Exploring effectiveness of CBT in obese patients with binge eating disorder: personality functioning is associated with clinically significant change

Abstract

Background Binge eating disorder (BED), as the most prevalent eating disorder, is strongly related to obesity and other somatic and psychiatric morbidity. Despite evidence-based treatments a considerable number of BED patients fail to recover. There is preliminary evidence for the association between psychodynamic personality functioning and personality traits on treatment outcome. However, research is limited and results are still contradictory. Identifying variables associated with treatment outcome could improve treatment programs. The aim of the study was to explore whether personality functioning or personality traits are associated with Cognitive Behavioral Therapy (CBT) outcome in obese female patients with BED or subthreshold BED. Methods Eating disorder symptoms and clinical variables were assessed in 168 obese female patients with DSM-5 BED or subthreshold BED, referred to a 6-month outpatient CBT program in a pre-post measurement design. Personality functioning was assessed by the Developmental Profile Inventory (DPI), personality traits by the Temperament and Character Inventory (TCI). Treatment outcome was assessed by the Eating Disorder Examination-Questionnaire (EDE-Q) global score and self-reported binge eating frequency. According to the criteria of clinical significance, 140 treatment completers were categorized in four outcome groups (recovered, improved, unchanged, deteriorated). Results EDE-Q global scores, self-reported binge eating frequency and BMI significantly decreased during CBT, where 44.3% of patients showed clinically significant change in EDE-Q global score. Treatment outcome groups showed significant overall differences on the DPI Resistance and Dependence scales and the aggregated ‘neurotic’ scale. Significant overall differences were found between groups on TCI Harm avoidance, although post hoc t-tests were non-significant. Furthermore, multiple logistic regression analysis, controlling for mild to moderate depressive disorder and TCI harm avoidance showed that ‘neurotic’ personality functioning was a significant negative predictor of clinically significant change. Conclusion Maladaptive (‘neurotic’) personality functioning is significantly associated with a less favorable outcome after CBT in patients with binge eating. Moreover, ‘neurotic’ personality functioning is a predictor of clinically significant change. Assessment of personality functioning and personality traits could support indication for more specified or augmented care, tailored towards the patients’ individual strengths and vulnerabilities. Trial registration This study protocol was retrospectively evaluated and approved on 16-06-2022 by the Medical Ethical Review Committee (METC) of the Amsterdam Medical Centre (AMC). Reference number W22_219#22.271.

Online Compassion Focused Therapy for overeating: Feasibility and acceptability pilot study

“…These findings are encouraging, especially when compared with other studies. Previous studies using EDE‐Q to assess clinically significant change after CBT for patients with binge eating had recovery rates at the end of the intervention ranging from 44 to 60% (Moore et al, 2021; van Riel et al, 2023; Wiberg et al, 2022). However, the small sample size compromises the study's power, and the results may not be generalizable, making comparison with previous treatment studies difficult.…”

Examining Studies on the Effectiveness of Cognitive Behavioral Therapy in Treating Eating Disorders: A Look at Both Western and Asian Studies

“…However, the majority of the research that we located for Western nations concentrated more on individual changes. In China, two studies (Gu L et al,2021; Chen, J et al,2021) [28]explored the feasibility and efficacy of group cognitive behavior therapy (G-CBT) adapted from enhanced cognitive behavior therapy for eating disorders (CBT-E) in Chinese AN patients. Both G-CBT and IOT groups showed significant improvement in eating pathology and associated psychopathology (ps < .001) throughout treatment, but no significant difference in symptom improvement was found between the two groups (ps > .05).…”