A large international team of investigators has reviewed current approaches to treating eating disorders and concluded that although personalization is widely valued, strong evidence to support tailored care strategies remains limited.
Feeding and eating disorders (FEDs)—including anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant/restrictive food intake disorder (ARFID)—are associated with serious medical complications and high mortality. Anorexia nervosa, in particular, has the highest mortality rate of any psychiatric condition.
Many patients with eating disorders also experience psychiatric comorbidities such as depression, anxiety, or obsessive-compulsive disorder, which can complicate treatment and lead to poorer outcomes. The investigators noted that just about 50% of patients fully recover with the best available psychological therapies, whereas 20% to 30% of them develop persistent, treatment-resistant disease.
“Patients, carers, and clinicians all have identified personalization of treatment as a priority,” said lead study author Ulrike H. Schmidt, of King’s College London, and colleagues.
Although there is increasing interest in using neuroimaging, machine learning, and other precision psychiatry tools to individualize treatment, these methods aren't yet ready for routine clinical use. Currently, personalization is largely driven by clinical judgment. Treatments like cognitive behavioral therapy for eating disorders (CBT-ED) and the Maudsley model for adults (MANTRA) incorporate individualized case formulations but lack clear guidance on how to match patients with specific interventions.
The investigators reviewed validated tools for assessing symptoms and tracking progress, including the Eating Disorder Examination (EDE) and the Eating Pathology Symptoms Inventory (EPSI). Early symptom improvement—typically within the first four to six sessions—was identified as a key predictor of long-term treatment success.
FEDs are known to lead to a range of serious medical issues. Self-starvation may cause cardiovascular issues, bone loss, and endocrine disruption. Purging behaviors are linked to electrolyte imbalances and cardiac risk. Binge-eating disorder is frequently associated with obesity, increasing the risk of type 2 diabetes, hypertension, and cardiovascular disease.
The investigators also highlighted disparities in diagnosis and access to care. Men, LGBTQ+ individuals, and those from racial and ethnic minorities are often underrepresented in treatment settings, despite evidence of increasing prevalence in these groups. The investigators recommended that future research and treatment approaches consider cultural, gender, and identity-related factors.
In the absence of robust precision tools, clinicians were advised to follow current evidence-based guidelines while tailoring care to individual patient needs. This includes close symptom monitoring and adjusting treatment strategies based on early response and clinical risk.
The authors reported no conflicts of interest.
Source: World Psychiatry