Author:

Keywords:

identity, eating disorders, ruminative exploration, identity disorder, psychosocial development

Abstract:

Identity formation represents a core developmental task during adolescence and emerging adulthood and has been proven important for general well-being and psychosocial functioning. Patients with an eating disorder (ED) seem to experience considerable difficulties constructing a personal identity and generally portray more identity confusion. Functional explanations for these difficulties have been well grounded in theoretical literature. Restrictive and binge eating have been described as ways to avoid identity distress and could act as (maladaptive) coping strategies to escape self-awareness. Impairments in overall identity formation have even been presented as the core of an eating disorder. However, limited research focusing on the specific mechanisms that characterize identity issues in ED patients exists. The present study makes use of a process-oriented identity model that comprises both adaptive (commitment making, identification with commitment, exploration in breadth, exploration in depth) and maladaptive (ruminative exploration) identity processes to gain a clearer understanding of which identity processes are most challenging for these patients. Using a 1:1 age-matched control group, the study aimed to (1) investigate how patients with ED navigate identity formation differently from individuals without this diagnosis and (2) how identity functioning is related to psychosocial functioning in the patient group. A total of 123 female in- and outpatients seeking treatment for EDs (Mage=28.49 years, SDage=9.91; range 11-57 years) and 123 female age-matched individuals drawn from a community sample participated in the study and completed self-report questionnaires. Paired samples t-tests indicated that ED patients scored significantly lower on the adaptive identity processes and higher on ruminative exploration. Hence, ED patients tend to repeatedly ask themselves the same identity questions, which obstructs them to adequately resolve identity issues. They experience greater problems in proactively exploring different identity alternatives and making self-endorsed commitments. When conducting cluster-analysis on the five identity processes, five identity statuses (or combinations of these processes) were identified. A multivariate analysis of variance indicated ED patients being overrepresented in the moratorium and diffusion identity statuses (both characterized by high scores on ruminative exploration). Furthermore, an identity disorder cluster, characterized by very low scores on all adaptive processes and very high scores on ruminative exploration, emerged for the first time. This identity status was made up solely of ED patients, seemed to capture particularly serious identity problems, and was related to the least adaptive psychosocial functioning (with the highest scores on depression, anxiety, borderline symptoms, non-suicidal self-injury and lowest scores on need satisfaction). Our findings corroborate the idea that eating disorders may arise as a mechanism to avoid issues in identity formation or to compensate for identity confusion. However, future research in non-clinical samples is needed to validate the relation between disturbed eating behaviour and identity functioning. Furthermore, this study lends support to theories proposing a dimensional approach to identity formation (cf. Kaufman, 2014), as adaptive, maladaptive, and even pathological identity functioning was presented among those with clinical problems.