Abstract
In the twenty years since the publication of the most widely used treatment manuals describing evidence-based therapies for eating disorders, there have been some substantial advances in the field. New methods of delivering treatments have been trialled and our perception of mental health has advanced; significant cultural changes have led to shifts in our societal landscape; and new technologies have allowed for more in-depth research to be conducted. As a result, our understanding of eating disorders and their treatment has broadened considerably. However, these new insights have not necessarily been translated into improved clinical practice. This paper highlights the changes we consider to have had the greatest impact on our work as experienced clinical psychologists in the field and suggests a list of new learnings that might be incorporated into clinical practice and research design.
Plain English summary
In the field of eating disorders the most commonly used manualised treatments are nearly twenty years old. There has been much progress in the field since then in terms of technologies, understandings and social changes. In this paper, two experienced clinical psychologists describe some of the more recent developments in the field and highlight ways to incorporate the new learnings into clinical practice and research design.
Introduction
In our long careers (over thirty years) in the eating disorders (EDs) field we have seen many changes. At the turn of the century, Cognitive Behaviour Therapy for Bulimia Nervosa (CBT-BN) was being developed into a transdiagnostic treatment by Professor Christopher Fairburn and his colleagues at Oxford University. However, it was only a few years before the publication of Cognitive Behaviour Therapy and Eating Disorders in 2009 [1] that Enhanced Cognitive Behaviour Therapy (CBT-E) began to be disseminated. Likewise, while family therapy for anorexia nervosa (AN) was being refined by Ivan Eisler and colleagues at the Maudsley Hospital in the nineties, it was only when the Treatment Manual for Anorexia Nervosa: A Family Based Approach [2] was published in 2001, with related research indicating positive outcomes, that clinicians became knowledgeable about, and trained in, Family Based Treatment (FBT). While these two therapies continue to be the leading evidence-based treatments (EBTs) for EDs, treatment outcomes remain limited.
In this paper we share our clinical experience of the past three decades to illustrate how the ED field has changed as more knowledge has emerged. We discuss the two most broadly used EBTs, CBT-E and FBT, in terms of their relevance today, their limitations, and how they might be expanded to encompass these changes. We stand by our support of these two EBTs and other EBTs that have been developed over the past two decades, e.g., The Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) [3] and Specialist Supportive Clinical Management (SSCM) [4], while examining their significance in the current climate.
Some of the changes that have had the greatest impact on our work over the past two decades have stemmed from new research into, for example, the impact of starvation on the brain, the genetic and neurobiological underpinnings of EDs, and the role of the microbiome. Other changes reflect broader sociocultural shifts such as greater acknowledgement of diversity including neurodiversity and diversity in terms of gender, ethnicity and body size/shape; greater acceptance of the value of lived experience in both research design and treatment, as well as the advent of social media and recognition of problems related to food insecurity. Additional changes have followed on from revisions in the DSM and from significant advances in treatments for other psychiatric conditions. We make some suggestions about how we might build on treatment protocols that are now two decades old and how we might adapt our approach to ED research in light of this new information.
Personalizing treatment
Whilst continuing to ground our work with patients in EBTs, we propose moving toward more individualised, flexible approaches than those prescribed in treatment manuals created over twenty years ago. Personalising treatment is an overarching recommendation that sits above all our suggestions, presented below, about ways of updating current EBTs.
In our view, personalising treatment involves developing competence to make treatments more appropriate by: (1) providing truly relevant, up-to-date psychoeducation, based on recent research findings, that is specific to the individual’s presentation; (2) making decisions about the treatment delivery that is most suited to the patient; (3) collaboratively developing treatment goals that reflect the patient’s current needs and values; (4) adapting or nuancing treatments to meet the needs of diverse populations; (5) paying attention to the sociocultural shifts that have occurred over the past twenty years; (6) modularizing EBTs, using adjunctive evidence-based techniques developed for other conditions; and (7) updating our research designs in order to address the questions we most need to answer in the most economical way. At present, there is little evidence that making personalised adaptations to EBTs leads to improved outcomes for people with eating disorders. We believe that this concept should be a priority for future research and we hope that the suggested new topics for consideration that we list below may spark new research.
#1: Psychoeducation using 21st Century research findings
Psychoeducation is a crucial component of CBT-E and FBT but recent research has provided us with more detailed information about the psychoeducation topics that are mentioned in these treatment manuals. With a greater appreciation of the effects of starvation on the brain, our increased knowledge of genetics, neurobiology, neuroplasticity and the gut-brain axis, we emphasize the importance of offering comprehensive psychoeducation early, starting during the assessment phase, to help patients and their families understand the illness and empower them to make informed decisions about their treatment and the recovery process. We suggest that clinicians update their knowledge about these key points.
The effects of starvation: beyond the Minnesota starvation experiment
While we have always known about the Keys Semi-Starvation Study [5], there is more appreciation nowadays of the far-reaching effects of starvation on the body and the brain, with Magnetic Resonance Imaging studies highlighting the significant neurological changes that follow prolonged malnutrition [6]. Additionally, there is recognition that the effects of starvation, including the resulting medical instability, can be present in individuals at any size [7].
Genetics, neurobiology and neuroplasticity
An explosion of research over the last decade has led to a greater understanding of the genetic, epigenetic and neurobiological underpinnings of EDs particularly in regard to Anorexia Nervosa (AN) [8, 9], Avoidant Restrictive Feeding and Intake Disorder (ARFID) [10], and Binge Eating Disorder (BED) [11]. Genome Wide Association Studies have accrued large enough samples to confirm evidence from twin and family studies of a strong genetic component to EDs [8, 12, 13]; they are highly heritable illnesses, not a “lifestyle choice.” These studies have also highlighted significant genetic correlations with other psychiatric conditions, including obsessive compulsive disorder, depression and anxiety [8] and AN-associated genes have been found to not only impact the brain, but also the gut and metabolic factors leading researchers to propose a reconceptualization of AN as a “metabo-psychiatric” disorder [14,15,16]. Neuroimaging evidence has confirmed the notion of a genetically driven, neurobiologically based AN temperament that influences vulnerability to and persistence of the illness [6, 17]. The role of epigenetics in the expression of EDs has also become better understood: we have learned about the complex links between genes and nutritional and environmental factors (e.g., calorie deficit, stress, trauma) that can modify gene expression and/or “switch on” genes related to the development and maintenance of EDs [17, 18]. Finally, recent neurobiological research has encompassed the notion of neuroplasticity and neuromodulation which increases hope for the development of more successful therapies [19,20,21].
The influence of the microbiome
Information about the gut-brain axis has led to a recognition of the influential role of the gut microbiome on mental health in general [22] and EDs in particular [23,24,25,26]. Gastrointestinal symptoms and problems such as irritable bowel syndrome, post-prandial fullness, reflux, constipation, bloating and abdominal pain are prevalent in individuals with EDs and are associated with high levels of distress and impairment [7, 27, 28]. There is an increasing body of research focusing on the complex links between the gut microbiome, gastrointestinal disturbances and EDs across the whole spectrum of eating pathology.
#2: Redefining treatment delivery in the 21st Century
The treatment team
The original treatment manuals for both CBT-E and FBT promote treatment by a single therapist, usually a mental health professional in isolation (with FBT requiring regular appointments with a medical practitioner). However, with the recognition of EDs as complex, genetically based neuropsychological disorders we have moved beyond the idea of treatment being delivered by a single therapist. It is generally accepted that good treatment for EDs requires a multi-disciplinary team with a range of knowledge and skills [29, 30]. We have come to value the special contribution of dietitians [31, 32] and current clinical practice guidelines recommend collaborative treatment from a multidisciplinary team including, at least, a medical practitioner, a mental health professional and a dietitian [33, 34]
We are also moving towards routinely including families, other supports and peer workers in the treatment team. In particular, there is an increasing awareness of the need to consider the voice of consumers; one third of the ‘three-legged stool’ of research evidence, clinical expertise and lived experience [35]. Recovery from an ED is seen as a long and complex progression, less about a disease process as conceptualised by clinicians, and more about reclaiming a place in the world [36]. It is only by including the voice of lived experience in truly collaborative, co-designed research that we will better understand what people with EDs need at each stage of the recovery process [37]. Thankfully, carers and supports are now recognised as valued contributors to recovery and carers can receive training to participate fully in their loved one’s recovery [17, 38, 39].
Treatment modality
The results of treatment trials that have compared different treatment modalities over the past twenty years now allow us more choice in treatment delivery. For example, we can offer shorter treatments such as CBT-Ten [40], therapy via telehealth [41], Guided Self-Help [42,43,44,45], online interventions [46,47,48,49,50,51], multi-family interventions [52, 53] or Temperament Based Treatment with Supports (TBT-S) five-day treatment models [54], with confidence that similar outcomes to individual therapy can be achieved.
Timing of treatment
Because of what we now know about neuroplasticity, neuroprogression and critical windows for intervention, there has been a move to prioritise treatment for those with recent onset (e.g., First Episode and Rapid Early Intervention service for Eating Disorders; FREED) [55]. Long waiting lists for specialist services have been managed by offering brief early interventions, e.g., Single Session Interventions [56, 57].
At the same time, we also have a responsibility to treat those who have had EDs for many years and to adapt our treatments to suit their priorities and needs, as we would do with all patients. Consumers tend to prefer the term “longstanding ED” to “severe and enduring ED,” or, ideally, no label regarding chronicity [58]. There are differences of opinion regarding EDs that have not responded to treatment, with some in the field [59] suggesting there are no features differentiating recent onset versus chronic EDs. While some people with longstanding EDs may appreciate a treatment approach that focuses on quality of life [60, 61], there is evidence that they can benefit from recovery-focused treatments that involve weight restoration, such as CBT-E [62].
#3 Reconceptualizing recovery goals
Rethinking definitions of “recovery”
Broadening our definitions of ‘recovery’ may allow more flexibility in determining treatment strategies. Really listening to an individual’s expectations and goals (rather than imposing on them our research-based views of what constitutes “recovery”) [63,64,65] can help patients and therapists make informed, collaborative decisions about treatment delivery. Research that has drawn on those with lived experience of an ED tells us that recovery is much more than simply achieving a certain BMI, scoring below a particular score on an ED questionnaire and exhibiting few ED behaviours [66,67,68]. When we listen to those with lived experience, we learn that recovery is a complex, moving target that can be defined differently for different people [36, 37, 68,69,70].
Rethinking weight goals
Related to this, there has been a shift in our thinking around weight goals for people with AN. When it comes to proposing targets for weight restoration, we need to pay appropriate attention to each patient’s specific context and background, rather than prescribing a “normal” BMI. The FBT manual suggests a goal of a BMI at the 50th percentile on BMI-for-age charts, and the CBT-E manual suggests aiming for a BMI of 19–20. We strongly believe in considering premorbid weight (if known), childhood body type, family body type and weight history (highest and lowest weight) to guide us. One size does not fit all: a fifteen-year-old girl with a slight premorbid body frame and a lean family body type may not need to weight restore to the 50th percentile, while a similarly aged girl, who was in a larger body as a child and comes from a family with many high-weight members, may need to weight restore well beyond that level [71]. We must not let our own weight bias prevent us from advocating for sufficient weight restoration.
#4: Building competency in working with diverse populations
The days of the ‘SWAG’ (skinny, white, affluent girls) stereotype in EDs are over. Our assessments and treatments must identify and address with sensitivity the needs of all individuals.
Neurodiversity
There is significant overlap between EDs and neurodivergent presentations such as autism [72,73,74,75,76,77] and attention deficit hyperactivity disorder [78,79,80,81]. Research has also demonstrated that feeding difficulties and eating disorders are overrepresented in people with intellectual disability [82, 83], giftedness [84,85,86], and Tourette’s Syndrome [87, 88]. While research into the links between EDs and neurodivergent presentations is just beginning to gather momentum (and the effects of starvation need to be distinguished from underlying neurodevelopmental conditions) the implications of this research has been signalled. For neurodivergent individuals, subtle differences in underlying approaches may be required regarding sensory, emotion and communication-based interventions [72, 89,90,91].
Gender diversity
It has become apparent that males, too, are affected by EDs—more commonly than we realised [92,93,94] and that current EBTs may not always provide a good fit for male patients [95,96,97,98]. Standardised measures of ED symptomatology, e.g., the Eating Disorders Examination [99] focusing on the drive for thinness, a common goal for females, do not capture the emerging concept of muscle dysmorphia [100,101,102].
The past decade has also seen a rise in the number of people identifying as transgender, non-binary or gender-fluid. Research has suggested that gay, bisexual and transgender individuals are at higher risk of developing an ED than their heterosexual and cisgender counterparts [103,104,105,106,107,108]. For transgender, non-binary and gender-fluid individuals, body image dissatisfaction occurs in the context of the person’s gender assigned at birth and current gender and sexual identity [103, 108, 109].
Racial diversity
Research has confirmed our clinical observation that EDs are found in all ethnicities, in similar rates to those of white populations. This includes indigenous populations in Australia [110]; and in the USA: African-Americans [111], Latinos [112] and Asian-Americans [113]; and in countries becoming westernised, e.g., Saudi Arabia [114]. Clinicians are becoming more open to identifying EDs in any ethnic group and providing culturally sensitive treatment.
Body diversity
Contrary to the common understanding in the 1990s and early 2000s, we now know that we cannot rely on Body Mass Index (BMI) as an indicator of health [115, 116]. Medical complications of caloric restriction and other ED behaviours can occur in individuals with bodies of all shapes and sizes, including individuals with high BMIs [7, 115,116,117,118]. Moreover, there is an increasing amount of robust medical evidence that challenges fundamental assumptions held by many (including medical professionals) about individuals in larger bodies, including the belief that “thinner is healthier” [115, 119]. Weight stigma [120, 121] has been shown to have adverse effects in relation to both social justice issues and medical implications [122,123,124,125]. Alongside this new information lies the often-ignored data clearly demonstrating that behavioural weight loss programs do not work in the long term and that dieting can set individuals up for binge eating and further weight gain [126,127,128,129,130]. Many clinicians have adopted the Health at Every Size® (HAES®) framework [131,132,133], a paradigm that has gathered momentum over the past decade, by helping to reduce ED behaviours and improve people’s relationship with food and movement, regardless of what occurs with their weight [7, 134].
Over the last quarter of a century there has been a rapid increase in the number of individuals opting for bariatric surgery which has resulted in another set of problems for individuals with EDs [135]. It is becoming more common to assess for and treat ED symptoms before any such surgery [134, 136,137,138,139].
#5: Updating treatments to accommodate other sociocultural shifts
Changing societal views on diversity, as outlined above, reflect an attitudinal sociocultural shift. However, over the past two decades there have been other major sociocultural changes that can be responded to appropriately within EBT.
The rise of social media
Twenty years ago, there were no smart phones. Since then, the twenty-four hours per day access to images of unattainable or photoshopped bodies, plus the rise of ‘thinspiraton’, ‘fitspiration’ and ‘influencers’ has changed our culture in unimagined ways [140]. Particularly with young people, treatments can include psychoeducation about media literacy, which may encourage people to be critical of what they see in the media. Building resilience against the onslaught of social media and other sociocultural influences is crucial for bringing about enduring change [141,142,143,144,145].
Food insecurity
Having access to good nutrition is the foundation of ED treatment. The intersection of eating disorders and food insecurity (the limited or uncertain availability of nutritionally adequate and safe foods) has been highlighted by recent research [146,147,148,149,150,151,152] with 23% of young adults experiencing food insecurity [149]. The linear relationship between eating pathology and food insecurity cannot be ignored, with food insecurity being linked to increasing rates of BED [150], BN [151] and food restriction [152] in disadvantaged social groups.
#6: Considering new ED diagnoses and advances in treatments for other conditions
Changes in the DSM
Twenty years ago, we were working from the Diagnostic and Statistical Manual of mental disorders, Fourth Edition, Text Revision [153]. In 2013, the Diagnostic and Statistical Manual of mental disorders, Fifth Edition [154] introduced two new ED diagnoses. The recognition of binge eating disorder (BED) has facilitated the development and testing of treatments for what is now regarded as the most common ED, both pharmacological [155] and psychological [156]. The introduction of ARFID has been followed by the development of specific interventions [157].
Incorporating specific modules into EBTs
Researchers and clinicians have started to broaden their scope in the quest to provide better care for people with EDs, applying treatments often developed and tested for other mental health conditions. CBT-E and FBT have been adapted by adding modules tailored to the individual’s needs and based on their specific formulation. Examples include modules focusing on: perfectionism [158,159,160,161,162,163]; strategies drawn from Dialectical Behaviour Therapy [164,165,166,167]; Cognitive Remediation Therapy (CRT) [89, 168, 169] or Cognitive Remediation and Emotion Skills Training (CREST) for rigid thinking [170,171,172]; TBT-S [17] for harnessing an individual’s traits for recovery; imagery rescripting [173,174,175,176]; or schema therapy [177, 178] to tackle core beliefs.
Incorporating physical activity into ED treatment
Neither of the two main EBTs focus on managing compulsive exercise. However, there is an awareness of the strong connection between driven movement and AN (mainly from animal studies) [179, 180] and we now have specific treatment approaches to address compulsive exercise [181,182,183]. There has also been a positive move toward integrating appropriate physical activity into treatment protocols [184,185,186,187,188,189,190].
#7: Updating research design
As we embrace the idea of updating our current EBTs for EDs, we must also turn our hand to moving forward with innovative research. The following suggestions may yield new and relevant insights for all ED presentations.
Moving away from the traditional Randomised Controlled Trial (RCT) design
There has been extensive acknowledgement of the limitations of research to date in the ED field [191]. The late 1990s heralded an era dominated by RCTs comparing different treatments for EDs [192]. Such large clinical trials have become too expensive to conduct rigorously and, while RCTs have contributed enormously to the field, their findings have traditionally been disappointing, with differences in outcomes between the treatments rarely detected (the “Dodo Bird” effect) [193]. As a field we have begun to think creatively about applied research designs that are practical and targeted, and which provide answers to questions that are current and relevant [194]. These may include well-powered trials of brief, focused interventions including Single Session Interventions [195] and the careful reporting of case series or case studies [196, 197].
Adopting mixed-method research designs
It is possible to adopt different mixed-method research formats. For example, using qualitative as well as quantitative designs in a complementary way to add richness and colour to numbers and statistics [198, 199] or using pooled data sets or data from large registries which would have the added advantage of requiring different research teams to cooperate in order to find answers [200,201,202,203,204,205,206]. We are also listening to the voice of lived experience with regards to research. The ED field has been encouraged to engage in more meaningful co-design involving consumers, clinicians and researchers, with the potential to drive better outcomes [35, 194]. It will take courage to partner with those with lived experience and encourage them to lead the research process. It is only with truly collaborative, co-designed, research that we can redefine recovery [36, 37]. Co-design has many benefits, such as empowering consumers to seek out EBT via a co-designed checklist [194].
Taking advantage of new technologies
Future research will continue to be shaped by technological advances, particularly in the cutting-edge fields of genetics, neurobiology, neuromodulation, digital technology and psychopharmacology [19, 207]. Researchers can take advantage of new technologies to continue to progress research in the field of EDs.
Summary
Clinicians specialising in the treatment of people with EDs must embrace new knowledge, new technologies, new treatment approaches and cultural shifts. Patients and families are asking for more individualised and personalised treatment. Many clinicians already report modifying EBTs [208]. However, we need to make sure that we adapt our robust EBTs thoughtfully and purposefully, so that we do not engage in unintentional “therapist drift” [209]. With such an approach—using and properly evaluating EBTs augmented by additional interventions—we can improve our treatments to help people move beyond their ED and flourish. A broadened, more flexible delivery of EBTs opens the door to innovative research designs that may start to bridge the often-cited gap between research and clinical practice.
Availability of data and materials
Not applicable.
Abbreviations
- ED:
-
Eating disorders
- CBT-BN:
-
Cognitive Behavioural Bulimia Nervosa
- CBT-E:
-
Enhanced cognitive behaviour therapy
- AN:
-
Anorexia nervosa
- FBT:
-
Family based treatment
- EBT:
-
Evidence based treatment
- MANTRA:
-
Maudsley anorexia nervosa treatment for adults
- SSCM:
-
Specialist supportive clinical management
- ARFID:
-
Avoidant restrictive feeding and intake disorder
- BMI:
-
Body mass index
- DSM:
-
Diagnostic and statistical manual of mental disorders
- BED:
-
Binge eating disorder
- CRT:
-
Cognitive remediation therapy
- EMDR:
-
Eye movement desensitization and reprocessing
- CREST:
-
Cognitive remediation and emotional skills training
- TBT-S:
-
Temperament based treatment with supports
- HAES:
-
Health at every size
- FREED:
-
First episode and rapid early intervention service for eating disorders
- RCT:
-
Randomised controlled trial
References
Fairburn CG. Cognitive behavior therapy and eating disorders. New York: Guilford Press; 2008.
Lock J, Le Grange D, Agras WS, Dare C. Treatment manual for anorexia nervosa: a family based approach. New York: The Guilford Press; 2001.
Schmidt U, Wade TD, Treasure J. The Maudsley model of anorexia nervosa treatment for adults (MANTRA): development, key features, and preliminary evidence. J Cogn Psychother. 2014;28:48–71.
McIntosh V, Jordan J, Luty SE, Carter FA, McKenzie JM, Bulik CM, Joyce PR. Specialist supportive clinical management for anorexia nervosa. Int J Eat Disorders. 2006;39:625–32.
Keys A, Brozek J, Henschel A, Mickelsen O, Taylor HL. The biology of human starvation (Vol. II). Minnesota: Minnesota Press; 1950.
Kaye W, Fudge J, Paulus M. New insights into symptoms and neurocircuit function of anorexia nervosa. Nat Rev Neurosci. 2009;10(8):573–84.
Gaudiani JL. Sick enough. New York: Routledge; 2019.
Watson H, Yilmaz Z, Thornton L, Hübel C, Coleman JRI, Bryois J, Bulik CM. Anorexia nervosa genome-wide association study identifies eight loci and implicates metabo-psychiatric origins. Nat Genet. 2019;51:1207–14.
Johnson JS, Cote AC, Dobbyn A, Sloofman L, Xu J, Cotter L, Charney AW, Eating Disorders Working Group of the Psychiatric Genomics Consortium, Birgegård A, Jordan J, Kennedy M, Landén M, Maguire SL, Martin NG, Mortensen PB, Thornton LM, Bulik CM, Huckins LM. Mapping anorexia nervosa genes to clinical phenotypes. Psychol Med 53, 2619–2633. https://doi.org/10.1017/S0033291721004554.
Kennedy H, Dinkler L, Kennedy MA, Bulik CM, Jordan J. How genetic analysis may contribute to the understanding of avoidant/restrictive food intake disorder (ARFID). J Eat Disord. 2022;10:53. https://doi.org/10.1186/s40337-022-00578-x.
Vrieze E, Leenaerts N. Neuronal activity and reward processing in relation to binge eating. Curr Opin Psychiatry. 2023;36(6):443–8.
Kirk KM, Martin FC, Mao A, Parker P, Maguire S, Thornton LM, Martin NG. The Anorexia Nervosa Genetics Initiative: study description and sample characteristics of the Australian and New Zealand arm. Aust N Z J Psychiatry. 2017;51:583–94. https://doi.org/10.1177/0004867417700731.
Thornton LM, Munn-Chernoff MA, Baker JH, Juréus A, Parker R, Henders AK, Bulik CM. The Anorexia Nervosa Genetics Initiative (ANGI): overview and methods. Contemp Clin Trials. 2018;74:61–9. https://doi.org/10.1016/j.cct.2018.09.015.
Hübel C, Abdulkadir M, Herle M, Loos RJF, Breen G, Bulik CM, Micali N. One size does not fit all: genomics differentiates among anorexia nervosa, bulimia nervosa, and binge-eating disorder. Int J Eat Disord. 2021;54(5):785–93. https://doi.org/10.1002/eat.23481.
Hübel C, Gaspar HA, Coleman JRI, Finucane H, Purves KL, Hanscombe KB, Prokopenko I, Graff M, Ngwa JS, Workalemahu T, O’Reilly PF, Bulik CM, Breen G. Genomics of body fat percentage may contribute to sex bias in anorexia nervosa. Am J Med Genet Part B Neuropsychiatric Genet. 2019;180(6):428–38. https://doi.org/10.1002/ajmg.b.32709.
Bulik CM, Flatt R, Abbaspour A, Carroll I. Reconceptualizing anorexia nervosa. Psychiatry Clin Neurosci. 2019;73(9):518–25. https://doi.org/10.1111/pcn.12857.
Hill LL, Knatz Peck S, Wierenga CE. Temperament based therapy with support for anorexia nervosa: a novel treatment. UK: Cambridge University Press; 2022.
Steiger H, Booij L. Eating disorders, heredity and environmental activation: getting epigenetic concepts into practice. J Clin Med. 2020;9(5):1332.
Keeler JL, Kan C, Treasure J, Himmerich H. Novel treatments for anorexia nervosa: insights from neuroplasticity research. Eur Eat Disord Rev. 2023. https://doi.org/10.1002/erv.3039.
Keeler J, Patsalos O, Thuret S, Ehrlich S, Tchanturia K, Himmerich H, Treasure J. Hippocampal volume, function and related molecular activity in anorexia nervosa: a scoping review. Exp Rev Clin Pharmacol. 2020. https://doi.org/10.1080/17512433.2020.1850256.
Keeler JL, Robinson L, Keeler-Schäffeler R, Dalton B, Treasure J, Himmerich H. Growth factors in anorexia nervosa: a systematic review and meta-analysis of cross-sectional and longitudinal data. World J Biol Psychiatry. 2022. https://doi.org/10.1080/15622975.2021.2015432.
Chen L, Wang D, Garmaeva S, Kurilshikov A, Vich Vila A, Gacesa R, Sinha T, Segal E, Weersma RK, Wijmenga C, Zhernakova A, Fu J. The long-term genetic stability and individual specificity of the human gut microbiome. Cell. 2021;184(9):2302–15. https://doi.org/10.1016/j.cell.2021.03.024.
Di Lodovico L, Mondot S, Doré J, Mack I, Hanachi M, Gorwood P. Anorexia nervosa and gut microbiota: a systematic review and quantitative synthesis of pooled microbiological data. Prog Neuropsychopharmacol Biol Psychiatry. 2021;106:110–4. https://doi.org/10.1016/j.pnpbp.2020.110114.
Morita C, Tsuji H, Hata T, Gondo M, Takakura S, Kawai K, Yoshihara K, Ogata K, Nomoto K, Miyazaki K. Gut dysbiosis in patients with anorexia. PLoS ONE. 2015;10(12): e0145274. https://doi.org/10.1371/journal.pone.0145274.
Monteleone AM, Troisi J, Serena G, Fasano A, Dalle Grave R, Cascino G, Marciello F, Calugi S, Scala G, Corrivetti G, Monteleone P. The gut microbiome and metabolomics profiles of restricting and binge-purging type anorexia nervosa. Nutrients. 2021;13:507. https://doi.org/10.3390/nu130205.
Schulz N, Belheouane M, Dahmen B, Ruan VA, Specht HE, Dempfle A, Herpertz-Dahlmann B, Baines JF, Seitz J. Gut microbiota alteration in adolescent anorexia nervosa does not normalize with short-term weight restoration. Int J Eat Disord. 2021;54(6):969–80. https://doi.org/10.1002/eat.23435.
Kleiman SC, Watson HJ, Bulik-Sullivan EC, Young Huh E, Tarantino LM, Bulik CM, Carroll IM. The intestinal microbiota in acute anorexia nervosa and during renourishment: relationship to depression. Psychosom Med. 2015;77(9):969–81. https://doi.org/10.1097/PSY.000000.
Borgo F, Riva A, Benetti A, Casiraghi MC, Bertelli S, Garbossa S, Anselmetti S, Scarone S, Pontiroli AE, Morace G, Borghi E, Sanz Y. Microbiota in anorexia nervosa: the triangle between bacterial species, metabolites and psychological tests. PLoS ONE. 2017;12(6): e0179739. https://doi.org/10.1371/journal.pone.0179739.
Bray M, Heruc G, Byrne S, Wright ORL. Collaborative dietetic and psychological care in Interprofessional Enhanced Cognitive Behaviour Therapy for adults with Anorexia Nervosa: a novel treatment approach. J Eat Disord. 2023. https://doi.org/10.1186/s40337-023-00743-w.
Heruc G, Hurst K, Casey A, Fleming K, Freeman J, Fursland A, Hart S, Jeffrey S, Knight R, Roberton M, Roberts M, Shelton B, Stiles G, Sutherland F, Thornton C, Wallis A. Wade T (2020) ANZAED eating disorder treatment principles and general clinical practice and training standards. J Eat Disord. 2020;8(1):1–63.
Khan M, Hui K, McCauley SM. What is a registered dietitian nutritionist’s role in addressing malnutrition? J Acad Nutr Diet. 2018;118(9):1804.
Jeffrey S, Heruc G. Balancing nutrition management and the role of dietitians in eating disorder treatment. J Eat Disord. 2020;8(1):64.
Hay P, Chinn D, Forbes D, Madden S, Newton R, Sugenor L, Touyz S, Ward W. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. Aust N Z J Psychiatry. 2014;48(11):1–62.
National Institute for Health and Care Excellence. Eating disorders: Recognition and treatment. Version 2.0. Full guideline. United Kingdom: The National Institute of Health and Care Excellence; 2017.
Peterson CB, Bleck Becker C, Treasure J, Shafran R, Bryant-Waugh R. The three-legged stool of evidence-based practice in eating disorder treatment: research, clinical, and patient perspectives. BMC Med. 2016. https://doi.org/10.1186/s12916-016-0615-5.
Conti JE. Recovering identity from anorexia nervosa: Women’s constructions of their experiences of recovery from anorexia nervosa over 10 years. J Constr Psychol. 2018;31(1):72–94.
LaMarre A, Healy-Cullen S, Tappin J, Burns M. Honouring differences in recovery: methodological explorations in creative eating disorder recovery research. Soc Sci. 2023;12(4):251. https://doi.org/10.3390/socsci12040251.
Treasure J, Willmott D, Ambwani S, Cardi V, Bryan DC, Schmidt U. Cognitive Interpersonal Model for Anorexia Nervosa revisited: the perpetuating factors that contribute to the development of the severe and enduring illness. J Clin Med. 2020;9(3):630.
Hibbs R, Rhind C, Leppanen J, Treasure J. Interventions for caregivers of someone with an eating disorder: a meta-analysis. Int J Eat Disord. 2015;48(4):349–61.
Waller G, Turner HM, Tatham M, Mountford V, Wade T. Brief cognitive behaviour therapy for non-underweight patients: CBT-T for eating disorders. Milton Park: Routledge; 2019.
Raykos BC, Erceg-Hurn DM, Hill J, Campbell BNC, McEvoy PM. Positive outcomes from integrating telehealth into routine clinical practice for eating disorders during COVID-19. Int J Eat Dis. 2021;54:1689–95.
Grilo CM, Masheb RM. A randomized controlled comparison of guided self-help cognitive behavioral therapy and behavioral weight loss for binge eating disorder. Behav Res Ther. 2005;43(11):1509–25.
Grilo CM, White MA, Gueorguieva R, Barnes RD, Masheb RM. Self-help for binge eating disorder in primary care: a randomized controlled trial with ethnically and racially diverse obese patients. Beh Res Therapy. 2013;51(12):855–61.
Yim SH, Schmidt U. Self-help treatment of eating disorders. Psychiatr Clin North Am. 2019;42:231–41. https://doi.org/10.1016/j.psc.2019.01.00621.
Traviss-Turner GD, West RM, Hill AJ. Guided self-help for eating disorders: a systematic review and metaregression. Eur Eat Disord Rev. 2017;25:148–64.
Linardon J, Shatte A, Messer M, Firth J, FullerTyszkiewicz M. E-mental health interventions for the treatment and prevention of eating disorders: an updated systematic review and meta-analysis. J Consulting Clin Psychol. 2020;88:994–1007. https://doi.org/10.1037/ccp0000575.
Barakat S, Maguire S, Smith KE, Mason TB, Crosby RD, Touyz S. Evaluating the role of digital intervention design in treatment outcomes and adherence to eTherapy programs for eating disorders: a systematic review and meta-analysis. Int J Eat Disord. 2019;52:1077–94. https://doi.org/10.1002/eat.23131.
Rom S, Miskovic-Wheatley J, Barakat S, Aouad P, Kim M, Fuller-Tyszkiewicz M, Maguire S. The acceptability, feasibility, and preliminary efficacy of a supported online self-help treatment program for binge-eating disorder. Front Psych. 2023;14:1229261–1229261.
Blalock DV, Le Grange D, Johnson C, Duffy A, Manwaring J, Tallent CN, Schneller K, Solomon AM, Mehler PS, McClanahan SF, Rienecke RD. Pilot assessment of a virtual intensive outpatient program for adults with eating disorers. Int J Eat Disord. 2020;28:789–95. https://doi.org/10.1002/erv.2785.
Levinson CA, Spoor SP, Keishishian AC, Pruitt A. Pilot outcomes from a multidisciplinary telehealth versus in-person intensive outpatient program for eating disorders during versus before the Covid-19 pandemic. Int J Eat Disord. 2021;54:1672–9. https://doi.org/10.1002/eat.23579.
Haderlein TP. Efficacy of technology-based eating disorder treatment: a meta-analysis. Curr Psychol. 2022;41:174–84.
Baudinet J, Eisler I, Dawson L, Simic M, Schmidt U. Multi-family therapy for eating disorders: a systematic scoping review of the quantitative and qualitative findings. Int J Eat Disord. 2021;54(12):2095–120. https://doi.org/10.1002/eat.23616.
Tantillo M, McGraw JS, Lavigne HM, Brasch J, Le Grange D. A pilot study of multifamily therapy group for young adults with anorexia nervosa: reconnecting for recovery. Int J Eat Disord. 2019;52(8):95.
Wierenga CE, Hill L, Knatz Peck S, McCray J, Greathouse L, Peterson D, et al. The acceptability, feasibility, and possible benefits of a neurobiologically-informed 5-day multifamily treatment for adults with anorexia nervosa. Int J Eat Disord. 2018;51(8):863–9.
McClelland J, Hodsoll J, Brown A, Lang K, Boysen E, Flynn M, Mountford VA, Glennon D, Schmidt U. A pilot evaluation of a novel First Episode and Rapid Early Intervention service for Eating Disorders (FREED). Eur Eat Disord Rev. 2018;26:129–40.
Fursland A, Erceg-Hurn D, Byrne S, McEvoy P. A single session assessment and psychoeducational intervention for eating disorders: impact on treatment waitlists and eating disorder symptoms. Int J Eat Disord. 2018. https://doi.org/10.1002/eat.22983.
Schleider JL, Smith AC, Ahuvia I. Realizing the untapped promise of single-session interventions for eating disorders. Int J Eat Disord. 2023. https://doi.org/10.1002/eat.23920.
Reay M, Holliday J, Steart J, Adams J. Creating a care pathway for patients with longstanding, complex eating disorder. J Eat Disord. 2022;10:128. https://doi.org/10.1186/s40337-022-00648-0.
Wildes JE, Forbush KT, Haga KE, Marcus MD, Attia E, Gianini LM, Wu W. Characterizing severe and enduring anorexia nervosa: an empirical approach. Int J Eat Disord. 2017. https://doi.org/10.1002/eat.22651.
Touyz S, Le Grange D, Lacey H, Hay P, Smith R, Maguire S, Bamford B, Pike KM, Crosby RD. Treating severe and enduring anorexia nervosa. Psychol Med. 2013;43:2501–11.
Eddy KT, Tabri N, Thomas JJ, Murray HB, Keshaviah A, Hastings E, Edkins K, Krishna M, Herzog DB, Keel PK, Franko DL. Recovery from anorexia nervosa and bulimia nervosa at 22-year follow-up. J Clin Psychiatry. 2017;78(2):184–9.
Raykos B, Erceg-Hurn D, McEvoy P, Fursland A, Waller G. Severe and enduring anorexia nervosa? Illness severity and duration are unrelated to outcomes from enhanced cognitive behaviour therapy. J Consulting Clin Psychol. 2018;86(8):702–9.
Bardone-Cone AM, Harney MB, Maldonado CR, Lawson MA, Robinson DP, Smith R, Tosh A. Defining recovery from an eating disorder: conceptualization, validation, and examination of psychosocial functioning and psychiatric comorbidity. Behav Res Ther. 2010;48(3):194–202.
Couturier J, Lock J. What is recovery in adolescent anorexia nervosa? Int J Eat Disord. 2006;39(7):550–5.
Williams SE, Watts TKO, Wade TD. A review of the definitions of outcome used in the treatment of bulimia nervosa. Clin Psychol Rev. 2012;32(4):292–300. https://doi.org/10.1016/j.cpr.2012.01.006.
de Vos JA, LaMarre A, Radstaak M, Bijkerk CA, Bohlmeijer ET, Westerhof GJ. Identifying fundamental criteria for eating disorder recovery: a systematic review and qualitative meta-analysis. J Eat Disord. 2017;5(1):1–14.
Duncan TK, Sebar B, Le J. Reclamation of power and self: a meta-synthesis exploring the process of recovery from anorexia nervosa. Adv Eat Disord Theory Res Pract. 2015;3(2):177–90.
Wetzler S, Hackmann C, Peryer G, Clayman K, Friedman D, Saffran K, Silver J, Swarbrick M, Magill E, van Furth E, Pike KM. A framework to conceptualize personal recovery from eating disorders: a systematic review and qualitative meta-synthesis of perspectives from individuals with lived experience. Int J Eat Disord. 2020;53(8):1188–203.
Stockford C, Stenfert Kroese B, Beesley A, Leung N. Women’s recovery from anorexia nervosa: a systematic review and meta-synthesis of qualitative research. Eat Disord. 2019;27(4):343–68.
Richmond TK, Woolverton GA, Mammel K, Ornstein RM, Spalding A, Woods ER, Forman SF. How do you define recovery? A qualitative study of patients with eating disorders, their parents, and clinicians. Int J Eat Disord. 2020;53(8):1209–18.
Seetharaman S, Golden NH, Halpern-Felsher B, Peebles R, Payne A, Carlson JL. Effect of a prior history of overweight on return of menses in adolescents with eating disorders. J Adolesc Health. 2017;60(4):469–71.
Tchanturia K, Smith C, Glennon D, Burhouse A. Towards an improved understanding of the Anorexia Nervosa and Autism spectrum comorbidity: PEACE pathway implementation. Front Psych. 2020;11:640–640.
Leppanen J, Sedgewick F, Halls D, Tchanturia K. Autism and anorexia nervosa: longitudinal prediction of eating disorder outcomes. Front Psych. 2022;13:985586–867. https://doi.org/10.3389/fpsyt.2022.985867.
Schröder SS, Danner UN, Spek AA, van Elburg AA. Problematic eating behaviours of autistic women—A scoping review. Eur Eat Disord Rev. 2022;30:510–37.
Keski-Rahkonen A, Ruusunen A. Avoidant-restrictive food intake disorder and autism: epidemiology, etiology, complications, treatment, and outcome. Curr Opin Psychiatry. 2023;36(6):438–42. https://doi.org/10.1097/YCO.0000000000000896.
Westwood H, Tchanturia K. Autism spectrum disorder in anorexia nervosa: an updated literature review. Curr Psychiatry Rep. 2017;19:41–41. https://doi.org/10.1007/s11920-017-0791-9.
Baraskewich J, von Ranson KM, McCrimmon A, McMorris CA. Feeding and eating problems in children and adolescents with autism: a scoping review. Autism. 2021;25(6):1805–1519.
Baraskewich J, Climie EA. The relation between symptoms of ADHD and symptoms of eating disorders in university students. J Gen Psychol. 2022;149(3):405–19. https://doi.org/10.1080/00221309.2021.187486.
Levin RL, Rawana JS. Attention-deficit/hyperactivity disorder and eating disorders across the lifespan: a systematic review of the literature. Clin Psychol Rev. 2016;50:22–36. https://doi.org/10.1016/j.cpr.2016.09.010.
Villa FM, Crippa A, Rosi E, Nobile M, Brambilla P, Delvecchio G. ADHD and eating disorders in childhood and adolescence: an updated minireview. J Affect Disord. 2023;321:565–271.
Yao S, Kuja-Halkola R, Martin J, Lu Y, Lichtenstein P, Norring C, Birgegård A, Yilmaz Z, Hübel C, Watson H, Baker J, Almqvist C, Eating Disorders Working Group of the Psychiatric Genomics Consortium, Thornton LM, Magnusson PK, Bulik CM, Larsson H. Associations Between Attention-Deficit/ Hyperactivity Disorder and Various Eating Disorders: A Swedish Nationwide Population Study Using Multiple Genetically Informative Approaches. Biological Psychiatry. 2019; 86:577–586
Gravestock S. Eating disorders in adults with intellectual disability. J Intellect Disabil Res. 2000;44(6):625–37.
Hove O. Survey on dysfunctional eating behavior in adult persons with intellectual disability living in the community. Res Dev Disabil. 2007;28:1–8.
Schilder CMT, van Elburg AA, Snellen WM, Sternheim LC, Hoek HW, Danner UN. Intellectual functioning of adolescent and adult patients with eating disorders. Int J Eat Disord. 2017;50:481–9.
Kothari R, Solmi F, Treasure J, Micali N. The neuropsychological profile of children at high risk of developing an eating disorder. Psychol Med. 2013;43:1543–54. https://doi.org/10.1017/S003329171200218.
Lopez C, Stahl D, Tchanturia K. Estimated intelligence quotient in anorexia nervosa: a systematic review and meta-analysis of the literature. Ann Gen Psychiatry. 2010;9:40–40.
Smith B, Rogers SL, Blissett J, Ludlow AK. The relationship between sensory sensitivity, food fussiness and food preferences in children with neurodevelopmental disorders. Appetite. 2020;150:104643–104643.
Smith B, Gutierrez R, Ludlow AK. A comparison of food avoidant behaviours and sensory sensitivity in adults with and without Tourette syndrome. Appetite. 2022;168:105713–105713.
Tchanturia K, Giombini L, Leppanen J, Kinnaird E. Evidence for Cognitive Remediation Therapy in young people with anorexia nervosa: systematic review and meta-analysis of the literature. Eur Eat Disord Rev. 2017;25(4):227–36. https://doi.org/10.1002/erv.2522.
Tchanturia K. Supporting autistic people with eating disorders: a guide to adapting treatment and supporting recovery. UK: Jessica Kingsley Publishers; 2021.
Li Z, Halls D, Byford S, Tchanturia K. Autistic characteristics in eating disorders: treatment adaptations and impact on clinical outcomes. Eur Eat Disord Rev. 2022;30(5):671–90. https://doi.org/10.1002/erv.2875.
Mitchison D, Mond J. Epidemiology of eating disorders, eating disordered behaviour, and body image disturbance in males: a narrative review. J Eat Disord. 2015;3(1):1–9.
Steinhausen HC, Jensen CM. Time trends in lifetime incidence rates of first-time diagnosed anorexia nervosa and bulimia nervosa across 16 years in a Danish nationwide psychiatric registry study. Int J Eat Disord. 2015;48(7):845–50.
Kask J, Ramklint M, Kolia N, Panagiotakos D, Ekbom A, Ekselius L, Papadopoulos FC. Anorexia nervosa in males: excess mortality and psychiatric co-morbidity in 609 Swedish in-patients. Psychol Med. 2017;47(8):1489–99.
Murray SB, Griffiths S, Mond JM. Evolving eating disorder psychopathology: conceptualising muscularity-oriented disordered eating. Br J Psychiatry. 2016;208(5):414–5.
Bunnell DW. Gender socialization, countertransference and the treatment of men with eating disorders. Clin Soc Work J. 2016;44:99–104.
Murray SB, Nagata JM, Griffiths S, Calzo JP, Brown TA, Mitchison D, Blashill AJ, Mond JM. The enigma of male eating disorders: a critical review and synthesis. Clin Psychol Rev. 2017;57:1–11.
Thapliyal P, Hay P, Conti J. Role of gender in the treatment experiences of people with an eating disorder: a metasynthesis. J Eat Disord. 2018;6(1):1–16.
Fairburn CG, Cooper Z, O’Connor M. The eating disorder examination. Int J Eat Disord. 1993;6:1–8.
Cooper M, Eddy KT, Thomas JJ, Franko DL, Carron-Arthur B, Keshishian AC, Griffiths KM. Muscle dysmorphia: a systematic and meta-analytic review of the literature to assess diagnostic validity. Int J Eat Disord. 2020;53(10):1583–604.
Rohman L. The relationship between anabolic androgenic steroids and muscle dysmorphia: a review. Eat Disord. 2009;17(3):187–99.
García-Rodríguez J, Alvarez-Rayón G, Camacho-Ruíz J, Amaya-Hernández A, Mancilla-Díaz JM. Muscle dysmorphia and use of ergogenics substances. A systematic review. Rev Colomb Psiquiatr (English ed). 2017;46(3):168–77.
Keski-Rahkonen A. Eating disorders in transgender and gender diverse people: characteristics, assessment, and management. Curr Opin Psychiatry. 2023;36(6):412–8. https://doi.org/10.1097/YCO.0000000000000902.
Parker LL, Harriger JA. Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature. J Eat Disord. 2020;8(51):1–20. https://doi.org/10.1186/s40337-020-00327-y.
Nagata JM, Ganson KT, Austin SB. Emerging trends in eating disorders among sexual and gender minorities. Curr Opin Psychiatry. 2020;33(6):562–7.
Calzo JP, Blashill AJ, Brown TA, Argenal RL. Eating disorders and disordered weight and shape control behaviors in sexual minority populations. Curr Psychiatry Rep. 2017;19(8):49. https://doi.org/10.1007/s11920-017-0801-y.
Mensinger JL, Granche JL, Cox SA, Henretty JR. Sexual and gender minority individuals report higher rates of abuse and more severe eating disorder symptoms than cisgender heterosexual individuals at admission to eating disorder treatment. Int J Eat Disord. 2020;53(4):541–54.
Dufy ME, Henkel KE, Earnshaw VA. Transgender clients’ experiences of eating disorder treatment. J LGBT Issues Couns. 2016;10(3):136–49.
Riddle MC, Safer J. Medical considerations in the care of transgender and gender diverse patients with eating disorders. J Eat Disord. 2022;10:178. https://doi.org/10.1186/s40337-022-00699-.
Burt A, Mitchison D, Dale E, Bussey K, Trompeter N, Lonergan A, Hay P. Prevalence, features and health impacts of eating disorders among First-Australian Yiramarang (adolescents) and in comparison to other Australian adolescents. J Eat Disord. 2020;8:10–10. https://doi.org/10.1186/s40337-020-0286-7.
Blostein F, Assari S, Caldwell CH. Gender and ethnic differences in the association between body image dissatisfaction and binge eating disorder among blacks. J Racial Ethnic Health Disparities. 2017;4:529–38.
Perez M, Ohrt TK, Hoek HW. Prevalence and treatment of eating disorders among Hispanics/Latino Americans in the United States. Curr Opin Psychiatry. 2016;29(6):378–83. https://doi.org/10.1097/YCO.0000000000000277.
Nicado EG, Hong S, Takeuchi D. Prevalence and correlates of eating disorders among Asian Americans: results from the national Latino and Asian American study. Int J Eat Disord. 2007;40(S3):S22–6. https://doi.org/10.1002/eat.20450.
AlShebali M, AlHadi A, Waller G. The impact of ongoing westernization on eating disorders and body image dissatisfaction in a sample of undergraduate Saudi women. Eating Weight Disord Stud Anorexia Bulimia Obes. 2021;26(6):1835–44. https://doi.org/10.1007/s40519-020-01028-w.
Dalili DD, Bazzocchi A, Dalili DE, Guglielmi G, Isaac A. The role of body composition assessment in obesity and eating disorders. Eur J Radiol. 2020;131: 109227.
Zembic A, Eckel N, Stefan N, Baudry J, Schulze MB. The role of body composition assessment in obesity and eating disorders: an empirically derived definition of metabolically healthy obesity based on risk of cardiovascular and total mortality. J Am Med Assoc Netw Open. 2021;4(5):e218505–e218505.
Duncan AE, Ziobrowski HN, Nicol G. The prevalence of past 12-month and lifetime DSM-IV eating disorders by BMI category in US men and women. Eur Eat Disord Rev. 2017;25:165–71.
Sawyer SM, Whitelaw M, Le Grange D, Yeo M, Hughes EK. Physical and psychological morbidity in adolescents with atypical anorexia nervosa. Pediatrics. 2016;137(4):4080. https://doi.org/10.1542/peds.2015-4080.
Lavie CJ, De Schutter A, Milanet RV. Healthy obese versus unhealthy lean: the obesity paradox. Nat Rev Endocrinol. 2015; 11: 55–62 https://doi.org/10.1038/nrendo.2014.16
Hart LM, Ferreira KB, Ambwani S, Gibson EB, Austin SB. Developing expert consensus on how to address weight stigma in public health research and practice: a Delphi study. Stigma Health. 2020;6:179–89.
Vartanian LR, Porter AM. Weight stigma and eating behavior: a review of the literature. Appetite. 2016;102:3–14.
Puhl RM, Luedicke J, Grilo CM. Obesity bias in training: attitudes, beliefs, and observations among advanced trainees in professional health disciplines. Obesity (Silver Spring). 2014;22(4):1008–15. https://doi.org/10.1002/oby.20637.
Mensinger JL, Tylka TL, Calamari ME. Mechanisms underlying weight status and healthcare avoidance in women: a study of weight stigma, body-related shame and guilt, and healthcare stress. Body Image. 2018;25:139–47.
Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griff JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015;16(4):319–26.
O’Brien KS, Latner JD, Puhl RM, Vartanian LR, Giles C, Griva K, Carter A. The relationship between weight stigma and eating behavior is explained by weight bias internalization and psychological distress. Appetite. 2016;102:70–6.
Mann T, Tomiyama AJ, Westling E, Lew AL, Samuels B, Chatman J. Medicare’s search for effective obesity treatments: diets are not the answer. Am Psychol. 2007;62(3):220–33. https://doi.org/10.1037/0003-066X.62.3.22.
Dombrowski SU, Knittle K, Avenell A, Araújo-Soares V, Sniehotta FF. Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials. Br Med J. 2014;348:1–12.
Cooper Z, Doll HA, Hawker DM, Byrne SM, Bonner G, Eeley E, O’Connor ME, Fairburn CG. Testing a new cognitive behavioural treatment for obesity: a randomized controlled trial with three-year follow-up. Behav Res Ther. 2010;48:706–13.
Tomiyama AJ. Weight stigma is stressful: a review of evidence for the cyclic obesity/weight-based stigma model. Appetite. 2014;82:8–15.
Butryn ML, Webb V, Wadden TA. Behavioral treatment of obesity. Psychiatry Clin N Am. 2011;34:841–59.
HAES®. US The Association for size Diversity and Health (ASDAH). 2023. https://www.sizediversityandhealth.org/content.asp. Accessed 28 July 2023.
Ulian MD, Aburad L, Da Silva Oliveira MS, Poppe ACM, Sabatini F, Perez I, Gualano B, Benatti FB, Pinto AJ, Vessoni A, Morais Sato P, Unsain RF, Baeza SF. Effects of health at every size® interventions on health-related outcomes of people with overweight and obesity: a systematic review. Obes Rev. 2018;19(12):1659–66.
Dugmore JA, Winten CG, Niven HE, Bauer J. Effects of weight-neutral approaches compared with traditional weight-loss approaches on behavioral, physical, and psychological health outcomes: a systematic review and meta-analysis. Nutr Rev. 2020;78(1):39–55.
Ralph A, Brennan L, Byrne S, Caldwell B, Farmer J, Hart LM, Heruc GA, Maguire S, Piya MK, Quin J, Trobe SK, Wallis A, Hay P. Management of eating disorders for people with higher weight: clinical practice guideline. J Eat Disord. 2022;10:121. https://doi.org/10.1186/s40337-022-00622-w.
D’Souza C, Hay P, Touyz S, Piya MK. Bariatric and cosmetic surgery in people with eating disorders. Nutrients. 2020;12(9):2861.
Ivezaj V, Carr MM, Brode C, Devlin M, Heinberg LJ, Sysko R, Williams-Kerver G, Mitchell JE. Disordered eating following bariatric surgery: a review of measurement and conceptual considerations. Surg Obes Relat Dis. 2021;17(8):1510–20.
Gradaschi R, Molinari V, Sukkar SG, De Negri P, Adami GF, Camerani G. Disordered Eating and Weight Loss after bariatric surgery. Eat Weight Disord. 2020;25(5):1191–6.
Parker K, O’Brien P, Brennan L. Measurement of disordered eating following bariatric surgery: a systematic review of the literature. Obes Surg. 2014;24(6):945–53.
Parker K, Brennan L. Measurement of disordered eating in bariatric surgery candidates: a systematic review of the literature. Obes Res Clin Pract. 2015;9(1):12–25.
Wilksch S, O’Shea A, Ho P, Byrne S, Wade T. The relationship between social media use and disordered eating in young adolescents. Int J Eat Disord. 2020;53:96–106. https://doi.org/10.1002/eat.23198.
Wilksch SM, O’Shea A, Wade TD. Media Smart-Targeted: diagnostic outcomes from a two-country pragmatic online eating disorder risk reduction trial for young adults. Int J Eat Disord. 2018;51:270–4.
Wade TD, Wilksch SM, Paxton SJ, Byrne SM, Austin SB. Do universal media literacy programs have an effect on weight and shape concern by influencing media internalization? Int J Eat Disord. 2017;50:731–8.
Wilksch S, Paxton S, Byrne SM, Austin SB, Wade T. An RCT of three programs aimed at reducing risk factors for both eating disorders and obesity: outcomes from the prevention across the spectrum study. J Eat Disord. 2014;2:1. https://doi.org/10.1186/2050-2974-2-S1-O43.
Wilksch SM, Paxton SJ, Byrne SM, Austin SB, McLean SA, Thompson KM, Dorairaj K, Wade TD. Prevention Across the Spectrum: a randomized controlled trial of three programs to reduce risk factors for both eating disorders and obesity. Psychol Med. 2015;45(9):1811–23.
Wilksch SM, Paxton SJ, Byrne SM, Austin SB, O’Shea A, Wade TD. Outcomes of three universal eating disorder risk reduction programs by participants with higher and lower baseline shape and weight concern. Int J Eat Disord. 2017;50(1):66–75. https://doi.org/10.1002/eat.22642.
Becker CB, Middlemass K, Taylor B, Johnson C, Gomez F. Food insecurity and eating disorder pathology. Int J Eat Disord. 2017;50:1031–40. https://doi.org/10.1002/eat.22735.
Urban B, Jones N, Freestone D, Steinberg DM, Baker JH. Food insecurity among youth seeking eating disorder treatment. Eat Behav. 2023. https://doi.org/10.1016/j.eatbeh.2023.101738.
Kuehne C, Hemmings A, Phillips M, İnce B, Chounkaria M, Ferraro C, Pimblett C, Sharpe H, Schmidt U. A UK-wide survey of healthcare professionals’ awareness, knowledge and skills of the impact of food insecurity on eating disorder treatment. Eat Behav. 2023;4:9. https://doi.org/10.1016/j.eatbeh.2023.101740.
Larson N, Laska MN, Neumark-Sztainer D. Food insecurity, diet quality, home food availability, and health risk behaviors among emerging adults: findings from the EAT 2010–2018 study. Am J Public Health. 2020;1:1. https://doi.org/10.2105/AJPH.2020.305783.
Rasmusson G, Lydecker JA, Coffino JA, White MA, Grilo CM. Household food insecurity is associated with binge-eating disorder and obesity. Int J Eat Disord. 2019;52(1):28–35.
Lydecker JA, Grilo CM. Food insecurity and bulimia nervosa in the United States. Int J Eat Disord. 2019;52:735–9. https://doi.org/10.1002/eat.23074.
Middlemass K, Cruz J, Gambo A, Johnson C, Taylor B, Gomez F, Becker CB. Food insecurity & dietary restraint in a diverse urban population. Eat Disord J Treatm Prev. 2020. https://doi.org/10.1080/10640266.2020.172334.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association; 2000.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author; 2013.
Griffiths KR, Yang J, Touyz SW, Hay PJ, Clarke SD, Korgaonkar MS, Gomes L, Anderson G, Foster S, Kohn MR. Understanding the neural mechanisms of lisdexamfetamine dimesylate (LDX) pharmacotherapy in Binge Eating Disorder (BED): a study protocol. J Eat Disord. 2019;7:23. https://doi.org/10.1186/s40337-019-0253-3.
Anderson LM, Smith KM, Schaefer LM, Crosby RD, Cao L, Engel SG, Crow SJ, Wonderlich SA, Peterson CB. Predictors and moderators of treatment outcome in a randomized clinical trial for binge-eating disorder. J Consult Clin Psychol. 2020;88(7):631–42.
Thomas JJ, Eddy KT. Cognitive behavioural therapy for avoidant/restrictive food intake disorder. Cambridge University Press. 2019. https://doi.org/10.1017/9781108233170.
Egan S, Wade TD, Shafran R. Perfectionism as a transdiagnostic process: a clinical review. Clin Psychol Rev. 2021;31:203–12.
Egan SJ, Shafran R, Wade TD. A clinician’s quick guide to evidence-based approaches: perfectionism. Clin Psychol. 2022;26(3):351–3.
Shafran R, Egan S, Wade TD. Overcoming Perfectionism: a self-help guide using scientifically supported cognitive behavioural techniques. London: Little Brown Book Group; 2018.
Egan S, Wade T, Shafran R, Antony M. Cognitive-behavioural treatment of perfectionism. NY, USA: Guilford Press; 2014.
Hurst K, Zimmer-Gembeck M. Focus on perfectionism in female adolescent anorexia nervosa. Int J Eat Disord. 2015;48:936–41.
Hurst K, Zimmer-Gembeck M. Family-based treatment with cognitive behavioural therapy for anorexia. Clin Psychol. 2019;23(1):61–70. https://doi.org/10.1111/cp.12152.
Dastan B, Zanjani SA, Adl AF, Habibi M. The effectiveness of dialectical behaviour therapy for treating women with obesity suffering from BED: a feasibility and pilot study. Clin Psychol. 2020;24(2):133–42.
Rahmani M, Omidi A, Asemi Z, Akbari H. The effect of dialectical behaviour therapy on binge eating, difficulties in emotion regulation and BMI in overweight patients with binge-eating disorder: a randomized controlled trial. Ment Health Prevent. 2018;9:13–8.
Lammers MW, Vroling MS, Crosby RD, van Strien T. Dialectical behavior therapy adapted for binge eating compared to cognitive behavior therapy in obese adults with binge eating disorder: a controlled study. J Eat Disord. 2020;8:27–27.
Kamody RC, Burton ET. In Martin CR, Patel CV, Preedy V (editors). Handbook of lifespan cognitive behavioral therapy childhood, adolescence, pregnancy, adulthood, and aging. The use of dialectical behavior therapy in childhood and adolescent eating disorders. London: Academic Press, 2023. p. 193–203. https://doi.org/10.1016/B978-0-323-85757-4.00039-0.
Tchanturia K. Cognitive Remediation Therapy (CRT) for Eating and Weight Disorders. London, UK: Routlege; 2014. ISBN-10 1138794031; ISBN-13 978-1138794030
Giombini L, Nesbitt S, Kusosa R, Hinallas K, Fabian C, Easter A, Tchanturia K. Neuropsychological and clinical findings of Cognitive Remediation Therapy feasibility randomised controlled trial in young people with anorexia nervosa. Eur Eat Disord Rev. 2022;30(1):50–60. https://doi.org/10.1002/erv.2874.
Tchanturia K, Doris E, Fleming C. Effectiveness of cognitive remediation and emotion skills training (CREST) for anorexia nervosa in group format: a naturalistic pilot study. Eur Eat Disord Rev. 2014;22(3):200–5.
Tchanturia K, Doris E, Mountford V, Fleming C. Cognitive Remediation and Emotion Skills Training (CREST) for anorexia nervosa in individual format: self-reported outcomes. BMC Psychiatry. 2015;15:53. https://doi.org/10.1186/s12888-015-0434-9.
Harrison A, Stavri P, Tchanturia K. Individual and Group Format Adjunct Therapy on Social Emotional Skills for Adolescent Inpatients with Severe and Complex Eating Disorders (CREST-A). Neuropsychiatrie. 2021;35(4):163–76. https://doi.org/10.1007/s40211-020-00375-5.
Hackmann A, Bennett-Levy J, Holmes EA. Oxford Guide to Imagery in Cognitive Therapy. UK: Oxford University Press; 2011. https://doi.org/10.1017/bec.2012.1
Hackmann A. Imagery rescripting in posttraumatic stress disorder. Cogn Behav Pract. 2011;18:424–32.
Cooper M, Todd G, Turner H. The effects of using imagery to modify core emotional beliefs in bulimia nervosa: an experimental pilot study. J Cogn Psychother. 2007;21(2):117–22.
Pennesi JL, Wade TD. Imagery rescripting and cognitive dissonance: a randomized controlled trial of two brief online interventions for women at risk of developing an eating disorder. Int J Eat D. 2018;51(5):439–48. https://doi.org/10.1002/eat.22849.
Simpson S, Smith E. Schema Therapy for Eating Disorders: Theory, practice and group treatment manual. London: Routledge; 2020.
Joshua PR, Lewis V, Kelty SF, Boer DP. Is schema therapy effective for adults with eating disorders? A systematic review into the evidence. Cogn Behav Therapy. 2023;52(3):213–31. https://doi.org/10.1080/16506073.2022.2158926.
Spadini S, Ferro M, Lamanna J, Malgaroli A. Activity-based anorexia animal model: a review of the main neurobiological findings. J Eat Disord. 2021;9:123–123.
Meyer C, Taranis L, Goodwin H, Haycraft E. Compulsive exercise and eating disorders. Eur Eat Disord Rev. 2011;19(3):174–89. https://doi.org/10.1002/erv.1122.
Hay P, Touyz S, Arcelus J, Pike K, Attia E, Crosby RD, Madden S, Wales J, La Puma M, Heriseanu AI, Young S, Meyer C. A randomized controlled trial of the compulsive Exercise Activity TheraPy (LEAP): a new approach to compulsive exercise in anorexia nervosa. Int J Eat Disord. 2018;51:999–1004.
Dittmer N, Voderholzer U, Mönch C, Cuntz U, Jacobi C, Schlegl S. Efficacy of a specialized group intervention for compulsive exercise in inpatients with anorexia nervosa: a randomized controlled trial. Psychother Psychosom. 2020;89(3):161–73.
Mathisen TF, Bratland-Sanda S, Rosenvinge JH, Friborg O, Pettersen G, Vrabel KA, et al. Treatment effects on compulsive exercise and physical activity in eating disorders. J Eat Disord. 2018;6(1):1–9.
Marcos YQ, Zarceño EL, López JAL. Effectiveness of exercise-based interventions in patients with anorexia nervosa: a systematic review. Eur Eat Disord Rev. 2020;29(1):3–19.
Cook B, Wonderlich SA, Mitchell J, Thompson R, Sherman R, McCallum K. Exercise in eating disorders treatment: systematic review and proposal of guidelines. Med Sci Sports Exerc. 2016;48(7):1408–14.
Danielsen M, Øyvind R, Bjørnelv S. How to integrate physical activity and exercise approaches into inpatient treatment for eating disorders: fifteen years of clinical experience and research. J Eat Disord. 2018;6:34–34. https://doi.org/10.1186/s40337-018-0203-5.
Moola FJ, Gairdner SE, Amara CE. Exercise in the care of patients with anorexia nervosa: a systematic review of the literature. Ment Health Phys Act. 2013;2(6):59–68.
Mathisen TF, Hay P, Bratland-Sanda S. How to address physical activity and exercise during treatment from eating disorders: a scoping review. Curr Opin Psychiatry. 2023;36(6):427–37. https://doi.org/10.1097/YCO.0000000000000892.
Ng LWC, Ng DP, Wong WP. Is supervised exercise training safe in patients with anorexia nervosa? A meta-analysis. Physiotherapy. 2013;99(1):1–11.
Zeeck A, Schlegel S, Jagau F, Lahmann C, Hartmann A. The Freiburg sport therapy program for eating disorders: a randomized controlled trial. J Eat Disord. 2020;8(1):31–43.
Wade TD, Johnson C, Byrne SM. Randomized controlled psychotherapy trials in eating disorders: improving their conduct, interpretation and usefulness. Int J Eat Disord. 2018;51:629–36.
Linardon J, Wade TD, de la Piedad GX, Brennan L. The efficacy of cognitive-behavioral therapy for eating disorders: a systematic review and meta-analysis. J Consult Clin Psychol. 2017;85(11):1080–94. https://doi.org/10.1037/ccp0000245.
Rosenzweig S. Some implicit common factors in diverse methods of psychotherapy. Am J Orthopsychiatry. 1936;6:412–5.
Wade TD, Hart LM, Mitchison D, Hay P. Driving better intervention outcomes in eating disorders: a systematic synthesis of research priority setting and the involvement of consumer input. Eur Eat Disord Rev. 2021;29(3):346–54. https://doi.org/10.1002/erv.2759.
Wade TD. Developing the “single-session mindset” in eating disorder research: Commentary on Schleider, et al 2023 Realizing the untapped promise of single-session interventions for eating disorders. Int J Eat Disorders. 2023;2023(56):864–6. https://doi.org/10.1002/eat.23930.
Steen E, Wade TD. Treatment of co-occurring food avoidance and alcohol use disorder in an adult: possible Avoidant Restrictive Food Intake Disorder? Int J Eat Disord. 2018;51(4):373–7. https://doi.org/10.1002/eat.22832.
Waller G, Tatham M, Turne H, Mountford VA, Bennetts A, Bramwell K, Dood J, Ingram L. A 10-session cognitive-behavioral therapy (CBT-T) for eating disorders: outcomes from a case series of non-underweight adult patients. Int J Eat Disord. 2018;51(3):262–9. https://doi.org/10.1002/eat.22837.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.
Becker AE, Arrindell A, Perloe A, Fay K, Striegel-Moore R. A qualitative study of perceived social barriers to care for eating disorders: perspectives from ethnically diverse health care consumers. Int J Eat Disord. 2010;43(7):633–47. https://doi.org/10.1002/eat.2075.
Swanson SA, Field AE. Commentary: considerations for the use of registry data to study adolescent eating disorder. Int J Epidemiol. 2016;45(2):488–90. https://doi.org/10.1093/ije/dyw084.
Attia E, Marcus MD, Walsh BT, Guarda A. The need for consistent outcome measures in eating disorder treatment programs: a proposal for the field. Int J Eat Disord. 2017;50(3):231–4. https://doi.org/10.1002/eat.22665.
Landstedt E, Wade TD, Fairweather-Schmidt AK, Hammarstrom A. Associations between adolescent risk for restrictive disordered eating and long-term outcomes related to somatic symptoms. Br J Health Psychol. 2018;23:496–518. https://doi.org/10.1111/bjhp.12301.
Trompeter N, Bussey K, Forbes MK, Mond J, Hay P, Basten C, Goldstein M, Thornton C, Heruc G, Byrne S, Griffiths S, Lonergan A, Touyz S, Mitchison D. Differences between Australian adolescents with eating disorder symptoms who are in treatment or not in treatment for an eating disorder. Early Interv Psychiatry. 2021;15(4):882–8. https://doi.org/10.1111/eip.13027.
Hamilton A, Mitchison D, Basten C, Byrne S, Goldstein M, Hay P, Heruc G, Thornton C, Touyz S. Understanding treatment delay: perceived barriers preventing treatment-seeking for eating disorders. Aust N Z J Psychiatry. 2022;56(3):248–59. https://doi.org/10.1177/00048674211020102.
Trompeter N, Bussey K, Forbes MK, Hay P, Goldstein M, Thornton C, Basten C, Heruc G, Roberts M, Byrne S, Griffiths S, Lonergan A, Mitchison D. Emotion dysregulation and eating disorder symptoms: examining distinct associations and interactions in adolescents. Res Child Adolescent Psychopathol. 2022;50(5):683–94. https://doi.org/10.1007/s10802-022-00898-1.
Babbott KM, Mitchison D, Basten C, Thornton C, Hay P, Byrne S, Goldstein M, Heruc G, van der Werf B, Consedine NS, Roberts M. Intuitive Eating Scale-2: psychometric properties and clinical norms among individuals seeking treatment for an eating disorder in private practice. Eat Weight Disord. 2022;27(5):1821–33. https://doi.org/10.1007/s40519-021-01326-x.
Davis H, Attia E. Pharmacotherapy of eating disorders. Curr Opin Psychiatry. 2017;30(6):452–7. https://doi.org/10.1097/YCO.0000000000000358.
Richard-Kassar T, Martin LA, Post KM, Goldsmith S. Understanding drift in the treatment of eating disorders using a mixed-methods approach. Eat Disord J Treatm Prev. 2023;31(6):573–87. https://doi.org/10.1080/10640266.2023.2201993.
Waller G. Evidence-based treatment and therapist drift. Beh Res Therapy. 2009;47:119–27.
Acknowledgements
Not applicable.
Funding
No funding was received for this manuscript.
Author information
Authors and Affiliations
Contributions
Both authors (SB and AF) contributed to the writing of this manuscript. Both authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Byrne, S.M., Fursland, A. New understandings meet old treatments: putting a contemporary face on established protocols. J Eat Disord 12, 26 (2024). https://doi.org/10.1186/s40337-024-00983-4
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s40337-024-00983-4