Objective The study aimed to investigate the complex relationship between eating disorder (ED) specific psychopathology, emotion dysregulation, and their longitudinal variations in patients with anorexia nervosa (AN) treated with a multidisciplinary approach including enhanced cognitive‐behavior therapy (CBT‐E), and to provide an integrated model which includes childhood trauma as a predictor of worse treatment outcomes. Method In total, 120 female patients with AN were evaluated at admission (T0), and 105 were re‐evaluated after 1 year (T1) of treatment. At T0, patients underwent a clinical assessment and filled the Symptom Checklist 90‐Revised (SCL90‐R), the Eating Disorders Examination Questionnaire (EDE‐Q), the Difficulties in Emotion Regulation Scale (DERS), and the Childhood Trauma Questionnaire (CTQ). SCL‐90‐R, EDE‐Q, and DERS were readministered at T1. Variations between T0 and T1 were evaluated, and the proposed model was investigated using bivariate latent change score analysis in a structural equation modeling (SEM) framework. Results An overall significant clinical amelioration was observed after treatment. A unidirectional effect of DERS scores on EDE‐Q variations was outlined by SEM: patients with higher baseline DERS scores achieved less EDE‐Q improvements, and EDE‐Q latent change score was significantly predicted by longitudinal variations of DERS—but not vice versa. Higher CTQ scores predicted reduced treatment efficacy for ED‐specific psychopathology through the mediating effect of higher baseline DERS scores. Discussion The present study sheds light on the mechanism by which early trauma compromises treatment outcome in patients with AN, underlining the crucial role of emotional dysregulation.

Objective: This study aimed to explore the role of attachment insecurity in predicting a worse longitudinal trend of eating disorder (ED) psychopathology and body uneasiness in patients with Anorexia Nervosa (AN) or Bulimia Nervosa (BN) treated with Enhanced Cognitive Behavior Therapy, considering the longitudinal interplay between these dimensions. Method: In total, 185 patients with AN or BN performed the baseline assessment, and 123 were re-evaluated after 1 year of treatment. Participants completed questionnaires evaluating ED psychopathology (Eating Disorders Examination Questionnaire) and body uneasiness (body uneasiness test). For the assessment of adult attachment, the Experiences in Close Relationships-Revised was administered at baseline. Bivariate latent change score analysis within the structural equation modeling framework was performed to investigate the evolution of ED psychopathology and body uneasiness, their longitudinal interplay, and the role of attachment style as an outcome predictor. Results: After treatment, all psychopathological features showed an overall improvement. Higher baseline levels of body uneasiness predicted a worse course of ED psychopathology. The change in body uneasiness over time depended on changes over time in ED psychopathology, but not vice versa. Insecure attachment predicted a worse longitudinal trend of ED psychopathology, and, through this impairment, it indirectly maintained higher levels of body uneasiness, as confirmed by mediation analyses.Discussion: The role of attachment insecurity as a predictor of treatment outcome suggests the need for an integration of the cognitive-behavioral conceptualization of EDs with a developmental perspective that considers attachment-related issues.Public significance statement: Considering the burden of EDs in terms of public health and the unsatisfactory response to standard treatments, the identification of

Background: The relationship between eating disorder (ED) specific psychopathology and depressive symptomatology in EDs is often debated. The aim of this study was to provide an explicative model regarding the mechanisms by which enhanced cognitive-behavior therapy (CBT-E) might determine an amelioration of depressive symptoms in patients with anorexia nervosa (AN) or bulimia nervosa (BN). Methods: A total of 157 women with AN or BN and no history of childhood trauma or bipolar disorder were evaluated before treatment and after 12 months of CBT-E. Self-administered questionnaires were used to measure ED psychopathology and depressive symptoms. Results: All psychopathological measures improved after treatment, with no significant additional improvement with the concomitant use of antidepressants. Structural equation modeling using the bivariate latent change score approach showed that higher levels of depressive symptoms at baseline were associated with a worse longitudinal trend of ED psychopathology, and vice versa. Finally, the amelioration of ED psychopathology predicted the improvement in depressive symptoms at follow-up, whereas data did not support the inverse path. Conclusion: This study elucidated the complex longitudinal interplay between ED psychopathology and depression during CBT-E, underlining the importance of addressing ED symptoms as a primary target in the case of comorbidity between AN or BN and depressive symptoms.