Personality Traits Affect CBT Outcomes Among Women With Binge Eating Disorder

CBT for binge eating may be affected by personality characteristics.

Different personality functioning and traits may affect response to cognitive behavioral therapy (CBT) for binge eating. These results were published in BMC Psychiatry.

Women (N=168) who were obese (≥30 kg/m2) and had binge eating disorder (BED) or engaged in binge eating were recruited for this study at Novarum in the Netherlands. The participants were offered 20 weekly sessions of CBT enhanced for eating disorders either in a group (61.4%) or individual (38.6%) setting with weekly psychomotor therapy.

The outcome of this study was the change to the Eating Disorder Examination Questionnaire (EDE-Q) on the basis of personality functioning and traits assessed using the Temperament and Character Inventory (TCI) and Developmental Profile Inventory (DPI) instruments. Treatment noncompliance was defined as missing 4 or more CBT sessions, recovery was defined as a reliable change index in EDE-Q score of more than      0.79, and significant recovery as a clinical cutoff of EDE-Q of less than 2.17 points.

Patients had a mean age of 41 (range, 18-68) years, they had a BMI of 39.25 (range, 30.11-56.70) kg/m2, 63.3% were diagnosed with BED, and 36.4% had subthreshold BED.

Impaired (‘neurotic’) levels of personality functioning were significantly associated with a less favorable outcome after CBT (treatment) in patients with binge eating.

A total of 140 patients completed treatment. Those who did not complete treatment had higher harm avoidance and novelty-seeking scores than treatment completers.

At baseline, the patients had an EDE-Q global score of 3.64 (SD, 0.80) points. After treatment, the global score had decreased to 2.25 (SD, 1.16) points, which was a significant difference (t[139], 13.75; P <.001). There was also a significant improvement in BMI from baseline (t[138], 4.35; P <.001).

Overall, 62 patients had changes in EDE-Q scores indicating recovery, 31 had improvement, and 47 were unchanged or deteriorated.

Stratified by outcome, significant EDE-Q global scores were observed among all 3 groups (t range, 2.49-20.24; all P ≤.016) whereas BMI was only significantly reduced among those who were recovered (t[60], 3.54; P <.001) or improved (t[30], 2.91; P =.007) but not those who were unchanged or deteriorated (t[46], 0.90; P =.371).

Compared with personality traits, the patients who were unchanged or deteriorated had significantly higher neurotic scale and dependence scores (all P ≤.048) and the improved group had higher resistance scores (P =.041) than the recovered group.

Significant predictors for recovery included depressive disorder (β, -0.55; P =.015) and DPI neurotic scale score (β, -0.44; P =.046).

The findings of this study may have been biased as all eating disorder symptoms and personality traits were self-reported.

These data indicated that personality functioning and traits may affect treatment outcomes in BED among women. The study authors concluded, “Impaired (‘neurotic’) levels of personality functioning were significantly associated with a less favorable outcome after CBT (treatment) in patients with binge eating. Furthermore, ‘neurotic’ personality functioning in addition to[,] and mild to moderate depressive disorder were identified as negative predictors of clinically significant change. This suggests that for patients with higher scores on ‘neurotic’ personality functioning the odds of being recovered after treatment decrease.”


van Riel L, van den Berg E, Polak M, et al. Exploring effectiveness of CBT in obese patients with binge eating disorder: personality functioning is associated with clinically significant change. BMC Psychiatry. 2023;23(1):136. doi:10.1186/s12888-023-04626-x