Therapeutic changes in personality features in anorexia nervosa and bulimia nervosa: A longitudinal study in a psychodynamic-oriented residential setting

Introduction: Despite symptomatic remission is considered an essential index for a successful therapy in patients with anorexia nervosa (AN) and bulimia nervosa (BN), several authors pointed out the importance of evaluating changes in more “structural” dimensions of patients’ functioning, such as specific personality features, which might shape and give meaning to eating-related symptoms. However, to date, personality-based outcome research in this field is still limited. This study aimed at exploring, through a multi-informant and longitudinal perspective, therapeutic changes in a broad spectrum of personality traits and in overall personality functioning, while also evaluating if changes in personality would predict symptom reduction. Methods: A national sample of cisgender women with a DSM-5-TR diagnosis of AN and BN (N= 72) was evaluated at intake, at discharge, and at a 6-month follow-up with the clinician-rated Shedler-Westen Assessment Procedure (SWAP-200). In all these time points, patients fulfilled self-report questionnaires on eating symptoms (Eating Attitudes Test-40, EAT-40), depressive features (Beck Depression Inventory-II, BDI-II), and psychological well-being (Psychological Well-Being Scale, PWB). Results: Findings showed statistically significant changes in several SWAP-200 Scales and Q-factors at both discharge and at 6-month follow-up. There was a significant increase in the healthy personality functioning scale, dysphoric: depressive–high functioning, and obsessive Q-factors, along with a decrease in the schizoid, schizotypal, and borderline PD Scales, as well as in the dysphoric: emotionally dysregulated Q-factor. Changes in healthy personality functioning were associated with a decrease in overall eating symptomatology and depressive symptoms at a 6-month follow-up and an increase in self-acceptance and personal growth. Discussion: These results support the view that the goals of psychodynamic-oriented approaches for AN and BN include, but can be extended beyond, the alleviation of eating-related symptoms. Then, considering multiple indices of therapeutic change enables a more clinically useful perspective of treatment outcomes in this clinical population.