To date, eating disorder (ED) treatments are lacking for ED patients with psychiatric sequelae of childhood trauma, and successful outcomes are scarce. Therefore, the aim of this study was to explore therapeutic change processes from a patient perspective in relation to good versus poor long-term ED outcome at 1-year follow-up. Outcome categories were based on clinician assessment of ED behavior and diagnoses, body mass index, and Eating Disorder Examination Questionnaire scores. Eleven White, cisgendered female ED patients with childhood trauma were interviewed after a 3-month inpatient treatment: data was analyzed with elements from grounded theory and interpretative phenomenological analysis. The qualitative analysis rendered change-related descriptions (9 subcategories) and obstacles to change (6 subcategories), and 3 process-related domains differentiated good from poor long-term outcome: trauma exposure (4 subcategories), patient agency (6 subcategories), and patient-therapist dynamics (3 subcategories). First, sensory and emotional trauma exposure in good outcome informants was contrasted with avoiding or not addressing trauma and body in poor outcome informants. Second, promotion of patient agency while receiving support in the good outcome group was contrasted to an orientation toward others' needs, distrust in own abilities, and difficulties showing vulnerability in the poor outcome group. Third, poor outcome informants described either a distanced or immersed/idealizing relationship to their therapist, as opposed to more balanced between self-assertion and vulnerability in good outcome informants. Our findings raise new hypotheses that trauma work, fostering patient agency, and focusing on relational dynamics in patient-therapist dyad may be important in producing enduring ED outcomes for these patients. Public Significance StatementThis study uses a patient perspective on therapeutic change processes in good and poor outcome cases at 1-year follow-up. Findings are reported from a patient sample for which proper treatments and successful outcomes are scarce: eating disorder patients with childhood trauma. Findings indicate that trauma exposure, fostering patient agency, and an experience of a supportive yet agencypromoting therapist-patient relationship may be potent ED treatment elements across treatment models.

Objective Although studies with short and intermediate observation time suggest favorable outcomes in regard to eating disorders (ED), there is limited knowledge on long‐term outcomes. The present study aimed to investigate the 5‐ and 17‐year outcome of adult patients with longstanding ED who were previously admitted to an inpatient ED unit. ED diagnoses and recovery, comorbid and general psychopathology, along with psychosocial functioning and quality of life were evaluated. Method Sixty‐two of the 80 living patients (78% response rate) with anorexia nervosa (n = 23), bulimia nervosa (n = 25), or other specified feeding or eating disorders (n = 14) at admission were evaluated. The mean age at the 17‐year follow‐up point was 46.2 (SD 7.5). The Eating Disorder Examination (EDE) was used to assess recovery. The Mini International Neuropsychiatric Interview (M.I.N.I.) and self‐report instruments provided additional information. Results There was a significant reduction in patients fulfilling criteria for an ED from the 5‐year to the 17‐year follow‐up, meanwhile recovery rates were stable. A total of 29% of the patients were fully recovered and 21% were partially recovered while the remaining 50% had not recovered. No significant changes were found in any self‐report measures and more than 70% had a comorbid disorder at both assessments. Discussion The findings illustrate the protracted nature of ED for adults with longstanding ED. A long illness duration prior to treatment is unfortunate and early detection and treatment is advisable.

Objective: This study aimed to report the presence of categorical and dimensional personality disorders (PD) in adults with longstanding eating disorders (ED) over a period of 17 years and to investigate whether changes in PD predict changes in ED symptoms or vice versa. Methods:In total, 62 of the 80 living patients (78% response rate) with anorexia nervosa (n = 23), bulimia nervosa (n = 25), or other specified feeding or ED (n = 14) at baseline were evaluated during hospital treatment and at 1-year, 2-year, 5-year, and 17-year follow-up. PD were assessed using the Structured Clinical Interview for DSM-IV Axis II disorders, and the eating disorder examination (EDE) interview was used to assess ED. Data were analyzed using multilevel modeling.Results: From baseline to the 17-year follow-up, the number of patients with any PD decreased significantly from 74.2% to 24.2%, and the total number of PD diagnoses declined from 80 to 22. Mean EDE score was significantly reduced from 4.2 (SD: 1.1) to 2.0 (SD: 1.6). There was a positive association between ED and PD where the initial level of either disorder was followed by similar levels of the other disorder throughout the entire follow-up period. High baseline levels of borderline PD predicted less decrease in ED symptoms. No significant within-person effects were found.Conclusions: Both ED and PD significantly declined over time. As the severity of either disorder seems to be associated with the other, thorough assessment and treatment that incorporates both the ED psychopathology and the personality disturbances are advisable.Public Significance Statement: While personality disorders were highly prevalent in the sample of patients with longstanding eating disorders, both disorders were significantly reduced at the 17-year follow-up. The disorders are related in the sense that an initial high level of either disorder is associated with a high level of the other over time. A thorough assessment and attention to both illnesses are advisable in therapy.