Scale. Self-esteem and general life satisfaction in former patients were compared with women in a large population study. Results: Former AN patients with no eating disorder and normal eating attitudes atfollow-up (n ¼ 21 [48%]) had similar TCI profiles and self-esteem as samples from normal populations, whereas participants with poorer outcome had significantly lower TCI Self Directedness, self-esteem, and life satisfaction scores. Life satisfaction was reduced in all outcome groups and was strongly associated with self-esteem. Conclusion: Personality, self-esteem, and life satisfaction varied significantlybetween outcome groups. The results indicate that young patients with AN with a good outcome may have normal personality and self-esteem features in young adulthood. C V 2006 by Wiley Periodicals, Inc. Keywords: anorexia nervosa; eating disorders; self-esteem; personality; general life satisfaction

(Int J Eat Disord 2006; 39:285–293)

Introduction
Numerous empirical studies have confirmedthat anorexia nervosa (AN) is associated with certain personality factors such as neuroticism, obsessiveness, perfectionism, and negative self-evaluation.1–5 Young patients with AN have been described by their parents as ‘‘perfect children,’’ and factors such as perfectionism, high levels of achievement, compliance, and restraint of negative emotions seem to be common in children and adolescents whodevelop this disorder.6 The psychological features observed in patients with AN may represent stable personality traits related to increased vulnerability to developing eating problems in response to stress, particularly in relation to the developmental challenges of puberty. However, the physical and psychological impairment accompanying starva-

Accepted 6 September 2005 *Correspondence to:Inger Halvorsen, MD, Buskerud Hospital, 3004 Drammen, Norway. E-mail: inger.halvorsen@r-bup.no 1 Department of Child and Adolescent Psychiatry, Buskerud Hospital, Drammen, Norway 2 Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway Published online 7 March 2006 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/eat.20248 C V 2006 WileyPeriodicals, Inc.

tion and malnutrition may influence the responses of patients with AN to instruments aimed at assessing stable personality factors. Results obtained during the acute phase may therefore not be representative of the patient’s personality characteristics before the onset or after recovery from the illness.7 Studies using the Temperament and Character Inventory (TCI)8 are consistent infinding that patients with AN have a high level of Harm Avoidance (reflecting cautiousness and anxiousness), a high level of Persistence (reflecting industriousness and perfectionism), and a low level of Self Directedness (reflecting a low sense of autonomy, effectiveness, and psychological integration).9–11 However, there is a lack of research on the TCI profiles in participants with childhood andadolescent-onset AN and therefore uncertainty as to whether participants with onset before or during puberty are similar to participants with a later onset of AN. The prevalence of personality disorders (PDs) in individuals with AN is high, with variations between studies ranging from 22% to 87% (mean 50%).12 Also, studies of patients with childhood and adolescent-onset AN compared with controls have...