Transdiagnostic Predictors of Treatment Outcome in Patients With Anorexia Nervosa Receiving Intensive Enhanced...

This study examined the role of maintenance mechanisms not specific to eating disorders, as conceptualized in enhanced cognitive behavioral therapy (CBT-E)-namely clinical perfectionism, low core self-esteem, mood intolerance, and interpersonal problems-in patients with anorexia nervosa receiving intensive focused CBT-E. The aim was to assess changes in these mechanisms during treatment and their predictive value for outcomes.

In this prospective cohort study, 113 patients aged 16-65 years were admitted for intensive CBT-E. Body mass index (BMI), eating disorder psychopathology, general psychopathology, and functional impairment were assessed at baseline, end of intensive treatment (EOIT), and 20-week follow-up. Non-eating disorder-specific variables were evaluated at baseline and EOIT.

Ninety-nine patients (87.6%) completed treatment, and 75 (75.8%) attended follow-up. All non-eating disorder-specific mechanisms showed significant improvement during treatment. No variable predicted the dropout rate. In intention-to-treat analyses, lower self-esteem at baseline predicted increased eating disorder psychopathology at EOIT, while lower self-esteem at EOIT predicted increased psychopathology at follow-up. Additionally, lower baseline sociability and interpersonal ambivalence at EOIT-features of interpersonal problems-predicted decreased BMI at EOIT and follow-up, respectively.

The focused form of intensive CBT-E is associated with significant improvements in non-eating disorder specific mechanisms in patients with anorexia nervosa. However, when low self-esteem or specific interpersonal difficulties are present, these factors significantly predict poorer outcomes in eating-disorder psychopathology and weight restoration. This suggests that, for a subset of patients, addressing these non-eating disorder specific mechanisms more directly may be necessary to optimize treatment response and sustain improvements over time.