**9. A model of a new approach: Eating disorders and coping strategies**

In initial studies it was considered that the role played by coping strategies in eating behaviours was not clear (Wolff, Crosby, et al., 2000). Later on, it has been indicated that difficulties on emotion control explain better the occurrence of binge eating than eating restriction or weight and corporal image overestimation do (Whiteside, Chen, et al., 2007), so that in a binge disorder explanatory model emotional vulnerability and deficient strategies for the regulation of emotions would be included. Patients with eating disorders are more inclined to avoid affection than to the acceptance and control of emotions (Corstorphine, Mountford, et al., 2007).

Coping strategies have been related to the prognostic of eating disorders and it has been observed that impulsiveness, present in some of its forms, is connected to maladaptive strategies of emotional regulation (Nagata, Matsuyama, et al., 2000).

 The specificity of deficient coping strategies found in patients with eating disorders has also been discussed. With respect to bulimia nervosa, it has been observed that the tendency to avoidance, understood as a coping strategy, could be more related to a depressive than to a bulimic symptomatology. However, other strategies such as problem solving or cognitive restructuring do not seem to differ depending on depressive symptoms (Tobin & Griffing, 1995).

The problem to be confronted when it´s time to assess how different coping strategies with a determined symptomatology or personality styles relate to each other lies in the fact that interrelations among different strategies are very frequent. (Folkman & Moskovitz, 2004). The studies which have related coping strategies and personality usually conclude that emotionally stable, extrovert and responsible people tend to solve situations or change the meaning of these situations perceiving their coping as efficient, while unstable and introvert people are used to withdraw from society and usually wish the situation had not occurred, perceiving little efficiency in their coping (Bouchard, 2003; Cano, Rodríguez, et al., 2007; David & Suls, 1999).

Knowledge about coping strategies in patients with eating disorders is relevant and this relevance does not only lie in a theoretical interest or in its relationship with comorbidity or personality characteristics but also in a therapeutic interest. Hence, learning of new and more adaptive forms of coping with problems and emotions is essential in some treatment forms for these pathologies (Foa & Wilson, 1991; Peterson, Wonderlich, et al., 2004).

In a recent study (Jáuregui Lobera, Estébanez, et al., 2009), it was observed that patients with eating disorders showed more self-criticism, social withdrawal, inadequate control centred upon emotions and inadequate control in general. On the contrary, a group of students showed bigger scores at problem solving, social support, cognitive restructuring, adequate control centred upon problems, and adequate control in general. Perceived self-efficacy was greater in the student group too. Regarding personality features in the group of patients, punctuation in introversion was significantly greater, while in the group of students

A higher incidence of self-harm in bulimia nervosa and anorexia nervosa purging-type

 The presence of borderline personality disorder in bulimic patients causes a poor prognostic, and this BPD has been mainly related to the presence of purging behaviours

 For the future, coping strategies studies could be proposed as something more operative than the idea of associating eating disorders to this or that personality style

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**11. References** 

punctuations are greater in the trustful, convincing and impulsive scales. The comparison between two groups of patients (eating disorders and other mental disorders) did not reveal the existence of differences in coping styles except at self-criticism, style in which patients' scores with eating disorders were relevantly greater than those obtained in other mental disorders. Regarding personality styles, punctuations at inhibited and impulsive personalities were greater in the patients with other mental disorders than in the group of eating disorders.

Comparing patients with anorexia and bulimia, patients with anorexia nervosa obtained higher scores at self-criticism, and also at convincing, respectful and sensitive personality. Patients with bulimia nervosa scored more at impulsive personality.

In the same study, a cluster analysis revealed the existence of two groups of patients. One group showed greater self-criticism, wishful thinking, social withdrawal, inadequate control centred upon emotions and inadequate control in general. In this group introversion, inhibition, sensitivity and impulsivity prevailed. In this group, 53.1% of the patients suffered from bulimia and 69% suffered from anorexia. In the other group, scores were higher in problem solving, social support, perceived self-efficacy, adequate control centred upon problems and adequate control in general. In this group scores at sociable, trustful, convincing and respectful personality were higher. In this group, 46.5% of the patients suffered from bulimia and 31% suffered from anorexia.

With respect to personality features, this study confirmed what has been highlighted by other authors (Cano, Rodríguez, et al., 2007) in the sense that stability-extroversion is associated to more adequate coping strategies, while unstable-introvert people present greater inadequacy. However, studies on personality and eating disorders have proven controversial because they have serious methodological deficiencies (Echeburúa & Marañón, 2001). For the future, coping strategies studies could be proposed as something more operative than the idea of associating eating disorders to this or that personality style and making prognostic inferences on the basis of it. In fact, the result of the cluster analysis executed, using the dispositional (personality) as well as the contextual (coping strategies) ratify such findings as those of other authors (Strober, Salkin, et al., 1982; Westen & Harnden-Fischer, 2001) in the sense that there is presence of subgroups of patients with eating disorders with worse coping strategies and prevailing of introversion-instability.
