The Interplay Between Personality and Clinical Syndromes in Eating Disorders: Implications for Personalized Treatment

Introduction: Eating disorders (EDs) are complex and multifactorial conditions with significant impacts on both physical and mental health. Despite advances in treatment, relapse rates remain high, highlighting the need for improved predictive models for treatment outcomes. This study aims to examine the role of personality traits and clinical syndromes, as assessed by the Millon Clinical Multiaxial Inventory-III (MCMI-III), in predicting treatment outcomes for individuals with EDs. Methods: A retrospective evaluation was conducted on 149 women diagnosed with EDs, receiving inpatient treatment at the Eating Disorder Unit of Casa di Cura Villa Margherita-KOS (Arcugnano-Vicenza) between 2020 and 2024. Participants completed the MCMI-III at treatment initiation, with the Eating Disorder Examination Questionnaire (EDE-Q) and Clinical Impairment Assessment (CIA) administered at baseline and discharge. Results: Regression analyses revealed that maladaptive personality traits (avoidant, dependent and histrionic) and clinical syndromes such as major depression were significant negative predictors of treatment response. In contrast, post-traumatic stress emerged as a positive predictor of improvement. Specific personality and clinical patterns were associated with changes in symptomatology, including reductions in eating concerns, shape concerns and clinical impairment. However, not all dimensions were predictive of treatment outcomes. Conclusion: This study underscores the importance of personalized treatment approaches that account for both personality traits and clinical syndromes in individuals with EDs. Future research should explore how these factors interact over time and inform tailored therapeutic strategies, particularly for those with comorbid traits or disorders.