Personality pathology and substance abuse in eating disorders: a longitudinal study.

OBJECTIVE: Substance abuse has been shown to predict poor outcome in eating disorder (ED) samples, and prior cross-sectional data on personality subtypes of EDs suggest that substance abuse is associated with dysregulated and possibly avoidant-insecure subtypes. This study investigates longitudinal associations between personality and substance use.

METHOD: Personality pathology and substance use were assessed in 213 individuals with anorexia nervosa and bulimia nervosa at baseline; substance use was assessed at regular follow-up intervals over a 9-year period.

RESULTS: Of the five personality factors identified, the obsessional-sensitive and high-functioning types were negatively associated with substance abuse at baseline, while the behaviorally dysregulated type was positively associated with substance abuse at baseline. Longitudinal associations were observed, suggesting that obsessional-sensitive personality type was protective against the development of substance abuse. Longitudinal associations between the other personality types and substance abuse were nonsignificant after baseline substance abuse history was included as a covariate in the model.

CONCLUSION: Substance use demonstrates cross-sectional associations with personality style, but substance abuse history appears to be the most important predictor of future substance abuse in women with eating disorders.