Coping As a Mediator of the Associations Between Maladaptive Personality Traits and Binge Eating in a Nationally Representative U.S. Adolescent Sample

Background: Binge eating disorder (BED) is the most prevalent eating disorder among adolescents in the U.S. Maladaptive personality traits and coping styles have been independently identified as correlates of eating disorders. Neuroticism is most frequently studied and considered a risk factor for eating disorders. Patients with eating disorders show a pattern of increased emotion-focused coping, such as avoidance, and decreased problem-focused coping. Less is known about associations among personality traits, coping styles, and binge eating in the general adolescent population. Assessing these associations is an important step toward identifying potential mechanisms involved in the development and maintenance of binge eating, which may further inform targets for intervention efforts. This study examined personality−binge eating and personality−coping associations and assessed whether coping styles mediate the associations between personality and binge eating.

Methods: This study used data from the National Comorbidity Survey: Adolescent Supplement (NCS-A), a nationally representative, cross-sectional study of 10,123 U.S. adolescents aged 13 to 18 years. Complex survey weights were applied prior to analyses. Age, race, and adolescents’ years of education were controlled in all analyses. Adjusted prevalence ratios were calculated to assess the associations between 1) personality traits (neuroticism, impulsivity, and aggression) and binge eating [lifetime prevalence of BED (n=162), subthreshold binge eating disorder (SBED; n=275), and duration of binge eating(n=445)] and 2) personality traits and coping (poor problem solving, avoidance, and distraction). We used the MacArthur approach for our mediation analysis of personality−coping−binge eating associations.

Results: Neuroticism, impulsivity, and aggression were significantly associated with higher lifetime prevalence of BED and SBED. Only neuroticism was positively associated with longer duration of binge eating. Neuroticism, impulsivity, and aggression were positively associated with poor problem solving, avoidance, and distraction coping. Avoidance coping was a significant mediator of the association between each personality traits and lifetime prevalence of BED or SBED.

Discussion: We found that avoidance coping mediated associations between maladaptive personality traits and binge eating. Future longitudinal studies are needed to establish causality in personality−coping−binge eating associations. Our findings, however, suggest a potential pathway by which personality traits may increase risk for binge eating. Study results may help inform strategies for reducing or preventing binge eating.