Eating Disorder Service Research Articles

Virtually delivered guided self-help for binge eating disorder and bulimia nervosa: findings from a service evaluation.

Timely intervention is beneficial to the effectiveness of eating disorder (ED) treatment, but limited capacity within ED services means that these disorders are often not treated with sufficient speed. This service evaluation extends previous research into guided self-help (GSH) for adults with bulimic spectrum EDs by assessing the feasibility, acceptability, and preliminary effectiveness of virtually delivered GSH using videoconferencing. Patients with bulimia nervosa (BN), binge eating disorder (BED) and other specified feeding and eating disorders (OSFED) waiting for treatment in a large specialist adult ED out-patient service were offered virtually delivered GSH. The programme used an evidence-based cognitive behavioural self-help book. Individuals were supported by non-expert coaches, who delivered the eight-session programme via videoconferencing. One hundred and thirty patients were allocated to a GSH coach between 1 September 2020 and 30 September 2022; 106 (82%) started treatment and 78 (60%) completed treatment. Amongst completers, there were large reductions in ED behaviours and attitudinal symptoms, measured by the ED-15. The largest effect sizes for change between pre- and post-treatment were seen for binge eating episode frequency (d = -0.89) and concerns around eating (d = -1.72). Patients from minoritised ethnic groups were over-represented in the non-completer group. Virtually delivered GSH is feasible, acceptable and effective in reducing ED symptoms amongst those with bulimic spectrum disorders. Implementing virtually delivered GSH reduced waiting times, offering a potential solution for long waiting times for ED treatment. Further research is needed to compare GSH to other brief therapies and investigate barriers for patients from culturally diverse groups.

A Qualitative Exploration of Prominent Factors Contributing to the Aetiology of Child and Adolescent Eating Disorder Presentations during the COVID-19 Pandemic: The Perspectives of Patients, Parents and Clinicians.

The aim of this study was to explore the prominent factors that contributed to the development of child and adolescent eating disorder presentations during the COVID-19 pandemic. This was achieved through a qualitative analysis of interviews gathered from (1) adolescent patients diagnosed with an eating disorder (ED) during the COVID-19 pandemic (aged 13-18) (n = 4), (2) parents of patients attending an ED service (n = 7) and (3) clinicians working within a specialist child and adolescent ED support service (n = 7). Reflexive thematic analysis was used to analyse the data and establish the most prominent aetiological factors reported. The most prominent aetiological factors reported were (1) the accumulation of risk factors; (2) seeking control amid increased anxiety, stress and uncertainty; (3) social isolation; (4) an increased focus on exercise and "healthy eating"; (5) increased social media use promoting unhelpful attention towards ED triggers; and (6) a lack of both awareness and support services. During the COVID-19 pandemic, the quantity and severity of ED presentations increased. The current study uncovered six themes perceived by patients, parents and clinical staff that contributed to the aetiology of ED presentations during the COVID-19 pandemic. It is hoped that the insight gained through this research study into ED aetiology may act as a basis for further research and support ED awareness, prevention and intervention in the future.

“It’s a Lot Deeper than the Way It Looks”: An Interpretative Phenomenological Analysis of Body Image for Men With Eating Disorders

Men represent a proportion of those with eating disorders yet are neglected in the existing literature. One area with limited research is how men with eating disorders experience body image. This study investigated how men with eating disorders make sense of their experience of body image. Ten male participants with diagnosed eating disorders were recruited from four National Health Service specialist adult eating disorder services. Semi-structured interviews were conducted, and data analysed with Interpretative Phenomenological Analysis. Analysis identified three themes: ‘Focus on Self’, ‘Focus on Others’ and ‘Systemic Influences and Pressures’. Findings indicated that body image was experienced intrapersonally, interpersonally, and systemically. This study adds to the limited accounts of body image among men with eating disorders. It is recommended that future research explore body image in underrepresented gender and sexuality groups and that clinicians incorporate the nuances of men’s experiences of body image into clinical assessment and treatment.

Listening to parents caring for individuals with eating disorders through the lens of the common-sense model of illness perception.

Marchetti and Sawrikar (International Journal of Eating Disorders, 2023) used the framework of the Common-Sense Model of the Self-Regulation to explore the perceptions and experiences of parents caring for individuals with anorexia nervosa (AN) from a systematic review of the literature. The studies they reviewed delved into the subjective experiences of parents and considered the influence of emotional and cognitive representations of AN which were predominantly negative. Parents play a key role in all stages of the management of an eating disorder and so our commentary sets the findings into the wider context of eating disorder services. It is important that we continue to forge a collaborative approach with parents that addresses their needs and insights to improve our knowledge about, and services for people with eating disorders.

Implementation of an all-age eating disorders service in the National health service in England: The Dorset experience.

This article provides a commentary on the development of an integrated all-age eating disorders service in the Eating disorders service within the NHS in Dorset. Previously separate services existed for those under the age of 18 and those age 18 and over. The change from traditional age based services to the all age service was prompted by the observed problems with transitions for patients, their families and the service such as discontinuities in care, and distress to patients and families. In addition the literature on transitions although limited in eating disorders showed that patient and carer perspectives were mostly negative about transitions. The aim was to create an all-age service working with patients of different ages, through developing the competencies of the team to appropriately meet the needs of the all age population. This paper describes the context and rationale for this change, its implementation using the organisational change policy approach to service transformation, including addressing the concerns of the stakeholders (patients, carers, staff, and mental health service commissioners), as well as observed changes in the service and its development. Since the all-age service started in 2016, new research has become available on both the improvement of the transition experience and the potential advantages of all-age services and relevant aspects are discussed.

A Narrative Review of Early Intervention for Eating Disorders: Barriers and Facilitators.

Eating disorders (EDs) are serious psychiatric illnesses that typically develop during adolescence and emerging adulthood. Early intervention is important for improved outcomes for young people with EDs, yet help-seeking is low and individuals often have a significantly protracted start to treatment, suggesting that early intervention is not well established in the ED field. Previous reviews on facilitators and barriers to early intervention for EDs largely cover perceived barriers related to patient variables and perspectives, whereas clinician-, service-, and healthcare system-related facilitators and barriers are less frequently reviewed. The aim of this review is to synthesize the literature on barriers to and facilitators of early intervention for EDs, regarding patient-, clinician-, service-, and healthcare system-related factors. A narrative review was conducted by searching for relevant peer-reviewed, English-language articles published up until July 2023 on PubMed and PsychINFO. The search was conducted in two steps. First, key search terms were used to identify existing reviews and meta-analyses on facilitators and barriers to early intervention for EDs. Then, additional search terms were added to search for primary and secondary research on patient/family, clinician, service, and healthcare system-related barriers and facilitators. The identified literature shows that, after overcoming intrinsic, motivational barriers (such as self-stigma, denial, and ambivalence), help-seeking individuals may be met with long service waiting lists and limited treatment options. Despite these barriers, there is ongoing research into early intervention in practice, which aims to reach underserved populations and facilitate early intervention despite high service demands and shortages of trained healthcare professionals. Funding for ED research and services has historically been low, and there is also a research-practice gap. This highlights the need for increased consideration of, and funding for early intervention for EDs, to remove barriers as well as facilitate discussions around how to make early intervention programs scalable and sustainable.

Co-producing an inclusive-care model for young people transitioning from adolescent eating disorder services to adult care: A qualitative study protocol for Transition for Eating Disorder Youth intervention.

Eating disorders (EDs) present a chronic issue to child paediatric mental health services due to their high mortality and relapse rates. The transition from Child and Adolescent Mental Health Services to Adult Mental Health Services is a particularly high-risk period for young people with EDs given their high vulnerability to change, which can negatively impact treatment outcomes. However, there is lack of evidence on the feasibility of inclusive and youth-specific interventions that address the multiple and complex needs of this group during their transition to adult care. This proposed study aims to develop a newly introduced model of care called Transition for Eating Disorder Youth intervention (TEDYi) for young people aged 16-18years with EDs transitioning from adolescent ED services to adult care. TEDYi will be co-produced with young people, carers, and staff targeting interpersonal and psychosocial needs during the transition process. The first phase of the study involves interviews with young people (N=15) and carers (N=15) as well as focus groups with mental health professionals (N=15) across four ED adolescent and adult specialist services to explore their transition experiences. The second phase, consists of four Experience-Based Co-Design workshops, aimed at collaboratively developing and refining TEDYi.

A service evaluation exploring the experience of adults from a South Asian background within an eating disorders service

This paper outlines an evaluation exploring the experience of South Asian adults within an outpatient eating disorders service. Four interviews were analysed using Reflexive Thematic Analysis which created four themes, each advocating for individualised approaches. Clinical recommendations are discussed.

Enhanced recovery support for people with eating disorders during the COVID-19 pandemic: quality improvement using a web-based, stepped-care programme in Canada

BackgroundThroughout the COVID-19 pandemic, the number of individuals struggling with eating disorders (EDs) increased substantially. Body Brave (a not-for-profit) created and implemented a web-based stepped-care Recovery Support Programme (RSP) to...

The Role of Primary Care in Bridging Adolescents Awaiting Eating Disorder Treatment.

The striking rise in adolescent eating disorders since the severe acute respiratory coronavirus syndrome 2 pandemic has amplified demands for specialty eating disorders services and contributed to protracted delays in care. In the context of these delays, patients are at risk for increased weight loss, medical instability, escalating disease progression and poor prognosis. Primary care providers (PCPs) are frequently the first point of contact for young patients with eating disorders and are often left to bridge the gap while families struggle to establish specialty care. Yet, beyond case detection and medical comanagement, there are no evidence-based guidelines that can assist PCPs to prepare families for treatment, halt disease progression, and begin the lengthy process of weight and nutritional restoration in efforts to reduce medical complications and support a favorable prognosis. We present the case of a 13-year-old girl with a restrictive eating disorder to illustrate how PCPs can use intervention principles and strategies derived from evidence-based eating disorder treatment to successfully manage adolescent patients until they can access specialty treatment. We offer concrete guidelines for decision-making, as well as suggested behavioral and medical interventions for the PCP. With evidence-based tools, PCPs are well-positioned to support young patients with restrictive eating disorders and their family members as they begin the process of recovery from an eating disorder.

Development of the medical admission pack project: Utilising the expert-by-experience voice to improve experiences of medical admissions in young people with eating disorders

Young people with eating disorders can present with physical health risks that require admission to a general hospital ward which can be a negative experience. As part of a service development initiative within the CAMHS Community Eating Disorder Service for Rotherham Doncaster and South Humber NHS Foundation Trust, we co-produced a Medical Admission Pack for Young People. It was designed based on assimilated data from a focus group, an interview and surveys, gathered from young people who had experienced an admission to a general ward, their parents/carers and ward staff. Thematic analysis was conducted to derive the three key themes: uncertainty, negative experiences and having a voice. The themes were used to guide the construction of The Medical Admission Pack, which was co-produced between the service and expert by experience service users, in line with the six principles of trauma-informed care (safety, trust, choice, collaboration, empowerment and cultural consideration). The packs were developed to help reduce the negative experiences during admissions by resolving uncertainty – to promote psychological safety and trust – as well as empowering young people. Anecdotal evidence suggests that the aims of the pack were met, however further evaluation is still needed. A further advancement of this pack was an edition for parents/carers, based on similar principles but suited to the needs of the parent/carer The parent/carer pack is relatively new and requires evaluation to determine the effectiveness.

Acceptability, feasibility and short-term outcomes of temperament based therapy with support (TBT-S): a novel 5-day treatment for eating disorders

BackgroundTemperament Based Therapy with Support (TBT-S) aims to target the mechanisms underlying the aetiology and maintenance of eating disorders, and was developed as an adjunct to treatment as usual. There is limited research investigating acceptability, feasibility and possible benefits of TBT-S. Therefore, the primary aim of the current study was to assess treatment feasibility and acceptability at a tertiary specialized eating disorders service in Norway, with a secondary aim to explore possible benefits in clinical outcome.MethodsForty-one patients (mean age 25.3, range 18–43) and 58 supports were assessed pre- and post TBT-S. The majority of the patients were diagnosed with either anorexia nervosa or atypical anorexia nervosa. Participants completed an 18-item Patient and Support Satisfaction Questionnaire, in addition to a questionnaire assessing the usefulness of the different intervention components and strategies utilised in TBT-S, as well as a 4-item treatment satisfaction questionnaire. Measures of treatment efficacy were completed at both time-points, whereas treatment acceptability was only assessed post-treatment.ResultsFindings reveal that TBT-S is a feasible treatment with high client satisfaction. Preliminary outcome data were also encouraging, and in line with previous studies. There were no voluntary drop-outs. All participants, both patients and supports, reported that TBT-S helped them deal more effectively with their challenges. After completing treatment, there was a significant decrease in patients’ self-reported eating disorder psychopathology, psychosocial impairment and state anxiety, while trait anxiety remained unchanged. Patients also reported significantly improved social relationships, whereas supports reported a significant increase in (own) psychological health. There were no differences in family functioning.ConclusionsTBT-S is a promising new treatment for eating disorders with high acceptability scores and low treatment attrition. Future studies should aim to explore methods which can most appropriately measure the effect of TBT-S and the usefulness of the different components of this treatment. Randomised controlled trials are needed to assess treatment efficacy of TBT-S.

General psychiatric inpatient care for persons with anorexia nervosa—an integrative literature review protocol

IntroductionPeople diagnosed with anorexia nervosa are offered or compelled to undergo various treatments and therapies. In Sweden, the lack of highly specialised eating disorder services means that people with anorexia...

Assessing the feasibility of an intervention for adolescents and parents transitioning out of paediatric eating disorder services: A mixed methods study.

To assess the feasibility of a new intervention designed to support adolescents and parents in the transition from paediatric eating disorder (ED) treatment to adult mental health services. Pre-transition adolescents with EDs, and their parents, were invited to complete up to five transition intervention components over 3months. A mixed methods design was used to assess intervention feasibility, comprised of acceptability and preliminary effectiveness. A single-arm pre-post design was used to collect and analyse quantitative survey and feasibility data. Individual qualitative interviews and written reflections were collected and analysed using content analysis. This study yielded a 33% (10/31) recruitment rate and 68% (13/19) retention rate. On average, participants completed 75% of the expected components in under 3months, with varied completion of each expected intervention component (40%-100%). Participants found the intervention convenient and helpful. Parents reported a significant decrease in guilt (Z=-2.02, p=0.04, d=-0.83). By 1-month post-transition, three adolescents transitioned to interim supports and none started specialist adult treatment. Although this transition intervention did not demonstrate adequate feasibility, its acceptability and effectiveness should be evaluated after an update based on participant feedback. Other solutions to bridge the transition gap for adolescents with EDs should continue to be identified. NCT04888273.

Effectiveness of enhanced cognitive behaviour therapy for patients aged 14 to 25: A promising treatment for anorexia nervosa in transition-age youth.

The study aimed to evaluate the effectiveness of enhanced cognitive behaviour therapy (CBT-E) on patients with anorexia nervosa (AN) aged 14 to 25 treated in a real-world setting. One hundred and fifteen patients with AN (n=61, age <18years) were recruited from consecutive referrals to a clinical eating disorder service offering outpatient CBT-E. Body Mass Index (BMI), BMI centiles, Eating Disorder Examination Questionnaire, Brief Symptom Inventory, and Clinical Impairment Assessment scores were recorded at admission, at the end of treatment, and at 20-week follow-up. The seventy-two patients (62.6%) who finished the programme showed considerable weight gain and reduced scores for clinical impairment and eating-disorder and general psychopathology. Changes remained stable at 20weeks. A comparison between adolescent and adult patients indicates similar improvements in eating-disorder psychopathology. The benchmark data yielded by this study suggest that CBT-E is a well-accepted and promising treatment that could be adopted to ensure continuity of care across the transitional age.

The alarms should no longer be ignored: survey of the demand, capacity and provision of adult community eating disorder services in England and Scotland before COVID-19.

This national pre-pandemic survey compared demand and capacity of adult community eating disorder services (ACEDS) with NHS England (NHSE) commissioning guidance. Thirteen services in England and Scotland responded (covering 10.7 million population). Between 2016-2017 and 2019-2020 mean referral rates increased by 18.8%, from 378 to 449/million population. Only 3.7% of referrals were from child and adolescent eating disorder services (CEDS-CYP), but 46% of patients were aged 18-25 and 54% were aged >25. Most ACEDS had waiting lists and rationed access. Many could not provide full medical monitoring, adapt treatment for comorbidities, offer assertive outreach or provide seamless transitions. For patient volume, the ACEDS workforce budget was 15%, compared with the NHSE workforce calculator recommendations for CEDS-CYP. Parity required £7 million investment/million population for the ACEDS. This study highlights the severe pressure in ACEDS, which has increased since the COVID-19 pandemic. Substantial investment is required to ensure NHS ACEDS meet national guidance, offer evidence-based treatment, reduce risk and preventable deaths, and achieve parity with CEDS-CYP.

Service evaluation of multi-family therapy for anorexia groups between 2013-2021 in a specialist child and adolescent eating disorders service.

The aims of the service evaluation were to examine the effectiveness of multi-family therapy for anorexia nervosa (MFT-AN) on family relationships, as well as to understand families' experiences of MFT in a specialist child and adolescent eating disorders service between 2013-2021. Mixed-methods were used (t-tests and reflexive thematic analysis). Delivery was in-person in 2013-2019, and moved online from 2020 due to COVID-19. Responses from a total of 57 families and 190 people were analysed. MFT improved family functioning from pre-to post MFT as measured by the Systemic Clinical Observation in Routine Evaluation (SCORE-15). Sub-group analysis by family roles showed that at four-month follow-up, the effects were no longer significant among parents. On the contrary, preliminary analysis showed that although young people did not report any improvement at post-intervention, family functioning was reported to increase at follow-up. Four themes were constructed: being together as a family and as a group; individuality: everyone's recovery is different; MFT as an emotion 'hotpot', and in-person versus virtual groups: not a one-size-fits-all. More robust follow-up data are needed to ascertain the effects of online MFT-AN.

Evidence of effectiveness of specialist supportive clinical management for anorexia nervosa in routine clinical practice: Outcomes from a clinical case series.

This study provides a preliminary report on the effectiveness of Specialist Supportive Clinical Management (SSCM) in a clinical case series of adults with anorexia nervosa, to supplement evidence of efficacy from controlled trials. Body mass index (BMI), eating disorder symptoms, mood and anxiety were measured at the start and end of treatment for 42 adults who received SSCM in a community eating disorders service. Significant improvements were observed on all outcome measures, with larger effect sizes for symptom change than BMI. Recovery rates appear similar to those in clinical trials. The study offers preliminary support for the effectiveness of SSCM in routine settings and identifies several areas for further research.

Implementation of the medical emergencies in eating disorders in adults guidance on non-specialist units

The Royal College of Psychiatrists recently published data showing an 84% increase in UK hospital admissions for eating disorders over the past 5 years, highlighting the importance of the college's new Medical Emergencies in Eating Disorders (MEED) guidance. This includes a 79% increase among adults, many of whom are admitted to general medical wards that do not have input from expert eating disorders services. Consequently, the multidisciplinary nutrition support team, nutrition specialist nurses and dietitians have a potentially vital role in implementing MEED to ensure that the appropriate nutritional, fluid and electrolyte management is in place for safe refeeding and avoidance of the potentially harmful underfeeding syndrome. Furthermore, the guidance includes special recommendations for the use of nasogastric feeding in eating disorder patients, which requires input from experts in this field, including specialist nurses and dietitians. This article focuses on the implementation of MEED on hospital wards that do not have input from specialist eating disorders services.

A return to Sartre. An existential approach to the therapeutic relationship with young people with anorexia nervosa: Clinical examples from an inpatient eating disorder service

ABSTRACT The NICE guidelines (2017) for the psychological treatment of anorexia nervosa in young people recommend family-based therapy, cognitive behaviour therapy or psychodynamic therapy focused on the eating disorder, of all which externalisation is an integral technique. In contrast to this, we are challenging the premise of this method by using Sartre’s phenomenological ontology that does not presuppose the separation of the person from the illness, which is the basic premise of the externalisation. We present the key-concepts of Sartre as described in ‘Being and Nothingness’. We describe the ontological categories of the in itself and for itself, and their development into human reality in the form of facticity and transcendence. In addition, we explore the concept of the look, the psychic body and the notion of objectification through three clinical cases. We conclude by reflecting on the value of Sartre’s existential ontology to the promotion of the importance of collaboration in co-constructing treatment with patients and their families.