Development and validation of the Premorbid Childhood Traits Questionnaire (PCT-Q) in eating disorders

  • Enrica MarzolaEmail author
  • Secondo Fassino
  • Giuseppe Migliaretti
  • Giovanni Abbate-Daga
  • Walter H. Kaye
Original Article
Part of the following topical collections:
  1. Personality and Eating and Weight disorders



Some features of eating disorders (EDs) are often present in childhood before the onset of the ED. We developed a novel questionnaire to retrospectively capture such childhood traits.


Focus groups were conducted at the University of California–San Diego, USA, and at the University of Turin, Italy. Three focus groups were conducted at each site, interviewing patients and parents to identify those traits that most commonly characterize childhood of patients with EDs. A preliminary version of the Premorbid Childhood Traits Questionnaire (PCT-Q) derived from these focus groups was then administered to 94 consecutive inpatients with an ED and to 286 healthy controls (HCs) at the Turin site. Also, 208 participants’ parents were enrolled as well; in fact, the PCT-Q was developed with both a proband and an informant version.


A 37-item final version of the PCT-Q was generated. Reliability analyses suggested acceptability for harm avoidance (HA), social phobia, alexithymia, interoceptive awareness (IA), and food obsessions. Inter-rater reliability ranged from fair to moderate. ED sufferers scored significantly higher than HCs on HA, social phobia, alexithymia, IA, and food obsessions.


These findings support the possibility that premorbid traits contribute to a risk to develop an ED in some individuals.

Level of evidence

III: case–control analytic study.


Anorexia nervosa Premorbid trait Childhood Harm avoidance Interoceptive awareness 



This is unfunded research.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

40519_2019_748_MOESM1_ESM.docx (63 kb)
Supplementary material 1 (DOCX 62 kb)


  1. 1.
    Klump KL, Strober M, Bulik CM, Thornton L, Johnson C, Devlin B et al (2004) Personality characteristics of women before and after recovery from an eating disorder. Psychol Med 34(8):1407–1418CrossRefPubMedGoogle Scholar
  2. 2.
    Carrot B, Radon L, Hubert T, Vibert S, Duclos J, Curt F, Godart N (2017) Are lifetime affective disorders predictive of long-term outcome in severe adolescent anorexia nervosa? Eur Child Adolesc Psychiatry 26:969–978. CrossRefPubMedGoogle Scholar
  3. 3.
    Anderluh MB, Tchanturia K, Rabe-Hesketh S, Treasure J (2003) Childhood obsessive-compulsive personality traits in adult women with eating disorders: defining a broader eating disorder phenotype. Am J Psychiatry 160(2):242–247. CrossRefPubMedGoogle Scholar
  4. 4.
    Jacobi C, Hayward C, de Zwaan M, Kraemer HC, Agras WS (2004) Coming to terms with risk factors for eating disorders: application of risk terminology and suggestions for a general taxonomy. Psychol Bull 130(1):19–65. CrossRefPubMedGoogle Scholar
  5. 5.
    Himmerich H, Bentley J, Kan C, Treasure J (2019) Genetic risk factors for eating disorders: an update and insights into pathophysiology. Ther Adv Psychopharmacol 9:2045125318814734. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Marzola E, Fassino S, Amianto F, Abbate-Daga G (2017) Affective temperaments in anorexia nervosa: the relevance of depressive and anxious traits. J Affect Disord 218:23–29. CrossRefPubMedGoogle Scholar
  7. 7.
    Fassino S, Abbate-Daga G, Amianto F, Leombruni P, Boggio S, Rovera GG (2002) Temperament and character profile of eating disorders: a controlled study with the Temperament and Character Inventory. Int J Eat Disord 32(4):412–425. CrossRefPubMedGoogle Scholar
  8. 8.
    Lilenfeld LR (2011) Personality and temperament. Curr Top Behav Neurosci 6:3–16. CrossRefPubMedGoogle Scholar
  9. 9.
    Thornton LM, Trace SE, Brownley KA, Ålgars M, Mazzeo SE, Bergin JE, Maxwell M, Lichtenstein P, Pedersen NL, Bulik CM (2017) A comparison of personality, life events, comorbidity, and health in monozygotic twins discordant for anorexia nervosa. Twin Res Hum Genet 20:310–318. CrossRefPubMedGoogle Scholar
  10. 10.
    Stanfield AC, McKechanie AG, Lawrie SM, Johnstone EC (2019) Owens D.G.C.: predictors of psychotic symptoms among young people with special educational needs. Br J Psychiatry 5:1–6. CrossRefGoogle Scholar
  11. 11.
    Culbert KM, Racine SE, Klump KL (2015) Research review: what we have learned about the causes of eating disorders—a synthesis of sociocultural, psychological, and biological research. J Child Psychol Psychiatry 56(11):1141–1164. CrossRefPubMedGoogle Scholar
  12. 12.
    Boone L, Soenens B, Luyten P (2014) When or why does perfectionism translate into eating disorder pathology? A longitudinal examination of the moderating and mediating role of body dissatisfaction. J Abnorm Psychol 123(2):412–418. CrossRefPubMedGoogle Scholar
  13. 13.
    Cloninger CR, Svrakic DM, Przybeck TR (1993) A psychobiological model of temperament and character. Arch Gen Psychiatry 50(12):975–990CrossRefPubMedGoogle Scholar
  14. 14.
    Atiye M, Miettunen J, Raevuori-Helkamaa A (2015) A meta-analysis of temperament in eating disorders. Eur Eat Disord Rev 23:89–99. CrossRefPubMedGoogle Scholar
  15. 15.
    Lilenfeld L, Wonderlich S, Riso L, Crosby R, Mitchell J (2006) Eating disorders and personality: a methodological and empirical review. Clin Psychol Rev 26(3):299–320CrossRefPubMedGoogle Scholar
  16. 16.
    Duffy ME, Rogers ML, Joiner TE, Bergen AW, Berrettini W, Bulik CM, Brandt H, Crawford S, Crow S, Fichter M, Halmi K, Kaplan AS, Klump KL, Lilenfeld L, Magistretti PJ, Mitchell J, Schork NJ, Strober M, Thornton LM, Treasure J, Woodside B, Kaye WH, Keel PK (2019) An investigation of indirect effects of personality features on anorexia nervosa severity through interoceptive dysfunction in individuals with lifetime anorexia nervosa diagnoses. Int J Eat Disord 52:200–205. CrossRefPubMedGoogle Scholar
  17. 17.
    Harrison A, O’Brien N, Lopez C, Treasure J (2010) Sensitivity to reward and punishment in eating disorders. Psychiatry Res 177(1–2):1–11. CrossRefPubMedGoogle Scholar
  18. 18.
    Jappe LM, Frank GK, Shott ME, Rollin MD, Pryor T, Hagman JO et al (2011) Heightened sensitivity to reward and punishment in anorexia nervosa. Int J Eat Disord 44(4):317–324. CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Bischoff-Grethe A, McCurdy D, Grenesko-Stevens E, Irvine LE, Wagner A, Yau WY, Fennema-Notestine C, Wierenga CE, Fudge JL, Delgado MR, Kaye WH (2013) Altered brain response to reward and punishment in adolescents with Anorexia nervosa. Psychiatry Res 214:331–340. CrossRefPubMedGoogle Scholar
  20. 20.
    Fassino S, Pierò A, Gramaglia C, Abbate-Daga G (2004) Clinical, psychopathological and personality correlates of interoceptive awareness in anorexia nervosa, bulimia nervosa and obesity. Psychopathology 37(4):168–174. CrossRefPubMedGoogle Scholar
  21. 21.
    Wierenga CE, Ely A, Bischoff-Grethe A, Bailer UF, Simmons AN, Kaye WH (2014) Are extremes of consumption in eating disorders related to an altered balance between reward and inhibition? Front Behav Neurosci 8:410. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Bailer UF, Price JC, Meltzer CC, Wagner A, Mathis CA, Gamst A et al (2017) Dopaminergic activity and altered reward modulation in anorexia nervosa-insight from multimodal imaging. Int J Eat Disord 50(5):593–596. CrossRefPubMedGoogle Scholar
  23. 23.
    Asaad Abdou T, Esawy HI, Abdel Razek Mohamed G, Hussein Ahmed H, Elhabiby MM, Khalil SA, El-Hawary YA (2018) Sleep profile in anorexia and bulimia nervosa female patients. Sleep Med 48:113–116. CrossRefGoogle Scholar
  24. 24.
    Smink FR, van Hoeken D, Hoek HW (2012) Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 14(4):406–414. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Southgate L, Tchanturia K, Collier D, Treasure J (2008) The development of the childhood retrospective perfectionism questionnaire (CHIRP) in an eating disorder sample. Eur Eat Disord Rev 16(6):451–462. CrossRefPubMedGoogle Scholar
  26. 26.
    American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders: DSM-5, 5th edn. American Psychiatric Association, ArlingtonCrossRefGoogle Scholar
  27. 27.
    First MB, Williams JB, Karg RS, Spitzer RL (2015) SCID-5-CV: structured clinical interview for DSM-5 disorders; clinician version. American Psychiatric Association Publishing, ArlingtonGoogle Scholar
  28. 28.
    Frost RO, Marten P, Lahart C, Rosenblate R (1990) The dimensions of perfectionism. Cogn Ther Res 14:449CrossRefGoogle Scholar
  29. 29.
    Garner DM (1991) Eating Disorder Inventory-2. Professional manual. Psychological Assessment Resources Inc, OdessaGoogle Scholar
  30. 30.
    Thiel A, Paul T (2006) Test–retest reliability of the Eating Disorder Inventory 2. J Psychosom Res 61(4):567–569CrossRefPubMedGoogle Scholar
  31. 31.
    Nunnally JC, Bernstein IH (1994) Psychometric theory, 3rd edn. Mc Graw Hill, New YorkGoogle Scholar
  32. 32.
    Cho E, Kim S (2015) Cronbach’s coefficient alpha: well known but poorly understood. Organ Res Methods 8(2):207–230CrossRefGoogle Scholar
  33. 33.
    Cortina JM (1993) What is coefficient alpha? An examination of theory and applications. J Appl Psychol 78(1):98–104CrossRefGoogle Scholar
  34. 34.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174CrossRefGoogle Scholar
  35. 35.
    Kaye WH, Bulik CM, Thornton L, Barbarich N, Masters K (2004) Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry 161(12):2215–2221. CrossRefPubMedGoogle Scholar
  36. 36.
    Abbate-Daga G, Quaranta M, Marzola E, Amianto F, Fassino S (2015) The relationship between alexithymia and intolerance of uncertainty in anorexia nervosa. Psychopathology 48(3):202–208. CrossRefPubMedGoogle Scholar
  37. 37.
    Kaye WH, Fudge JL, Paulus M (2009) New insights into symptoms and neurocircuit function of anorexia nervosa. Nat Rev Neurosci 10(8):573–584. CrossRefPubMedGoogle Scholar
  38. 38.
    Bailer UF, Frank GK, Price JC, Meltzer CC, Becker C, Mathis CA et al (2013) Interaction between serotonin transporter and dopamine D2/D3 receptor radioligand measures is associated with harm avoidant symptoms in anorexia and bulimia nervosa. Psychiatry Res 211(2):160–168. CrossRefPubMedGoogle Scholar
  39. 39.
    Swinbourne J, Hunt C, Abbott M, Russell J, St Clare T, Touyz S (2012) The comorbidity between eating disorders and anxiety disorders: prevalence in an eating disorder sample and anxiety disorder sample. Aust N Z J Psychiatry 46(2):118–131. CrossRefPubMedGoogle Scholar
  40. 40.
    Deep AL, Nagy LM, Weltzin TE, Rao R, Kaye WH (1995) Premorbid onset of psychopathology in long-term recovered anorexia nervosa. Int J Eat Disord 17(3):291–297PubMedGoogle Scholar
  41. 41.
    Salbach-Andrae H, Lenz K, Simmendinger N, Klinkowski N, Lehmkuhl U, Pfeiffer E (2008) Psychiatric comorbidities among female adolescents with anorexia nervosa. Child Psychiatry Hum Dev 39(3):261–272. CrossRefPubMedGoogle Scholar
  42. 42.
    Pollice C, Kaye WH, Greeno CG, Weltzin TE (1997) Relationship of depression, anxiety, and obsessionality to state of illness in anorexia nervosa. Int J Eat Disord 21(4):367–376CrossRefPubMedGoogle Scholar
  43. 43.
    Wade TD, Bulik CM, Neale M, Kendler KS (2000) Anorexia nervosa and major depression: shared genetic and environmental risk factors. Am J Psychiatry 157(3):469–471. CrossRefPubMedGoogle Scholar
  44. 44.
    Steinglass J, Albano AM, Simpson HB, Carpenter K, Schebendach J, Attia E (2012) Fear of food as a treatment target: exposure and response prevention for anorexia nervosa in an open series. Int J Eat Disord 45(4):615–621. CrossRefPubMedGoogle Scholar
  45. 45.
    Waller G, Shaw T, Meyer C, Haslam M, Lawson R, Serpell L (2012) Persistence, perseveration and perfectionism in the eating disorders. Behav Cogn Psychother 40(4):462–473. CrossRefPubMedGoogle Scholar
  46. 46.
    Frank GK, Roblek T, Shott ME, Jappe LM, Rollin MD, Hagman JO et al (2012) Heightened fear of uncertainty in anorexia and bulimia nervosa. Int J Eat Disord 45(2):227–232. CrossRefPubMedGoogle Scholar
  47. 47.
    Hasler BP, Kirisci L, Clark DB (2016) Restless sleep and variable sleep timing during late childhood accelerate the onset of alcohol and other drug involvement. J Stud Alcohol Drugs 77(4):649–655CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Jacoby A, Snape D, Lane S, Baker GA (2015) Self-reported anxiety and sleep problems in people with epilepsy and their association with quality of life. Epilepsy Behav 43:149–158. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of NeuroscienceUniversity of TurinTurinItaly
  2. 2.Department of Clinical and Biological SciencesUniversity of TurinTurinItaly
  3. 3.Department of PsychiatryUniversity of CaliforniaSan DiegoUSA

Personalised recommendations