Eating disorders and aggressiveness among adolescents Introduction The psychobiological correlates of anorexia and bulimia nervosa have already been extensively investigated (1–3). However, despite the evidence of a link between the behavioural and cognitive dimensions of aggressiveness and eating disorders, only few studies have empirically tested this relation (4–7). Nevertheless, three classes of con- siderations support the importance of aggressive- ness in the development and course of eating disorders. First of all, hostility and anger, which pertain to the cognitive and emotional dimensions of aggressiveness, were described as an antecedent of the disorder both in anorexia and bulimia nervosa (8). These intense feelings may associate to unresolved severe early negative experiences, such as physical and sexual abuse, which occur more often in patients affected by these disorders than in controls (9, 10); hostile feelings could also result from conflicts arising in the patient’s family as a consequence of disordered eating behaviour com- bined with need for autonomy, which these patients perceive in an ambivalent way (8, 11). Anger and hostility may associate with impul- sivity and, particularly in bulimic patients, lead to deviant behaviour expressed through stealing and kleptomania, sexual promiscuity and substance abuse (12–14), all conditions which in turn may lead to conflict and aggression. Also impulsivity may be disclosed through self-injurious behav- iours, sometimes culminating in suicide attempts (15, 16). Attempted suicide is, indeed, one of the most severe psychiatric symptoms in the course of anorexia and bulimia nervosa (17, 18). Suicide is considered one of the main causes of death in anorexia nervosa (19, 20). The risk of death by suicide is thought to be high in bulimia nervosa, too, but follow-up studies are still insufficient to provide a definite statement (21). The links between aggressiveness and suicidality are well known. People with a higher level of expressed aggression and hostility bear a greater risk of dying by suicide and other violent causes (22). Among adolescent suicide attempters, higher familial load for suicide attempt is associated with higher ratings of aggression in the probands (23). In general, suicide attempters score significantly Miotto P, De Coppi M, Frezza M, Petretto DR, Masala C, Preti A. Eating disorders and aggressiveness among adolescents. Acta Psychiatr Scand 2003: 108: 183–189. ª Blackwell Munksgaard 2003. Objective: To explore the links between propensity to aggression and eating disorders in a sample of school-aged adolescents in a northeastern area of Italy. Method: In a mixed male–female sample of 1000 adolescents (10% of the district’s population aged 15–19 years) we administered the Eating Attitudes Test, the Bulimic Investigatory Test of Edinburgh and the Body Attitudes Test, as measures of abnormal eating attitudes and behaviours, and the Aggression Questionnaire, as a measure of the propensity to aggression. Results: Females scored significantly higher than males at all eating disorders inventories (P < 0.0001). Males scored higher than females at the Aggression Questionnaire. In both genders, there was a positive correlation between scores at any of the eating disorders inventories and those at the Aggression Questionnaire (P < 0.0001). Conclusion: Overtly expressed aggression might have a negative impact on the course of eating disorders and on the compliance with treatment, also enhancing the risk of suicide. P. Miotto 1* ,M.DeCoppi 1* , M. Frezza 1 , D. R. Petretto 2 , C. Masala 2 , A. Preti 2,3 1 Department of Drugs and Alcohol Dependence, ULS 7, Conegliano, TV, Italy, 2 Department of Psychology, University of Cagliari, Cagliari, Italy and 3 Genneruxi Medical Center, Cagliari, Italy Key words: anorexia nervosa/psychology; bulimia/ psychology; eating disorders/epidemiology; aggression; adolescence Dr Antonio Preti, Centro Medico Genneruxi, via Cost- antinopoli 42, I-09129 Cagliari, Italy E-mail: apreti@tin.it *Present address: Department of Psychiatry, ULS 7, Conegliano, TV, Italy Accepted for publication February 26, 2003 Acta Psychiatr Scand 2003: 108: 183–189 Printed in UK. All rights reserved Copyright ª Blackwell Munksgaard 2003 ACTA PSYCHIATRICA SCANDINAVICA ISSN 0001-690X 183