Anorexia nervosa is a severe mental illness with modest treatment outcomes, and hospitalizations are frequently required. AN is robustly associated with a constellation of personality traits, including perfectionism, harm avoidance and anxiety. Psychopathological and personality aspects can influence treatment response and outcome in the hospital setting potentially favoring a greater individualization of treatments. This study aims to analyze inpatients with AN to ascertain as to whether personality traits can be associated with the improvement of eating psychopathology. We expected that more adaptive personality traits upon admission could correlate with the improvement of eating psychopathology upon hospital discharge.
One-hundred and thirteen inpatients with AN were consecutively enrolled and asked to complete the following assessment instruments: Temperament and Character Inventory (TCI), State Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), Eating disorders inventory-2 (EDI-2), and the Eating Disorders Examination Questionnaire (EDE-Q). Clinical parameters including Body Mass Index (BMI) were assessed at admission as well.
When compared between admission and discharge, patients significantly improved in BMI, state anxiety and depression. As regards eating psychopathology, patients did not significantly improve on the EDI-2 core subscales (i.e., drive for thinness, bulimia, body dissatisfaction), with the exception of the bulimia subscale; in contrast, the EDE-Q total score showed a significant improvement upon discharge. According to their improvement (Improved Drive For Thinness, I-DT) versus worsening (Worsened Drive for Thinness, W-DT) of the DT subscale upon hospital discharge, 46 patients were classified as W-DT while 67 patients as I-DT. Only cooperativeness on the TCI was found to significantly differ between groups.
Increasingly effective and individualized treatments are needed for AN sufferers. We confirmed that hospitalizations are overall effective in improving eating symptoms; furthermore, higher cooperativeness upon admission, a character dimension of personality, resulted as associated with the improvement of drive for thinness upon discharge. A deeper psychopathological characterization of patients with AN could be helpful in planning treatments for AN patients.