A proportion of patients with anorexia nervosa require compulsory admission due to treatment refusal in the context of high medical or psychiatric risk.

The clinical characteristics and treatment outcomes of patients with anorexia nervosa compulsorily admitted for in-patient care (current and previous) were compared with those of patients admitted voluntarily. The characteristics of their caregivers were also evaluated.

This is a secondary analysis of the Transition Care in Anorexia Nervosa Through Guidance Online from Peer and Carer Expertise trial. We included 274 patient–caregiver dyads: 62 on compulsory admission (‘current compulsory’), 48 on voluntary admission with a history of compulsory treatment (‘previous compulsory’) and 164 on voluntary admission without a history of compulsory treatment (‘voluntary’). Baseline demographic and clinical characteristics, and longitudinal clinical outcomes at 3–6 and 9–12 months, were compared across groups.

Patients in the current compulsory group had an earlier age of onset, a higher proportion of obsessive–compulsive disorder comorbidity and less motivation and confidence to change compared with the voluntary group. The previous compulsory group showed a longer illness duration, older age and lower body mass index (BMI) compared with the other groups. All groups showed improvement, with similar outcomes at the end of the study except for depression symptoms and BMI. Caregivers had varying levels of distress and caregiving skills at baseline, which had improved by the end of the study.

People receiving current or previous compulsory treatment presented with diverse clinical presentations. Further studies are needed to determine whether more individualised approaches improve outcomes in these subgroups.

Trial registration number and data-set information: ISRCTN14644379.

Early intervention increases the likelihood of eating disorder recovery but many young people delay help-seeking. We developed a smartphone-friendly, online decision-making tool to address this gap (FREED-Mobile (FREED-M)).

To conduct a randomised controlled feasibility trial of the FREED-M decision-making tool with 16- to 25-year-olds with a suspected eating disorder and no previous treatment for this.

Participants were randomly allocated to FREED-M or an active control in a parallel group, two-arm trial. Outcomes were measured at weeks 0 (baseline), 4 (post-intervention) and 12 (follow-up). The primary feasibility outcome was attrition at follow-up. Other outcomes included motivational, clinical and economic measures.

We over-recruited with 204 randomised participants (including 20 fraudulent participants). Main analyses were conducted with 184 genuine responders (FREED-M: n = 91, control: n = 93). At baseline, participants’ mean age was 21.0 (s.d. 2.0) years, 89% identified as female and 64% as White. Mean body mass index was 23.1 kg/m2 (6.3). N = 83 participants had an anorexia nervosa-like disorder, 101 had another eating disorder or high eating disorder risk. Attrition at week 12 was n = 112 (61%). Of the n = 42 FREED-M participants who provided acceptability ratings, 79% liked the intervention and 66% found it useful. Between-group effect sizes for motivation and readiness to change were small to medium at 4 weeks (d = 0.27 and d = 0.15, respectively) favouring FREED-M, but differences were not sustained at follow-up (d = −0.02 and d = −0.12, respectively).

Although the attrition rate was high, recruitment exceeded expectations. Acceptability of FREED-M was high among participants who provided acceptability ratings. Motivation/readiness to change and help-seeking are candidates for primary outcomes in a future randomised controlled trial.

Reinforcement motivation, particularly heightened punishment sensitivity and its imbalance relative to reward sensitivity (“motivational bias”), can predict outcomes in anorexia nervosa (AN). However, previous studies did not account for affective symptoms, which are intertwined with reinforcement processes and illness trajectory. This study examined whether affective symptoms explain outcomes beyond reinforcement motivation.

Adolescent girls and young women with AN (n = 192; Mage = 16.33 years, SD = 2.61) completed self-report measures of punishment/reward sensitivity, depressive symptoms, and trait anxiety at treatment admission and at 1-year follow-up. Outcomes included ED symptoms, body mass index, and multidimensional recovery (Morgan–Russell outcome assessment schedule). Cross-sectional comparisons included long-term recovered individuals (n = 154) and healthy controls (n = 440); longitudinal associations were tested using nested linear regression.

Patients with AN and recovered individuals showed elevated punishment sensitivity (η2ₚ = 0.19) and stronger motivational bias (punishment>reward; η2ₚ = 0.17). At baseline, reinforcement motivation and affective symptoms showed limited predictive utility. Longitudinally, shifts in motivational bias were associated with ED symptoms and multidimensional outcomes (|β| > 0.248, pFDR < .002), whereas changes in affective symptoms were the most robust and consistently associated predictors (|β| > 0.173, pFDR < .017).

Depressive symptom improvement emerged as the key predictor of outcome, showing stronger associations with follow-up ED symptoms and psychosocial functioning than reinforcement motivation. While changes in reinforcement motivation accompanied ED outcomes, affective symptom change was more predictive across outcomes. These findings emphasize the importance of prioritizing affective processes within developmentally tailored AN treatment frameworks.

There has been growing interest in developing a clinical staging model for eating disorders (EDs). The aim of this scoping review is to investigate the extent, range, and nature of research that can inform clinical staging approaches for EDs.

This review was conducted following the Joanna Briggs Institute methodology for scoping reviews and the PRISMA extension for Scoping Reviews. A search of PubMed, PsycINFO, MEDLINE and Web of Science databases was conducted. Sixty studies were included for review, and data were extracted according to revised pre-published criteria. Studies were summarized using narrative synthesis.

Thirty-six of the included manuscripts were quantitative, 18 were qualitative, and six were conceptual/review papers. The included studies primarily focused on anorexia nervosa in white, female samples and compared only two stages of illness, equating to “early” and “longstanding” or “severe and enduring” EDs. “Middle” stages or transitions between stages were not well-defined. Stages have mostly been conceptualized using duration of illness or other behavioral or clinical parameters, with few (neuro) biological studies identified. Factors that may modify illness stage have not yet been integrated into ED staging literature.

There is growing consensus that early- and later-stage EDs have distinct characteristics and treatment requirements; however, these distinctions require clearer definition. Recommendations for future research are outlined, emphasizing integration of psychosocial and biological research, focused investigation of illness phases outside of early and longstanding phases, and evaluation of personalized, stage-based treatments. A tentative staging model for EDs is proposed.

The increasing demand for adolescent eating disorder services during and following the COVID-19 pandemic necessitated alternative treatment approaches. Traditional in-patient and daycare settings faced challenges, including resource limitations and geographical accessibility.

To describe and evaluate the outcomes of the Hospital at Home (H@H) service, an innovative, virtual, intensive treatment programme designed to prevent in-patient admissions or shorten length of in-patient stay.

A prospective cohort of 71 consecutive admissions from October 2021 to December 2024 was established. Data included percentage median body mass index (%mBMI), Eating Disorders Examination Questionnaire (EDE-Q), Children’s Global Assessment Scale (CGAS) and any readmissions for in-patient treatment within the following 6 months. Qualitative feedback was also sought from staff and a sample of patients and family members.

Of the 71 admissions to H@H, only 9 (13%) required hospitalisation. Mean %mBMI increased significantly, from 82.4% (s.d. 8.17) on admission to 90.07% (s.d. 9.44) on discharge (p < 0.001, 95% CI 5.67 to 9.61). Global EDE-Q score improved significantly, from 3.75 (s.d. 1.32) on admission to 2.62 (s.d. 1.45) on discharge (p < 0.001, 95% CI −1.47 to −0.78). Average CGAS improved significantly, from 38.7 (s.d. 7.4) on admission to 51.8 (s.d. 14.2) on discharge (p < 0.001, 95% CI 10.06 to 16.11). Families and patients reported high satisfaction with the virtual care model.

This innovative model prevented hospital admissions, demonstrating clinical benefits and high user satisfaction. Expansion and further research are recommended to explore the long-term clinical outcomes and cost-effectiveness.

Cognitive behavioural therapy (CBT) for eating disorders (EDs) does not yield consistent long-term recovery for all patients, highlighting the need to better understand underlying cognitive mechanisms. Recent work suggests that beliefs about losing control – particularly anticipated catastrophic consequences – may serve as key etiological and maintenance factors.

This study examined whether negative beliefs about losing control predict general ED symptomatology in an undergraduate sample.

Data were drawn from a larger psychometric study on control-related constructs and obsessive-compulsive symptoms. A total of 262 undergraduate participants completed the Beliefs About Losing Control Inventory – Second Edition (BALCI-II), Eating Disorder Examination Questionnaire (EDE-Q 6.0), and Depression, Anxiety and Stress Scale (DASS-21).

Simple linear regression indicated that BALCI-II total scores significantly predicted EDE-Q total scores (adj. R2=.08, F1,260=23.61, p<.001). However, in a hierarchical regression, BALCI-II scores did not account for additional variance in ED symptoms beyond depression (ΔR2=.18, ΔF1,259=.624, p=.43). Subscale analyses showed that fears of losing control leading to overwhelming emotions significantly predicted ED symptoms (β=.22, t259=3.03, p=.006), whereas fears related to madness and dangerous behaviours were not significant predictors.

Beliefs about losing control – especially fears of overwhelming emotions – appear to contribute to ED symptom maintenance. These findings provide initial psychometric support for prior qualitative research and suggest such beliefs may represent a meaningful treatment target within CBT. Future research should investigate causal relationships between these beliefs and ED psychopathology.

The treatment of eating disorders by the National Health Service in England and Wales adheres to the National Institute for Health and Care Excellence (NICE) guidelines, which were informed by an experimental evidence base.

As the presentation and treatment of eating disorders have been shown to vary on the basis of age, we aimed to review the representation of older people in the evidence base for the NICE guidelines.

The evidence base was reviewed by identification of participant ages and the recruitment methods used in the experimental literature. The use of clinician referral was of particular interest, owing to the age-dependent risk of eating disorders being misdiagnosed in older adults.

The results highlighted low participant ages across the evidence base, most notably in anorexia nervosa samples. In accordance with the age data, a high frequency of clinician referral was used to recruit participants, with the highest rate identified in anorexia nervosa samples.

NICE guidance fails to consider the economic, social, political and health contexts around onset or chronological development of an eating disorder, with no reference to comorbidities which are commonly reported with older people or how this might affect diagnosis, formulation and treatment recommendations. Research is urgently required to inform clinical recommendations for older adults.

While increasing research is reporting a higher presence of autistic traits (AT) in patients with borderline personality disorder (BPD), both autism spectrum disorder (ASD) and BPD have been associated in literature with a vulnerability to trauma and eating disorders.

The present study aimed at evaluating trauma-related symptoms and eating disorder symptoms in BPD patients with or without significant AT.

A sample of 73 BPD patients was assessed with the adult autism subthreshold (AdAS) Spectrum, trauma and loss spectrum-self report (TALS-SR), and EDI-2 questionnaires.

The findings revealed that BPD patients with autistic traits (BPD-AT) scored significantly higher on the eating disorder inventory (EDI-2) and trauma and loss scale (TALS-SR) compared to those without AT. Moreover, while both AdAS Spectrum and TALS-SR scores predicted higher EDI-2 scores, a significant mediating effect of TALS-SR on the relationship between AdAS Spectrum and EDI-2 scores was reported.

These results suggest that AT may imply more severe clinical correlates in the BPD population, including an enhanced vulnerability toward psychopathological traits frequently reported in BPD patients such as eating disorders and trauma-related symptoms, stressing the need to clarify the complex interactions among these disorders and the factors that may shape specific illness trajectories.

Standard treatments for eating disorders (EDs) typically include nutritional rehabilitation, psychotherapy, and pharmacotherapy, often resulting in modest effectiveness. Neuromodulation has been proposed as a potential add-on strategy. This review aims to critically evaluate its effects on EDs.

The PICO framework was used to conduct a search according to the PRISMA guidelines for systematic reviews (PROSPERO Registration no. CRD42024559700). Descriptive and clinical data for each study, including comorbidity and safety, were tabulated by disorder. Quality assessment was performed using the RoB2 and ROBINS-I tools.

Fifty-eight studies examining rTMS, tDCS, DBS, ECT, iTBS, and dTMS in AN, BN, and BED met inclusion criteria. In AN, the effects of rTMS and tDCS on weight and BMI were modest, with notable benefits for adolescents. Conversely, in refractory AN, DBS produced significant and lasting increases in BMI and reductions in comorbid psychopathology. For BN, single-session rTMS reduced cravings acutely, while multisession results were mixed; tDCS enhanced self-control. In BED, right-DLPFC tDCS decreased cravings, food intake, and binge frequency, showing a dose-dependent effect, whereas early data on NAcc DBS were promising but limited.

Noninvasive stimulation methods effectively reduced cravings and impulsivity, showing more consistent improvements in BN and BED than in weight restoration for AN. Overall, this pattern replicates recent review reports. However, variations in study designs, stimulation protocols, and outcome measures may undermine the reliability of these conclusions and complicate comparisons across studies. Future studies should be adequately powered, multisession, with durability endpoints, and target and dose refinement.

Test whether a dissonance-based transdiagnostic eating disorder treatment, body project treatment (BPT), produces greater reduction in brain reward region response to the thin ideal and behaviors used to pursue this ideal and eating disorder symptoms, and higher abstinence from eating disorder behaviors and remittance from eating disorder diagnoses than a matched transdiagnostic interpersonal psychotherapy (IPT).

Women with various eating disorders (N = 83) were randomized to 8-week group-implemented BPT or IPT and completed functional magnetic resonance imaging (fMRI) at pretest and posttest, and surveys and masked diagnostic interviews at pretest, posttest, and 6-month follow-up.

BPT versus IPT participants showed significantly greater reductions in mid cingulate cortex response to thin models, anterior cingulate cortex response to eating disorder behavior words, eating disorder symptoms (d = 0.54), and body dissatisfaction (d = 0.57), and marginally greater reductions in psychosocial impairment (d = 0.39) at posttest, as well as significantly greater reductions in body dissatisfaction (d = 0.68) and psychosocial impairment (d = 0.63), and marginally greater reductions in eating disorder symptoms (d = 0.53) at 6-month follow-up. At posttest, BPT versus IPT participants showed significantly greater abstinence from binge eating and purging (48% versus 23%, respectively) but did not differ on remittance from eating disorder diagnoses (52% versus 44%, respectively).

Results provide further evidence of target engagement for BPT and suggest that it is more effective than IPT in treating a range of eating disorders.

While around one-fifth of UK secondary school pupils exhibit clinically significant eating pathology, in-school mental health provision does not include interventions to address such eating pathology.

This preliminary qualitative study aimed to explore the views of staff, parents and pupils, on the idea of introducing a school-based brief cognitive behavioural therapy programme for non-underweight eating disorders.

31 pupils, 22 parents and 27 staff participated in 12 focus groups across four schools. The semi-structured interview guide covered topics around the practicalities of a potential eating disorders treatment programme, the acceptability of the intervention, and likelihood of future uptake.

Five over-arching themes and 12 subthemes emerged, reflecting the scale of eating and body image concerns, management limitations, and the importance of prioritising mental health over education. Advantages, challenges, considerations, and solutions were proposed for an in-school eating disorders treatment programme.

These qualitative data show that there is support for an appropriately implemented in-school delivery of brief, evidence-based treatment, demonstrating the potential scope of such an approach to support children and adolescents to receive early help with their eating problems and body image concerns.

Pharmacological efforts to treat anorexia nervosa (AN) have predominantly repurposed medications that treat conditions with overlapping symptoms and yielded generally disappointing results. Despite limited empirical support, SSRIs are often prescribed to patients with AN. Whether SSRIs are effective in a subgroup of individuals with AN, such as those with depression, is not known.

A secondary analysis of a randomized trial of fluoxetine versus placebo for relapse prevention in AN was conducted. Participants (n = 92) were weight-restored women with AN who completed the Beck Depression Inventory (BDI) at the time of randomization. BDI scores were dichotomized to reflect moderate/severe depression (BDI > 20, n = 26). A Cox Proportional Hazards model estimated the association of the level of depression, medication, and their interaction with time to relapse. Mixed effects models examined the effects of medication on symptom trajectories in high versus low depression groups and whether depression severity modified the effect of the drug on symptom trajectory.

There was a significant interaction between medication and depression severity in time to relapse (hazard ratio = 0.46, 95% CI: [0.25, 0.85], p = .01). Depression severity modified the effect of fluoxetine on the time course of symptoms of depression (β = −0.27, 95% CI: [−0.42,-0.12], p = 0.001) and bulimia (β = −0.15, 95% CI: [−0.25,-0.05], p = 0.004) in the twelve month follow-up period.

Fluoxetine was more effective than placebo in reducing relapse among more depressed, weight-restored individuals with AN. These results require replication but provide support for the use of antidepressant medication for patients with AN who remain depressed following weight restoration.