Rethinking treatment outcome in eating disorders: Measuring therapeutic change in psychological well-being, personality, and overall mental functioning

Widely used criteria for quantify treatment response in eating disorders (EDs) are typically focused on the reduction of overall symptomatology and modifications of physical or nutritional aspects. However, effective interventions for ED patients should also target other psychological dimensions relevant to a broader definition of mental health, such as empathy, autonomy, self-acceptance, meaning in life, relationships’ quality, and affective regulation, among others. The aim of this study was to evaluate the effectiveness of a residential treatment program for EDs applying a comprehensive definition of therapeutic change, which include symptom reduction as well as changes in psychological well-being, personality, and overall mental functioning. Eighty-four ED patients were evaluated at both treatment onset and discharge using the Shedler-Westen Assessment Procedure-200 (SWAP-200) and the Psychodiagnostic Chart-2 (PDC-2)—a clinician-rated tool derived from the Psychodynamic Diagnostic Manual (PDM-2). At the same time points, patients were asked to complete the Psychological Well-being Scales (PWB), the Eating Disorder Inventory-3 (EDI-3), and the Beck Depression Inventory-II (BDI-II). Findings showed a statistically significant pre-post symptom reduction, with moderate to large effect sizes, especially on overall eating disorder risk and depressive symptoms severity. Pre-post comparisons also showed significant gains in all PWB dimensions, as well as improvements in SWAP-200 healthy personality functioning and PDC-2 overall mental functioning. Higher baseline ED symptom severity, an earlier age of ED onset, and a greater number of dietary restrictions per week were negatively related to pre-post change in psychological well-being and personality functioning. These results suggest that the combination of measures of both mental health and psychopathology could provide a comprehensive perspective of therapeutic change with maximal clinical utility.