Characteristics of self-regulation in adolescent patients with anorexia nervosa.

The purpose of the study was to investigate the different modes of self-regulation in adolescent anorexia nervosa (AN). A self-system questionnaire, the Narcissism Inventory, was given to 61 adolescent females with AN and 61 controls. Patients with AN reported higher overall disturbances in self-regulation than controls. In particular, a highly unstable self-system, a tendency to use idealization as modus of regulation, and high narcissistic gain from their illness was found in the patient group; however, the patients did not report a 'classic narcissistic self'. Furthermore, we were able to differentiate between two clusters of patients, one with high (n = 34) and one with low (n = 27) disturbance in self-regulation; the latter reported a shorter duration of illness and lower oral control but did not differ on any other clinical variables. Stronger relationships were found between the dimension 'endangered self' and the overall scores of the Eating Attitudes Test (EAT) and the Eating Disorder Inventory (EDI) as well as two subscales of the EAT and five of the EDI. Our study in anorexic adolescents demonstrated that the self-system is experienced as highly unstable, that idealization is used as mode of regulation, and that the dimension of the 'classic narcissistic self' is less important in this patient group. It is important to evaluate the system of self-regulation for planning treatment in the individual patient according to their needs.