eating disorders research paper thesis statement

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• Published: 30 May 2023

Eating disorder outcomes: findings from a rapid review of over a decade of research

• Jane Miskovic-Wheatley 1 , 2 ,
• Emma Bryant 1 , 2 ,
• Shu Hwa Ong 1 , 2 ,
• Sabina Vatter 1 , 2 ,
• Anvi Le 3 ,
• National Eating Disorder Research Consortium ,
• Stephen Touyz 1 , 2 &
• Sarah Maguire 1 , 2  

Journal of Eating Disorders volume  11 , Article number:  85 ( 2023 ) Cite this article

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Eating disorders (ED), especially Anorexia Nervosa (AN), are internationally reported to have amongst the highest mortality and suicide rates in mental health. With limited evidence for current pharmacological and/or psychological treatments, there is a grave responsibility within health research to better understand outcomes for people with a lived experience of ED, factors and interventions that may reduce the detrimental impact of illness and to optimise recovery. This paper aims to synthesise the literature on outcomes for people with ED, including rates of remission, recovery and relapse, diagnostic crossover, and mortality.

This paper forms part of a Rapid Review series scoping the evidence for the field of ED, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021–2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/MEDLINE were searched for studies published between 2009 and 2022 in English. High-level evidence such as meta-analyses, large population studies and Randomised Controlled Trials were prioritised through purposive sampling. Data from selected studies relating to outcomes for people with ED were synthesised and are disseminated in the current review.

Of the over 1320 studies included in the Rapid Review, the proportion of articles focused on outcomes in ED was relatively small, under 9%. Most evidence was focused on the diagnostic categories of AN, Bulimia Nervosa and Binge Eating Disorder, with limited outcome studies in other ED diagnostic groups. Factors such as age at presentation, gender, quality of life, the presence of co-occurring psychiatric and/or medical conditions, engagement in treatment and access to relapse prevention programs were associated with outcomes across diagnoses, including mortality rates.

Results are difficult to interpret due to inconsistent study definitions of remission, recovery and relapse, lack of longer-term follow-up and the potential for diagnostic crossover. Overall, there is evidence of low rates of remission and high risk of mortality, despite evidence-based treatments, especially for AN. It is strongly recommended that research in long-term outcomes, and the factors that influence better outcomes, using more consistent variables and methodologies, is prioritised for people with ED.

Plain English summary

Eating disorders are complex psychiatric conditions that can seriously impact a person’s physical health. Whilst they are consistently associated with high mortality rates and significant psychosocial difficulties, lack of agreement on definitions of recovery, remission and relapse, as well as variations in methodology used to assess for standardised mortality and disability burden, means clear outcomes can be difficult to report. The current review is part of a larger Rapid Review series conducted to inform the development of Australia’s National Eating Disorders Research and Translation Strategy 2021–2031. A Rapid Review is designed to comprehensively summarise a body of literature in a short timeframe to guide policymaking and address urgent health concerns. This Rapid Review synthesises the current evidence-base for outcomes for people with eating disorders and identifies gaps in research and treatment to guide decision making and future clinical research. A critical overview of the scientific literature relating to outcomes in Western healthcare systems that may inform health policy and research in an Australian context is provided in this paper. This includes remission, recovery and relapse rates, diagnostic cross-over, the impact of relapse prevention programs, factors associated with outcomes, and findings related to mortality.

Introduction

Eating disorders (ED), especially Anorexia Nervosa (AN), have amongst the highest mortality and suicide rates in mental health. While there has been significant research into causal and maintaining factors, early identification efforts and evidence-based treatment approaches, global incidence rates have increased from 3.4% calculated between 2000 and 2006 to 7.8% between 2013 and 2018 [ 1 ]. While historically seen as a female illness, poorer outcomes are increasingly seen in other genders, including males [ 2 ].

Over 3.3 million healthy life years are lost worldwide due to ED each year, and many more lost to disability due to medical and psychiatric complications [ 3 ]. Suicide accounts for approximately 20% of non-natural deaths among people with ED [ 4 ]. As this loss of healthy life is preventable, there is a grave responsibility to better understand outcomes for people with ED, including factors which may minimise the detrimental impact they have on individuals, carers, and communities, as well as to optimise recovery.

There has been considerable debate within the clinical, scientific and lived experience (i.e., patient, consumer, carer) communities about the definition and measurement of key outcomes in ED, including ‘remission’ from illness (a period of relief from symptoms), ‘relapse’ (a resumption of symptoms) and ‘recovery’ (cessation of illness) [ 5 , 6 ], which can compromise outcome comparisons. Disparities include outcome variables relating to eating behaviours as well as medical, psychological, social and quality of life factors. There is increasing awareness in the literature of the elevated likelihood of diagnostic crossover [ 7 ]; research examining specific diagnostic profiles potentially misses outcomes where symptom experience transforms rather than alleviates. Methodological approaches in outcomes research are varied, the most significant being length of time to follow up, compromising direct study comparisons.

The aim of this Rapid Review (RR) is to synthesise the literature on outcomes for people with ED, including rates of remission, recovery and relapse, diagnostic crossover, and mortality. Factors influencing outcomes were summarised including demographic, illness, treatment, co-morbidities, co-occurring health conditions, societal factors, and impact of relapse prevention programs. This RR forms one of a series of reviews scoping the field of ED commissioned to inform the Australian National Eating Disorders Research and Translation Strategy 2021–2031 [ 8 ]. The objective is to evaluate the current literature in ED outcomes to identify areas of consensus, knowledge gaps and suggestions for future research.

The Australian Government Commonwealth Department of Health funded the InsideOut Institute for Eating Disorders (IOI) to develop the Australian Eating Disorders Research and Translation Strategy 2021–2031 [ 8 ] under the Psych Services for Hard to Reach Groups initiative (ID 4-8MSSLE). The strategy was developed in partnership with state and national stakeholders including clinicians, service providers, researchers, and experts by lived experience (including consumers and families/carers). Developed through a 2 year national consultation and collaboration process, the strategy provides the roadmap to establishing ED as a national research priority and is the first disorder-specific strategy to be developed in consultation with the National Mental Health Commission. To inform the strategy, IOI commissioned Healthcare Management Advisors (HMA) to conduct a series of RRs to broadly assess all available peer-reviewed literature on the six DSM-V [ 9 ] listed ED. RR’s were conducted in the following domains: (1) population, prevalence, disease burden, Quality of Life in Western developed countries; (2) risk factors; (3) co-occurring conditions and medical complications; (4) screening and diagnosis; (5) prevention and early intervention; (6) psychotherapies and relapse prevention; (7) models of care; (8) pharmacotherapies, alternative and adjunctive therapies; and (9) outcomes (including mortality) (current RR), with every identified paper allocated to only one of the above domains from abstract analysis by two investigators. Each RR was submitted for independent peer review to the Journal of Eating Disorders special edition, “Improving the future by understanding the present: evidence reviews for the field of eating disorders”.

A RR Protocol [ 10 ] was utilised to swiftly synthesise evidence to guide public policy and decision-making [ 11 ]. This approach has been adopted by several leading health organisations, including the World Health Organization [ 12 ] and the Canadian Agency for Drugs and Technologies in Health Rapid Response Service [ 13 ], to build a strong evidence base in a timely and accelerated manner, without compromising quality. RR was chosen as the most suitable design as it is conducted with broader search terms and inclusion criteria allowing to gain a better understanding of a specific field, returning a larger number of search results and providing a snapshot of key findings detailing the current state of a field at study [ 10 ]. A RR is not designed to be as comprehensive as a systematic review—it is purposive rather than exhaustive and provides actionable evidence to guide health policy [ 14 ].

The RR is a narrative synthesis adhering to the PRISMA guidelines [ 15 ]. It is divided by topic area and presented as a series of papers. Three research databases were searched: ScienceDirect, PubMed and Ovid/MEDLINE. To establish a broad understanding of the progress made in the field of eating disorders, and to capture the largest evidence base on the past 13 years (originally 2009–2019, but expanded to include the preceding two years), the eligibility criteria for included studies into the RR were kept broad. Therefore, included studies were published between 2009 and 2022, in English, and conducted within Western healthcare systems or health systems comparable to Australia in terms of structure and resourcing. The initial search and review process was conducted by three reviewers between 5 December 2019 and 16 January 2020. The re-run for the years 2020–2021 was conducted by two reviewers at the end of May 2021 and a final run for 2022 conducted in January 2023 to ensure the most up to date publications were included prior to publication.

The RR had a translational research focus with the objective of identifying evidence relevant to developing optimal care pathways. Searches, therefore, used a Population, Intervention, Comparison, Outcome (PICO) approach to identify literature relating to population impact, prevention and early intervention, treatment, and long-term outcomes. Purposive sampling focused on high-level evidence studies such as: meta-analyses; systematic reviews; moderately sized randomised controlled trials (RCTs) ( n  > 50); moderately sized controlled-cohort studies ( n  > 50), or population studies ( n  > 500). However, the diagnoses Avoidant Restrictive Food Intake Disorder (ARFID), Eating Disorder Not Otherwise Specified (EDNOS), Other Specified Feeding or Eating Disorder (OSFED) and Unspecified Feeding or Eating Disorder (UFED) necessitated a less stringent eligibility criterion due to a paucity of published articles. As these diagnoses are newly captured in the DSM-V [ 9 ] (released in 2013, within the allocated search timeframe), the evidence base is emerging, and fewer studies have been conducted. Thus, smaller studies ( n  ≤ 20) and narrative reviews were also considered and included. Grey literature, such as clinical or practice guidelines, protocol papers (without results) and Masters’ theses or dissertations, was excluded.

Full methodological details including eligibility criteria, search strategy and terms and data analysis are published in a separate protocol paper [ 10 ]. The full RR included a total of over 1320 studies (see Additional file 1 : Fig. S1). Data from included studies relating to outcomes for eating disorders were synthesised and are presented in the current review.

Of the 1320 articles included in the RR, the proportion of articles focused on outcomes in ED was relatively small, just less than 9% ( n  = 116) (see Additional file 2 : Table S1). Studies typically examined outcomes in AN, Bulimia Nervosa (BN) and Binge Eating Disorder (BED), with limited research in other diagnostic groups. Whereas most outcome studies reported recovery, remission and relapse rates, others explored factors impacting outcomes, such as quality of life, co-occurring conditions, and outcomes from relapse prevention programs.

ED, particularly AN, have long been associated with an increased risk of mortality. The current review summarises best available evidence exploring this association. Several factors complicate these findings including a lack of consensus on definitions of remission, recovery and relapse, widely varying treatment protocols and research methodologies, and limited transdiagnostic outcome studies or syntheses such as meta-analyses. Table 1 provides a summary of outcomes reported by studies identified in this review. There is considerable heterogeneity in the reported measures.

Overall outcomes

A good outcome for a person experiencing ED symptomatology is commonly defined as either remission or no longer meeting diagnostic criteria, as well as improved levels of psychosocial functioning and quality of life [ 28 , 29 ]. However, such a comprehensive approach is rarely considered, and there is no consensus on a definition for recovery, remission, or relapse for any of the ED diagnoses [ 30 , 31 ]. To contextualise this variation, definitions and determinants for these terms are presented in Table 2 .

The terms ‘remission’ and ‘recovery’ appear to be used interchangeably in the literature. Whilst ‘remission’ is usually defined by an absence of diagnostic symptomatology, and ‘recovery’ an improvement in overall functioning, the period in which an individual must be symptom-free to be considered ‘remitted’ or ‘recovered’ varies greatly between studies, follow-up (FU) time periods are inconsistent, and very few studies examine return to psychosocial function and quality of life (QoL) after alleviation of symptoms. The current review uses the terms adopted by the original studies. ‘Relapse’ is typically defined by a return of symptoms after a period of symptom relief. The reviewed studies report a variety of symptom determinants including scores on standardised psychological and behavioural interviews or questionnaires, weight criteria [including Body Mass Index (BMI) or %Expected Body Weight (%EBW)], clinical assessment by a multidisciplinary team, self-reported ED behaviours, meeting diagnostic criteria, or a combination of the above.

Remission, recovery, and relapse

In a global overview of all studies reviewed, remission or recovery rates were reported for around half of the cohort, regardless of diagnostic group. For example, a 30 month FU study of a transdiagnostic cohort of patients found 42% obtained full and 72% partial remission, with no difference between diagnostic groups for younger people; however, bulimic symptoms emerged frequently during FU, regardless of initial diagnosis [ 44 ]. A 6 year study following the course of a large clinical sample ( n  = 793) reported overall recovery rates of 52% for AN, 50–52% for BN, 57% for EDNOS-Anorectic type (EDNOS-A), 60–64% for BED and 64–80% for EDNOS-Bulimic type (EDNOS-B) [ 7 ]. Of those who recorded full remission at end of treatment (EOT), relapse was highest for AN (26%), followed by BN (18%), and EDNOS-B (16%). Relapse was less common for individuals with BED (11–12%), and EDNOS-A (4%). Change in diagnosis (e.g., from AN to BN) was also seen within the relapse group [ 7 ].

Longer-term FU studies may more accurately reflect the high rates of relapse and diagnostic crossover associated with ED. A 17 year outcome study of ED in adult patients found only 29% remained fully recovered, with 21% partially recovered and half (50%) remaining ill [ 52 ], noting the protracted nature of illness for adults with longstanding ED. Relapse is observed at high rates (over 30%) among people with AN and BN at 22 year FU [ 61 ]. In a large clinical study using predictive statistical modelling, full remission was more likely for people with BED (47.4%) and AN (43.9%) compared to BN (25.2%) and OSFED (23.2%) [ 41 ]. This result is distinct from other studies citing AN to have the worst clinical outcomes within the diagnostic profiles [ 52 ]. The cut‐off points for the duration of illness associated with decreased likelihood of remission were 6–8 years for OSFED, 12–14 years for AN/BN and 20–21 years for BED [ 41 ]. As with recovery rates, reported rates of relapse are highly variable due to differing definitions and study methodologies used by researchers in FU studies [ 35 , 61 ].

Evidence from a meta-analysis of 16 studies found four factor clusters that significantly contributed to relapse; however, also noted a substantial variability in procedures and measures compromising study comparison [ 62 ]. Factors contributing to heightened risk of relapse included severity of ED symptoms at pre- and post-treatment, presence and persistence of co-occurring conditions, higher age at onset and presentation to assessment, and longer duration of illness. Process treatment variables contributing to higher risk included longer duration of treatment, previous engagement in psychiatric and medical treatment (including specialist ED treatment) and having received inpatient treatment. These variables may indicate more significant illness factors necessitating a higher intensity of treatment.

Importantly, full recovery is possible, with research showing fully recovered people may be indistinguishable from healthy controls (HCs) on all physical, behavioural, and psychological domains (as evaluated by a battery of standardised assessment measures), except for anxiety (those who have fully recovered may have higher general anxiety levels than HCs) [ 29 ].

Diagnostic crossover

Most studies reported outcomes associated with specific ED diagnoses; however, given a significant proportion of individuals will move between ED diagnoses over time, it can be challenging to determine diagnosis-specific outcomes. Results from a 6 year FU study indicated that overall individuals with ED crossed over to other ED diagnoses during the FU observational period, most commonly AN to BN (23–27%), then BN to BED (8–11%), BN to AN (8–9%) and BED to BN (7–8%) [ 7 ]. Even higher crossover trends were observed in the subgroup reporting relapse during the FU period, with 61.5% of individuals originally diagnosed with AN developing BN, 27.2% and 18.1% of individuals originally diagnosed with BN developing AN and BED respectively, and 18.7% of people with a previous diagnosis of BED developing BN [ 7 ].

A review of 79 studies also showed a significant number of individuals with BN (22.5%) crossed over to other diagnostic groups (mostly OSFED) at FU [ 63 ]. A large prospective study of female adolescents and young adults in the United States ( n  = 9031) indicated that 12.9% of patients with BN later developed purging disorder and between 20 and 40% of individuals with subthreshold disorders progressed to full threshold disorders [ 64 ]. Progression from subthreshold to threshold eating disorders was higher for BN and BED (32% and 28%) than for AN (0%), with researchers suggesting higher risk for binge eating [ 66 ]. Progression from subthreshold to full threshold BN and BED was also common in adolescent females over the course of an 8 year observational study [ 33 ]. Some researchers contend that such diagnostic ‘instability’ demonstrates a need for ‘dimensional’ approaches to research and treatment which have greater focus on the severity rather than type of symptoms [ 7 ]. Diagnostic crossover is common and should be considered in the long-term management and monitoring of people with an ED.

Anorexia nervosa (AN)

People with restrictive-type ED have the poorest prognosis compared to the other diagnostic groups, particularly individuals displaying severe AN symptomatology (including lower weights and higher body image concerns) [ 44 ]. There is a paucity of effective pharmacological and/or psychological treatments for AN [ 65 ]. Reported rates of recovery vary and include 18% [ 56 ] to 52% at 6 year FU [ 7 ] to 60.3% at 13 year FU [ 20 ] and 62.8% at 22 year-FU [ 61 ]. Reported relapse rates in AN also vary, for example, 41.0% at 1 year post inpatient/day program treatment [ 35 ] to 30% at 22 year FU [ 61 ]. Average length of illness across the reviewed studies also varies from 6.5 years [ 56 ] to 14 years [ 41 ].

A variety of reported outcomes from treatment studies is likely due to the breadth of treatments under investigation, diverse study protocols and cohorts. For example, in a mixed cohort of female adult patients with AN and Atypical AN (A-AN), 33% were found to have made a full recovery at 3 year FU after treatment with cognitive behavioural therapy (CBT) [ 57 ], while 6.4% had a bad outcome and 6.4% a severe outcome. However, in a 5–10 year FU study of paediatric inpatients (mean age 12.5 years) approximately 41% had a good outcome, while 35% had intermediate and 24% poor outcome [ 66 ]. Multimodal treatment approaches including psychiatric, nutritional, and psychological rehabilitation have been found to be most efficacious for moderate to severe and enduring AN but noting a discrete rate of improvement [ 67 ].

Very few factors were able to predict outcomes in AN. Higher baseline BMI was consistently found to be the strongest predictor of recovery, and better outcomes were associated with shorter duration of illness [ 7 , 55 , 61 , 66 ]. Earlier age of illness onset [ 59 , 68 , 69 ] and older age at presentation to treatment [ 30 ] were related to chronicity of illness and associated with poorer outcome.

There was a consensus across a variety of studies that engagement in binge/purge behaviours (Anorexia Nervosa Binge/Purge subtype; AN-BP) was associated with a poorer prognosis [ 20 , 56 , 70 ]. Similarly, individuals with severe and enduring AN restrictive sub-type (AN-R) are likely to have a better outcome than individuals with AN-BP. AN-BP was associated with a two-fold greater risk of relapse compared to AN-R [ 30 , 35 ]. Some studies, however, were unable to find an association between AN subtype and outcome [ 55 ]. Other factors leading to poorer outcome and higher probability of relapse were combined ED presentations, such as combined AN/BN [ 35 ], higher shape concern [ 57 ], lower desired weight/BMI [ 44 ], more ED psychopathology at EOT, low or decreasing motivation to recover, and comorbid depression [ 35 , 61 ].

Preliminary genetic work has found associations between a single nucleotide polymorphism (SNP) in a ghrelin production gene (TT genotype at 3056 T-C) and recovery from AN-R [ 71 ], and the S-allele of the 5-HTTLPR genotype increasing the risk susceptibility for both depressive comorbidity and diagnostic crossover at FU of AN patients [ 72 ]. These studies, however, need to be interpreted with caution as they were conducted over a decade ago and have not since been replicated. Research in eating disorder genetics is a rapidly emerging area with potential clinical implications for assessment and treatment.

Bulimia nervosa (BN)

Overall, studies pertaining to a diagnostic profile of BN report remission recovery rates of around 40–60%, depending on criteria and FU period, as detailed below. Less than 40% of people achieved full symptom abstinence [ 73 ] and relapse occurred in around 30% of individuals [ 61 ]. A meta-analysis of 79 case series studies reported rates of recovery for BN at 45.0% for full recovery and 27.0% for partial remission, with 23.0% experiencing a chronic course and high rates of treatment dropout [ 63 ]. At 11 year FU, 38.0% reported remission in BN patients, increasing to 42.0% at 21 year [ 45 ]. At 22 year FU, 68.2% with BN were reported to have recovered [ 41 ]. Higher frequency of both objective binge episodes and self-induced vomiting factors influencing poorer outcomes [ 44 ].

Considering impact of treatment, analysis of engagement in self-induced vomiting as a predictor for outcome indicated there were no differences between groups in treatment dropout or response to CBT among a sample of 152 patients with various types of EDs (AN-BP, BN, EDNOS) at EOT [ 74 ]. Meta-analysis of results from 45 RCTs on psychotherapies for BN found 35.4% of treatment completers achieved symptom abstinence [ 73 ] with other studies indicating similar rates of recovery (around 52–59% depending on DSM criteria) [ 7 ].

Studies delivering CBT or other behavioural therapies reported the best outcomes for BN [ 73 ]. Specifically, early treatment progression, elimination of dietary restraint and normalisation of eating behaviour resulted in more positive outcomes [ 22 ]. These findings are supported by results from a study comparing outcomes of CBT and integrative cognitive-affective therapy (ICAT) [ 75 ]. Additional moderating effects were shown at FU (but not EOT), with greater improvements for those with less baseline depression, higher stimulus seeking (the need for excitement and stimulation) and affective lability (the experience of overly intense and unstable emotions) in the ICAT-BN group and lower stimulus seeking in the Enhanced Cognitive Behavioural Therapy (CBT-E) group. Lower affective lability showed improvements in both treatment groups [ 75 ]. Such findings indicate personality factors may deem one treatment approach more suitable to an individual than another.

A review of 4 RCTs of psychotherapy treatments for BN in adolescents (including FBT and CBT) reported overall psychological symptom improvement by EOT predicting better outcomes at 12 months, which underscored the need for not only behavioural but psychological improvement during 6 month treatment [ 31 ]. Other factors leading to poorer outcomes included less engagement in treatment, higher drive for thinness, less global functioning, and older age at presentation [ 45 ]. More research is needed into consistent predictors, mediators and moderators focused on treatment engagement and outcomes [ 22 ].

While many studies combine findings for BN and BED, one study specifically considered different emotions associated with binge eating within the two diagnostic profiles [ 60 ]. At baseline, binge eating was associated with anger/frustration for BN and depression for BED. At FU, objective binge eating (OBE) reduction in frequency (a measure of recovery) was associated with lower impulsivity and shape concern for BN but lower emotional eating and depressive symptoms for BED. These differences may provide approaches for effective intervention targets for differing presentations; however, how these may play out within a transdiagnostic approach requires further enquiry.

Binge eating disorder (BED)

BED is estimated to affect 1.5% of women and 0.3% of men worldwide, with higher prevalence (but more transient) in adolescents. Most adults report longstanding symptoms, 94% lifetime mental health conditions and 23% had attempted suicide, yet only half were in recognised healthcare or treatment [ 76 ].

Compared with AN and BN, long-term outcomes, and treatment success for individuals with BED were more favourable. Meta-analysis of BED abstinence rates suggests available psychotherapy and behavioural interventions are more effective for this population [ 77 ]. Additionally, stimulant medication (i.e., Vyvanse) has been found to be particularly effective to reduce binge eating [see [ 78 ] for full review]. Results from a study of people who received 12 months of CBT for BED indicated high rates of treatment response and favourable outcomes, maintained to 4 year FU. Significant improvements were observed with binge abstinence increasing from 30.0% at post-treatment to 67.0% at FU [ 79 ]. A meta-analysis reviewing psychological or behavioural treatments found Interpersonal Therapy (IPT) to be the treatment producing the greatest abstinence rates [ 73 ]. In a comparative study of IPT and CBT, people receiving CBT experienced increased ED symptoms between treatment and 4 year FU, while those who received IPT improved during the same period. Rates of remission at 4 year FU were also higher for IPT (76.7%) versus CBT (52.0%) [ 80 ].

One study specifically explored clinical differences between ED subtypes with and without lifetime obesity over 10 years. Prevalence of lifetime obesity in ED was 28.8% (ranging from 5% in AN to 87% in BED), with a threefold increase in lifetime obesity observed over the previous decade. Observed with temporal changes, people with ED and obesity had higher levels of childhood and family obesity, older-age onset, longer ED duration, higher levels of ED (particularly BED and BN) and poorer general psychopathology than those who were not in the obese weight range [ 81 ], suggesting greater clinical severity and poorer outcomes for people of higher weight.

Comparison of 6 year treatment outcomes between CBT and Behavioural Weight Loss Treatment (BWLT) found CBT more effective at post-treatment but fading effectiveness over time, with remission rates for both interventions lower than other reported studies (37%) [ 82 ]. A meta-analytic evaluation of 114 published and unpublished psychological and medical treatments found psychological treatments, structured self-help, and a combination of the two were all effective at EOT and 12 month FU but noted a wide variation in study design and quality, and the need for longer term FU. Efficacy and FU data for pharmacological and surgical weight loss treatments were lacking [ 77 ].

Whilst high weight and associated interventions (such as bariatric surgery) can be associated with any ED, they are frequently studied in relation to BED. A significant proportion of individuals seeking bariatric surgery (up to 42%) displayed binge eating symptomatology [ 83 ], yet little is known about the effect of these interventions on ED psychopathology and whether this differs by type of intervention. A systematic review of 23 studies of changes in ED behaviour following three different bariatric procedures found no specific procedure led to long term changes in ED profiles or behaviours [ 84 ]; however, another study investigating the placement of an intragastric balloon in obese patients found post-surgical reductions in grazing behaviours, emotional eating and EDNOS scores [ 85 ]. Bariatric surgery in general is associated with a reduction in ED, binge eating and depressive symptoms [ 86 ].

Outcomes among patients receiving bariatric surgery with and without BED were assessed where weight loss was comparable between the groups at 1 year FU. However, compared with participants receiving a BWLT-based lifestyle modification intervention instead of surgery, bariatric surgery patients lost significantly less weight at a 10.3% difference between groups. There was no significant difference between lifestyle modification and surgery groups in BED remission rates [ 87 ]. These results indicate that BLWT-type interventions are more effective than surgery at promoting weight loss in individuals with BED over a 1 year FU period, and people with BED and higher BMI were able to maintain weight loss in response to psychotherapy (CBT) at up to 5 year FU [ 88 ]. In analysis of health-related quality of life (HRQoL) in people with BED who received various levels of CBT (therapist-led, therapist-assisted and self-help), evaluation indicated that all modalities resulted in improvements to HRQoL. Poorer outcomes were associated with obesity and ED symptom severity at presentation, stressing the importance of early detection and intervention measures [ 89 ]. Research into the role of CBT in strengthening the effect of bariatric surgery for obesity is ongoing but promising [ 90 ].

EDNOS, OSFED and UFED

Similarly to BED, a diagnosis of DSM-IV EDNOS (now OSFED) was associated with a more favourable outcome than AN or BN, including shorter time to remission. One study reported remission rates for both EDNOS and BED at 4 year FU of approximately 80% [ 21 ]. The researchers suggested that an ‘otherwise specified’ diagnostic group might be comprised of individuals transitioning into or out of an ED rather than between diagnostic categories; however, more work is needed in this area to fully understand this diagnostic profile. The reported recovery rate from EDNOS-A has been found to be much lower at 57% than for EDNOS-B at 80% (DSM-V). One factor suggested leading to poorer outcomes for EDNOS-A was a higher association with a co-occurring condition of major depression and/or dysthymia not found in other EDNOS subtypes [ 7 ]. Another study found purging occurred in 6.7% from total (cross-diagnostic) ED referrals, but this subtype did not have different post-treatment remission rates or completion rates compared to non-purging profiles [ 91 ], so results are mixed.

Acknowledging the scarcity of research within these diagnostic groups, remission rates for adolescents including those with a diagnosis of Other Specified Feeding or Eating Disorder (OSFED) and Unspecified Feeding or Eating Disorder (UFED) was reported to be 23% at 12 month FU in the one study reviewed, but no detail was provided on recovery rates by diagnosis [ 26 ]. No available evidence was identified specifically for the DSM-V disorders OSFED or UFED for adults.

Avoidant/Restrictive Food Intake Disorder (ARFID)

Research into outcomes for people with ARFID is lacking, with only three studies meeting criteria for the review [ 23 , 24 , 25 ]. While, like AN, recovery for people with ARFID is usually measured by weight gain targets, one of the three studies [ 63 ] identified by this review instead reported on outcomes in terms of meeting a psychiatric diagnosis, making comparison between the studies difficult.

In a cross-diagnostic inpatient study, individuals presenting with ARFID were younger, had fewer reported ED behaviours and co-occurring conditions, less weight loss and were less likely to be bradycardic than individuals presenting with AN [ 25 ]. Although both groups received similar caloric intakes, ARFID patients relied on more enteral nutrition and required longer hospitalisations but had higher rates of remission and fewer readmissions than AN patients at 12 months. This study highlights the need for further investigation into inpatient treatment optimisation for different diagnostic profiles.

People with ARFID who had achieved remission post-treatment were able to maintain remission until 2.5 year FU, with most continuing to use outpatient treatment services [ 23 ]. In a 1 year FU study assessing ARFID, 62.0% of patients had achieved remission as defined by weight recovery and no longer meeting DSM-V criteria [ 25 ]. In a study following children treated for ARFID to a mean FU of 16 years post-treatment (age at FU 16.5–29.9 years), 26.3% continued to meet diagnostic criteria for ARFID with no diagnostic crossover, suggesting symptom stability [ 24 ]. Rates of recovery for ARFID patients in this study were not significantly different to the comparison group who had childhood onset AN, indicating similar prognoses for these disorders. No predictors of outcome for patients with ARFID were identified by the articles reviewed [ 63 ].

Community outcomes

While most outcome studies derive from health care settings, two studies were identified exploring outcomes of ED within the community. The first reported the 8 year prevalence, incidence, impairment, duration, and trajectory of ED via annual diagnostic interview of 496 adolescent females. Controlling for age, lifetime prevalence was 7.0% for BN/subthreshold BN, 6.6% for BED/subthreshold BED, 3.4% for purging disorder, 3.6% for AN/atypical AN, and 11.5% for feeding and eating disorders not otherwise classified. Peak onset age across the ED diagnostic profiles was 16–20 years with an average episode duration ranging from 3 months for BN to a year for AN; researchers noted that these episodes were shorter than the average duration estimates reported in similar research and may be representative of the transient nature of illness rather than longer term prognosis. ED were associated with greater functional impairment, distress, suicidality, and increased use of mental health treatment [ 27 ].

A second study followed 70 young people (mean age of 14 years at study commencement) meeting DSM-IV criteria for a binge eating or purging ED and found 44% no longer met criteria at ages 17 or 20, while 25% still met criteria at age 20 (the latter individuals were more likely to have externalising behaviour problems and purging behaviour at age 17). Those who experienced a persistent ED were less likely to complete secondary education and report higher depressive and anxiety symptoms at age 20, indicating the ongoing impacts of ED on education and quality of life [ 92 ]. These studies provide information about the course and outcome of early onset ED at the population level with indicators of predictive and maintaining factors.

Factors relating to outcomes

Several factors relating to outcomes have been studied across ED presentations and in specific diagnostic profiles. These include predictors of outcome, moderators or mediators of outcome, and illness reinforcers, considering age of presentation and duration of illness, ED symptomatology, presence of co-occurring medical and psychiatric conditions, and treatment characteristics.

Age of presentation

Age of presentation to treatment has been shown to have a significant impact on outcome in all diagnoses. One study considering ED in general (including AN, BN and EDNOS) showed presentation at mid-life drastically decreased chances of achieving a good outcome in response to treatment (“good” outcome defined as BMI ≥ 18.5, 3 month remission of symptoms and Eating Disorder Examination Questionnaire (EDE-Q) scores within or better than normal range). Six percent of mid-life (≥ 40 years) presentations achieved a good outcome post-treatment compared to 14% of young adults (18–39 years) and 28% of younger people (< 18 years) [ 28 ]. This finding has also been seen in research comparing 22 year outcomes of AN and BN [ 61 ].

People presenting in mid-life often have more complex medical and psychiatric profiles as well as life circumstances. They are also far more likely to have a sustained length of illness by the time of initial presentation: 27.8 years compared with 1.2 years for youths [ 28 ]. Longer duration of illness is associated with greater increase in self-reported clinical impairment [ 93 ]; however, illness duration does not necessarily influence treatment outcome, though wide variation in study protocol and quality limit the interpretability of these findings [ 37 , 94 ]. The disparity in rates of favourable outcome between age groups highlights the importance of prevention, screening, awareness of ED in primary care settings and early intervention programs, as well as targeted programs for those presenting with more complex psychosocial and life challenges.

Clinical features and co-occurring conditions

A systematic review assessed the average duration of untreated illness duration in help-seeking populations at first contact to treatment services at 29.9 months for AN, 53.0 months for BN and 67.4 months for BED [ 69 ]. ED clinical factors significantly influence outcomes, with poorer prognosis in those with time of untreated illness, primary diagnosis of AN [ 95 ], lower BMI at presentation [ 93 ], and presence of binge/purge symptomatology [ 20 , 56 ]. Certain ED behaviours and cognitions at intake predict better outcome such as lower rates of purging behaviour, higher rates of body image flexibility [ 96 ], and lower EDE-Q scores at baseline [ 97 ].

There is strong evidence for the presence of co-occurring medical and psychiatric conditions as a predictor of outcome in ED. At 22 year FU, the presence of co-occurring psychiatric conditions including Major Depressive Disorder (MDD) and Substance Use Disorder (SUD) were negatively correlated with recovery, with those who had recovered from an ED being 2.17 times less likely to have MDD and 5.33 times less likely to have SUD [ 98 ]. Co-occurring mood disorders consistently lead to poorer outcomes [ 47 , 51 , 55 , 99 ] and greater chance of moving between ED diagnoses [ 7 ]. In one study, presence of a mood disorder was the strongest predictor of classification of AN-R (but not AN-BP) [ 61 ]. Comorbid personality disorder was found in several studies to be the most common predictor of poorer outcome in ED [ 20 , 41 , 44 , 67 ].

In an adolescent sample, 39% of individuals with AN met criteria for at least one other psychiatric disorder and poorer prognosis was associated with co-occurring diagnoses of Obsessive Compulsive Disorder (OCD) and autistic traits [ 59 ]. In a large community childhood health longitudinal study, presence of any ED profile was predictive of later anxiety and mood disorders. AN was prospectively associated with long term low weight, while BN and BED with obesity, drug use and deliberate self-harm compared to age-matched children who did not have an ED profile [ 100 ].

Personality traits have also been found to be associated with poorer outcomes such as low persistence and harm avoidance in AN, lower self-directedness (BN) and reward dependence (BED) [ 41 ]. Higher perfectionism at intake predicted a lower likelihood of remission at 12 months in an adolescent sample [ 26 ], a finding consistent with previous research in adult cohorts [ 41 ].

Medical comorbidities such as malnutrition [ 72 ], concurrent type 1 diabetes [ 39 , 42 ], bodily pain [ 55 ] and viral infections [ 72 ] have been identified as risk factors for poorer outcomes and increased rates of relapse. Other co-occurring factors associated with poorer outcomes for people with ED include anxiety [ 47 , 56 , 93 ], dissociative experiences [ 101 ], impulsivity [ 56 ], adjustment disorder [ 95 ], use of psychotropic medications [ 30 ], and autistic traits have been associated with greater use of ED treatment [ 102 ].

Psychosocial, environmental and health factors

A large United States community study found positive correlation between higher rates of smoking behaviour and ED in women [ 99 ]. The same study also reported birth-related outcomes in women with ED including having a later first birth, pregnancy health concerns, experience of miscarriage or abortion [ 99 ], and women with ED may have increased experience of adverse pregnancy and neonatal outcomes, and lower numbers of children [ 3 ]. For women with a history of ED, ED symptoms tend to alleviate during pregnancy; however, they commonly resurface during the postnatal period, and up to a third of women with ED report postnatal depression [ 103 , 104 ].

Demographic factors leading to poorer prognosis include being male [ 72 ], of the LGBTQIA + community [ 105 ], being from a non-white ethnic background, low family education levels [ 99 ], lower socioeconomic status, living in a remote or rural area [ 72 ], poor employment and social adjustment [ 30 ], functional impairment [ 47 ], and having a family member with an ED [ 99 ]. Complicating prognosis are additional factors such as financial stress (individuals with ED face yearly health care costs 48% higher than the general population, while the presence of co-occurring psychiatric conditions is associated with 48% lower yearly earnings [ 3 ]. These financial challenges limit ability to access evidence-based treatments (especially in countries lacking in publicly funded health care) which may prolong illness.

There is strong evidence to suggest QoL is reduced in people with an ED [ 3 , 106 ]. It is important to consider associations between QoL, ED symptomatology and treatment outcome. Evidence-based treatments have demonstrated positive effects on QoL in addition to reduction in ED symptomatology, for example, improvements in QoL and psychological functioning and well-being were seen in response to CBT in a cross-diagnostic sample [ 43 ]. However, a meta-analysis of ED outcome studies found that the QoL of recovered ED patients remained lower than in healthy populations, highlighting the importance of prevention efforts [ 107 ] and restoration of QoL in relapse prevention. These studies highlight the high public health and clinical burden of eating disorders and the need to consider co-occurring medical and psychiatric conditions during comprehensive assessment history-taking, treatment planning and provision.

Treatment factors

Early progression in treatment can provide indication of treatment outcomes. In an RCT comparing Family Based Treatment (FBT) and Adolescent Focused Therapy (AFT) for adolescents with AN, most people who achieved remission at 1 year FU maintained recovery to 4 years FU regardless of treatment arm with remission rates tended to remain stable after 1 year [ 108 ]. The First Episode Rapid Early Intervention for Eating Disorders (FREED) service model for young adults with AN reported significant and rapid clinical improvements in over 53.2% of people compared to 17.9% TAU and also reported more cost-effective treatment [ 109 ]. In a transdiagnostic study comparing inpatient vs outpatient settings, rapid response to treatment (defined here as a clinically meaningful reduction in disorder-specific symptoms within the first ten sessions) was the only outcome predictor accounting for 45.6% of variance in ED symptoms, suggesting future work should evaluate mediators and moderators of rapid response [ 37 ]. A systematic review of outcome predictors and mediators in response to CBT indicated that early behavioural and cognitive change was associated with positive outcomes across ED diagnoses [ 22 ]. Similarly, a recent systematic review and meta-analysis of 20 years of accumulated evidence concluded early response to treatment the most robust predictor of better treatment outcomes, however, only half of people investigated across numerous studies showed early change, and more research was needed to determine outcome predictors [ 110 ]. Ongoing assessment to identify individuals who do not show early response to treatment (defined by healthy weight and absence of ED behaviours at 12 month FU), as well as provision of targeted engagement approaches, may improve outcomes [ 47 ].

Due to the frequent need for medical stabilisation in the early and acute stages of AN, the role of hospitalisation needs to be considered in the evaluation of treatment outcomes. In a large patient cohort study ( n  = 7505) with 5 year FU, a clear trend was observed with the per-patient 5 year cumulated number of inpatient days decreasing by 6% per annum after adjustment for age at diagnosis, parental mental health, and household income. The number of hospital admissions decreased by 2% per year, although there was no change in outpatient visits [ 111 ]. Factors contributing to better outcomes were not identified in this study, but in other research, early change in %EBW and ED psychopathology in adolescent inpatients predicted later change in the same ED variables [ 18 ]. Another study showed longer first admission predicted increased use of the health system in young adults [ 112 ].

In a multicentre RCT there was no difference between higher or lower calorie refeeding on clinical remission or medical hospitalisation to 12 month FU [ 113 ]. A systematic scoping review of 49 studies found adolescent day programs (intensive treatment programmes that do not involve an overnight stay at the treatment facility) can be an effective alternative to inpatient hospitalisation or step up/down in treatment intensity and are generally associated with weight gain and improvements in ED and comorbid psychopathology [ 114 ]. Outcomes in the review were sustained from 3 months to 2 years from EOT; however, due to large variability in the content, structure and theoretical underpinnings of reviewed programs, findings should be interpreted with caution.

Difficulties with emotion regulation are also associated with poor outcome across diagnostic profiles. There is evidence to suggest emotion-focused treatment is beneficial both to emotional functioning and mood as well as ED severity for people with elevated emotion regulation issues at baseline with positive effects lasting up to 5 years FU [ 115 ].

Self-esteem, self-compassion, and motivation

There is little conclusive evidence regarding predictors of poor response to evidence-based treatments [ 22 , 58 ]; however, low self-esteem has been implicated across all ED diagnoses [ 98 , 101 ], particularly AN [ 55 ]. A meta-analysis exploring the role of self-esteem on treatment outcomes indicated that while self-esteem did not predict remission or long-term weight related outcomes, it did mediate progression during inpatient treatment (greater increase in self-esteem during inpatient treatment was associated with higher remission and lower relapse rates at FU) [ 116 ]. Relatedly, high fear of self-compassion was associated with greater severity of ED symptoms in individuals with an active ED, suggesting that a fearful unwillingness to become more self-compassionate, rather than the absence of self-compassion, may lead to more detrimental outcomes [ 117 ].

Greater pre-treatment motivation has also been associated with ED symptom improvement and management of co-occurring anxiety and depression, in a systematic review and meta-analysis of 42 longitudinal studies [ 118 ]. Therapeutic interventions that include enhancement of motivation, self-esteem and self-compassion have been shown across studies to improve treatment outcomes across diagnostic profiles [ 117 ].

Relapse prevention programs

Whilst the role of treatment is crucial in the alleviation of symptoms and restoration of wellbeing, active provision of evidence-based post-treatment recovery care may be an important determining factor in relapse prevention. Research suggests the period in which individuals are at greatest risk of relapse is between four and nine-months following discharge [ 35 ], with between 31 and 41% relapsing at one to two years post-discharge [ 62 ].

To reduce readmission among a group of females receiving inpatient treatment for AN at an Australian specialist child and adolescent ED service, a 10 week transition ‘day’ program was developed and evaluated. The delivered program allowed for a ‘step down’ option and was found to have significant benefit for participants, who achieved an average weight gain of over 1 BMI point and decreased ED symptomatology at six-month FU [ 65 ]. Promising findings were also seen in a 6-session post-(inpatient and/or outpatient) treatment relapse prevention program designed by clinicians, parents, and patients in the Netherlands, which included a take-home workbook and appointments up to 18 months (frequency dependent on patient progress). Evaluated with young people with AN-R and AN-BP, 70% maintained post-discharge recovery to the end of the study period [ 36 ]. Such programs were evaluated in the context of a comprehensive specialist service with no control group comparison to measure the impact of the specific intervention, and there was no FU assessment following conclusion of the intervention to assess maintenance. Although more work is needed, these studies indicate the value of targeted relapse prevention programs.

Online relapse prevention programs

There is emerging evidence to support the safety and efficacy of internet-based relapse prevention programs aimed at preventing readmission to intensive ED treatment following discharge. These programs have the potential to be widely disseminated to individuals who may otherwise disengage from ongoing support due to access issues (e.g., living in an underserviced area, financial burden) or personal reasons such as stigma or shame [ 119 , 120 ].

A 9-session (1/month) CBT-based online relapse prevention program for women with AN discharged from inpatient treatment (baseline BMI x̄  = 17.7) found participants who completed the program had significant gains in BMI at end of program ( x̄  = 19.1) while the treatment as usual (TAU) control group did not ( x̄  = 17.7). Of note, participants who were 1–2 sessions short of completing the program maintained a higher BMI ( x̄  = 18.0) than the TAU group, whereas participants with less than 50% completion had a significantly lower BMI than any group including TAU ( x̄  = 17.0) [ 121 ]. A similar CBT-based online program targeted toward women discharged from inpatient treatment for BN found that the intervention group reported 46.0% fewer vomiting episodes compared to TAU, with some improvement in symptom abstinence (intervention group: 21.4%, TAU control = 18.9%), although this finding was not statistically significant [ 122 ].

In Hungary, an internet-based aftercare support program for individuals who had received inpatient or outpatient treatment for BN or related EDNOS in the 12 months prior to the study included information and support offered via 30 min chat sessions with peers and clinicians. Results showed 40.6% of the intervention group reported improvement compared to TAU waitlist controls (24.4%), although this difference was not statistically significant. The study noted that, although on the waitlist for the internet-based aftercare support program, the TAU group could still access additional treatment if so required. Evaluation findings report the program was feasible and well accepted [ 123 ].

Text messaging-based interventions have also been trialled to maintain engagement post-treatment, whereby participants send regular symptom reports to the clinical team with feedback provided. A 12 week ‘mobile therapy’ study with a group of women exiting CBT treatment for BN resulted in significant improvement in binge/purge frequency, ED and depressive symptoms from baseline to FU, with high rates of protocol adherence (87.0%), although there was no control group comparison [ 124 ]. Further evidence was provided in a 16 week weekly symptom report study of women with BN following inpatient discharge, with a significantly larger proportion of the intervention group achieving remission (51%) compared with TAU (36%) at 8 months FU. There was no significant difference between groups in terms of outpatient service use [ 125 ]. Results from these studies conflict with evidence from a systematic review of 15 studies, which was unable to support the effectiveness of text messaging-based programs for people with ED as either a sole or adjunctive component of the intervention [ 126 ]; however, this review noted the lack of a common evaluation framework making comparison difficult.

Despite advances in awareness and treatment, ED, particularly AN, continue to be associated with increased risk of mortality [ 4 ]. Studies identified that focus on the assessment of ED mortality, as well as data from the Global Burden of Disease Study 2016 are discussed in this section. Importantly, there are several different metrics used to report mortality. These include the Standardised Mortality Ratio (SMR), or the number of observed deaths in a cohort versus the number of expected deaths in a reference population (where a rate greater than one is interpreted as excess mortality); Weighted Mortality Ratio (WMR), or the weighted average of age-specific mortality rates per 100,000 persons; Crude Mortality Rate (CMR) , or the number of deaths in a given period divided by the population exposed to risk of death in that period; and Years of Life Lost (YLL), a summary measure of premature mortality calculated by subtracting the age at death from the standard life expectancy in a reference population.

Standardised, weighted, and crude mortality

AN is consistently described as having the highest mortality rate of the ED, but actual rate difference varies between studies. A summary of Standardised Mortality Ratios across studies is presented in Table 3 . SMRs from a meta-analysis suggest that measured mortality of AN is approximately three times as high as for other ED diagnoses, and in a UK study of ED patients ( n  = 1892) accessing services between 1992 and 2004, the SMR for AN was almost five times higher than other ED [ 127 ]. This is consistent with other research (a meta-analysis summarising 41 studies) reporting people with AN were 5.2 [3.7–7.5] times more likely to die prematurely from any cause [ 128 ]. A longitudinal study ( n  = 246) found SMR of AN to be only twice as high compared to BN, but still 6.5 times the rate expected in the general population [ 49 ].

Some studies did not report higher SMR for AN compared to other ED, however, methodological differences need to be considered. For example, some studies reported comparable SMR for AN to other ED, but subthreshold AN cases were included (previously catagorised as EDNOS) which may have reduced the calculated AN SMR [ 104 , 108 ]. In a British study using English National Hospital Episodes Statistics (2001–2009) comparing AN and BN, little difference in SMRs was reported [ 132 ]. The diagnosis of BN was less likely than other diagnosis to be recorded as the primary diagnosis and may not have been representative.

In a 22 year trial FU of a large sample of inpatients treated for BN, 2.4% had died [ 45 ]; the CMR for BN was 0.32% [ 63 ] and in severely malnourished patients, the crude mortality rate rose to 11.5% with SMR 15.9 [CI 95% (11.6–21.4)], just over 5 years post-treatment [ 137 ]. WMR has been found to be 5.1 for AN, 1.7 for BN, and 3.3 for EDNOS. SMRs were 5.86 for AN, 1.93 for BN, 1.92 for EDNOS [ 4 ] and 1.5–1.8 for BED [ 76 ].

Mortality rates in AN were highest during the first year after admission to treatment, while in BN it is in the first two years [ 134 ], with a higher risk in adolescence [ 140 ]. In AN, peak age of risk of death has been reported to be 15 years of age, BN 22 years and EDNOS 18–22 years [ 141 ]. Substance use disorders (including alcohol and/or cannabis) increased mortality in people with eating disorders across the diagnostic profiles [ 142 ].

In ED, peak age of risk for males may be earlier than females [ 141 ]. SMRs are higher for males (SMR = 7.24; 95% CI 6.58–7.96) relative to females (SMR = 4.59; 95% CI 4.34–4.85) overall, and in all age groups [ 131 ]. This may be due to the lower likelihood of males to self-identify or be identified with ED resulting in treatment delays and higher severity of illness when finally seeking help [ 131 ]. In mortality research conducted with a male-only sample, similarly high SMRs for males with BN and particularly AN as in majority female samples [ 2 ] were reported; however, mortality rates of EDNOS in males were considerably higher than those reported in female-dominant or female-only samples. Moreover, a case-controlled study found there was a sex difference across all diagnostic categories in CMR, with male to female being 15–5% in AN, 8–3% in BN, and 4–3% in EDNOS, but there were no significant sex differences in SMR for any diagnostic group, with males showing a shorter survival time after onset [ 2 ]. Researchers have suggested that increased mortality in males could be due to several factors, including reluctance to seek treatment and current treatment approaches being less effective in males [ 138 ]. Further research in males with ED is required to better understand the impact and response in male patients. Regardless of the mortality metric used, these studies indicate the vital importance of considering elevated mortality risk across the range of ED diagnoses.

Years of life lost/years lived with disability

The Global Burden of Disease Study 2016 reported that YLL due to premature death attributable to AN was 0.4 per 100,000. No YLL were attributed to BN; however, cause-specific mortality (CSM)—where each death is attributed to a single underlying cause—was, per thousand, 0.5 for AN (with a 2.9% increase from 1980 to 2016) and 0.1 for BN (21.8% increase from 1980 to 2016) [ 143 ]. The 2019 extension advocated for the inclusion of BED and OSFED in the Global Burden of Disease Study, previously excluded, as both diagnostic groups accounted for the majority of global ED cases and accounted for an unrepresented 41.9 million people living with ED [ 144 ].

Estimates are that over 3.3 million healthy life years are lost per year worldwide due to eating disorders. Years lived with a disability (YLDs) have increased from 2007 to 2017 for both AN (6.2% increase) and BN (10.3%), a higher rate than other mental disorders (− 0.1%). ED outcomes include reduced self-reported quality of life and estimated health care costs at 48% higher than for the general population [ 3 ].

Risk factors

Little is known about specific risk factors for mortality, although some variables have been reported in the literature. People who receive inpatient treatment for AN have more than five to seven times mortality risk when matched to age and gender and compared to other ED diagnoses [ 3 , 131 , 133 ]. For individuals receiving AN or BN treatment in outpatient settings, the risk is still twice that of controls [ 3 ]. Older age of presentation is a significant risk; adult presentations are associated with much higher mortality rates than adolescent presentations likely due to longer duration of illness at presentation, higher rates of medical and psychiatric complications and less engagement in treatment [ 4 , 28 , 68 , 137 , 139 ]. Higher mortality rates (especially in AN) are associated with lower BMI, longer duration of illness at service presentation [ 4 , 49 , 68 , 137 , 139 ], diuretic use [ 68 ], and occurrence of an in-hospital suicide attempt [ 68 , 137 ]. Certain treatment factors may be associated with higher risk of mortality, including transfer to medical intensive care unit, discharge against medical advice, and shorter hospital stays [ 137 ]. Other factors associated with increased risk of mortality include poor psychosocial functioning, substance use [ 28 , 49 ] and absence of family ED history [ 28 ].

Cause of death

Results from a large prospective 20 year (1985–2005) longitudinal study of individuals admitted to inpatient services in Germany ( n  = 5839) showed people with AN were likely to die from health issues caused by their disorder, most commonly circulatory failure, cachexia, and multiple organ failure [ 133 ]. Other studies have identified somatic risk factors including anaemia, dysnatremia, infection, cardiac complications and haematological comorbidities [ 137 ]. A 2021 study reported rates of medical complications for severe AN, which included anaemia (79%), neutropenia (53.9%), hypertransaminasemia (53.7%), osteoporosis (46.3%), hypokalemia (39.5%), hypophosphatemia (26%), hypoglycaemia (13.8%), infectious complications (24.3%), cardiac dysfunction (7.1%), and proven gelatinous bone marrow transformation (6.5%). Five (1.4%) of the patients in this study died of the following causes: septic shock of pulmonary origin ( n  = 1), septic shock of urinary origin ( n  = 1) and suicide ( n  = 3) [ 145 ].

Suicide is the most common non-natural cause of death in people with AN, BN, BED and EDNOS [ 133 ]. High rates of suicidality were reported in a meta-analysis of 36 studies published between 1966 and 2010 with data showing one in five individuals who died from an ED did so by suicide [ 4 ]. Risk of suicide may be particularly elevated in AN [Hazard Ratio (HR) 5.07; 95% CI 1.37–18.84] and BN (HR 6.07; 95% CI 2.47–14.89) even when specialised treatments are available [ 134 ]: people with AN are 18.1 [11.5–28.7] times more likely to die by suicide than 15–34 year old females in the general population [ 128 ]. This is supported by results from a meta-review exploring risk of all-cause and suicide across major mental disorders. 1.7 million patients and over a quarter of a million deaths were examined, finding all mental health disorders had an increased mortality rate to the general population; however, substance use and AN were the highest, translating into 10–20 year reductions in life expectancy, with borderline personality disorder, AN, depression and bipolar disorder having the highest suicide risk [ 146 ].

This rapid review, which synthesised the available literature on ED remission, relapse and recovery rates including associated moderating and mediating variables such as psychosocial and treatment characteristics, highlighted significant challenges of synthesising outcome literature. This includes a wide variety of ways in which key outcomes ‘remission’, ‘relapse’ and ‘recovery’ are not only defined but also how they are measured and analysed. There is no consensus among clinical or research communities on these definitions for any of the ED diagnoses [ 30 , 31 , 94 ]; thus, comparison between studies is challenging.

As EDs have amongst the highest rates of mortality of the mental health disorders, including one in five deaths caused by suicide, research into preventable causes of death, mitigatable risk, prevention and treatment efficacy is of paramount importance. It is noteworthy that current reported YLL and YLD for ED are likely an underestimate due to lack of robust epidemiological data, methodological limitations of burden of disease studies, absence of the illness group from national surveys and underreporting of mortality [ 147 ].

‘Relapse’ is typically defined by a return of symptoms after a period of reduced symptomatology; however, reviewed studies report a variety of methods to measure this, including multidisciplinary healthcare team assessment, scores on standardised psychological and behavioural interviews or questionnaires, weight criteria (including BMI or %EBW), reported eating disorder behaviours, meeting DSM (IV or V) diagnostic criteria, or a combination of the above. More difficult is determining if there is a difference between ‘remission’ and ‘recovery’, with remission usually determined by an absence of diagnostic symptomatology (again, characterised by a variety of methods), and recovery an improvement in overall functioning. Many studies report remission and recovery interchangeably, and very few incorporate returns to psychosocial functioning and QoL post alleviation of symptoms [ 29 ]. More standardised definitions may progress research [ 148 ] by allowing direct comparison between outcome studies, improving the ability of future investigations to predict and report relapse versus recovery rates and to comprehensively evaluate intervention and relapse prevention approaches.

An additional challenge across studies is a highly variable period between initial assessment or baseline and the time at which ‘outcome’ is assessed—ranging from as little as one week up to 25 years. As rates of relapse increase with illness progression, relatively short FU periods may compromise the understanding of true long-term outcomes. Longer-term FU studies are crucial to understand optimised models of care for sustained recovery and wellbeing.

Along with illness progression over time in individuals, the shift of diagnostic profiles among the individual may differ the definition of relapse or remission and thus impacts on outcome measures. Most research protocols adopt a firm inclusion/exclusion criterion, focusing on specific diagnostic profiles; however, findings from this review suggest considering a transdiagnostic approach in outcomes research which may better reflect the potentially transient nature of ED symptomatology [ 44 ]. This may have implications for diagnoses such as OSFED, potentially a transient category [ 21 ], rather than categorisation in or out of full ED diagnostic syndromes. Identification and consideration of transdiagnostic profiles, combined ED presentations and co-occurring mental health conditions should be considered in the long-term management and monitoring of individuals.

Studies within this review reported on cohorts of individuals with a formal diagnosis and research conducted within treatment settings. However, previous research has suggested that incidence rates within the community are considerable, and yet help-seeking of any type for a problem related to ED symptoms is uncommon, ranging between 22 and 40% [ 106 ] and there can be a significant time delay from first symptom experience [ 69 ]. A recent large community survey of the impact of COVID-19 on people with ED reported up to 70% of people who experienced ED symptoms were not in treatment [ 149 ] suggesting a significant proportion of people with an ED are not captured within this outcome review. Outcomes for this population are largely unknown [ 150 ] but preliminary research suggests they may be less favourable [ 151 , 152 ].

Improved QoL has been shown to be a significant predictor of positive outcome and is an opportunity for broader scope interventions for people with ED [ 107 ], and yet consistent and more wholistic markers of life quality are rarely integrated into research or clinical decision making [ 153 , 154 ]. It is also noted that outcome determinants in the reviewed studies are predominantly biometric (e.g., weight) and ED symptom related, whereas qualitative lived experience evidence suggests a broader range of person-centred metrics should be used to measure outcome. These include supportive relationships (e.g., receiving support, advice and encouragement from others, including family, friends, and/or professional carers), sense of hope, identity, meaning and purpose, feelings of empowerment and self-compassion [ 155 ]. Involvement of those to whom the work pertains (i.e., individuals with lived experience) is essential in future outcomes research to add richness and utility to theoretical frameworks, methodological approaches and conclusions [ 156 ].

Key findings

ED frequently take a chronic course, with less than half of individuals achieving recovery at long-term FU [ 41 , 44 , 52 ]. Between 30 and 41% of people will relapse within two years of receiving treatment [ 35 , 61 ], and between 20 and 61% will experience more than one type of eating disorder [ 7 , 63 , 64 ]. As with much of the extant ED literature, most outcome research has been conducted in AN. Restrictive ED are consistently associated with the poorest prognosis. This review identified recovery rates in the range of 18–60% for AN and an average length of illness of between 6.5 and 14 years [ 41 , 56 ]. Binge/purge symptomatology within AN is associated with worse outcome [ 20 , 56 ]. Recovery rates for BN are slightly more optimistic at 35–59% [ 7 , 45 , 63 , 157 ], and similarly for BED at 37–77% [ 79 , 80 , 82 ]. There is limited data available on outcomes in ARFID, OSFED, and UFED.

Factors associated with a more positive long-term outcome include lower age of presentation [ 28 , 61 ], shorter duration of illness at first presentation [ 69 , 93 , 94 ], higher pre-treatment motivation to recover [ 116 ], and demonstrated early response to treatment [ 18 , 75 , 110 , 112 ]. Factors associated with poorer outcome are lower BMI at presentation [ 93 ], presence of binge/purge symptomatology [ 20 , 30 , 44 , 56 ], and presence of comorbid psychiatric condition/s such as depression, anxiety, or personality disorder [ 44 , 47 , 51 , 55 , 67 , 98 , 99 ]. Males, LGBTQIA + community [ 104 , 105 ], neurodiversity [ 102 ], individuals from non-white/ethnic backgrounds, and those from lower socioeconomic brackets or rural/remote communities are also more likely to experience a poor outcome [ 18 , 72 , 76 , 77 ].

Relapse following ED treatment is common [ 11 , 35 , 36 , 62 , 148 ] and is most likely to occur 4–9 months post discharge [ 35 ]. Up to 41% of individuals will relapse by the second-year post-discharge [ 62 ]. Aftercare relapse prevention programs, including online and face-to-face initiatives such as text-message based interventions, daily feedback to clinicians and intensive day programs have been shown to increase chance of maintaining recovery [ 121 , 123 – 125 ]. The implementation of such programs may be key to improving long-term recovery rates particularly for those individuals who may otherwise disengage from treatment for access reasons (such as living in an underserviced area) or because of the stigma of engaging with mental health care [ 119 , 120 ]. There is emerging evidence in the effectiveness of online intervention for preventing relapse and promoting treatment gains when individuals are motivated to change; however, evidence is not conclusive potentially due to the high variability of the interventions and evaluations of such programs.

ED are associated with unacceptably high mortality rates, and particularly high risk of suicide [ 128 , 133 ]. Of the ED, AN carries the highest mortality risk [ 49 , 127 , 128 ]. Standardised mortality ratios (SMRs) identified by this review ranged between 1.2 and 15.9 for AN; 1.4 and 4.8 for BN; 1.01 and 3.3 for BED; and 1.3 to 4.7 for EDNOS/OSFED [ 2 , 4 , 20 , 121 , 127 , 128 , 132 , 134 , 135 , 137 , 139 ]. Factors associated with increased risk of mortality include having received inpatient treatment [ 3 , 131 , 133 ], longer duration of untreated illness [ 4 , 28 , 68 , 68 , 137 , 139 ] and lower BMI at presentation [ 4 , 49 , 68 , 137 , 139 ]. Males are at higher risk of death than females [ 2 ].

Strengths and limitations

This rapid review has several strengths inherent to the methodological approach of the series, conducted to inform the Australian Eating Disorders Research and Translation Strategy 2021–2031 [ 1 ]. The RR process broadly assessed all available high-level evidence peer-reviewed literature swiftly [ 24 ], included all diagnostic categories covering transdiagnostic continuums, considered the full demographic range available and reported a variety of methodological designs including clinical trials (across a variety of settings), systematic reviews, meta-analyses, and population-level research. It aimed to provide the most comprehensive and current review possible with coordination of complex findings into a more cohesive structure. It was noted where applicable the limitations of conclusions drawn from this review, such as the widely disparate definitions and measurements for key outcome data (i.e., remission, relapse, and recovery rates), crossover from DSM-IV to DSM-V criteria (due to timeframe of search), vastly different periods of follow up impacting findings, and conflicting evidence. As with the series of rapid reviews, the inclusion criteria of evidence may have potentially excluded relevant evidence, and it is noted that evidence is always emerging.

This RR of outcomes in ED identified several gaps in current knowledge and provides direction for future strategic research directives, specifically, defining the key outcomes of remission, recovery, and relapse, with consensus of determinants and inclusion of broader QoL measures and lived experience. Identifying and refining risk factors, mediating and moderating factors that may influence outcomes is ongoing, with longer-term FU research needed to track remission versus relapse, diagnostic crossover and optimisation of treatment engagement and recovery. Regarding mortality literature, this review noted considerable gaps [ 146 ], with variety reporting methods, a paucity of research between population level reporting and small hospital outcome studies, and minimal investigation into life circumstances relating to death, especially as many of these deaths may be preventable. With low rates of remission despite evidence-based care and high risk of mortality, especially for AN, it is strongly recommended that focused, long-term follow-up research is prioritised for people with ED.

Availability of data and materials

Not applicable—all citations provided.

Abbreviations

Atypical anorexia nervosa

Adolescent focused therapy

• Anorexia nervosa

Anorexia nervosa binge/purge subtype

Anorexia nervosa restricting subtype

Avoidant restrictive food intake disorder

• Binge eating disorder

Body mass index

• Bulimia nervosa

Behavioural weight loss therapy

Cognitive behaviour therapy

Enhanced cognitive behavioural therapy

Crude mortality rate

Diagnostic and statistical manual of mental disorders

Expected body weight

• Eating disorders

Eating disorder examination questionnaire

Eating disorder not otherwise specified

Eating disorder not otherwise specified-anorectic type

Eating disorder not otherwise specified-bulimic type

End of treatment

Family-based therapy

Healthcare management advisors

Health related quality of life

Integrative cognitive-affective therapy

InsideOut Institute

Interpersonal therapy

Major depressive disorder

Objective binge eating

Obsessive compulsive disorder

Other specified feeding or eating disorder

Quality of life

Randomised controlled trial

National eating disorder research & translation strategy rapid review

Standardised mortality ratio

Substance use disorder

Treatment as usual

Unspecified feeding or eating disorder

Weighted mortality ratio

Years of life lost

Years lived with a disability

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Acknowledgements

The InsideOut Institute is a collaboration between the University of Sydney and Sydney Local Health District. We thank all the staff from the Institution for their support of this significant project. The authors would like to thank and acknowledge the hard work of Healthcare Management Advisors (HMA) who were commissioned to undertake the Rapid Review. Additionally, the authors would like to thank all members of the consortium and consultation committees for their advice, input, and considerations during the development process. Further, a special thank you to the carers, consumers and lived experience consultants that provided input to the development of the Rapid Review and wider national Eating Disorders Research & Translation Strategy. Finally, thank you to the Australian Government—Department of Health for their support of the current project. National Eating Disorder Research Consortium Members (alphabetical order of surname): *indicates named authors. Phillip Aouad InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. Sarah Barakat InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. Robert Boakes School of Psychology, Faculty of Science, University of Sydney, NSW Australia. Leah Brennan School of Psychology and Public Health, La Trobe University, Victoria, Australia. Emma Bryant* InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. Susan Byrne School of Psychology, Western Australia, Perth, Australia. Belinda Caldwell Eating Disorders Victoria, Victoria, Australia. Shannon Calvert Perth, Western Australia, Australia. Bronny Carroll InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. David Castle Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia. Ian Caterson School of Life and Environmental Sciences, University of Sydney, Sydney, New South Wales, Australia. Belinda Chelius Eating Disorders Queensland, Brisbane, Queensland, Australia. Lyn Chiem Sydney Local Health District, New South Wales Health, Sydney, Australia. Simon Clarke Westmead Hospital, Sydney, New South Wales, Australia. Janet Conti Translational Health Research Institute, Western Sydney University, Sydney NSW Australia. Lexi Crouch Brisbane, Queensland, Australia. Genevieve Dammery InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. Natasha Dzajkovski InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. Jasmine Fardouly School of Psychology, University of New South Wales, Sydney, New South Wales, Australia. John Feneley New South Wales Health, New South Wales, Australia. Amber-Marie Firriolo University of Sydney, NSW Australia. Nasim Foroughi Translational Health Research Institute, Western Sydney University, Sydney NSW Australia. Mathew Fuller-Tyszkiewicz School of Psychology, Faculty of Health, Deakin University, Victoria, Australia. Anthea Fursland School of Population Health, Faculty of Health Sciences, Curtain University, Perth, Australia. Veronica Gonzalez-Arce InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. Bethanie Gouldthorp Hollywood Clinic, Ramsay Health Care, Perth, Australia. Kelly Griffin InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. Scott Griffiths Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia. Ashlea Hambleton InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. Amy Hannigan Queensland Eating Disorder Service, Brisbane, Queensland, Australia. Mel Hart Hunter New England Local Health District, New South Wales, Australia. Susan Hart St Vincent’s Hospital Network Local Health District, Sydney, New South Wales, Australia. Phillipa Hay Translational Health Research Institute, Western Sydney University, Sydney NSW Australia. Ian Hickie Brain and Mind Centre, University of Sydney, Sydney, Australia. Francis Kay-Lambkin School of Medicine and Public Health, University of Newcastle, New South Wales, Australia. Ross King School of Psychology, Faculty of Health, Deakin University, Victoria, Australia. Michael Kohn Paediatrics & Child Health, Children's Hospital, Westmead, Sydney, Australia. Eyza Koreshe InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. Isabel Krug Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia. Jake Linardon School of Psychology, Faculty of Health, Deakin University, Victoria, Australia. Randall Long College of Medicine and Public Health, Flinders University, South Australia, Australia. Amanda Long Exchange Consultancy, Redlynch, New South Wales, Australia. Sloane Madden Eating Disorders Service, Children’s Hospital at Westmead, Sydney, New South Wales, Australia. Sarah Maguire* InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. Danielle Maloney InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. Peta Marks InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. Sian McLean The Bouverie Centre, School of Psychology and Public Health, La Trobe University, Victoria, Australia. Thy Meddick Clinical Excellence Queensland, Mental Health Alcohol and Other Drugs Branch, Brisbane, Queensland, Australia. Jane Miskovic-Wheatley* InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. Deborah Mitchison Translational Health Research Institute, Western Sydney University, Sydney NSW Australia. Richard O’Kearney College of Health & Medicine, Australian National University, Australian Capital Territory, Australia. Shu Hwa Ong* InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. Roger Paterson ADHD and BED Integrated Clinic, Melbourne, Victoria, Australia. Susan Paxton La Trobe University, Department of Psychology and Counselling, Victoria, Australia. Melissa Pehlivan InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. Genevieve Pepin School of Health & Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia. Andrea Phillipou Swinburne Anorexia Nervosa (SWAN) Research Group, Centre for Mental Health, School of Health Sciences, Swinburne University, Victoria, Australia. Judith Piccone Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia. Rebecca Pinkus School of Psychology, Faculty of Science, University of Sydney, NSW Australia. Bronwyn Raykos Centre for Clinical Interventions, Western Australia Health, Perth, Western Australia, Australia. Paul Rhodes School of Psychology, Faculty of Science, University of Sydney, NSW Australia. Elizabeth Rieger College of Health & Medicine, Australian National University, Australian Capital Territory, Australia. Karen Rockett New South Wales Health, New South Wales, Australia. Sarah-Catherine Rodan InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. Janice Russell Central Clinical School Brain & Mind Research Institute, University of Sydney, New South Wales, Sydney. Haley Russell InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. Fiona Salter Ramsay Health Care, Perth, Australia. Susan Sawyer Department of Paediatrics, The University of Melbourne, Australia. Beth Shelton National Eating Disorders Collaboration, Victoria, Australia. Urvashnee Singh The Hollywood Clinic Hollywood Private Hospital, Ramsey Health, Perth, Australia. Sophie Smith Sydney, New South Wales, Australia. Evelyn Smith Translational Health Research Institute, Western Sydney University, Sydney NSW Australia. Karen Spielman InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. Sarah Squire The Butterfly Foundation, Sydney, Australia. Juliette Thomson The Butterfly Foundation, Sydney, Australia. Stephen Touyz* InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. Ranjani Utpala The Butterfly Foundation, Sydney, Australia. Lenny Vartanian School of Psychology, University of New South Wales, Sydney, New South Wales, Australia. Sabina Vatter* InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia. Andrew Wallis Eating Disorder Service, The Sydney Children’s Hospital Network, Westmead Campus, Sydney, Australia. Warren Ward Department of Psychiatry, University of Queensland, Brisbane, Australia. Sarah Wells University of Tasmania, Tasmania, Australia. Eleanor Wertheim School of Psychology and Public Health, La Trobe University, Victoria, Australia. Simon Wilksch College of Education, Psychology and Social Work, Flinders University, South Australia, Australia. Michelle Williams Royal Hobart, Tasmanian Health Service, Tasmania, Australia.

The RR was in-part funded by the Australian Government Department of Health in partnership with other national and jurisdictional stakeholders. As the organisation responsible for overseeing the National Eating Disorder Research & Translation Strategy, InsideOut Institute commissioned Healthcare Management Advisors to undertake the RR as part of a larger, ongoing, project. Role of Funder: The funder was not directly involved in informing the development of the current review.

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Authors and affiliations.

Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia

Jane Miskovic-Wheatley, Emma Bryant, Shu Hwa Ong, Sabina Vatter, Phillip Aouad, Sarah Barakat, Emma Bryant, Bronny Carroll, Genevieve Dammery, Natasha Dzajkovski, Veronica Gonzalez-Arce, Kelly Griffin, Ashlea Hambleton, Eyza Koreshe, Sarah Maguire, Danielle Maloney, Peta Marks, Jane Miskovic-Wheatley, Shu Hwa Ong, Melissa Pehlivan, Sarah-Catherine Rodan, Haley Russell, Karen Spielman, Stephen Touyz, Sabina Vatter, Stephen Touyz & Sarah Maguire

Sydney Local Health District, Sydney, Australia

Healthcare Management Advisors, Melbourne, Australia

School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia

Robert Boakes, Rebecca Pinkus & Paul Rhodes

School of Psychology and Public Health, La Trobe University, Victoria, Australia

Leah Brennan & Eleanor Wertheim

School of Psychology, Perth, Western Australia, Australia

Susan Byrne

Eating Disorders Victoria, Victoria, Australia

Belinda Caldwell

Perth, Australia

Shannon Calvert

Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia

David Castle

School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, Australia

Ian Caterson

Eating Disorders Queensland, Brisbane, QLD, Australia

Belinda Chelius

Sydney Local Health District, New South Wales Health, Sydney, Australia

Westmead Hospital, Sydney, NSW, Australia

Simon Clarke

Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia

Janet Conti, Nasim Foroughi, Phillipa Hay, Deborah Mitchison & Evelyn Smith

Brisbane, Australia

Lexi Crouch

School of Psychology, University of New South Wales, Sydney, NSW, Australia

Jasmine Fardouly & Lenny Vartanian

University of Sydney, Sydney, NSW, Australia

Carmen Felicia & Amber-Marie Firriolo

New South Wales Health, Sydney, NSW, Australia

John Feneley & Karen Rockett

School of Psychology, Faculty of Health, Deakin University, Victoria, Australia

Mathew Fuller-Tyszkiewicz & Ross King

School of Population Health, Faculty of Health Sciences, Curtain University, Perth, Australia

Anthea Fursland

Hollywood Clinic, Ramsay Health Care, Perth, Australia

Bethanie Gouldthorp & Jake Linardon

Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia

Scott Griffiths & Isabel Krug

Queensland Eating Disorder Service, Brisbane, QLD, Australia

Amy Hannigan

Hunter New England Local Health District, New Lambton, NSW, Australia

St Vincent’s Hospital Network Local Health District, Sydney, NSW, Australia

Brain and Mind Centre, University of Sydney, Sydney, Australia

School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia

Francis Kay-Lambkin

Westmead Hospital, Sydney, Australia

Michael Kohn

College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

Randall Long

Exchange Consultancy, Redlynch, NSW, Australia

Amanda Long

Eating Disorders Service, Children’s Hospital at Westmead, Sydney, NSW, Australia

Sloane Madden

The Bouverie Centre, School of Psychology and Public Health, La Trobe University, Victoria, Australia

Sian McLean

Clinical Excellence Queensland, Mental Health Alcohol and Other Drugs Branch, Brisbane, QLD, Australia

Thy Meddick

College of Health and Medicine, Australian National University, Canberra, ACT, Australia

Richard O’Kearney & Elizabeth Rieger

ADHD and BED Integrated Clinic, Melbourne, VIC, Australia

Roger Paterson

Department of Psychology and Counselling, La Trobe University, Victoria, Australia

Susan Paxton

School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia

Genevieve Pepin

Swinburne Anorexia Nervosa (SWAN) Research Group, Centre for Mental Health, School of Health Sciences, Swinburne University, Victoria, Australia

Andrea Phillipou

Children’s Health Queensland Hospital and Health Service, Brisbane, QLD, Australia

Judith Piccone

Centre for Clinical Interventions, Western Australia Health, Perth, WA, Australia

Bronwyn Raykos

Central Clinical School Brain & Mind Research Institute, University of Sydney, Sydney, NSW, Australia

Janice Russell

Ramsay Health Care, Perth, Australia

Fiona Salter

Department of Paediatrics, The University of Melbourne, Parkville, Australia

Susan Sawyer

National Eating Disorders Collaboration, Victoria, Australia

Beth Shelton

The Hollywood Clinic Hollywood Private Hospital, Ramsey Health, Perth, Australia

Urvashnee Singh

Sydney, Australia

Sophie Smith

The Butterfly Foundation, Sydney, Australia

Sarah Squire, Juliette Thomson & Ranjani Utpala

Eating Disorder Service, The Sydney Children’s Hospital Network, Westmead Campus, Sydney, Australia

Andrew Wallis

Department of Psychiatry, University of Queensland, Brisbane, Australia

Warren Ward

University of Tasmania, Hobart, TAS, Australia

Sarah Wells

College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia

Simon Wilksch

Royal Hobart, Tasmanian Health Service, Hobart, TAS, Australia

Michelle Williams

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National Eating Disorder Research Consortium

• Phillip Aouad
• , Sarah Barakat
• , Robert Boakes
• , Leah Brennan
• , Emma Bryant
• , Susan Byrne
• , Belinda Caldwell
• , Shannon Calvert
• , Bronny Carroll
• , David Castle
• , Ian Caterson
• , Belinda Chelius
• , Lyn Chiem
• , Simon Clarke
• , Janet Conti
• , Lexi Crouch
• , Genevieve Dammery
• , Natasha Dzajkovski
• , Jasmine Fardouly
• , Carmen Felicia
• , John Feneley
• , Amber-Marie Firriolo
• , Nasim Foroughi
• , Mathew Fuller-Tyszkiewicz
• , Anthea Fursland
• , Veronica Gonzalez-Arce
• , Bethanie Gouldthorp
• , Kelly Griffin
• , Scott Griffiths
• , Ashlea Hambleton
• , Amy Hannigan
• , Susan Hart
• , Phillipa Hay
• , Ian Hickie
• , Francis Kay-Lambkin
• , Ross King
• , Michael Kohn
• , Eyza Koreshe
• , Isabel Krug
• , Jake Linardon
• , Randall Long
• , Amanda Long
• , Sloane Madden
• , Sarah Maguire
• , Danielle Maloney
• , Peta Marks
• , Sian McLean
• , Thy Meddick
• , Jane Miskovic-Wheatley
• , Deborah Mitchison
• , Richard O’Kearney
• , Shu Hwa Ong
• , Roger Paterson
• , Susan Paxton
• , Melissa Pehlivan
• , Genevieve Pepin
• , Andrea Phillipou
• , Judith Piccone
• , Rebecca Pinkus
• , Bronwyn Raykos
• , Paul Rhodes
• , Elizabeth Rieger
• , Sarah-Catherine Rodan
• , Karen Rockett
• , Janice Russell
• , Haley Russell
• , Fiona Salter
• , Susan Sawyer
• , Beth Shelton
• , Urvashnee Singh
• , Sophie Smith
• , Evelyn Smith
• , Karen Spielman
• , Sarah Squire
• , Juliette Thomson
• , Stephen Touyz
• , Ranjani Utpala
• , Lenny Vartanian
• , Sabina Vatter
• , Andrew Wallis
• , Warren Ward
• , Sarah Wells
• , Eleanor Wertheim
• , Simon Wilksch
•  & Michelle Williams

Contributions

AL carried out and wrote the initial review from the first search; JMW conducted subsequent reviews, analysed results, wrote the first manuscript and the final edit; EB, SHO and SV contributed to specific sections, detailed tables and figures, responded to review comments and contributed to ongoing drafts to manuscript completion; the National Eating Disorder Research Consortium reviewed and provided expert feedback; ST and SM provided project direction, methodological design, comprehensively reviewed the manuscript and provided overall supervision and leadership. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jane Miskovic-Wheatley .

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Not applicable.

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Competing interests.

ST receives royalties from Hogrefe and Huber, McGraw Hill and Taylor and Francis for published books/book chapters. He has received honoraria from the Takeda Group of Companies for consultative work, public speaking engagements and commissioned reports. He has chaired their Clinical Advisory Committee for Binge Eating Disorder. He is the Editor in Chief of the Journal of Eating Disorders. He is a committee member of the National Eating Disorders Collaboration as well as the Technical Advisory Group for Eating Disorders. AL undertook work on this RR while employed by HMA. JMW and SM are guest editors of the special issue “Improving the future by understanding the present: evidence reviews for the field of eating disorders.”

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Supplementary Information

Additional file 1: fig. s1..

PRISMA flow diagram.

Additional file 2: Table S1.

Studies included in the Rapid Review.

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Miskovic-Wheatley, J., Bryant, E., Ong, S.H. et al. Eating disorder outcomes: findings from a rapid review of over a decade of research. J Eat Disord 11 , 85 (2023). https://doi.org/10.1186/s40337-023-00801-3

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DOI : https://doi.org/10.1186/s40337-023-00801-3

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Affiliations.

• 1 Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. Electronic address: [email protected].
• 2 Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Serviço de Psiquiatria e Saúde Mental, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
• 3 Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
• PMID: 32171414
• DOI: 10.1016/S0140-6736(20)30059-3

Eating disorders are disabling, deadly, and costly mental disorders that considerably impair physical health and disrupt psychosocial functioning. Disturbed attitudes towards weight, body shape, and eating play a key role in the origin and maintenance of eating disorders. Eating disorders have been increasing over the past 50 years and changes in the food environment have been implicated. All health-care providers should routinely enquire about eating habits as a component of overall health assessment. Six main feeding and eating disorders are now recognised in diagnostic systems: anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant-restrictive food intake disorder, pica, and rumination disorder. The presentation form of eating disorders might vary for men versus women, for example. As eating disorders are under-researched, there is a great deal of uncertainty as to their pathophysiology, treatment, and management. Future challenges, emerging treatments, and outstanding research questions are addressed.

Copyright © 2020 Elsevier Ltd. All rights reserved.

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• Research Support, Non-U.S. Gov't
• Diagnosis, Differential
• Feeding and Eating Disorders* / diagnosis
• Feeding and Eating Disorders* / physiopathology
• Feeding and Eating Disorders* / psychology
• Feeding and Eating Disorders* / therapy
• Nutritional Status

Thesis Helpers

Find the best tips and advice to improve your writing. Or, have a top expert write your paper.

154 In Depth Eating Disorder Research Topics For Your Dissertation

Before you get started on potential eating disorder thesis or dissertation ideas, you should first know what eating disorder means. Eating disorder is a behavioral condition that patterns consistent uneasiness when it comes to eating.

It is associated with uncomfortable thoughts and emotions and it could affect the physiological, psychological, and social function of the body. Eating disorders cut across bulimia, avoidant restrictive food intake disorder, binge eating disorder, anorexia nervosa, and many other areas. Writing a comprehensive eating disorder thesis or dissertation requires dissecting any of these types of eating disorders.

Characteristics Of A Good Thesis Research Paper

Before your eating disorder thesis paper can be termed perfect for your essay or research study, these are the necessary things that must be present in the paper.

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• Original and Coherent: While your paper can contain studies from other authors, you must ensure that you credit them. You must also ensure that you input your thoughts into what you write. Doing this makes you possess the good qualities of a trustworthy and reliable researcher. You must not compromise on originality, and you must also be coherent with your writing.

All these will help you create a detailed and well-constructed research paper on eating disorders.

Research Questions About Eating Disorders

As you already know, eating disorders are behavioral challenges when it comes to feeding. It manifests in different ways and it affects people.

To create interesting research on eating disorders, you may need research questions about eating disorders. Questions to consider include:

• What does eating disorder mean professionally?
• What is the rate at which eating disorders occur to people?
• What are the main factors leading to eating disorders?
• Does an individual personality trait has any influence on the person’s eating disorder?
• How does individual personality trait affect eating disorders?
• Examining anorexia nervosa and bulimia: what are the basic differences?
• What is the treatment for people suffering from eating disorders?
• How do eating disorders manifest amongst people?
• What is the leading treatment to solve the challenge of eating disorders?
• What is the most effective potentiality of recovery?
• Are there any factors that determine recovery potentiality and rate?
• Would it be better to address the symptoms over the problems of eating disorders?
• Would it be effective to offer treatments rather than provide advice to manage them?
• Does treatment for eating disorders mean therapy?
• What are the risks patients might face?
• What are the guidelines for health officials on eating disorders?

Eating Disorders Research Paper

As a student of research, exercising your writing abilities is one of the requirements for graduate certification. Your professors and teachers at university and college want to know what you can produce.

These are significant current eating disorder research topics that can aid in identifying the issues to target in today’s world:

• Evaluate the factors leading to bulimia amongst teenagers
• Examine the means to prevent and correct anorexia nervosa amongst teenagers
• Discuss why the diagnosis of anorexia is significant amongst youngsters
• Evaluate the mental consequence of bulimia amongst kids
• Examine the physical Influence of bulimia amongst kids
• Observe bulimia from the position of a psychologist
• Examine the significance of parents in helping prevent eating disorders
• Examine the category of children who are susceptible to anorexia nervosa and bulimia
• Examine the long-term consequence of anorexia and bulimia on kids
• Examine the Influence of society and family with kids overwhelmed by eating disorders
• Discuss how anorexia and bulimia will affect the social lifestyle of kids
• Examine how anorexia nervosa and bulimia will influence the emotions and attitudes of kids towards others
• Examine how TV shows and other public communication networks can help change children’s disorders
• Examine the fundamental basis of eating disorders amongst people
• Discuss the possibilities of eating disorders amongst private school students that public schools
• Examine the events of self-injurious in the lens of eating disorders
• Discuss the major things that help in curbing eating disorders
• Examine any five pieces of literature related to the eating disorder and their relevance to current discussions
• Examine various standpoints of different scholars on their subject as well their significance
• Discuss the role of intimidation in worsening eating disorder conditions
• Examine a calorie program to know the effect of eating disorders on children’s weight
• Research to know the statistics of those affected by stunted eating culture
• Discuss how sleeping disorder connects with eating disorders
• Examine the core biological features of a sleeping disorder and compare it with an eating disorder
• Critically discuss Night Eating Syndrome (NES)
• Does eating disorder less to substance abuse? Discuss
• Discuss whether stopping addictive habits will help with eating disorders
• Examine is vegetarianism has a role to play in eating disorder
• Examine how the tension in sport could lead to eating disorders
• Would you say that hereditary factors are considerations for eating disorders?
• Discuss the importance of body fat to eating disorder
• Examine the effects of eating contemplation on eating disorders
• Discuss how sex abuse connects with eating disorders
• Examine the major hunger drive leading to eating disorders
• Does the lack of required food lead to eating disorders: discuss
• Examine the influence of obesity patterning o eating disorder
• Listen to the story of any victim and analyze what caused their eating disorder
• Discuss the way experiences and thought can shape eating desires.

Research Topics On Eating Disorders

For your undergraduate or college research, you can pursue in-depth research into eating disorders. Eating disorders could be considered biological and psychological issues.

You can consider the following research topics in eating disorders:

• Examine how the symptoms of anorexia and bulimia overlap
• Discuss the basic psychological makeup of eating disorder
• Discuss the pursuit of perfectionism and how it enhances a behavior of the eating disorder
• Examine the need for psychotherapy to help eating disorder patients
• Discuss the eating disorder by assessing the intellectual impairment of the patients
• Discuss the complex nature of eating disorders leading to suicide amongst kids
• Examine the high risk of suicide rate amongst those with bulimia and anorexia and why
• Discuss the variations interconnected with anorexia therapy
• Would you say unhappiness and physical shame about the body worsens bulimia and anorexia?
• Would you say their disappointment and discontent about other things lead to anorexia and bulimia?
• Critically examine Nasser, Katzman, and Gordon’s ‘Eating Disorders: People in Transition’
• Discuss Janet’s book titled ‘Skills-Based Learning with regard to Caring for a family member with an Eating Disorder: The New Maudsley Method’ and its significance
• Examine the paths to healing as established by Alexander Lucas in ‘Demystifying Boeing underweight Nervosa: An Optimistic Guide to Knowledge and Healing’
• Observe the perspectives of Sharlene and how thinness affects eating disorders in ‘Am I Thin A Sufficient Amount of Yet? The very cult associated with thinness and also the Commercialization for Identity’
• Discuss Carrie Arnold’s ‘Decoding Anorexia’
• Critically discuss A.M. Logue’s ‘The Mindset of Taking and Drinking’
• Examine how obesity contributes to eating disorders as noted in Linda Smolak et al’s ‘Body Photo, Eating Disorders, in addition to Obesity around Youth: Analysis, Prevention, and also Treatment’
• Discuss the importance of diagnosis to the condition through the lens of Kevin Thompson et al’s ‘Exacting Splendor: Theory, Diagnosis, and Treatment of Body Image Disturbance’
• Evaluate how subconscious features of bulimia and anorexia develop amongst girls
• Discuss the main features of anorexia amongst female athletes
• Examine the factors that could hinder recovery
• Discuss why women of any age are more prone to eating disorders than men
• Discuss the odds of eating disorder through the epidermis
• Examine the symptoms of bulimia and anorexia amongst men
• Evaluate the symptoms of anorexia and bulimia amongst women
• Do you think diagnosis for anorexia are often underrated?
• Discuss the factors that shape the future of a patient’s eating disorder
• After identifying the disorder, what do most patients do?
• Examine the connection of disinterest in sex to eating disorders
• Does eating disorder affect any group of people more?
• Examine the consequences of eating disorders on the LGBTQ community
• Examine the major differences in eating disorders amongst male and female military personnel
• How do anorexia and bulimia affect women libido?
• Examine the design models and risks of eating disorders
• Discuss the process of medical diagnosis
• Examine possible solutions to eating disorders
• Discuss the risks of eating disorders
• Choose any three lifestyles and examine how eating disorders would affect patients with such lifestyle
• Examine the tactics patients use to evade therapy
• Do you think the work on decoding eating disorders is done?

Thesis About Eating Disorders

Systems of treating eating disorders could be considered controversial but interesting submissions from doctors and officials about eating disorders could be helpful in your research. Consider the following custom ideas and expand them in your thesis statement or research:

• Discuss with three doctors within your institution and know their take on eating disorder
• Speak with three doctors outside your Institution and know their take on eating disorders
• Identify the influence on dieting on eating disorder
• Identify the influence of weight loss on eating disorders
• Discuss the influence of eating disorders on academics
• Discuss the treatments of Ayahuasca
• What are eating disorder treatment techniques based on?
• What are the institutional positions on eating disorders?
• Discuss the role of the family in treating eating disorders
• Examine the role of friends in treating eating disorders
• Discuss the significance of health insurance in eating disorder
• Evaluate the issues that complicate bulimia and anorexia
• Examine the factors that ruin chances of hastening to heal
• Go through the medical report of any patient with bulimia and analyze it
• Go through the medical report of a patient with anorexia and analyze it
• Get a chance to sit in therapy with a patient with anorexia and examine their response habits
• Examine the response habit of a patient with bulimia in therapy
• Discuss how productive therapy sessions could be
• Identify the importance of support groups for eating disorder patients
• Discuss the purpose of support groups for eating disorder patients using any two examples
• Does the loss of appetite connect with eating disorders?
• Will eating Disorder be managed, not cured?
• What are the latest scientific breakthroughs on eating disorders?
• What is Virtual Reality Graded Exposure Therapy (VRGET) all about?
• Examine the Influence of culture on eating disorders
• Examine the influence of bullying on eating disorders
• Discuss the Influence of internet threats on eating disorders
• Examine how western culture react to bulimia
• Discuss how western communities react to anorexia
• Examine the trends of eating disorders from over 50 years
• How do major ethnic groups react to eating disorders?
• Discuss how publicity of eating disorder help people open up about it.

Review the following books:

• Lauren Greenfield’s ‘Thin’
• Jenni Schaefer’s ‘Life Without Impotence: How An individual Woman Stated Independence Right from Her Eating Disorder and How It is possible to Too’.
• Marya Hornbacher’s ‘Wasted: A Memoir of Anorexia nervosa and Bulimia’
• Sarah Dessen’s ‘Just Listen’
• Herriet Brown’s ‘Brave Girl Eating: A new Family’s Tom Anorexia’
• Ellen Hopkins’ ‘Identical’
• Bev Mattocks’ ‘Please Eat…: A Single Parent’s Struggle to 100 % free Her Teenage Son Through Anorexia’
• Nancy Tucker’s ‘The Amount of Time in Between: A good Memoir connected with Hunger in addition to Hope’.

Eating Disorder Body Image Research Topics

Body image disorder or body dysmorphic disorder is the consistent worry over appearance. This could be obsessing over weight gain or weight loss which lead to greater health challenges.

To discuss this, you can consider these topics:

• Evaluate the examples of body image challenges
• Discuss the connection between body image issues and depression
• Discuss the connection between anorexia and body image issues
• How do body image disturbances emerge?
• Examine the effects of eating habits on body image
• Discuss how the concern of others affect obese people
• Examine how the worry and anxiety of relatives affect thin people
• Examine three records of those with body image disorder and understand the motivating factors
• Discuss the motivating factors behind poor dieting
• Examine the negative outcome of diets
• Examine how staying hungry affect patients with eating disorders
• What are the cons of disordered eating
• Discuss the relationship of love in reducing negative image perception
• Examine how unhealthy eating habit affects mental health
• Discuss how unhealthy eating habits influence decision-making processes
• How does negative body image affect teenagers?
• How does negative body image affect adults?
• How do parents impose negative body image on kids?
• Examine the consequence of bad comments on kids with obesity
• Examine the nexus between bullying and unhealthy eating habits.

Don’t Want To Do Research?

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• Publications
• Published Papers, 2024

Published Papers by year

Walter Kaye and the UCSD Eating Disorders Research team have published over 250 papers on the neurobiology of eating disorders. These publications include behavioral, treatment, and cognitive neuroscience studies that have improved understanding of the clinical presentation, genetics, neurotransmitter systems, and neural substrates involved in appetite dysregulation and disordered eating. These studies are guiding the development of more effective, neurobiologically informed interventions.

• Change in motivational bias during treatment predicts outcome in anorexia nervosa
• Sophie R. Abber MS, Susan M. Murray PhD, Carina S. Brown MS, Christina E. Wierenga PhD
• doi: 10.1002/eat.24156. Epub 2024 February 01.
• Wiley Online Library
• The acceptability, feasibility, and possible benefits of a neurobiologically-informed 5-day multifamily treatment for adults with anorexia nervosa
• Christina E. Wierenga, Laura Hill, Stephanie Knatz Peck, Jason McCray, Laura Greathouse, Danika Peterson, Amber Scott, Ivan Eisler, Walter H. Kaye
• oi: 10.1002/eat.22876. Epub 2018 May 2.
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Eating Disorders, Essay Example

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Introduction

Eating disorders affect men and women of all ages, although adolescents tend to be the age group that is more susceptible. This is because, as their bodies are changing, they may feel more pressure by society as well as peer groups to look attractive and fit in (Segal et al). Types of eating disorders include Anorexia, Bulimia and Compulsive Overeating, which can also be related to the first two. The reasons behind Eating Disorder usually stem from a reaction to low self-esteem and a negative means of coping with life and stress (Something Fishy).  Eating disorders are also often associated with an underlying psychological disorder, which may be the reason behind the eating disorder or which may develop from the Eating Disorder itself. Mental health disorders that are often associated with Eating Disorder include Anxiety, Depression, Multiple Personality Disorder, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, BiPolar, BiPolar II, Borderline Personality Disorder, Panic Disorder and Dissociative Disorder. The longer a person suffers from ED, the more probable that they will be dealing with another mental illness, most likely Anxiety or Depression (Something Fishy). The eventual outcome of Eating Disorder can be deadly. “Some eating disorders are associated with a 10-15% mortality rate and a 20-25% suicide rate. Sometimes, anorexia, bulimia and compulsive eating may be perceived as slow suicide (Carruthers).” In order to prevent the deadly consequences of Eating Disorder and to prevent it from becoming more pervasive in society, it is necessary to recognize the correct treatment method for this disease.  Traditional treatments have focused on providing risk information to raise awareness of the consequences of Eating Disorder (Lobera et al 263). However, since Eating Disorder is a mental illness, a more effective treatment is one that offers psychological evaluation, counseling and treatment. Cognitive Behavioral Therapy is emerging as a more robust and effective method that can be used not only to treat Eating Disorder but the associated mental illnesses that may accompany it.

The Problem

Eating disorder is pervasive in society and can have deadly consequences on those that suffer from it. Many time Eating Disorder goes undetected by family members and friends because those suffering will go to great lengths to hide their problem. However, there are some signs and symptoms that can be clues that a person is suffering from some sort of eating disorder. According to Segal, these signs can include:

• Restricting Food or Dieting: A change in eating habits that includes restricting food or excessive dieting. The person my frequently miss meals or not eat, complaining of an upset stomach or that they are not hungry. A use of diet pills or illegal drugs may also be noticed.
• Bingeing: Sufferers may binge eat in secret, which can be hard to detect since they will usually do it late at night or in a private place. Signs of potential bingeing are empty food packages and wrappers and hidden stashes of high calorie junk food or desserts.
• Purging: Those who suffer from bulimia will force themselves to throw up after meals to rid their body of added calories. A sign that this is occurring is when a person makes a trip to the bathroom right after eating on a regular basis, possible running water or a fan to hide the sound of their vomiting. They may also use perfume, mouthwash or breath mints regularly to disguise the smell. In addition to vomiting, laxatives or diuretics may also be used to flush unwanted calories from the body.
• Distorted body image and altered appearance: People suffering from Eating Disorder often have a very distorted image of their own body. While they may appear thin to others, they may view themselves as fat and attempt to hide their body under loose clothing. They will also have an obsessive preoccupation with their weight, and complain of being fat even when it is obvious to others that this is not the case.

There are several possible side effects from Eating Disorders, both physical and psychological. Physical damage can be temporary or permanent, depending on the severity of the eating disorder and the length of time the person has been suffering from it.  Psychological consequences can be the development of a mental illness, especially depression and anxiety. Some sufferers of Eating Disorder will also develop a coping mechanism such as harming themselves, through cutting, self-mutilation or self-inflicted violence, or SIV (Something Fishy).

Physical consequences of Eating Disorders depend on the type of eating disorder that the person has. Anorexia nervosa can lead to a slow heart rate and low blood pressure, putting the sufferer at risk for heart failure and permanent heart damage. Malnutrition can lead to osteoporosis and dry, brittle bones. Other common complications include kidney damage due to dehydration, overall weakness, hair loss and dry skin. Bulimia nervosa, where the person constantly purges through vomiting, can have similar consequences as Anorexia but with added complications and damage to the esophagus and gastric cavity due to the frequent vomiting. In addition, tooth decay can occur because of damage caused by gastric juices. If the person also uses laxatives to purge, irregular bowel movements and constipation can occur. Peptic ulcers and pancreatitis can also common negative heath effects (National Eating Disorders Association).  If the Eating Disorder goes on for a prolonged time period, death is also a possible affect, which is why it is important to seek treatment for the individual as soon as it is determined that they are suffering from an Eating Disorder.

Once it is recognized that a loved one may be suffering from an Eating Disorder, the next step is coming up with an effective intervention in time to prevent any lasting physical damage or death. The most effective treatment to date is Cognitive-behavioral therapy, an active form of counseling that can be done in either a group or private setting (Curtis). Cognitive-behavioral therapy is used to help correct poor eating habits and prevent relapse as well as change the way the individual thinks about food, eating and their body image (Curtis).

Cognitive-behavioral therapy is considered to be one of the most effective treatments for eating disorders, but of course this depends on both the counselor administrating the therapy and the attitude of the person receiving it.  According to Fairburn (3), while patients with eating disorders “have a reputation for being difficult to treat, the great majority can be helped and many, if not most, can make a full and lasting recovery.” In the study conducted by Lobera et al, it was determined that students that took part in group cognitive-behavioral therapy sessions showed a reduced dissatisfaction with their body and a reduction in their drive to thinness. Self esteem was also improved during the group therapy sessions and eating habits were significantly improved.

“The overall effectiveness of cognitive-behavioral therapy can depend on the duration of the sessions. Cognitive-behavioral therapy is considered effective for the treatment of eating disorders. But because eating disorder behaviors can endure for a long period of time, ongoing psychological treatment is usually required for at least a year and may be needed for several years (Curtis).”

  Alternative solutions

Traditional treatments for Eating Disorders rely on educating potential sufferers, especially school aged children, of the potential damage, both psychological and physical, that can be caused by the various eating disorders .

“ Research conducted to date into the primary prevention of eating disorders (ED) has mainly considered the provision of information regarding risk factors. Consequently, there is a need to develop new methods that go a step further, promoting a change in attitudes and behavior in the  target population (Lobera et al).”

The current research has not shown that passive techniques, such as providing information, reduces the prevalence of eating disorders or improves the condition in existing patients. While education about eating disorders, the signs and symptoms and the potential health affects, is an important part of providing information to both the those that may know someone who is suffering from an eating disorder and those that are suffering from one, it is not an effective treatment by itself. It must be integrated with a deeper level of therapy that helps to improve the self-esteem and psychological issues from which the eating disorder stems.

Hospitalization has also been a treatment for those suffering from an eating disorder, especially when a complication, such as kidney failure or extreme weakness, occurs. However, treating the symptom of the eating disorder will not treat the underlying problem. Hospitalization can effectively treat the symptom only when it is combined with a psychological therapy that treats the underlying psychological problem that is causing the physical health problem.

Effectively treating eating disorders is possible using cognitive-behavioral therapy. However, the sooner a person who is suffering from an eating disorder begins treatment the more effective the treatment is likely to be. The longer a person suffers from an eating disorder, the more problems that may arise because of it, both physically and psychologically. While the deeper underlying issue may differ from patient to patient, it must be addressed in order for an eating disorder treatment to be effective. If not, the eating disorder is likely to continue. By becoming better educated about the underlying mental health issues that are typically the cause of eating disorder, both family members and friends of loved ones suffering from eating disorders and the sufferers themselves can take the steps necessary to overcome Eating Disorder and begin the road to recovery.

Works Cited

“Associated Mental Health Conditions and Addictions.” Something Fishy, 2010. Web. 19 November2010.

Carruthers, Martyn. Who Has Eating Disorders?   Soulwork Solutions, 2010. Web. 19 November 2010.

Curtis, Jeanette. “Cognitive-behavioral Therapy for Eating Disorders.” WebMD (September 16, 2009). Web. 19 November 2010.

Fairburn, Christopher G. Cognitive Behavior Therapy and Eating Disorders. New York: The Guilford Press, 2008. Print.  

“Health Consequences of Eating Disorders” National Eating Disorders Association (2005). Web. 21 November 2010.

Lobera, I.J., Lozano, P.L., Rios, P.B., Candau, J.R., Villar y Lebreros, Gregorio Sanchez, Millan, M.T.M., Gonzalez, M.T.M., Martin, L.A., Villalobos, I.J. and Sanchez, N.V. “Traditional and New Strategies in the Primary Prevention of Eating Disorders: A Comparative Study in Spanish Adolescents.” International Journal of General Medicine 3  (October 5, 2010): 263-272. Dovepress.Web. 19 November 2010.

Segal, Jeanne, Smith, Melinda, Barston, Suzanne. Helping Someone with an Eating Disorder: Advice for Parents, Family Members and Friends , 2010. Web. 19 November 2010.

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Creating a strong research paper on eating disorders: thesis statement writing tips.

These research papers discuss issues relating to abnormal attitudes towards food, and which change eating habits and behaviour. Study of eating habits and behaviours has been on focus for some time now, especially since they carry damaging results such as increased obesity among children. There are many issues to focus on when writing this type of paper, from the types of disorders, their causes to effects. A strong research paper will detail present data and information (not very old data) on eating disorders. One might have to narrow down on a particular country or area if it is a case study paper.  

Identify all the types of eating disorder

A paper on the types of eating disorder can begin by identifying all the types of eating disorder - there are many types, from anorexia nervosa, bulimia, to binge eating. It can then explain each in detail. First, a thesis statement is the argument a writer will consider as central in his writing. The related thesis statement would, for instance, focus on taking a position on which is the most prevalent type of eating disorder. It may also take a position on which is most prevalent among a given age group such as children. One can also provide data from recognized institutions about these issues.

Write a thesis statement

In discussing the causes of eating disorder, a researcher can focus on the main cause in writing the thesis statement. For instance, asserting that the lack of parental guidance on best eating habits among children is the major cause of eating disorders as the thesis statement. A student/writer must, however, do some investigations on the causes of the disorder, to ensure that the statement is developed from a point of knowledge. Investigations also must be done in consideration of reputable sources - for instance peer-reviewed articles from established journals in medicine or food science.

Write about the causes and effects

While discussing causes of eating disorders, a writer/student might focus on what the major cause of the disorder they think is. Again, some background checks from existing literature will ensure that the statement is developed from a position of knowledge other than guess work. Remember, the thesis statement must be proved by evidence later on the body of the paper. If the lecturer has not specified the topic, it is advisable to carry out a background check to see which areas have enough materials before getting started. This will be critical to avoiding a writer's block and quickening the writing process.

Always remember to make the thesis statement as catchy as possible. It should also be clear about the issues targeted. A strong paper must also be revised to remove grammatical errors.

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A critique of the literature on etiology of eating disorders

Azadeh a rikani.

1 Douglas Hospital Research Centre, Montreal, Quebec, Canada, H4H 1R3;

3 Department of Psychiatry, McGill University, Montreal, Quebec, Canada, H3A 1A1;

Zia Choudhry

2 Department of Human Genetics, McGill University, Montreal, Quebec, Canada, H3H 1B1;

4 Division of Research & Medical Education, International Maternal and Child Health Foundation, Montreal, QC, Canada, H7S 2N5;

Adnan M Choudhry

5 Neurochemistry Research Unit, University of Karachi, Karachi, Pakistan, 71000;

Muhammad W Asghar

6 Department of Pharmaceutical Sciences, University of Alberta, Edmonton, AB, T6G 2E1;

Dilkash Kajal

7 Department of Medical Imaging, University of Ottawa, Ottawa, ON, K1N 6N5;

Abdul Waheed

8 Department of Family and Community Medicine, Pennsylvania State University, Hershey, PA, USA, 17033;

Nusrat J Mobassarah

9 Institute of Integrated Cell-Material Science, Kyoto University, Yoshida Ushinomiyacho, Sakyo – ku, JAPAN, 606-8501

The development of eating disorders including anorexia nervosa, bulimia nervosa, binge eating disorder, and atypical eating disorders that affect many young women and even men in the productive period of their lives is complex and varied. While numbers of presumed risk factors contributing to the development of eating disorders are increasing, previous evidence for biological, psychological, developmental, and sociocultural effects on the development of eating disorders have not been conclusive. Despite the fact that a huge body of research has carefully examined the possible risk factors associated with the eating disorders, they have failed not only to uncover the exact etiology of eating disorders, but also to understand the interaction between different causes of eating disorders. This failure may be due complexities of eating disorders, limitations of the studies or combination of two factors. In this review, some risk factors including biological, psychological, developmental, and sociocultural are discussed.

Introduction

Eating disorders, particularly, anorexia nervosa and bulimia nervosa have been center of attention for clinicians and researchers. Eating disorders are one of the significant problems in the care of adolescents and even children. These complex disorders are believed to arise from interaction of multiple risk factors. Eating disorders are defined by disturbance in eating habits that may be either excessive or insufficient food intake. Bulimia nervosa, anorexia nervosa, and binge eating are the most common forms of eating disorder based on diagnostic and statistical manual of mental disorders (DSM-IV). As defined in DSM-IV, anorexia nervosa is a constant attempt to maintain body weight below minimally normal weight (85%) or body mass index <17.5 for age and height, with an intense fear of weight gain even though under weight, and inaccurate perception of own body size, shape, or weight. It may accompany with amenorrhea in girls and women after menarche. DSM-IV also defines bulimia nervosa as recurrent binge eating episodes followed by recurrent purging, excessive exercise, or prolonged fasting at least two times per week for three months. Excessive concern about weight or shape is also very common in bulimia nervosa. Another type of eating disorders is binge-eating disorder that is characterized with recurrent binge eating without purging, excessive exercise, or fasting. Atypical eating disorder is referred to clinically significant eating disorders associated with unexplained weight loss, rumination, unexplained food intolerances or an extremely picky eating habit that does not meet the criteria of anorexia nervosa, bulimia, or binge disorder. 1

Prevalence of Eating Disorders

The average prevalence rates for anorexia nervosa and bulimia nervosa are 0.3% and 1% among adolescence and young people in western countries respectively. Prevalence rates of anorexia nervosa and bulimia nervosa increase during transition period from adolescence to adulthood. 2 Lifetime prevalence rates for eating disorder are higher among women than men ( Table 1 ). 3 A Canadian study reported that 4% of Canadian boys in grade nine and ten used anabolic steroids. Use of anabolic steroid in males may be an indicator of body preoccupation. The estimated rate of anorexia nervosa and bulimia nervosa in males is between 5% and 15%. 4 Men’s reluctance to be diagnosed with eating disorders or to participate in the study of eating disorders have been a big challenge; consequently, rate of eating disorders in males may be higher than it is reported. According to a 2002 survey, prevalence of eating disorders is 1.5% among Canadian women aged 15–24 years. 5 Another Canadian survey in 2002 indicated that 28% of girls in grade nine and 29% of girls in grade ten showed weight loss behaviors. 4

Impact of Eating Disorders on the Canadian Economy

Although eating disorders mostly receive community treatment, hospitalization may be needed for severe cases. In-patient crude hospital separations for any diagnosed eating disorders have increased by 4.7% between 1994 and 1999 in Canada (Canadian Institute for Health Information, 1999). Despite decrease in hospitalization duration for eating disorders between 1987 and 1999 reported by the Center for Chronic Disease Prevention and Control, Public Health Agency for Canada reported increased rates of hospitalization for eating disorders among women in general hospitals. In 2005/2006, hospitalization rate for adolescence girl with eating disorders were 2.5 times the rate of young women and 6 times the rate of any other groups (Canadian Institute for Health Information, 2008). The increase in the rate of hospitalization could be due to either increased cases of inpatient treatment or higher rate of eating disorders, or combination of two factors. Further studies are required to clarify exact cause(s) of increased rate of hospitalization for eating disorders in Canada. In 1993 physician billing data, hospitalization data, and self-reported productivity losses were used to estimate mental illness cost to Canadian economy. It was estimated that the cost of mental illnesses was $7.331 billion in 1997. 6

Although eating disorders are among the mental illnesses that occasionally require hospitalization since hospitalization rate is increasing, even if costs of outpatient services are not taken into account, eating disorders can have a considerable impact on the Canadian economy. The exact estimation of economic burden of mental illness including eating disorders would be a big challenge, because of a lack of accurate data both on cost of services and productivity losses.

Mortality Rate in Eating Disorders

Anorexia nervosa has the highest mortality rate of any other mental illnesses. It is estimated that 10% of people with anorexia nervosa die within 10 years of the onset of disorder (Sullivan, 2002). One study showed the mean crude mortality rate of 5.0% for anorexia nervosa. In the surviving patients, on an average, only 46.9% of patients had full recovery, while 33.5% improved, and 20.8% had a chronic course of disease. 7 , 8 Based on total sample of 196 female with bulimia nervosa, the mean crude mortality rate was 2.0% for bulimia nervosa. 10 A lower standardized mortality rate (the ratio of the observed number of deaths to the expected number of deaths in a matched population) for anorexia nervosa compared to normal populations is reported by some studies. However, a recent Canadian study that assessed 326 patients diagnosed with anorexia nervosa for 20 years showed a higher mortality rate for anorexia nervosa patients than normal populations in Canada. 11 , 12 The challenges that this study faced over 20 years of follow up are: disconnection of cases with research group because of moving outside the British Columbia province; reassessment of previously diagnosed cases of eating disorders three times over 20 years based on three different revisions of DSM-IV that could have led to removal of few cases from study after a long term follow up.

Psychiatric Co-morbidity in Eating Disorders

Various psychiatric co-morbidities such as depression, anxiety disorder, obsessive-compulsive disorder, substance abuse, attention-deficit hyperactivity disorders, and personality disorders are prominent in patients with eating disorders. Suicide and suicide attempts are dangerous comorbidities in eating disorders. Although primary cause of pre-mature death in eating disorders are medical co-morbidities, a meta-analysis that combined the results of 42 published studies of mortality of eating disorders determined that the second most common cause of death in eating disorders is suicide. 7 About 10% to 20% of patients with anorexia nervosa and 25% to 35% of patients with bulimia nervosa have a history of at least one suicide attempt. Standardized mortality rate for suicide in anorexia nervosa is estimated to be up to 5 or even more. 11 According to the statistics from public health agency of Canada, suicide is the eleventh cause of death in Canada, and more than 3,500 suicides, at a rate of about 11 per 100,000 are recorded per year. Eating disorders clearly contribute to suicide rates in Canada. An accurate suicide rate of eating disorders is very difficult because of unreliability of suicide statistics in general, difficulties in uncovering the exact cause of death, and undiagnosed cases of eating disorders who commit suicide.

Medical Co-morbidity in Eating Disorders

Wide range of medical complications such as anemia, endocrine system dysfunction, electrolytes disturbances, and cardiovascular diseases accompany eating disorders. Severity of medical complications depend on speed of weight loss, severity of underweight, duration of eating disorders, age of patients, and the intensity of purging ( Table 2 ). 11

Etiology of Eating Disorders

Biological factors.

Genetic effects: A growing body of twin studies confirmed that there is an undeniable link between genetic factors and eating disorders. One of the twin study, in which twenty- six twins with anorexia nervosa including 13 twins (7MZ, 6DZ) with threshold and 13 twins (7MZ, 6DZ) with sub-threshold anorexia nervosa were studied, 13 neither of DZ twins met the criteria for diagnosis of anorexia nervosa, while 29%–50% of MZ twins were concordant for anorexia nervosa. Although some of the twin studies believe that contributions of shared environmental effects (the same family environment in which twins grow up), and non-shared environmental effects (negative life events) are often small but these effects were also included in the reported twin studies.

One of the limitations of twin study could be due to the short follow up period. Some cases that are not concordant may turn to be concordant later, and unaccounted cases can affect heritability estimate for eating disorders. Small sample size is another limitation in twin studies that prohibits researchers to study wide range of non-shared and shared environmental effects, and probably overestimates rate of heritability. Study of larger sample size that preferentially includes different racial groups would be more useful.

Neurobiology

Serotonin (5-hydroxytryptamin, 5HT) is believed to participate not only in appetite regulation but also in mood regulation. Altered tone or transmission of serotonin mediates anxiety reaction, problem with response inhibition, aggression, suicidality, heightened vigilance, and self-injury. 14 Although exact cause of 5-HT dysfunction in eating disorders is unknown, but several studies presumed that alteration of 5-HT1A and 5-HT2A receptor activities, the 5-HTT (5-HT transporter), and CSF 5-HIAA levels can be involved in patients with eating disorders. 15 Several studies confirmed persistence of alterations in serotonin activity, 16 , 17 and also persistence of anxiety, perfectionism, and obsessive behavior 18 after recovery from anorexia nervosa and bulimia nervosa.

Regarding these findings, serotonin may indirectly mediate its effects on development of eating disorders through some personality traits that are prominent in patients with eating disorders. Study of subtle differences in patterns of functional alteration of serotonin in subjects with pre-morbid personality traits without eating disorders, and in subjects with eating disorders without these personality traits may be helpful though sample size would be small in this group. Data collection related to pre-morbid personality traits would be highly desirable. Interestingly, one experimental study showed alteration of mesolimibic dopamine and serotonin as a result of restricted eating coupled with excessive exercise in activity-based anorexia model. 19 Based on this observation, it can be concluded that aberrant eating behaviors can potentially alter serotonin function and therefore result in persistence of functional alterations of serotonin after recovery of eating disorders. Neither of the studies interrogated persistence of functional alterations of serotonin as a “scar of prolonged aberrant eating behavior”. Although, study of possible functional alterations of serotonin due to aberrant eating behaviors is costly and invasive, but it would contribute to understanding complex relationship between functional alterations of serotonin and eating disorder.

Though one previous study suggested heritability of functional alterations of serotonin by showing anomalous peripheral uptake of serotonin in unaffected first-degree relatives of bulimia nervosa patients 20 but functional alterations of serotonin can be still considered as an outcome of aberrant eating behavior in patients. Further studies are required to confirm heritability of abnormalities of serotonin functions in eating disorders. To differentiate abnormalities of serotonin due to heritability from those due to aberrant eating behaviors, study of serotonin function in suspected subjects before the onset of eating disorders may be useful.

Psychology Factors

Body image disturbance.

Body cachexia, the degree of body satisfaction and dissatisfaction is believed to be an integral part of self-esteem. Individuals assess their bodies by measuring them against ideal body type of culture. The result of this self-assessment determines body satisfaction or dissatisfaction. 21 A prospective study on college freshman women showed that figure dissatisfaction, ineffectiveness and, public self-consciousness were associated with symptoms of eating disorders. 22 Since the body dissatisfaction data collection was done after development of eating disorders in this study, body dissatisfaction could be a predictor for worsening of eating symptoms rather than a predictor for development of eating disorders. Striegelmoore et al. also showed that severity of body dissatisfaction are correlated with worsening of disordered eating in sample of first year college women. 20 Another Study disproved body image disturbance as a predictive of later eating disorders after 2 years follow up of college students. 21 Considering to changes in patterns of thinking due to developmental process, studies that begin to collect data in very early adolescence, and follow up patients into adulthood may be more informative.

Another useful approach is the study of body dissatisfaction in subjects who already recovered from eating disorders (recovered study design). Regardless of the fact that eating disorders are known as psychiatric disturbances with persistent residual symptoms, this type of study could define the role of body dissatisfaction either as an etiology or as a clinical feature of eating disorders. Examination of other variables that decrease or increase the risk of eating disorders may overcome lack of unanimous agreement about role of body dissatisfaction in development of eating disorders. Stice et al. opposed the role of body image disturbances in development of eating disorder because they believe that body dissatisfaction is a risk factor for depression. 23 Regarding this notion, concurrent depression should be carefully assessed in patients with eating disorders when studying body dissatisfaction as a risk factor for eating disorders.

A Canadian survey showed that 34% of adolescent girls and 24% of adolescent boys in Grades 6 to 10 thought that they were too obese. This notion increased among adolescent girls from 25% in grade 6 to 40% in grade 10, while only 15% were actually obese (Public Health Agency of Canada, 2008). Regarding significant number of students with body dissatisfaction, prospective studies are required to find out what percentage of these Canadian adolescent girls and boys will develop full picture of eating disorders later. In addition to huge amount of budget required, this study may face another big challenge that is convincing adolescent girls and especially boys to participate in this study. This study helps health care system in Canada to plan prevention, early diagnosis, and treatment of potential future patients with eating disorders in advance.

Personality traits

Role of personality disorders in the development of eating disorders has been the center of attention for many researchers. Several studies have found that personality traits such as impulsivity, novelty seeking, stress reactivity, harm avoidance, perfectionism, and other personality traits are common in patients with eating disorders. Most of these studies assessed personality traits in their subjects during illness. Therefore, their personality traits could be a reflection of adverse effects of starvation. 24 A study shows the effect of starvation and recurrent binge and purging on development of anxiety, social withdrawal, and irritability in previously normal people only a few weeks after restricted food intake (Keys et al., 1950). Numerous studies used personality inventories such as Eating Disorder Inventory (EDI) to assess specific cognitive and behavioral dimensions of eating disorders such as drive for thinness, bulimia, body dissatisfaction ineffectiveness, perfectionism, interpersonal distrust, interceptive awareness, and maturity fear. Personality inventories are designed for the assessment of adult populations. Consequently use of these inventories for assessment of personality traits in majority of subjects with eating disorders who are typically in early adolescent may not be appropriate. 24 One important factor that could have possible effect on the accuracy of results in the study of personality traits in adolescences is the constantly changing patterns of perception about the environment and oneself due to ongoing developmental changes in personality. Medical and non-medical therapy in patients with chronic eating disorders could also affect post-morbid functions and personality traits of these patients. Interestingly some studies show the changes in behavior patterns such as harm avoidance, persistence, self-directedness, and self-transcendence after in-patient Cognitive Behavioral Therapy (CBT) for eating disorders. 11 Future researches should be aware of the effects of therapy on the result of study of personality traits in eating disorder cases.

Developmental factors

Childhood sexual abuse.

Despite the fact that childhood sexual (CSA) abuse as a risk factor for eating disorders has been a source of debate among clinicians and researchers. While some studies showed strong relationship between CSA and eating disorders, some other studies strongly refuse to accept this relationship. Discrepancy between the results of various studies could be due to the non-uniformity in definition of CSA. Although association between different psychiatric disorders with severity of trauma due to CSA is not well understood yet, but different severity of CSA ranging from non-touching, single episode to long-term sexual abuse combined with physical abuse reported by victims may affect the result of studies. The entry time of sexually abused subjects with eating disorders into the study should also be considered. If the gap between the development of eating disorders and occurrence of sexual abuse is very short, subjects may not be recovered from memories of such a horrible experience. Severity of eating disorders might also affect their sexual abuse reports. In severe forms of eating disorders, CSA experience may be inaccessible to victims. 26 Increase in the rate of CSA reported between 1998 and 2003 in Quebec 27 ( Table 3 ) could be a warning sign for increased rate of psychiatric problems including eating disorder in Canada. A well-designed research project with consideration on the subject’s ethnic origins, age at the time of sexual abuse, socioeconomic class, and family dynamics could contribute to the understanding of possible relationship between CSA eating disorder with CSA. The challenges this research may face are accuracy of data, careful examination of other variables, lack of victims’ confidence to report the abuse to police or to child protection system, and clear definition of CSA. This study could also suffer from the problem of cost effectiveness.

Socio-Cultural Factor

Western cultural influence.

Exposure to western culture that values slim body for women is presumed to play an important role in the increased eating disorders worldwide. Rate of eating disorders in countries such as Japan, Iran, and Singapore continues to increase among women who have been exposed to western culture through temporary living in western countries for education, or even short-time vacation, or through mass media. 28 , 29 Increase in the rate of eating disorders in populations exposed to western culture in those countries could strongly support the role of western culture in the development of eating disorders. Study of effects of western culture in relation to incidence of eating disorders in non-western immigrant women and girls has been recently given special attention. Swanson et al. studied binge eating (BED) disorder in Mexican immigrants to U.S. 30 Although anxiety and depression may not be etiology of BED, they adjusted prior anxiety and depression that could act as non-specific markers of high risk for psychopathology. This study showed significantly increased rate of BED in U.S born Mexican with two U.S born parents. This study also concluded that cultural influence underlying in the increased rate of BED occurs slowly. Most of the studies failed to control at least one variable such as socioeconomic status especially family income, which may have a positive correlation with body dissatisfaction, age differences, despite strong link between age and eating disorders. 31 Usage of English language at home and religion could also be a potential cause of higher tendency for thinking about dieting and body shape, and as an indicator of acculturation. 32 , 33

Another study demonstrated that as generations further removed from immigration experiences, influence of western culture on body ideals and standards becomes prominent. In this study native Canadian born woman with one or no immigrant parent already completed acculturation had higher tendency to think about dieting than immigrant women or native-born women with two immigrant parents. Acculturation in this paper was defined as the adoption of Canadian values, lifestyle habits, particularly, eating habits, and dietary preferences. As far as development of eating disorders is concerned, the term “acculturation” is referred to adoption of negative aspects of Canadian eating and lifestyle habits similar to the symptoms of eating disorders, especially BED. 32 Although this research group carefully considered effects of family income, age differences, and English-speaking at home, but neither of the subjects in this study fulfilled diagnostic criteria for eating disorders based on DSM-IV criteria. This study also failed to control psychobiological factors that might possibly make the subjects vulnerable to sociocultural pressures.

A large population of immigrants in Canada coming from non-western countries provides an excellent opportunity to study influences of western culture on different ethnic origins with different religious affiliations, socioeconomic status, and eating habits.

This study could contribute to better understanding of connection between western culture and eating disorders. Careful examination of a broad range of non-specific factors that result in psychiatric disorders associated with immigration in immigrant patients with eating disorder and their family may be a challenge for this study. Study of gene influence, particularly, in generations of families of mixed heritage with eating disorders is highly recommended.

It has been hypothesized that eating disorders have multiple and often shared etiologies including biological, psychological, developmental, and sociocultural. A tightly woven network of causes, symptoms, and outcomes of eating disorders makes the study of etiology of these disorders very challenging. Some suggested risk factors for eating disorders require to be defined as either integral parts of eating disorders syndrome such as body dissatisfaction, and perfectionism or outcome of prolonged disordered eating such as functional alterations in serotonin, and some mood disturbances. Researchers should structure their thought processes around this concept that some of currently well-known risk factors for eating disorders are concurrent symptoms of eating disorders. Hence paying special attention to the new and evolved concepts is highly recommended while studying the etiology of eating disorders.

The article complies with International Committee of Medical Journal editor’s uniform requirements for manuscript.

Conflict of Interests: None; Source of funding: None.

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List of 122 Eating Disorder Research Topics

Are you looking for some eating disorder research topics that you can use as your own? Of course, you are! Otherwise, why would you be reading this blog post? Well, the good news is that we have just what you are looking for right here on this page.

No, you don’t have to download anything. You don’t have to pay anything either. All our 122 eating disorder research topics are free to use as you see fit. We have just finished updating the list, so you can find unique topics that are entirely original. Nobody in your class has probably found them, so you’re safe.

Best Eating Disorder Research Topics on the Internet

Every student should focus on studying or learning for his terms or exams. However, hunting for eating disorder research topics can take hours – if not days. You probably don’t have so much free time on your hands. This is why, if you need to write an eating disorders research paper, you should first visit our blog. You will find that our topics are the best on the Internet. Also, here is what you get if you visit our page periodically:

Our list of topics is updated relatively frequently, so you will probably be able to get an original topic right here in just a couple of minutes. All our topics are relatively easy to write about. You can find plenty of information online about 99% of these topics. You will never have to pay anything to get topics. They are all free. You are also free to reword them to suit your needs. You can get a list of new topics from our expert writers if you can’t find what you are looking for on this page.

So, let’s take a look at our list of the latest and most interesting eating disorder research topics.

Anorexia Research Paper Ideas

Talking about anorexia may not be the easiest thing in the world, but we have some anorexia research paper ideas that are not that complicated right here:

• What causes anorexia in children?
• The 3 most effective anorexia nervosa treatments
• How do affected people perceive their anorexia?
• Physical effects of anorexia nervosa
• Psychological effects of anorexia
• The ethics behind the nasogastric tube treatment
• The link between anorexia and infertility
• The link between osteoporosis
• The link between anorexia and heart damage
• Cultural factors that influence the occurrence of anorexia
• Does anorexia cause depression?
• Anorexia nervosa in evolutionary psychiatry

Eating Disorders Research Paper Topics

Have you been asked by your professor to write a research paper on an eating disorder or related subject? Check out these unique eating disorders research paper topics:

• Best screening tools for eating disorders
• Compare and contrast 2 eating disorders
• Discuss eating disorders to social media
• A short history of eating disorders
• How can one achieve body positivity?
• Most interesting myths about eating disorders
• Differences between bulimia and anorexia
• What causes the relapse of eating disorders?
• The epidemic of anorexia in the United States
• Mass media’s effect on body image in the UK
• Gender role in eating disorders

Children Eating Disorders

We can guarantee that if you write about children eating disorders, you will capture the attention of your professor from the first two sentences. Give these topics a try:

• Self-injury in children with anorexia
• Occurrence of bulimia nervosa in adolescents
• Treating autistic children with anorexia
• What causes eating disorders among children in the US?
• Correcting children’s eating disorders in the United Kingdom
• Preventing relapses in young children
• The developmental psychology behind eating disorders
• Mental development problems in children with anorexia
• Successful parenting to prevent the occurrence of anorexia
• Television and its effects on self-esteem
• The link between fat-shaming and anorexia

Top Questions About Eating Disorders

Wondering what are the top questions about eating disorders today? Our experts have compiled them in an original list of questions below:

• What factors influence complete recovery for eating disorders?
• Can we develop personalized treatments for each patient?
• Should the symptoms be treated first?
• What chances does a person with co-morbidities have to survive an episode of anorexia?
• Which type of treatment offers the best chances of complete recovery?
• What can parents do to help children with anorexia?
• What are the risk factors that lead to bulimia nervosa?
• What causes self-harm in patients with anorexia?
• Why are eating disorders on the rise in developed countries?

Binge Eating Disorder Topics

Yes, binge eating is a very serious eating disorder. So why now write an essay about it? Check out these interesting binge eating disorder topics and pick the one you like:

• The social problems associated with binge eating
• The psychological problems caused by binge eating
• Physical issues caused by the binge eating disorder
• Differences between binge eating and bulimia
• Differences between binge eating and anorexia nervosa
• Prevalence of binge eating in healthy adults in the US
• Underreporting problems in the male population
• Benefits of counseling
• Surgery affects on binge eating
• Best lifestyle interventions in cases of binge eating
• Effective medication against binge eating disorders

Eating Disorder Topics for College

If you are a college student, you need a more complex topic to win a top grade. Take a look at these great eating disorder topics for college and take your pick:

• Household income effects on bulimia incidence
• The accuracy of the Eating Disorder Examination
• Effects of anorexia on the reproductive system
• An in-depth analysis of the refeeding syndrome
• Using hypnotherapy to treat bulimia nervosa
• The effect of selective serotonin reuptake inhibitor on binge eating
• Using olanzapine in anorexia nervosa cases
• Cognitive-behavioral therapy for binge eating
• The mortality rate of anorexia nervosa patients
• The effects of fluoxetine on bulimia nervosa patients
• The role of antidepressants in treating bulimia

Complex Eating Disorder Research Topics

If you want to impress your professor and awe your classmates, you may need to consider picking a topic from our list of complex eating disorder research topics below:

• Discuss physical morbidity caused by eating disorders
• The first documented case of anorexia nervosa
• An in-depth look at eating disorder psychosocial morbidity
• Binge eating in the Roman society
• Effective methods for eating recovery
• Sports effects on the occurrence of bulimia nervosa
• Bulimia nervosa in the 18th century
• Analyze the accuracy of the Anorectic Behavior Observation Scale
• An in-depth look at evolutionary psychiatry
• Topiramate and zonisamide for treating binge eating
• Using anti-obesity medications for bulimia and binge eating

Bulimia Nervosa Essay Topics

Of course, you can write an essay about bulimia nervosa or something related to it. Let’s help you with some bulimia nervosa essay topics:

• 5 lesser-known facts about bulimia
• Famous people who had bulimia
• The psychological consequences of bulimia
• Physical effects of bulimia nervosa
• Gender’s role in the bulimia nervosa disorder
• Effective methods to diagnose bulimia
• Effective treatments against bulimia nervosa
• First symptoms of bulimia
• Incidence of bulimia cases among children in the US
• Can willpower alone treat bulimia nervosa?

Eating Disorder Research Topics in Nursing

If you are a nursing student (or are attending a nursing class), you may find these eating disorder research topics in nursing highly interesting:

• Nursing’s role in eating disorder recovery
• Discuss nursing best practices when dealing with anorexia
• Nursing techniques for patients with bulimia
• Treating the symptoms of anorexia nervosa effectively

Treatments for Eating Disorders

Your professor will surely appreciate you taking the time to research various treatments for eating disorders. You may get some bonus points if you use one of these topics:

• The best treatment for bulimia nervosa
• A universal treatment for all eating disorders
• Medications that are effective against the binge eating disorder
• Talk about the use of hypnosis to treat eating disorders
• Discuss the cure rate for anorexia nervosa

Anorexia Nervosa Research Paper Topics

Did you run out of ideas for your eating disorder research paper? No problem, just check out the following anorexia nervosa research paper topics and pick the one you like:

• First symptoms and manifestations of anorexia nervosa
• Is anorexia nervosa contagious?
• Genetic transmission of the anorexia nervosa disorder
• Risk factors that influence anorexia nervosa in the United States
• Effective medication for the anorexia nervosa disorder

Gender Issues and Eating Disorders

Yes, there are many gender issues that you can talk about when it comes to eating disorders. We have an entire list of gender issues and eating disorders ideas right here for you:

• The gender with the highest rates of eating disorders
• Men and their struggle with anorexia nervosa
• Gender issues that make diagnosis difficult
• Mortality rates of eating disorders by gender
• Stereotypes related to eating disorders

Easy Eating Disorder Research Topics

These easy eating disorder research topics are for students who don’t want to spend days doing the research and writing the essay:

• What causes bulimia?
• Psychiatric help for eating disorder patients
• Effective medications that prevent anorexia episodes
• What causes anorexia nervosa?
• How can the binge eating disorder be treated effectively?
• Psychological problems caused by eating disorders

Controversial Eating Disorder Research Topics

Take a look at some controversial eating disorder research topics and pick one. Probably nobody in your school has even thought about writing a paper on any of these ideas:

• Anorexia Nervosa portrayal in the media in the United States
• Forced therapy in eating disorders in Eastern Europe
• Negative social media effects on the treatment of eating disorders
• False positives when diagnosing people with eating disorders
• Palliative care for people with anorexia and co-morbidities

Eating Disorder Topics for High School

If you are a high school student, you will be thrilled to learn that we have some very simple topics about eating disorders. Check out our list of eating disorder topics for high school students:

• An in-depth analysis of anorexia nervosa
• The history of binge eating in the United States
• Effective treatment options for bulimia nervosa
• The best way to diagnose an eating disorder
• The role of the family in treating eating disorders
• Dangerous medications used to treat eating disorders

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