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Differences in eating disorder symptoms and affect regulation for residential eating disorder patients with problematic substance use



The aim of the current study was to investigate differences in treatment outcomes for residential eating disorder (ED) treatment patients diagnosed with comorbid substance use disorders (SUDs), particularly differences in ED pathology and affect dysregulation.


Secondary data analysis was conducted on data from a previous study of 140 patients at a residential ED facility. SUD was diagnosed by a staff psychiatrist upon admission, and SUD diagnosis was extracted from electronic health records for the current study. Self-report measures of eating pathology and affect dysregulation from pre-treatment and post-treatment assessments were analyzed.


20.1% of the sample (n = 29) were diagnosed with a substance use disorder at the start of treatment. Contrary to hypotheses, those with comorbid SUD did not significantly differ in eating pathology severity, depression symptoms, emotion dysregulation, or psychological acceptance at baseline. Also contrary to hypotheses, individuals with comorbid SUD and ED evidenced slightly larger improvements in certain areas of eating pathology and affect dysregulation throughout treatment than those with ED diagnosis only.


These findings suggest that residential ED treatment is an appropriate treatment choice for individuals with comorbid SUD. The observed improvements in affect dysregulation combined with a period of forced abstinence from maladaptive affect regulation behaviors may explain these positive results, though more research is needed to test the mechanisms of action of residential treatment for this population.

Level of evidence

IV, multiple time series analysis.

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Correspondence to Megan L. Michael.

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The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

The current study was a secondary data analysis of data from a previous study [25]. The previous study was approved by the Institutional Review Board at Drexel University and by the Core Research Committee at the Renfrew Center.

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Informed consent was obtained from all individuals included in the study.

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Michael, M.L., Juarascio, A. Differences in eating disorder symptoms and affect regulation for residential eating disorder patients with problematic substance use. Eat Weight Disord 25, 1805–1811 (2020).

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