Psychological treatment and personality traits in anorexia nervosa

Project description

Background

Anorexia nervosa is a serious eating disorder that often begins in adolescence or early adulthood and, for many individuals, follows a long-term course. Despite access to established treatments, only some patients achieve full recovery, while others remain partially symptomatic or develop a chronic condition. This highlights the need for treatment models that do not only focus on symptom reduction, but also address psychological processes that may contribute to maintaining the disorder.Obsessive-compulsive personality traits, such as rigidity, perfectionism, and emotional overcontrol, are common in anorexia nervosa and are associated with both the development of the disorder and poorer treatment outcomes. These traits overlap with what is described in the literature as overcontrol and are clinically relevant also in the context of psychiatric comorbidity, which is common in anorexia nervosa. At the same time, knowledge about how these personality traits are affected by treatment remains limited, despite their potential importance for long-term recovery.

Radically open dialectical behavior therapy (RO-DBT) is a transdiagnostic treatment developed for individuals with a high degree of overcontrol, with a focus on increasing flexibility, emotional expression, and social connectedness. Previous studies of RO-DBT in anorexia nervosa have shown promising results, but have mainly been conducted in inpatient settings or in small outpatient studies using modified treatment protocols. There is therefore a clear need for systematic evaluations of RO-DBT in outpatient psychiatric care that consider feasibility, acceptability, and clinical outcomes.

Project aims

The overall aim of the project is to evaluate radically open dialectical behavior therapy (RO-DBT) as a treatment option for patients with anorexia nervosa in outpatient psychiatric care. Particular focus is placed on the feasibility, acceptability, and clinical relevance of the treatment, as well as on how changes in obsessive-compulsive personality traits are related to clinical improvement. More specifically, the project aims to:

• examine whether RO-DBT can be implemented in a feasible and acceptable way in outpatient psychiatric care for patients with anorexia nervosa
• describe changes in eating-disorder symptoms, functioning, and obsessive-compulsive personality traits during and after treatment
• deepen the understanding of treatment processes by studying how changes in personality traits and symptoms co-vary over time
• integrate quantitative and qualitative perspectives to capture both measurable outcomes and experienced change among patients, therapists, and close others

Overall, the project addresses a central knowledge gap in the treatment of anorexia nervosa: the lack of systematically evaluated treatment models in routine care that explicitly target personality-related mechanisms linked to the development and maintenance of the disorder.

Results

So far, one study has been published within the framework of the project. The study showed that the treatment was feasible to implement in outpatient psychiatric care, was experienced as meaningful by participants, and yielded indications of clinical improvement.

_{Ejdemyr et al. (2025). Feasibility and acceptability of radically open dialectical behavior therapy for anorexia nervosa in outpatient care. Link}

Collaborations and clinical context

The project is conducted within outpatient psychiatric services in Region Västernorrland, in close collaboration with the National Highly Specialized Care for Eating Disorders. The research is carried out within Magnus Sjögren’s research group at Umeå University and in collaboration with researchers at Karolinska Institutet, Uppsala University, and Washington University School of Medicine.

Funding

The project is funded by Region Västernorrland, the Fredrik and Ingrid Thuring Foundation, and the Kempe Foundations.