Adverse Childhood Experiences, Emotional–Cognitive Profiles, and Response to Cognitive Remediation and Emotion Skills Training in Anorexia Nervosa

Abstract

ABSTRACT Background Anorexia nervosa (AN) involves restrictive eating and marked difficulties in emotion regulation and cognitive flexibility. Cognitive Remediation and Emotion Skills Training (CREST) targets these domains, but outcomes may vary by psychological profile and adverse childhood experiences (ACEs). This study examined the associations of emotional–cognitive profiles and ACEs with treatment response following CREST in inpatients with AN. Methods We studied 198 female inpatients with AN who completed baseline and post‐treatment assessments after an 8‐week group CREST programme. Cluster analysis of the Difficulties in Emotion Regulation Scale (DERS), Toronto Alexithymia Scale‐20 (TAS‐20), Detail and Flexibility Questionnaire (DFLEX), and Obsessive–Compulsive Inventory–Revised (OCI‐R) identified subgroups. Outcomes (ΔEDE‐Q, ΔDFLEX, ΔTAS, ΔBMI) were compared across clusters. Childhood Trauma Questionnaire (CTQ) subscales were tested in multinomial regression and moderation models. Results Three clusters emerged: Cluster 1 (low impairment), Cluster 0 (moderate impairment), and Cluster 2 (globally impaired). Groups differed in age, illness duration, BMI, and adversities exposure (all p < 0.05). Psychological outcomes differed: ΔDFLEX (H = 63.7, p < 0.001) and ΔTAS ( p < 0.001), with Cluster 2 showing the greatest gains. Emotional abuse was positively associated with both the moderate and globally impaired profiles, whereas physical abuse specifically predicted the globally impaired profile. Sexual abuse was inversely associated with both impaired profiles. Moderation analyses indicated that associations between ACE severity and psychological change varied across emotional–cognitive profiles, with direction and magnitude differing by outcome and ACE subtype. Conclusions Greater short‐term psychological changes were observed in the globally impaired profile, although baseline severity warrants cautious interpretation. Adverse childhood experiences were associated with profile membership and heterogeneous patterns of psychological change across profiles.