La personnalité des anorexiques, marquée par le perfectionnisme et la rigidité psychique, prend une place centrale dans la description et les tentatives de compréhension de la maladie. Notre but est de synthétiser les données la concernant et de préciser les distinctions entre les sous-types d'anorexie mentale. Les anorexiques restrictives sont associées à la personnalité obsessionnelle-compulsive et dans une moindre mesure à la personnalité évitante. Leur profil de tempérament est spécifié par un score haut d'Évitement de la Douleur et un score bas de Recherche de Nouveauté. Le profil de personnalité et de tempérament des boulimarexiques est moins spécifique, recoupant celui des anorexiques restrictives et celui des boulimiques. L'évaluation de la personnalité et l'établissement du profil tempéramental constituent un outil utile dans la prise en charge clinique de ces patientes et une cible thérapeutique.

The multidimensional approach could be the most accurate to analyze eating disorders. It, this perspective anorexia nervosa could be triggered by a non-specific dieting and become a full-blown eating disorder syndrome because of different risk factors. Biological, familial and social influences and premorbid personality disorder could constitute some of these core vulnerability traits. In this review, the relationship between personality features and anorexia nervosa (and its different subtypes) is described. Perfectionism and psychorigidity are major personality traits of patients with anorexia nervosa. The prevalence of personality disorders is higher among anorectic patients than in controls. The anxious-cluster personality disorder is detected in excess in anorexia nervosa, mainly of the restrictive type, including the obsessive-compulsive personality disorder and, to a less extent, the avoidant personality. This cluster was reported to be in excess in patients with anorexia nervosa according to retrospective assessment of premorbide personality disorder, in patient after recovery of comorbid mood or anxiety disorder, and even in weight-restored patients. Patients with anorexia nervosa and a personality disorder have a poorer prognosis and a higher frequency of comorbid psychiatric disorders than those without such comorbidity. The dimensional approach conceptualizes personality disorder as an extreme of normally distributed personality traits. Cloninger distinguished four core dimensions of temperament (novelty seeking, harm avoidance, reward dependence, persistence) and three dimensions of character (self-directedness, cooperativeness, self-transcendance). The use of such quantitative approach of personality profiles allowed to find personality specificities in 8 to 68% of patients with anorexia nervosa who do not have a syndromic personality disorder. High harm avoidance and low novelty seeking characterize patients with anorexia nervosa. Previous descriptions from the literature are in accordance with this description. The association of these two temperament dimensions, specifically distinguishes anorectic patients with the restrictive type. This profile is also stable, as being observed even after recovery. Personality and temperament of patients with anorexia nervosa and comorbid bulimia nervosa, entitled bulimarexia (“boulimarexie”) in french, is less clear-cut, sharing many traits of each personality profile. Detecting a personality disorder and assessing the temperament profile of eating disorder may help to predict outcome, treatment sensitivity, the potential onset of a different eating disorder or also another psychiatric disorder. Assessing personality disorder and temperament profile in patients with anorexia nervosa may thus be a way to further understand the risk factors involved in eating disorder, and could be taken into account when selecting the most appropriate therapeutic strategy.