The interplay between personality disorders’ features, anger expression and disordered eating: A network analysis study

Introduction: Eating disorders (EDs) are systematically ranked amongst the most complex of all psychiatric illnesses to treat. Personality disorders (PDs) are common co-occurring conditions, and a growing literature points toward the central role of dysfunctional levels of anger in this clinical population. However, to date, no studies have conjointly explored these variables through a Network Analysis (NA). Then, this approach was applied to evaluate the relationships between personality disorders’ (PD) features (at Cluster A, B, and C level), the experience and the expression of anger, and both restrictive and bulimic ED-symptoms. Methods: A national sample of patients with a DSM-5-TR diagnosis of EDs (N = 232), who were admitted to a specialized residential treatment, were evaluated at intake with the Shedler-Westen Assessment Procedure (SWAP-200). In the same time point, patients were also asked to complete the State-Trait Anger Expression Inventory (STAXI), the Eating Attitude Test (EAT-40), and the Bulimic Investigatory Test, Edinburgh (BITE). Results: Findings showed that the STAXI Anger Expression Inwards and Anger Expression Control had high centrality, along with EAT Dieting Behavior. Anger Expression Inwards was connected to both Oral Control and Food Preoccupation. With respect to PDs, the SWAP-200 Cluster B emerged as a bridge symptom between BITE overall bulimic symptoms and STAXI Anger Reaction, and this variable also showed an high betweenness value. Discussion: These NA results highlight a complex interplay between anger and several dimensions of ED-pathology, while also suggesting the potential bridging role of Cluster B personality traits when considering bulimic symptoms. Research on individual differences in the field of EDs may help identify new relevant targets for tailored therapeutic interventions in this difficult-to-treat population.