eating disorder research paper pdf

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Publications
Account settings
My Bibliography
Collections
Citation manager

Save citation to file

Email citation, add to collections.

Create a new collection
Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

Search in PubMed
Search in NLM Catalog
Add to Search

Eating disorders

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.

PubMed Disclaimer

Eating disorders: innovation and progress urgently needed. The Lancet. The Lancet. Lancet. 2020 Mar 14;395(10227):840. doi: 10.1016/S0140-6736(20)30573-0. Lancet. 2020. PMID: 32171393 No abstract available.

Publication types

Search in MeSH

Related information

Cited in Books

LinkOut - more resources

Full text sources.

ClinicalKey
Elsevier Science
MedlinePlus Health Information

Research Materials

NCI CPTC Antibody Characterization Program

Miscellaneous

NCI CPTAC Assay Portal
Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

JavaScript disabled

You have to enable JavaScript in your browser's settings in order to use the eReader.

Or try downloading the content offline

Did you know?

Reader environment loaded

Loading publication (1.4 MB)

Large documents might take a while

Information

Author Services

Initiatives

You are accessing a machine-readable page. In order to be human-readable, please install an RSS reader.

All articles published by MDPI are made immediately available worldwide under an open access license. No special permission is required to reuse all or part of the article published by MDPI, including figures and tables. For articles published under an open access Creative Common CC BY license, any part of the article may be reused without permission provided that the original article is clearly cited. For more information, please refer to https://www.mdpi.com/openaccess .

Feature papers represent the most advanced research with significant potential for high impact in the field. A Feature Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for future research directions and describes possible research applications.

Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive positive feedback from the reviewers.

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

Original Submission Date Received: .

Active Journals
Find a Journal
Journal Proposal
Proceedings Series
For Authors
For Reviewers
For Editors
For Librarians
For Publishers
For Societies
For Conference Organizers
Open Access Policy
Institutional Open Access Program
Special Issues Guidelines
Editorial Process
Research and Publication Ethics
Article Processing Charges
Testimonials
Preprints.org
SciProfiles
Encyclopedia

Article Menu

Subscribe SciFeed
Recommended Articles
PubMed/Medline
Google Scholar
on Google Scholar
Table of Contents

Find support for a specific problem in the support section of our website.

Please let us know what you think of our products and services.

Visit our dedicated information section to learn more about MDPI.

JSmol Viewer

Current discoveries and future implications of eating disorders.

1. Introduction

3. current discoveries of eating disorders, 3.1. anorexia nervosa (an), 3.2. bulimia nervosa (bn), 3.3. binge eating disorder (bed), 3.4. treatments of eating disorders, 4. discussion, 4.1. limitations of the current eating disorders research, 4.2. future direction of eating disorder research, 5. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

Diaz-Marsa, M.; Alberdi-Paramo, I.; Niell-Galmes, L. Nutritional supplements in eating disorders. Actas Esp. Psiquiatr. 2017 , 45 , 26–36. [ Google Scholar ]
Zipfel, S.; Schmidt, U.; Giel, K.E. The hidden burden of eating disorders during the COVID-19 pandemic. Lancet Psychiatry 2022 , 9 , 9–11. [ Google Scholar ] [ CrossRef ]
Azzeh, M.; Peachey, G.; Loney, T. Prevalence of High-Risk Disordered Eating Amongst Adolescents and Young Adults in the Middle East: A Scoping Review. Int. J. Env. Res. Public. Health 2022 , 19 , 5234. [ Google Scholar ] [ CrossRef ]
Rantala, M.J.; Luoto, S.; Krama, T.; Krams, I. Eating Disorders: An Evolutionary Psychoneuroimmunological Approach. Front. Psychol. 2019 , 10 , 2200. [ Google Scholar ] [ CrossRef ] [ Green Version ]
van Eeden, A.E.; van Hoeken, D.; Hoek, H.W. Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Curr. Opin. Psychiatry 2021 , 34 , 515–524. [ Google Scholar ] [ CrossRef ]
Hotzy, F.; Risch, L.; Motteli, S. Nutritional Needs in Mental Healthcare: Study Protocol of a Prospective Analytic Observational Study Assessing Nutritional Status, Eating Behavior and Barriers to Healthy Eating in Psychiatric Inpatients and Outpatients Compared to Healthy Adults. Front. Psychiatry 2022 , 13 , 906234. [ Google Scholar ] [ CrossRef ]
Coelho, J.S.; Lee, T.; Karnabi, P.; Burns, A.; Marshall, S.; Geller, J.; Lam, P.Y. Eating disorders in biological males: Clinical presentation and consideration of sex differences in a pediatric sample. J. Eat. Disord. 2018 , 6 , 40. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Ragnhildstveit, A.; Slayton, M.; Jackson, L.K.; Brendle, M.; Ahuja, S.; Holle, W.; Moore, C.; Sollars, K.; Seli, P.; Robison, R. Ketamine as a Novel Psychopharmacotherapy for Eating Disorders: Evidence and Future Directions. Brain Sci. 2022 , 12 , 382. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Petropoulou, A.; Bakounaki, G.; Grammatikopoulou, M.G.; Bogdanos, D.P.; Goulis, D.G.; Vassilakou, T. Eating Disorders and Disordered Eating Behaviors in Cystic Fibrosis: A Neglected Issue. Children 2022 , 9 , 915. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Olguin, P.; Fuentes, M.; Gabler, G.; Guerdjikova, A.I.; Keck, P.E., Jr.; McElroy, S.L. Medical comorbidity of binge eating disorder. Eat. Weight. Disord. 2017 , 22 , 13–26. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Cena, H.; Vandoni, M.; Magenes, V.C.; Di Napoli, I.; Marin, L.; Baldassarre, P.; Luzzi, A.; De Pasquale, F.; Zuccotti, G.; Calcaterra, V. Benefits of Exercise in Multidisciplinary Treatment of Binge Eating Disorder in Adolescents with Obesity. Int. J. Env. Res. Public. Health 2022 , 19 , 8300. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Rendina-Ruedy, E.; Smith, B.J. Common Dietary Modifications in Preclinical Models to Study Skeletal Health. Front. Endocrinol 2022 , 13 , 932343. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Fontana, L.; Garzia, E.; Marfia, G.; Galiano, V.; Miozzo, M. Epigenetics of functional hypothalamic amenorrhea. Front. Endocrinol 2022 , 13 , 953431. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Frostad, S. Are the Effects of Malnutrition on the Gut Microbiota-Brain Axis the Core Pathologies of Anorexia Nervosa? Microorganisms 2022 , 10 , 1486. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Freizinger, M.; Recto, M.; Jhe, G.; Lin, J. Atypical Anorexia in Youth: Cautiously Bridging the Treatment Gap. Children 2022 , 9 , 837. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Pedreira, C.C.; Maya, J.; Misra, M. Functional hypothalamic amenorrhea: Impact on bone and neuropsychiatric outcomes. Front. Endocrinol 2022 , 13 , 953180. [ Google Scholar ] [ CrossRef ]
Keeler, J.L.; Patsalos, O.; Chung, R.; Schmidt, U.; Breen, G.; Treasure, J.; Hubertus, H.; Dalton, B. Short communication: Serum levels of brain-derived neurotrophic factor and association with pro-inflammatory cytokines in acute and recovered anorexia nervosa. J. Psychiatr. Res. 2022 , 150 , 34–39. [ Google Scholar ] [ CrossRef ]
Reyes-Haro, D. Glial cells in anorexia. Front. Cell Neurosci. 2022 , 16 , 983577. [ Google Scholar ] [ CrossRef ]
Djogo, T.; Robins, S.C.; Schneider, S.; Kryzskaya, D.; Liu, X.; Mingay, A.; Gillon, C.J.; Kim, J.H.; Storch, K.F.; Boehm, U.; et al. Adult NG2-Glia Are Required for Median Eminence-Mediated Leptin Sensing and Body Weight Control. Cell Metab. 2016 , 23 , 797–810. [ Google Scholar ] [ CrossRef ]
Frintrop, L.; Liesbrock, J.; Paulukat, L.; Johann, S.; Kas, M.J.; Tolba, R.; Heussen, N.; Neulen, J.; Konrad, K.; Herpertz-Dahlmann, B.; et al. Reduced astrocyte density underlying brain volume reduction in activity-based anorexia rats. World J. Biol. Psychiatry 2018 , 19 , 225–235. [ Google Scholar ] [ CrossRef ] [ Green Version ]
Giel, K.; Zipfel, S.; Hallschmid, M. Oxytocin and Eating Disorders: A Narrative Review on Emerging Findings and Perspectives. Curr. Neuropharmacol. 2018 , 16 , 1111–1121. [ Google Scholar ] [ CrossRef ]
Lafrance, V.; Inoue, W.; Kan, B.; Luheshi, G.N. Leptin modulates cell morphology and cytokine release in microglia. Brain Behav. Immun. 2010 , 24 , 358–365. [ Google Scholar ] [ CrossRef ]
Cai, X.; Liu, H.; Feng, B.; Yu, M.; He, Y.; Liu, H.; Liang, C.; Yang, Y.; Tu, L.; Zhang, N.; et al. A D2 to D1 shift in dopaminergic inputs to midbrain 5-HT neurons causes anorexia in mice. Nat. Neurosci. 2022 , 25 , 646–658. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Sutton Hickey, A.K.; Duane, S.C.; Mickelsen, L.E.; Karolczak, E.O.; Shamma, A.M.; Skillings, A.; Li, C.; Krashes, M.J. AgRP neurons coordinate the mitigation of activity-based anorexia. Mol. Psychiatry 2022 , 28 , 1622–1635. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Plata-Salaman, C.R.; Sonti, G.; Borkoski, J.P.; Wilson, C.D.; French-Mullen, J.M. Anorexia induced by chronic central administration of cytokines at estimated pathophysiological concentrations. Physiol. Behav. 1996 , 60 , 867–875. [ Google Scholar ] [ CrossRef ]
Casper, R.C. Restlessness and an Increased Urge to Move (Drive for Activity) in Anorexia Nervosa May Strengthen Personal Motivation to Maintain Caloric Restriction and May Augment Body Awareness and Proprioception: A Lesson From Leptin Administration in Anorexia Nervosa. Front. Psychol. 2022 , 13 , 885274. [ Google Scholar ] [ PubMed ]
Hebebrand, J.; Hildebrandt, T.; Schlogl, H.; Seitz, J.; Denecke, S.; Vieira, D.; Gradl-Dietsch, G.; Peters, T.; Antel, J.; Lau, D.; et al. The role of hypoleptinemia in the psychological and behavioral adaptation to starvation: Implications for anorexia nervosa. Neurosci. Biobehav. Rev. 2022 , 141 , 104807. [ Google Scholar ] [ CrossRef ]
Shobeiri, P.; Kalantari, A.; Teixeira, A.L.; Rezaei, N. Shedding light on biological sex differences and microbiota-gut-brain axis: A comprehensive review of its roles in neuropsychiatric disorders. Biol. Sex. Differ. 2022 , 13 , 12. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Russell, G. Bulimia nervosa: An ominous variant of anorexia nervosa. Psychol. Med. 1979 , 9 , 429–448. [ Google Scholar ] [ CrossRef ]
Castillo, M.; Weiselberg, E. Bulimia Nervosa/Purging Disorder. Curr. Probl. Pediatr. Adolesc. Health Care 2017 , 47 , 85–94. [ Google Scholar ] [ CrossRef ]
Wang, H.R.; Hu, S.W.; Zhang, S.; Song, Y.; Wang, X.Y.; Wang, L.; Li, Y.Y.; Yu, Y.M.; Liu, H.; Liu, D.; et al. KCNQ Channels in the Mesolimbic Reward Circuit Regulate Nociception in Chronic Pain in Mice. Neurosci. Bull. 2021 , 37 , 597–610. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Wang, L.; Bi, K.; An, J.; Li, M.; Li, K.; Kong, Q.M.; Li, X.N.; Lu, Q.; Si, T.M. Abnormal structural brain network and hemisphere-specific changes in bulimia nervosa. Transl. Psychiatry 2019 , 9 , 206. [ Google Scholar ] [ CrossRef ] [ PubMed ] [ Green Version ]
Berner, L.A.; Simmons, A.N.; Wierenga, C.E.; Bischoff-Grethe, A.; Paulus, M.P.; Bailer, U.F.; Kaye, W.H. Altered anticipation and processing of aversive interoceptive experience among women remitted from bulimia nervosa. Neuropsychopharmacology 2019 , 44 , 1265–1273. [ Google Scholar ] [ CrossRef ]
Monteleone, P.; Martiadis, V.; Colurcio, B.; Maj, M. Leptin secretion is related to chronicity and severity of the illness in bulimia nervosa. Psychosom. Med. 2002 , 64 , 874–879. [ Google Scholar ] [ PubMed ]
Brewerton, T.D.; Lesem, M.D.; Kennedy, A.; Garvey, W.T. Reduced plasma leptin concentrations in bulimia nervosa. Psychoneuroendocrinology 2000 , 25 , 649–658. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Jimerson, D.C.; Mantzoros, C.; Wolfe, B.E.; Metzger, E.D. Decreased serum leptin in bulimia nervosa. J. Clin. Endocrinol. Metab. 2000 , 85 , 4511–4514. [ Google Scholar ] [ CrossRef ]
Hu, Y.; Kang, Q.; Chen, C.; Guo, L.; Chen, J. Increased plasma asprosin levels are associated with overeating and loss of control in drug-free bulimia nervosa. Eat. Weight. Disord. 2022 , 27 , 2783–2789. [ Google Scholar ] [ CrossRef ]
Mihov, Y.; Treyer, V.; Akkus, F.; Toman, E.; Milos, G.; Ametamey, S.M.; Johayem, A.; Hasler, G. Metabotropic glutamate receptor 5 in bulimia nervosa. Sci. Rep. 2020 , 10 , 6374. [ Google Scholar ] [ CrossRef ] [ Green Version ]
Qiu, A.; Adler, M.; Crocetti, D.; Miller, M.I.; Mostofsky, S.H. Basal ganglia shapes predict social, communication, and motor dysfunctions in boys with autism spectrum disorder. J. Am. Acad. Child. Adolesc. Psychiatry 2010 , 49 , 539–551, 551.e1-4. [ Google Scholar ]
Berner, L.A.; Wang, Z.; Stefan, M.; Lee, S.; Huo, Z.; Cyr, M.; Marsh, R. Subcortical Shape Abnormalities in Bulimia Nervosa. Biol. Psychiatry Cogn. Neurosci. Neuroimaging 2019 , 4 , 1070–1079. [ Google Scholar ] [ CrossRef ]
Lecomte, A.; Zerrouk, A.; Sibeoni, J.; Khan, S.; Revah-Levy, A.; Lachal, J. The role of food in family relationships amongst adolescents with bulimia nervosa: A qualitative study using photo-elicitation. Appetite 2019 , 141 , 104305. [ Google Scholar ] [ CrossRef ]
Hudson, J.I.; Hiripi, E.; Pope, H.G., Jr.; Kessler, R.C. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol. Psychiatry 2007 , 61 , 348–358. [ Google Scholar ] [ CrossRef ] [ Green Version ]
di Giacomo, E.; Aliberti, F.; Pescatore, F.; Santorelli, M.; Pessina, R.; Placenti, V.; Colmegna, F.; Clerici, M. Disentangling binge eating disorder and food addiction: A systematic review and meta-analysis. Eat. Weight. Disord. 2022 , 27 , 1963–1970. [ Google Scholar ] [ CrossRef ]
Hilker, I.; Sanchez, I.; Steward, T.; Jimenez-Murcia, S.; Granero, R.; Gearhardt, A.N.; Rodriguez-Munoz, R.C.; Dieguez, C.; Crujeiras, A.B.; Tolosa-Sola, I.; et al. Food Addiction in Bulimia Nervosa: Clinical Correlates and Association with Response to a Brief Psychoeducational Intervention. Eur. Eat. Disord. Rev. 2016 , 24 , 482–488. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Imperatori, C.; Fabbricatore, M.; Vumbaca, V.; Innamorati, M.; Contardi, A.; Farina, B. Food Addiction: Definition, measurement and prevalence in healthy subjects and in patients with eating disorders. Riv. Psichiatr. 2016 , 51 , 60–65. [ Google Scholar ] [ PubMed ]
Cao, X.; Xu, P.; Oyola, M.G.; Xia, Y.; Yan, X.; Saito, K.; Zou, F.; Wang, C.; Yang, Y.; Hinton, A., Jr.; et al. Estrogens stimulate serotonin neurons to inhibit binge-like eating in mice. J. Clin. Investig. 2014 , 124 , 4351–4362. [ Google Scholar ] [ CrossRef ] [ PubMed ] [ Green Version ]
Val-Laillet, D.; Aarts, E.; Weber, B.; Ferrari, M.; Quaresima, V.; Stoeckel, L.E.; Alonso-Alonso, M.; Audette, M.; Malbert, C.H.; Stice, E. Neuroimaging and neuromodulation approaches to study eating behavior and prevent and treat eating disorders and obesity. Neuroimage Clin. 2015 , 8 , 1–31. [ Google Scholar ] [ CrossRef ]
Xu, P.; He, Y.; Cao, X.; Valencia-Torres, L.; Yan, X.; Saito, K.; Wang, C.; Yang, Y.; Hinton, A., Jr.; Zhu, L.; et al. Activation of Serotonin 2C Receptors in Dopamine Neurons Inhibits Binge-like Eating in Mice. Biol. Psychiatry 2017 , 81 , 737–747. [ Google Scholar ] [ CrossRef ] [ Green Version ]
Zhang, X.; van den Pol, A.N. Rapid binge-like eating and body weight gain driven by zona incerta GABA neuron activation. Science 2017 , 356 , 853–859. [ Google Scholar ] [ CrossRef ]
Hildebrandt, B.A.; Ahmari, S.E. Breaking It Down: Investigation of Binge Eating Components in Animal Models to Enhance Translation. Front. Psychiatry 2021 , 12 , 728535. [ Google Scholar ] [ CrossRef ]
Mineo, D.; Cacace, F.; Mancini, M.; Vannelli, A.; Campanelli, F.; Natale, G.; Marino, G.; Cardinale, A.; Calabresi, P.; Picconi, B.; et al. Dopamine drives binge-like consumption of a palatable food in experimental Parkinsonism. Mov. Disord. 2019 , 34 , 821–831. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Prins, K.; Huisman, M.; McLuskey, A.; Mies, R.; Karels, B.; Delhanty, P.J.D.; Visser, J.A. Ghrelin deficiency sex-dependently affects food intake, locomotor activity, and adipose and hepatic gene expression in a binge-eating mouse model. Am. J. Physiol. Endocrinol. Metab. 2022 , 322 , E494–E507. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Micioni Di Bonaventura, E.; Botticelli, L.; Del Bello, F.; Giorgioni, G.; Piergentili, A.; Quaglia, W.; Cifani, C.; Micioni Di Bonaventura, M.V. Assessing the role of ghrelin and the enzyme ghrelin O-acyltransferase (GOAT) system in food reward, food motivation, and binge eating behavior. Pharmacol. Res. 2021 , 172 , 105847. [ Google Scholar ] [ CrossRef ]
Burmester, V.; Graham, E.; Nicholls, D. Physiological, emotional and neural responses to visual stimuli in eating disorders: A review. J. Eat. Disord. 2021 , 9 , 23. [ Google Scholar ] [ CrossRef ]
Yu, Y.; Miller, R.; Groth, S.W. A literature review of dopamine in binge eating. J. Eat. Disord. 2022 , 10 , 11. [ Google Scholar ] [ CrossRef ]
Alboni, S.; Micioni Di Bonaventura, M.V.; Benatti, C.; Giusepponi, M.E.; Brunello, N.; Cifani, C. Hypothalamic expression of inflammatory mediators in an animal model of binge eating. Behav. Brain Res. 2017 , 320 , 420–430. [ Google Scholar ] [ CrossRef ]
Abbott, S.; Dindol, N.; Tahrani, A.A.; Piya, M.K. Binge eating disorder and night eating syndrome in adults with type 2 diabetes: A systematic review. J. Eat. Disord. 2018 , 6 , 36. [ Google Scholar ] [ CrossRef ] [ Green Version ]
Harris, S.R.; Carrillo, M.; Fujioka, K. Binge-Eating Disorder and Type 2 Diabetes: A Review. Endocr. Pract. 2021 , 27 , 158–164. [ Google Scholar ] [ CrossRef ]
Bryant, E.; Spielman, K.; Le, A.; Marks, P.; Touyz, S.; Maguire, S. Screening, assessment and diagnosis in the eating disorders: Findings from a rapid review. J. Eat. Disord. 2022 , 10 , 78. [ Google Scholar ] [ CrossRef ]
Riva, G.; Malighetti, C.; Serino, S. Virtual reality in the treatment of eating disorders. Clin. Psychol. Psychother. 2021 , 28 , 477–488. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Quansah Amissah, R.; Basha, D.; Bukhtiyarova, O.; Timofeeva, E.; Timofeev, I. Neuronal activities during palatable food consumption in the reward system of binge-like eating female rats. Physiol. Behav. 2021 , 242 , 113604. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Abdelaal, M.; le Roux, C.W.; Docherty, N.G. Morbidity and mortality associated with obesity. Ann. Transl. Med. 2017 , 5 , 161. [ Google Scholar ] [ CrossRef ] [ PubMed ] [ Green Version ]
Boye, K.S.; Ford, J.H.; Thieu, V.T.; Lage, M.J.; Terrell, K.A. The Association Between Obesity and the 5-Year Prevalence of Morbidity and Mortality Among Adults with Type 2 Diabetes. Diabetes Ther. 2023 , 14 , 709–721. [ Google Scholar ] [ CrossRef ]
Lenz, M.; Richter, T.; Muhlhauser, I. The morbidity and mortality associated with overweight and obesity in adulthood: A systematic review. Dtsch. Arztebl. Int. 2009 , 106 , 641–648. [ Google Scholar ]
Sambandam, S.; Bokhari, S.; Tsai, S.; Nathan, V.S.; Senthil, T.; Lanier, H.; Huerta, S. Morbidity and Mortality in Non-Obese Compared to Different Classes of Obesity in Patients Undergoing Transtibial Amputations. J. Clin. Med. 2022 , 12 , 267. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Rekkers, M.E.; Aardenburg, L.; Scheffers, M.; van Elburg, A.A.; van Busschbach, J.T. Shifting the Focus: A Pilot Study on the Effects of Positive Body Exposure on Body Satisfaction, Body Attitude, Eating Pathology and Depressive Symptoms in Female Patients with Eating Disorders. Int. J. Env. Res. Public. Health 2022 , 19 , 11794. [ Google Scholar ] [ CrossRef ]
Navarro-Tapia, E.; Almeida-Toledano, L.; Sebastiani, G.; Serra-Delgado, M.; Garcia-Algar, O.; Andreu-Fernandez, V. Effects of Microbiota Imbalance in Anxiety and Eating Disorders: Probiotics as Novel Therapeutic Approaches. Int. J. Mol. Sci. 2021 , 22 , 2351. [ Google Scholar ] [ CrossRef ]
Palmieri, S.; Mansueto, G.; Scaini, S.; Caselli, G.; Sapuppo, W.; Spada, M.M.; Sassaroli, S.; Ruggiero, G.M. Repetitive Negative Thinking and Eating Disorders: A Meta-Analysis of the Role of Worry and Rumination. J. Clin. Med. 2021 , 10 , 2448. [ Google Scholar ] [ CrossRef ]
Barnes, R.D.; Ivezaj, V.; Martino, S.; Pittman, B.P.; Paris, M.; Grilo, C.M. Examining motivational interviewing plus nutrition psychoeducation for weight loss in primary care. J. Psychosom. Res. 2018 , 104 , 101–107. [ Google Scholar ] [ CrossRef ]
Yohn, S.E.; Galbraith, J.; Calipari, E.S.; Conn, P.J. Shared Behavioral and Neurocircuitry Disruptions in Drug Addiction, Obesity, and Binge Eating Disorder: Focus on Group I mGluRs in the Mesolimbic Dopamine Pathway. ACS Chem. Neurosci. 2019 , 10 , 2125–2143. [ Google Scholar ] [ CrossRef ]
Manasse, S.M.; Espel, H.M.; Forman, E.M.; Ruocco, A.C.; Juarascio, A.S.; Butryn, M.L.; Zhang, F.; Lowe, M.R. The independent and interacting effects of hedonic hunger and executive function on binge eating. Appetite 2015 , 89 , 16–21. [ Google Scholar ] [ CrossRef ] [ Green Version ]
Sultson, H.; Kreegipuu, K.; Akkermann, K. Exploring the role of momentary positive and negative affect in overeating and binge eating: Evidence for different associations among men and women. Appetite 2022 , 168 , 105758. [ Google Scholar ] [ CrossRef ]
Guerdjikova, A.I.; Mori, N.; Casuto, L.S.; McElroy, S.L. Novel pharmacologic treatment in acute binge eating disorder-role of lisdexamfetamine. Neuropsychiatr. Dis. Treat. 2016 , 12 , 833–841. [ Google Scholar ] [ CrossRef ] [ Green Version ]
Schneider, E.; Martin, E.; Rotshtein, P.; Qureshi, K.L.; Chamberlain, S.R.; Spetter, M.S.; Dourish, C.T.; Higgs, S. The effects of lisdexamfetamine dimesylate on eating behaviour and homeostatic, reward and cognitive processes in women with binge-eating symptoms: An experimental medicine study. Transl. Psychiatry 2022 , 12 , 9. [ Google Scholar ] [ CrossRef ]
Heal, D.J.; Gosden, J. What pharmacological interventions are effective in binge-eating disorder? Insights from a critical evaluation of the evidence from clinical trials. Int. J. Obes. 2022 , 46 , 677–695. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Heal, D.J.; Smith, S.L. Prospects for new drugs to treat binge-eating disorder: Insights from psychopathology and neuropharmacology. J. Psychopharmacol. 2022 , 36 , 680–703. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Romano, A.; Micioni Di Bonaventura, M.V.; Gallelli, C.A.; Koczwara, J.B.; Smeets, D.; Giusepponi, M.E.; De Ceglia, M.; Friuli, M.; Micioni Di Bonaventura, E.; Scuderi, C.; et al. Oleoylethanolamide decreases frustration stress-induced binge-like eating in female rats: A novel potential treatment for binge eating disorder. Neuropsychopharmacology 2020 , 45 , 1931–1941. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Dakanalis, A.; Clerici, M.; Stice, E. Prevention of eating disorders: Current evidence-base for dissonance-based programmes and future directions. Eat. Weight. Disord. 2019 , 24 , 597–603. [ Google Scholar ] [ CrossRef ] [ Green Version ]
Touyz, S.; Hay, P. The future of eating disorders research: An editorial. J. Eat. Disord. 2022 , 10 , 10. [ Google Scholar ] [ CrossRef ]
Jagielska, G.; Kacperska, I. Outcome, comorbidity and prognosis in anorexia nervosa. Psychiatr. Pol. 2017 , 51 , 205–218. [ Google Scholar ] [ CrossRef ]
Chatelet, S.; Wang, J.; Gjoertz, M.; Lier, F.; Monney Chaubert, C.; Ambresin, A.E. Factors associated with weight gain in anorexia nervosa inpatients. Eat. Weight. Disord. 2020 , 25 , 939–950. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Van Huysse, J.L.; Smith, K.; Mammel, K.A.; Prohaska, N.; Rienecke, R.D. Early weight gain predicts treatment response in adolescents with anorexia nervosa enrolled in a family-based partial hospitalization program. Int. J. Eat. Disord. 2020 , 53 , 606–610. [ Google Scholar ] [ CrossRef ]
Loomes, R.; Bryant-Waugh, R. Widening the reach of family-based interventions for Anorexia Nervosa: Autism-adaptations for children and adolescents. J. Eat. Disord. 2021 , 9 , 157. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Monteleone, A.M.; Pellegrino, F.; Croatto, G.; Carfagno, M.; Hilbert, A.; Treasure, J.; Wade, T.; Bulik, C.M.; Zipfel, S.; Hay, P.; et al. Treatment of eating disorders: A systematic meta-review of meta-analyses and network meta-analyses. Neurosci. Biobehav. Rev. 2022 , 142 , 104857. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Leppanen, J.; Cardi, V.; Ng, K.W.; Paloyelis, Y.; Stein, D.; Tchanturia, K.; Treasure, J. The effects of intranasal oxytocin on smoothie intake, cortisol and attentional bias in anorexia nervosa. Psychoneuroendocrinology 2017 , 79 , 167–174. [ Google Scholar ] [ CrossRef ] [ Green Version ]
Schwenzer, C.; Voelz, C.; Kogel, V.; Schlosser, A.; Herpertz-Dahlmann, B.; Beyer, C.; Seitz, J.; Trinh, S. Fear and food: Anxiety-like behavior and the susceptibility to weight loss in an activity-based anorexia rat model. Clin. Transl. Sci. 2022 , 15 , 889–898. [ Google Scholar ] [ CrossRef ]
Sorrentino, D.; Mucci, A.; Merlotti, E.; Galderisi, S.; Maj, M. Modified nutritional counselling to increase motivation to treatment in anorexia nervosa. Eur. Psychiatry 2005 , 20 , 186–187. [ Google Scholar ] [ CrossRef ]
Gruber, M.; Konig, D.; Holzhauser, J.; Castillo, D.M.; Bluml, V.; Jahn, R.; Leser, C.; Werneck-Rohrer, S.; Werneck, H. Parental feeding practices and the relationship with parents in female adolescents and young adults with eating disorders: A case control study. PLoS ONE 2020 , 15 , e0242518. [ Google Scholar ] [ CrossRef ]
Cassioli, E.; Rossi, E.; Vizzotto, C.; Malinconi, V.; Vignozzi, L.; Ricca, V.; Castellini, G. Avoidant Attachment Style Moderates the Recovery of Healthy Sexuality in Women With Anorexia Nervosa Treated With Enhanced Cognitive Behavior Therapy (CBT-E): A 2-Year Follow-Up Study. J. Sex. Med. 2022 , 19 , 347–355. [ Google Scholar ] [ CrossRef ]
Catone, G.; Salerno, F.; Muzzo, G.; Lanzara, V.; Gritti, A. Association between anorexia nervosa and other specified eating or feeding disorders and paranoia in adolescents: What factors are involved? Riv. Psichiatr. 2021 , 56 , 100–106. [ Google Scholar ]
Powers, P.S.; Bruty, H. Pharmacotherapy for eating disorders and obesity. Child. Adolesc. Psychiatr. Clin. N. Am. 2009 , 18 , 175–187. [ Google Scholar ] [ CrossRef ]
Dalle Grave, R.; El Ghoch, M.; Sartirana, M.; Calugi, S. Cognitive Behavioral Therapy for Anorexia Nervosa: An Update. Curr. Psychiatry Rep. 2016 , 18 , 2. [ Google Scholar ] [ CrossRef ]
Kaa, B.S.; Bunemann, J.M.N.; Clausen, L. A benchmark study of a combined individual and group anorexia nervosa therapy program. Nord. J. Psychiatry 2022 , 77 , 447–454. [ Google Scholar ] [ CrossRef ]
de Vos, J.; Houtzager, L.; Katsaragaki, G.; van de Berg, E.; Cuijpers, P.; Dekker, J. Meta analysis on the efficacy of pharmacotherapy versus placebo on anorexia nervosa. J. Eat. Disord. 2014 , 2 , 27. [ Google Scholar ] [ CrossRef ]
Berner, L.A.; Brown, T.A.; Lavender, J.M.; Lopez, E.; Wierenga, C.E.; Kaye, W.H. Neuroendocrinology of reward in anorexia nervosa and bulimia nervosa: Beyond leptin and ghrelin. Mol. Cell Endocrinol. 2019 , 497 , 110320. [ Google Scholar ] [ CrossRef ]
Harrington, B.C.; Jimerson, M.; Haxton, C.; Jimerson, D.C. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. Am. Fam. Physician 2015 , 91 , 46–52. [ Google Scholar ] [ PubMed ]
Agras, W.S.; Bohon, C. Cognitive Behavioral Therapy for the Eating Disorders. Annu. Rev. Clin. Psychol. 2021 , 17 , 417–438. [ Google Scholar ] [ CrossRef ]
Stabouli, S.; Erdine, S.; Suurorg, L.; Jankauskiene, A.; Lurbe, E. Obesity and Eating Disorders in Children and Adolescents: The Bidirectional Link. Nutrients 2021 , 13 , 4321. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Bello, N.T.; Yeomans, B.L. Safety of pharmacotherapy options for bulimia nervosa and binge eating disorder. Expert. Opin. Drug Saf. 2018 , 17 , 17–23. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Crow, S.J. Pharmacologic Treatment of Eating Disorders. Psychiatr. Clin. North. Am. 2019 , 42 , 253–262. [ Google Scholar ] [ CrossRef ]
Klein, D.A.; Sylvester, J.E.; Schvey, N.A. Eating Disorders in Primary Care: Diagnosis and Management. Am. Fam. Physician 2021 , 103 , 22–32. [ Google Scholar ]
Denman, E.; Parker, E.K.; Ashley, M.A.; Harris, D.M.; Halaki, M.; Flood, V.; Stefoska-Needham, A. Understanding training needs in eating disorders of graduating and new graduate dietitians in Australia: An online survey. J. Eat. Disord. 2021 , 9 , 27. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Hay, P.; Palavras, M.A.; da Luz, F.Q.; Dos Anjos Garnes, S.; Sainsbury, A.; Touyz, S.; Appolinario, J.C.; Claudino, A.M. Physical and mental health outcomes of an integrated cognitive behavioural and weight management therapy for people with an eating disorder characterized by binge eating and a high body mass index: A randomized controlled trial. BMC Psychiatry 2022 , 22 , 355. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Brownley, K.A.; Berkman, N.D.; Peat, C.M.; Lohr, K.N.; Cullen, K.E.; Bann, C.M.; Bulik, C.M. Binge-Eating Disorder in Adults: A Systematic Review and Meta-analysis. Ann. Intern. Med. 2016 , 165 , 409–420. [ Google Scholar ] [ CrossRef ] [ PubMed ] [ Green Version ]
Mathisen, T.F.; Rosenvinge, J.H.; Friborg, O.; Vrabel, K.; Bratland-Sanda, S.; Pettersen, G.; Sundgot-Borgen, J. Is physical exercise and dietary therapy a feasible alternative to cognitive behavior therapy in treatment of eating disorders? A randomized controlled trial of two group therapies. Int. J. Eat. Disord. 2020 , 53 , 574–585. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Walenda, A.; Bogusz, K.; Kopera, M.; Jakubczyk, A.; Wojnar, M.; Kucharska, K. Emotion regulation in binge eating disorder. Psychiatr. Pol. 2021 , 55 , 1433–1448. [ Google Scholar ] [ CrossRef ]
Schneider, E.; Higgs, S.; Dourish, C.T. Lisdexamfetamine and binge-eating disorder: A systematic review and meta-analysis of the preclinical and clinical data with a focus on mechanism of drug action in treating the disorder. Eur. Neuropsychopharmacol. 2021 , 53 , 49–78. [ Google Scholar ] [ CrossRef ]
Costa, M.B.; Melnik, T. Effectiveness of psychosocial interventions in eating disorders: An overview of Cochrane systematic reviews. Einstein 2016 , 14 , 235–277. [ Google Scholar ] [ CrossRef ] [ Green Version ]
Karam, A.M.; Fitzsimmons-Craft, E.E.; Tanofsky-Kraff, M.; Wilfley, D.E. Interpersonal Psychotherapy and the Treatment of Eating Disorders. Psychiatr. Clin. 2019 , 42 , 205–218. [ Google Scholar ] [ CrossRef ]
Forrest, L.N.; Franko, D.L.; Thompson-Brenner, H.; Grilo, C.M. Examining changes in binge-eating disorder network centrality and structure in patients treated with cognitive-behavioral therapy versus interpersonal psychotherapy. Int. J. Eat. Disord. 2022 , 56 , 944–955. [ Google Scholar ] [ CrossRef ]
Grilo, C.M.; Reas, D.L.; Mitchell, J.E. Combining Pharmacological and Psychological Treatments for Binge Eating Disorder: Current Status, Limitations, and Future Directions. Curr. Psychiatry Rep. 2016 , 18 , 55. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Garvey, W.T.; Mechanick, J.I.; Brett, E.M.; Garber, A.J.; Hurley, D.L.; Jastreboff, A.M.; Nadolsky, K.; Pessah-Pollack, R.; Plodkowski, R. Reviewers of the AACEOCPG American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. Endocr. Pract. 2016 , 22 (Suppl. S3), 1–203. [ Google Scholar ] [ CrossRef ] [ PubMed ] [ Green Version ]
Safer, D.L.; Adler, S.; Dalai, S.S.; Bentley, J.P.; Toyama, H.; Pajarito, S.; Najarian, T. A randomized, placebo-controlled crossover trial of phentermine-topiramate ER in patients with binge-eating disorder and bulimia nervosa. Int. J. Eat. Disord. 2020 , 53 , 266–277. [ Google Scholar ] [ CrossRef ] [ PubMed ] [ Green Version ]
Adams, G.; Turner, H.; Hoskins, J.; Robinson, A.; Waller, G. Effectiveness of a brief form of group dialectical behavior therapy for binge-eating disorder: Case series in a routine clinical setting. Int. J. Eat. Disord. 2021 , 54 , 615–620. [ Google Scholar ] [ CrossRef ]
Carter, J.C.; Kenny, T.E.; Singleton, C.; Van Wijk, M.; Heath, O. Dialectical behavior therapy self-help for binge-eating disorder: A randomized controlled study. Int. J. Eat. Disord. 2020 , 53 , 451–460. [ Google Scholar ] [ CrossRef ]
Lammers, M.W.; Vroling, M.S.; Crosby, R.D.; van Strien, T. Dialectical behavior therapy compared to cognitive behavior therapy in binge-eating disorder: An effectiveness study with 6-month follow-up. Int. J. Eat. Disord. 2022 , 55 , 902–913. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Duan, H.; Zhu, L.; Li, M.; Zhang, X.; Zhang, B.; Fang, S. Comparative efficacy and acceptability of selective serotonin reuptake inhibitor antidepressants for binge eating disorder: A network meta-analysis. Front. Pharmacol. 2022 , 13 , 949823. [ Google Scholar ] [ CrossRef ]
Amodeo, G.; Cuomo, A.; Bolognesi, S.; Goracci, A.; Trusso, M.A.; Piccinni, A.; Neal, S.M.; Baldini, I.; Federico, E.; Taddeucci, C.; et al. Pharmacotherapeutic strategies for treating binge eating disorder. Evidence from clinical trials and implications for clinical practice. Expert Opin. Pharmacother. 2019 , 20 , 679–690. [ Google Scholar ] [ CrossRef ]
Spalding, W.M.; Bertoia, M.L.; Bulik, C.M.; Seeger, J.D. Treatment characteristics among patients with binge-eating disorder: An electronic health records analysis. Postgrad. Med. 2022 , 135 , 254–264. [ Google Scholar ] [ CrossRef ]
Guerdjikova, A.I.; Williams, S.; Blom, T.J.; Mori, N.; McElroy, S.L. Combination Phentermine-Topiramate Extended Release for the Treatment of Binge Eating Disorder: An Open-Label, Prospective Study. Innov. Clin. Neurosci. 2018 , 15 , 17–21. [ Google Scholar ]
Fardouly, J.; Crosby, R.D.; Sukunesan, S. Potential benefits and limitations of machine learning in the field of eating disorders: Current research and future directions. J. Eat. Disord. 2022 , 10 , 66. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Haghshomar, M.; Shobeiri, P.; Brand, S.; Rossell, S.L.; Akhavan Malayeri, A.; Rezaei, N. Changes of symptoms of eating disorders (ED) and their related psychological health issues during the COVID-19 pandemic: A systematic review and meta-analysis. J. Eat. Disord. 2022 , 10 , 51. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Gorrell, S.; Reilly, E.E.; Brosof, L.; Le Grange, D. Use of Telehealth in the Management of Adolescent Eating Disorders: Patient Perspectives and Future Directions Suggested from the COVID-19 Pandemic. Adolesc. Health Med. Ther. 2022 , 13 , 45–53. [ Google Scholar ] [ CrossRef ] [ PubMed ]

Click here to enlarge figure

Eating Disorder	Treatments (Non-Drug)	Medications
Anorexia nervosa (AN)	Short-term hospitalization [ , , ].	There is no single effective drug approved for the treatment of anorexia nervosa.
	Home-based therapy is the evidence-based treatment for teenagers with anorexia [ , ].	Anti-anxiety medications help anorectics to comply with nutritional rehabilitation programs [ , ].
	Nutritional counseling: Nutritional counseling is the main line of nutritional recovery and is designed to teach anorexics about their body’s need for food and essential nutrients [ , , ].	Antipsychotics are also recommended in selected AN patients, who are not to eat in spite of ongoing anti-anxiety medications [ , ].
	Individual therapy: Anticipatory behavior therapy, specifically augmentative cognitive–behavioral therapy, contributes to adults [ , ].	Altered regulation of the hormone leptin may play role in the persistence of anorexia nervosa [ , ].
Bulimia nervosa (BN)	Psychotherapy: Also called talk therapy, this type of counseling can include cognitive–behavioral therapy, family-based therapy, and interpersonal psychotherapy [ , , ].	Antidepressants, such as selective serotonin re-uptake inhibitors (SSRIs) (including Celexa, Lexapro, Prozac, and Zoloft) in combination with psychological therapies, are now a mainstay in bulimia therapy [ , , ].
Bulimia nervosa (BN)	Dietitian support and nutritional education: A nutritionist can design a meal plan to help develop healthy eating habits , ].	No medications are approved to treat bulimia nervosa.
Binge eating disorder (BED)	Cognitive–behavioral therapy (CBT): CBT is highly effective in reducing the number of binge eating episodes in individuals [ , , ].	Lisdexamfetamine dimesylate (LDX) is currently the only drug approved by the FDA for the treatment of binge eating disorder [ , , ].
	Interpersonal psychotherapy: It can help reduce binge eating triggered by bad communication abilities and relationships [ , , ].	Weight loss drugs: Xenical, Contrave, Qsymia, etc. [ , , ].
	The act of dialectic behavior therapy: It reduces the desire to overeat through studying behavioral skills that can help regulate emotions and perfect relationships with other people [ , , ].	Topiramate (Topamax), an anticonvulsant antidepressant [ , , , ].

The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

Feng, B.; Harms, J.; Chen, E.; Gao, P.; Xu, P.; He, Y. Current Discoveries and Future Implications of Eating Disorders. Int. J. Environ. Res. Public Health 2023 , 20 , 6325. https://doi.org/10.3390/ijerph20146325

Feng B, Harms J, Chen E, Gao P, Xu P, He Y. Current Discoveries and Future Implications of Eating Disorders. International Journal of Environmental Research and Public Health . 2023; 20(14):6325. https://doi.org/10.3390/ijerph20146325

Feng, Bing, Jerney Harms, Emily Chen, Peiyu Gao, Pingwen Xu, and Yanlin He. 2023. "Current Discoveries and Future Implications of Eating Disorders" International Journal of Environmental Research and Public Health 20, no. 14: 6325. https://doi.org/10.3390/ijerph20146325

Article Metrics

Article access statistics, further information, mdpi initiatives, follow mdpi.

Subscribe to receive issue release notifications and newsletters from MDPI journals

Open access
Published: 15 November 2022

Conceptualizing eating disorder recovery research: Current perspectives and future research directions

Heather Hower 1 , 2 ,
Andrea LaMarre 3 ,
Rachel Bachner-Melman 4 , 5 ,
Erin N. Harrop 6 ,
Beth McGilley 7 &
Therese E. Kenny 8

Journal of Eating Disorders volume 10 , Article number: 165 ( 2022 ) Cite this article

5236 Accesses

10 Citations

6 Altmetric

Metrics details

How we research eating disorder (ED) recovery impacts what we know (perceive as fact) about it. Traditionally, research has focused more on the “what” of recovery (e.g., establishing criteria for recovery, reaching consensus definitions) than the “how” of recovery research (e.g., type of methodologies, triangulation of perspectives). In this paper we aim to provide an overview of the ED field’s current perspectives on recovery, discuss how our methodologies shape what is known about recovery, and suggest a broadening of our methodological “toolkits” in order to form a more complete picture of recovery.

This paper examines commonly used methodologies in research, and explores how incorporating different perspectives can add to our understanding of the recovery process. To do this, we (1) provide an overview of commonly used methodologies (quantitative, qualitative), (2) consider their benefits and limitations, (3) explore newer approaches, including mixed-methods, creative methods (e.g., Photovoice, digital storytelling), and multi-methods (e.g., quantitative, qualitative, creative methods, psycho/physiological, behavioral, laboratory, online observations), and (4) suggest that broadening our methodological “toolkits” could spur more nuanced and specific insights about ED recoveries. We propose a potential future research model that would ideally have a multi-methods design, incorporate different perspectives (e.g., expanding recruitment of diverse participants, including supportive others, in study co-creation), and a longitudinal course (e.g., capturing cognitive and emotional recovery, which often comes after physical). In this way, we hope to move the field towards different, more comprehensive, perspectives on ED recovery.

Our current perspectives on studying ED recovery leave critical gaps in our knowledge about the process. The traditional research methodologies impact our conceptualization of recovery definitions, and in turn limit our understanding of the phenomenon. We suggest that we expand our range of methodologies, perspectives, and timeframes in research, in order to form a more complete picture of what is possible in recovery; the multiple aspects of an individual’s life that can improve, the greater number of people who can recover than previously believed, and the reaffirmation of hope that, even after decades, individuals can begin, and successfully continue, their ED recovery process.

Plain English summary

How we research eating disorder (ED) recovery impacts what we know (perceive as fact) about it. In this paper we aim to provide an overview of the ED field’s current perspectives on recovery, discuss how our methodologies shape what is known about recovery, and suggest a broadening of our methodological “toolkits” in order to form a more complete picture of recovery. To do this, we (1) provide an overview of commonly used methodologies (quantitative, qualitative), (2) consider their benefits and limitations, (3) explore newer approaches, including mixed-methods, creative methods (e.g., Photovoice, digital storytelling), and multi-methods (e.g., quantitative, qualitative, creative methods, psycho/physiological, behavioral, laboratory, online observations), and (4) propose a potential future research model with a multi-methods design, incorporating different perspectives (e.g., increasing recruitment of diverse participants, including supportive others in study co-creation), and a longitudinal course (e.g., capturing cognitive recovery, which often comes after physical). In this way, we seek to expand our picture of what is possible in recovery; the multiple aspects of an individual’s life that can improve, the greater number of people who can recover than previously believed, and the reaffirmation of hope that, even after decades, individuals can begin and continue their ED recovery process.

How we research the process of eating disorder (ED) recovery impacts what we know (perceive as fact) about this process. Traditionally, research has focused more on the “what” of recovery (e.g., establishing criteria for recovery, connecting research and clinical experiences, reaching consensus definitions) than the “how” of recovery research (e.g., timing and framing of ED recovery items and measures, type of methodologies, triangulation of perspectives). Given that our “ways of looking” are inextricably tied to what we are looking at [ 1 ] it is important to step back and investigate how research methods shape what we can know about a phenomenon of interest. This exploration can offer insight into missing pieces of the analytic puzzle (e.g., the current gaps in our knowledge), and invite novel ways of researching ED recovery (e.g., incorporating different perspectives).

ED recovery research that is published in peer-reviewed journals most frequently uses quantitative (numerical, “objective”) Footnote 1 statistical methods, or qualitative (descriptive, “subjective”) interview methods, in order to convey their findings. In this paper, we provide an overview of commonly used methods and outline key analytic features of various types of analyses that fit within these broader method categories. We also present an examination of these commonly used methods, reflecting on the benefits and limitations of each, and what each allows us to know, or not know, about ED recovery. Following this overview, we explore mixed-methods (quantitative and qualitative), creative methods (e.g., Photovoice, digital storytelling), and multi-methods (e.g., quantitative, qualitative, creative methods, psycho/physiological, behavioral, laboratory, online observations), which may provide directions for future research, and enable new understandings of ED recovery.

Importantly, we are not suggesting that researchers abandon these commonly used quantitative or qualitative methods or that one approach is inherently better than others. Rather, we are recommending a broadening of our methodological “toolkits,” to increase the clarity of purpose of our studies, along with an alignment of the methods used. This may enable the development of more nuanced and specific insights about ED recoveries that take into account context, varied perspectives, and different positionalities. In this paper we thus aim to provide an overview of the ED field’s current perspectives on recovery, illuminate how those perspectives are necessarily informed by our methodological choices, and recommend broadening our methodological “toolkits” in order to form a more complete picture about what can be known as possible in recovery.

Ontological and epistemological stances in ED recovery research

The goal or purpose of ED recovery research depends largely on the ontological (the “what” of research) and the epistemological (the “how” of research) stances endorsed by the researcher [ 2 , 3 ]. This is often considered to be foundational in qualitative research, but is less frequently named in quantitative approaches. We give a brief overview of these stances here, because how a researcher views the world will inevitably impact the goal of the research and the methodological approaches used. In this way, we cannot present a discussion of recovery methodologies without also considering ontology and epistemology.

Ontological stance refers to what we believe can be known [ 4 , 5 ]. From a realist perspective, there is a single objective truth which exists [ 6 ]. On the other side, a relativist perspective suggests that there is no singular reality outside of human practices [ 7 ]. Researchers can therefore vary along this spectrum in terms of their assumptions about what knowledge exists.

Epistemology refers to how we can come to know this information [ 8 ]. For example, positivism argues that we can come to understand or know an objective reality through rigorous scientific practices [ 9 , 10 ]. This is the foundation of the scientific approach and what has often been referred to as the “hard sciences.” Recently, there has been a shift in which individuals from this perspective acknowledge that data collection and interpretation may be imperfect and influenced by researcher characteristics; what is now known as post-positivism [ 11 ].

Many of the quantitative approaches that will be discussed in this paper come from a post-positivist framework in that they assume there is an objective recovery “truth” that can be uncovered if we are rigorous in our approach and seek to minimize bias. On the other side, there are contextualist [ 12 ] and constructionist [ 13 ] epistemologies. Contextualism situates knowledge and the people who create it (e.g., participants, researchers) in a broader context, acknowledging that no one person can know everything. Constructionism argues that meaning is multiple, socially-constructed, and connected to wider systems of power. In this way, there is no one definition or understanding of a phenomenon.

The ontological/epistemological stance and research assumptions that dictate the approaches we take in turn inform debates on recovery. Those coming from different traditions will thus have different views of what can be known about the phenomenon. For example, the frames of (post)positivism typically underlie quantitative research, and researchers coming from this perspective have long been calling for a clear, consistent, and applicable definition of recovery (e.g., [ 14 , 15 , 16 , 17 ]). However, no overall consensus definition has been reached to date, which has several implications from a (post)positivist perspective. This lack of conceptual clarity, and between-study differences in measurement approaches, impact our ability to compare the findings between studies, including reported recovery rates, which can vary dramatically, depending upon the definitions and clinical groups used (e.g., [ 14 , 15 , 18 , 19 ]).

The belief that there is a need for a singular definition is one way of understanding the utility of recovery and may be useful for some groups. The intent of our paper, though, is not to provide a statement about what a consensus definition might be. Rather, we are offering a more diverse view of methodological perspectives (which stem from various ontological and epistemological stances) and ideas that might allow for forward movement in the field. In a dialectal format, this can involve both movement toward and away from consensus, including perspectives which do not seek to identify a single recovery definition. These paths are sometimes polarized, indicating that research aiming for (provisional) consensus is incompatible with research pushing into new areas. We suggest that both can be simultaneously pursued, acknowledging that one does not discount the other.

ED recovery research approaches: A brief overview

Quantitative research stemming from (post)positivist perspectives has tended to emphasize “objective” illness and recovery criteria that can be measured and compared in the lab/treatment, such as body mass index (BMI) (e.g., [ 20 ]), and behavioral/cognitive symptoms (e.g., [ 21 , 22 ]). For example, scores of validated ED measures such as the Eating Attitudes Test (EAT) [ 23 ] are frequently subdivided into “threshold” (criteria met for a probable clinical diagnosis) or “subthreshold” (diagnostic criteria unlikely to be met). Changes in measurable physical, behavioral, and symptomatic criteria are characteristic of the medical model of recovery, with a growing body of research suggesting that such approaches may not fit as well with lived experience perspectives [ 24 , 25 ].

In a systematic review of 126 studies looking at predictors of ED outcomes [ 26 ], symptom remission was used as a key outcome in over 80% of studies. This may differ from the “process” recovery criteria typically used in clinical settings, where the individual’s progress in therapy (e.g., how they navigate their recovery, showing improvements in not only symptoms, but also psychosocial functioning) may affect the extent to which they are deemed “recovered.”

A key element of these different definitions hinges on the extent to which symptom remission is considered an important first step in recovery. This point has often been promoted as self-evident, but is inconsistent with some orientations to recovery. For instance, a recovery model orientation, which has been noted to be potentially resonant with EDs (e.g., [ 27 ]) starts with an emphasis on a person’s goals and contexts, rather than assuming that symptom remission is a first step. This does not mean that “anything goes"; a recovery model promotes collaboration and discussion in exploring what recovery means and does for the person seeking it [ 28 , 29 ].

More recently, researchers have suggested that in alignment with this recovery model, it may be possible to continue to exhibit some symptoms (e.g., behaviors), but have improvement in other areas (e.g., improved psychosocial functioning, QOL), and still feel that one is in ED recovery (e.g., [ 27 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]). ED advocacy groups led by people with lived experience are also beginning to support approaches to harm reduction within ED recovery circles, such as those promoted by Nalgona Positivity Pride. Indeed, there are now several ED-specific, standardized measures of functioning and QOL that can provide more insight in this area, including the Eating Disorders Quality of Life (EDQOL) [ 36 ], Quality of Life for Eating Disorders (QOL ED) [ 37 ], Health-Related Quality of Life in Eating Disorders Questionnaire (HeRQoLED) [ 38 ], Eating Disorders Quality of Life Scale (EDQLS) [ 39 ], and, more recently, the Eating Disorders Recovery Questionnaire (EDRQ) [ 40 ]. In addition to assessing QOL from a quantitative perspective, QOL can also be explored qualitatively, allowing it to be contextualized against the landscape of participants’ lives.

What is considered to “matter” in ED recovery definitions thus far also differs to some extent according to who is asked. Researchers, clinicians, and people with lived experience (individuals and supportive others such as parents, family, partners, friends, mentors) may emphasize different criteria for ED recovery [ 41 ]. Further, these categories are not distinct; people may simultaneously occupy multiple positionalities at once, such as researchers and/or clinicians who also have lived experience of ED. While a consensus definition among clinicians is arguably becoming a more plausible goal [ 16 ], there may still be significant divergence of opinion between the larger clinical, research, and lived experience spaces [ 18 ]. Nevertheless, Bachner-Melman et al. [ 42 ] also found a broad area of overlap in the perspectives of people with lived experience of an ED, family members, and ED therapists, on what recovery encompasses. They proposed a questionnaire to measure four aspects of ED recovery that were agreed on by these overlapping perspectives: lack of symptoms, acceptance of self and body, social and emotional connection, and physical health [ 20 ].

Lived experience, including personally having lived with an ED, as well as being a “support” for someone with an ED (e.g., parents, family, partners, friends, mentors), necessarily informs a particular person’s ED recovery definition and provides an additional lens on the same construct. Thus, individuals who have lived through an ED may have a different view of recovery to that of their “supports” (e.g., improved psychosocial functioning, QOL, vs. medical stability, decreases in behaviors, and vice versa). However, the recovery priorities of individuals and “supports” may also align. For example, recent studies have indicated that both individuals and parents/families place high value on increased body acceptance and independence in the individual’s recovery process [ 43 , 44 ]. In addition, there is a relatively new resource for partners of those with ED, which focuses on understanding, supporting, and connecting with the partner on shared recovery goals [ 45 ]. In the book “Loving Someone with an Eating Disorder,” Dana Harron includes perspective-taking exercises to help the person understand their partner’s struggle, strategies for dealing with mealtime challenges, up-to-date facts about EDs, and self-care tips to help the person maintain healthy boundaries [ 45 ].

Conceptual and methodological challenges in ED recovery research

Related to the above, researchers face a number of conceptual and methodological questions when exploring ED recovery. For example, whether or not recovery should be considered per individual ED, or trans-diagnostically, is an important question in the recovery definition literature. Bardone-Cone et al. [ 15 ] suggest that a transdiagnostic approach is most appropriate, given that diagnoses can shift, and symptoms can fluctuate over time. Indeed, longitudinal studies have indicated that participants report receiving a single ED diagnosis at one point in time, however, over their lifetime, they would have met criteria for two, three, or four “different” ED diagnoses at different times (e.g., [ 46 ]). Anecdotally, our co-authors have also noted this when recruiting participants for research. Instead of necessitating an overall cessation of ED symptoms within one diagnostic category in the traditional categorical approach, a transdiagnostic approach could rather focus on improving the status of individual symptoms (e.g., frequency of restricting, binging) as a marker of individual “recovery.”

Beyond differences in being able to compare clinical groups across research findings, we might also consider who is most commonly included in these recovery studies (and who is not). There are many significant logistical barriers to receiving an ED diagnosis and related treatment worldwide. Indeed, practical barriers include: cost, insurance coverage, rurality, transportation, work or education schedules, and lack of available childcare, which disproportionately affects people from potentially disadvantaged groups (e.g., [ 47 , 48 , 49 , 50 ]). The process of recovery itself invokes privilege (e.g., who is able to be diagnosed, who has access to formal treatment, and who is recovering in the “right way”). For example, EDs may be missed, or diagnoses delayed, in those who do not fit the stereotypical picture of a person with an ED, including those in larger, or non-emaciated, bodies [ 51 , 52 ].

The majority of the studies thus far on ED recovery definitions are therefore composed predominantly of non-diverse participant samples who have the means to overcome the barriers to treatment access (i.e., predominantly White, thin, socioeconomically privileged, cisgender women, drawn primarily from clinical settings). Indeed, there has been comparatively little research on other populations with EDs (e.g., cis men, trans and nonbinary people, children, elders, higher weight individuals, individuals with binge eating disorder [BED], comorbidities, or late onset), as these groups often do not have access to the diagnoses and treatments that are the gateway to research study participation. These limitations determine whose recoveries we can learn about, and excludes other experiences [ 18 , 53 , 54 ].

Traditionally, those with lived experience have not been invited to co-design recovery research, limiting study participation and the diversity of representation. Even when recovery research includes non-clinical samples, methodology choices impact who is selected for participation. For example, studies that exclude potential participants with BMIs above certain levels (e.g., BMIs that are considered “overweight” or “obese”) exclude many ED recovery experiences automatically, limiting the view of what “recovery” looks like.

Additionally, the specific terminology of “recovery” may not resonate with all people experiencing life beyond an ED [ 55 ], causing some potential participants to self-select out of such studies. Some people with lived experience note that the term “recovery” is prescribed and carries preconceptions [ 56 , 57 ]. Indeed, there are nuances and connotations involved with the use of the word “recovery.” Some individuals may consider themselves “in recovery” (on a continuous journey), while others may consider themselves “recovered” (having moved past the ED completely). In this way, the meaning of “recovery” can indicate both a process and a state [ 58 ]. Stringent criteria for including people in studies as “recovered” may pre-define the group with whom recovery is being explored. Other terminology, such as severe and enduring anorexia nervosa (SEAN), and severe and enduring eating disorders (SEED), emphasize more chronic conditions. However, these terms are not always helpful for people experiencing longer-lasting ED, as they may insinuate that healthcare providers (or the patient) have given up hope for recovery [ 59 , 60 , 61 , 62 ].

Given that “recovery” as a term does not resonate with all [ 55 , 63 , 64 , 65 ], using other terms, including non-clinical ones (e.g., “getting better”, “healing”) to refer to these experiences may increase the diversity of experiences in the literature. As we will explain, these methodological features matter in recovery research because they significantly impact what we can know about ED recovery, and for whom.

Positioning ourselves

We come into this work from various vantage points; we name our positionalities here, since researchers’ subjectivity inevitably shapes their research and interpretations [ 66 ]. Engaging with the subjective, rather than presuming objectivity is the most ethical and effective stance in research, and can invite opportunities to uncover new and different knowledge [ 67 ]. The authors bring research and clinical lenses to bear on this work; some of us are primarily or exclusively researchers in the ED field, whereas others also practice clinically. We come from Global North countries, and all of us are White. We were thus trained in scientific traditions that privilege certain ways of knowing and doing that reflect the English and White dominant landscape of academia. While most of us benefit from thin privilege, able-bodied privilege, and cis-hetero privilege, our authorship team also includes those with non-binary, queer, fat, and chronically ill identities. Some of us have lived experience with ED, and have used this to inform our research and clinical practice. Some of us are newer to the ED field, whereas others have been working in the field for over 30 years. While we are different in some ways, our sameness centers around the academic privilege we have to access, interpret and navigate these literatures and their methodologies.

Overview and analysis of ED research methods

Below we provide an overview of the commonly used quantitative and qualitative research methods, along with tables that illustrate examples of the different types of analyses that fit within these broader methodological categories. We also analyze the benefits and limitations of each method, focusing on what we can learn from them and identifying relevant gaps in the literature.

Quantitative methods

As noted above, quantitative methods typically stem from a (post)positivist ontological/epistemological stance, which inherently affects how data are interpreted and understood. This is a core consideration of how we in turn can view the findings. This approach aims to provide “objective” results [ 68 ]; in this case, it is “recovery by the numbers.” It allows for the measurement of results through data, relying on a systematic approach of empirical investigation, and based on the assumption that there is a singular recovery definition which can be known. Researchers use statistical models, computational techniques, and mathematics to develop and test specific hypotheses. The types of quantitative analyses range from relatively simple descriptive/comparative measures to more complex multivariate measures and multi-level designs (which are all influenced by their study samples, assessments, and testable hypotheses). Data can be collected from the traditional in-person research study (or through video conferencing), or alternatively, from participant surveys (e.g., online, phone, mail, text).

Different types of quantitative methods have been employed in ED recovery research (see Table 1 ). Descriptive studies focus on the “how/what/when/where,” rather than the “why” (e.g., examining aspects of recovery definitions [ 69 ]), and comparative studies have a procedure to conclude that one variable is better than another (e.g., comparing different recovery definitions for agreement [ 70 ]). Univariate analyses examine the statistical characteristics of a single variable (e.g., dichotomous yes/no variable differences between recovery groups on a single measure [ 33 ], continuous range variable differences between recovery groups on multiple measures [ 71 ]), while bivariate analyses determine the empirical relationship between two variables (X and Y) (e.g., relationships between recovery attitudes and related variables [ 72 ]). Multivariate analyses aim to determine the best combination of all possible variables to test the study hypothesis (e.g., comparing recovery and healthy control groups across different recovery scores [ 73 ]).

According to (post)positivist stances, these quantitative methods have the anticipated or theoretical benefits of enabling researchers to reach higher sample sizes (increases generalizability), randomize participants (reduces bias), and replicate results (validates data). In practice, though, generalizability extends only to the sample that is recruited (as noted above, in most cases, thin, White women), and randomization within that sample thus does not increase the diversity of results. The relative focus on “novel” research means that replication studies are not conducted to the degree we would hope or expect.

In addition, quantitative methods limit what can be known about any particular individual. For example, numbers can tell us a person’s standardized assessment scores, but they do not include the detailed descriptions of the individual’s experiences. They also reduce recovery to a single experience which may overlook the tremendous diversity in lived experiences. Similarly, while statistical analyses can account for contextual confounding variables, they cannot tell us the broader factors which influence the delivery and the function of interventions.

Qualitative methods

Overall, qualitative methods offer the potential to engage deeply with phenomenon of interest, often stemming from non-positivist epistemological stances (e.g., constructionist, feminist). While qualitative methods are commonly critiqued for small sample sizes, in a qualitative paradigm, small samples allow researchers to dig into the nuances illustrated in participants’ stories, strengthening study findings. The aim of qualitative research is in-depth, contextualized analysis, rather than generalizations. Qualitative methods often, but not always, involve interacting directly with participants in the form of interviews or focus groups. However, qualitative research can also involve analyses of existing textual or image data, such as blog or social media posts, or news articles. A core feature of qualitative research is the researchers’ focus on exploring meaning in voiced or textual data, vs. using only quantitative measures.

Despite shared features, qualitative methods vary enormously in terms of data collection and analysis types. This is due in part to the differences in theoretical basis, epistemologies, ontologies, and paradigms that inform what meaning researchers perceive as possible to achieve. Some (e.g., [ 74 ]) draw on the concepts of “big Q” and “small q” to differentiate in broad terms between the qualitative methods [ 75 ]. Briefly, “big Q” methods invite and acknowledge researcher subjectivity, whereas “small q” approaches attempt to aim at more “objective interpretation,” [ 76 ], which is more similar to (post)positivist approaches. Further, “big Q” approaches tend to delve into the connections between knowledge production, analysis, and sociocultural contexts in which research takes place, whereas “small q” approaches tend to focus more on descriptive, groundwork-laying analysis for quantitative methods to provide generalizability [ 76 ]. Neither approach is inherently “better;” they are designed to achieve distinct findings.

Some of the qualitative methods that have been commonly used to explore ED recovery experiences are summarized in Table 2 . Note that these are not the only methods used. Some (particularly earlier) studies, describe their methods as “qualitative,” without specifying the exact type(s) of analysis. The differences between these various types of methods are at times subtle.

Discourse Analysis (DA) focuses on language not as just a route to content, but as powerful in and of itself (e.g., analysis of talk about recovery) [ 77 , 78 ]. Within DA, Linguistic Analysis adds a focus on language present in the text, with more of an emphasis on terms used, and their connotations (e.g., explorations of Internet message board communications about recovery) [ 79 ]. Also within DA, Narrative-Discursive Analysis adds a focus on social power (e.g., analysis of recovery interviews with a gender lens [ 80 ]), alongside an emphasis on stories (individual and broader, social stories). Narrative Approaches emphasize the story (e.g., analyses of participant writing, life-history), and situates recovery within the broader culture [ 31 , 81 , 82 , 83 , 84 ]). Phenomenological and Phenomenographic Approaches, including Interpretive Phenomenological Analysis (IPA) aim to get in “close” to participant embodied experiences (e.g., focus on recovery self-process in specific groups such as men, former patients, people in recovery from AN specifically [ 85 , 86 , 87 ]). Grounded Theory emphasizes context-specific “ground-up” theory developed from participant responses (e.g., development of cyclical, phase, and process models of recovery in/outside of treatment contexts [ 65 , 88 , 89 , 90 , 91 ]). Thematic Analysis (TA) is aimed at developing patterns/themes based on data (e.g., exploring patterns in experiences of recovery [ 92 , 93 , 94 ]) and can look quite different depending on the type of thematic analysis employed, ranging from more descriptive to more analytical. Content Analysis summarizes and organizes experiences amongst a particular group in a particular context (e.g., describing the content of interviews with specific groups, for example, athletes, or exploring the content of a particular stage of recovery, such as late-stage recovery [ 95 , 96 , 97 , 98 , 99 ]).

It is also possible to use different qualitative methods to explore similar phenomenon. For example, a constructivist grounded theory exploration of people who have received treatment for AN may focus on theorizing what ED recovery processes are occurring for this particular group [ 99 , 100 ]. An IPA of this same group, meanwhile, may emphasize the development of a set of themes relating to shared perspectives on what the experience felt like [ 101 , 102 ].

Qualitative methods can thus provide detailed descriptions of a wide diversity of lived experiences. This enables us to have a broader perspective of what is possible in recovery. Additionally, these methods allow us to consider the contextual factors which influence the delivery and the function of interventions. A potential further benefit is the individual’s own process of reflecting on their changes in recovery (via study participation), which may provide insight and encouragement for continuing on their path.

Critiques of qualitative methods tend to center around the concept of generalizability, though as noted this is not typically the goal of qualitative approaches. As noted above, quantitative studies, which typically focus on a person’s ED standardized assessment scores, and account for contextual confounding variables through statistical analyses, theoretically generate findings which can be applied to other populations from the study sample. However, as we have indicated, extrapolation of the results of mostly homogenous groups (e.g., predominantly White, thin, socioeconomically privileged, cisgender women, drawn primarily from clinical settings) falsely assumes that the course and outcomes will be the same for all.

Exploration of mixed-methods, creative methods, and multi-methods research

While ED recovery researchers have primarily conducted either quantitative or qualitative studies, some have integrated alternative or multiple methods in their designs. Below we explore some of these methods, which may enable new understandings of ED recovery. These include mixed-methods (usually a weaving of quantitative and qualitative), creative methods (e.g., Photovoice, digital storytelling), and multi-methods (e.g., complementary combinations of quantitative, qualitative, creative methods, psycho/physiological, behavioral, laboratory, online observations).

Mixed-methods (weaving of quantitative and qualitative)

It has been argued that mixed-methods allow us to weave together our quantitative and qualitative insights by acknowledging the benefits and limits of both designs. Cluster analysis intends to combine these methods with the goal of maximizing benefits [ 103 ]. For the qualitative aspects of the analysis, data is coded to themes using one of the qualitative methods, and each individual unit of data (e.g., person) is coded for the presence or absence of each theme. For the quantitative aspects of the analysis, data is plotted to identify different clusters of individuals, and then these clusters are interpreted via statistical methods. Cluster analysis aims to provide greater insight into groups of individuals, and potentially elucidate different clusters of “recovery definitions.” However, the qualitative analysis in this approach is inherently reductionistic (e.g., people are coded to create a quantitative measure), which aligns with the post-positivist stance associated with quantitative analyses. From this view, the approaches are not actually integrated; rather they are complimentary. Indeed, it may not be possible to truly integrate them when they emerge from different epistemological stances. We suggest, however, that integration is not needed.

Bachner-Melman et al. [ 42 ] used exploratory factor analysis to identify four factors that mapped onto ED recovery which had general agreement between participants with a lifetime ED diagnosis, healthy family members, and ED clinicians; (1) lack of symptomatic behavior, (2) acceptance of self and body, (3) social and emotional connection, and (4) physical health. These factors were then confirmed using confirmatory factor analysis. Utilizing more than one method thus expands our perspectives of ED recovery, allowing us to broaden our understanding of what can be known about recovery. Yet as noted above, we caution readers in viewing mixed-method approaches as an overall panacea; the approach tends to be more (post)positivist, and aims to quantify experiences, which may not be the goal for researchers from other stances. Again, this is not to say that the approach is without merit, but that it is important to acknowledge what it aims to do (or know).

Creative methods (photovoice, digital/verbal storytelling, collages, drawings)

Quantitative and qualitative methods are, of course, not the only options at the disposal of researchers interested in exploring ED recovery. Some researchers have elected to take creative approaches to research, seeking to explore recovery in different ways. Potentially, such methods enable researchers to “see” facets of recovery phenomenon that are less evident in methods that primarily hinge on either words or numbers [ 57 ]. To date, ED recovery researchers have used creative methods such as Photovoice [ 104 , 105 ], which aims to involve participants in the process of generating and analyzing research data [ 106 ]. This method may be particularly useful for generating disseminable results, with a view towards change in policy settings for the benefit of people in recovery [ 104 ].

Another creative method, digital storytelling [ 57 , 107 ], encourages participants to “story themselves” at a particular moment in time. This may enable the creation of more nuanced, rich, and person-centered depictions of recovery; the participant’s voice is centered in a way that may be less feasible in research that seeks to generate patterns across several participants’ accounts [ 107 ]. Like Photovoice, digital stories can also be used to work toward enhancing understandings of recovery amongst people who do not have lived experience (e.g., healthcare providers) [ 57 ].

Other creative methods include the use of collages, verbal storytelling, drawing,and more [ 108 , 109 , 110 ]. Placing the decision about which creative method to use in the hands of research participants may also enable a redressing of traditional power dynamics in research that position the researcher as the ultimate decision-maker [ 57 ].

Multi-methods (complimentary use of multiple methods)

Given that ED recovery is a complex phenomenon, one approach to exploring it is the use of a multi-method research design, including different complimentary types of analyses (e.g., quantitative, qualitative, creative methods, psycho/physiological, behavioral, laboratory, online observations), and ideally from different perspectives (e.g., individuals, “supports,” clinicians, researchers, policy makers, and other stakeholders). Broadening our methodological “toolkits” may allow for more nuanced and specific insights about ED recoveries, taking into account context, varied perspectives, and positionalities.

Several studies of ED symptom assessment have employed multi-method designs thus far, and each of these has the potential to contribute a piece of the “ED recovery puzzle.” For example, Stewart et al. [ 111 ] conducted a mixed method investigation of the experiences young people, parents, and clinicians had of online ED treatment during COVID-19. They used a mixed quantitative (Likert scale rating questions) and qualitative (free text entry questions) survey which they analyzed using a summary approach (quantitative) and reflexive thematic analysis (qualitative). Leehr and colleagues [ 112 ] analyzed binge eating episodes under negative mood conditions via electroencephalography (EEG) and eye tracking (ET) in a laboratory.

Bartholome et al. [ 113 ] combined standardized instrument interviews, laboratory investigations, and ecological momentary assessment (EMA) to collect data on binge eating episodes in participants with BED. In order to examine underlying mechanisms of the somatic sensation of “feeling fat,” Mehak and Racine [ 114 ] used multiple methods of self-reports, EMA, heart rate variability, laboratory measurements of BMI, dual energy X-ray absorptiometry (DEXA) scans, and clothing sizes.

Technological advances can offer more in-depth information about the recovery process, and could be utilized further in research studies. For example, EMA allows for moment by moment collection of data on phenomenon of interest. This can include biological functions (e.g., heart rate), as well as feelings and behaviors in an individual’s daily life. This approach provides a more “real time” look into experiences (versus having to recall such experiences later on in a survey, or in an interview). In the case of ED recovery, future research can explore the answer to the question of what “active” recovery looks like on a daily basis for individuals via EMA (e.g., what challenges do individuals encounter; how does it impact their behavior/feelings?).

Other technological laboratory tools, such as fMRI, DEXA, and other scanning techniques, can add visual information about the current physical state of recovery (and any related functional “scars” from the ED). It may be helpful in future studies to provide this feedback so individuals can have an accurate picture of the medical status of their body, and make adjustments (e.g., take Vitamin D to increase bone density).

Additional methodological approaches/considerations

Co-design with different perspectives in ed recovery research.

We believe it will be helpful to incorporate different perspectives in ED recovery research for many reasons. For example, expanding who is included in our studies, what identities are represented, and those with both formal and informal treatment, will increase the participant representation, relevance, and generalizability of the findings [ 53 ]. This in turn will allow us to know more about the process of recovery for different individuals and groups, and will broaden our conceptualization of the phenomenon. Ideally, future research will include individuals with lived experiences and their “supports” (e.g., parents, families, partners, friends, mentors), as well as clinicians and researchers, in co-designing studies that could identify and assess aspects of ED recovery that are important to all of the constituents.

Longitudinal research design

We also underscore the need for an extended duration of studies in order to better understand the longitudinal course and outcome of individuals in ED recovery. This design will allow us to compare recovery operalizations vs. subsequent relapse rates, to track how perspectives of recovery develop and change over time (via quantitative, qualitative and mixed-method measures), and how these in turn affect an individual’s identity (e.g., [ 15 ]).

There are several areas of potential future longitudinal research. For example, follow-up on cognitive recovery (which we know tends to occur later (e.g., [ 43 ]), and how related timelines for this may impact subsequent relapse rates, tracking recovery changes over time with mixed or multi-methods designs in underrepresented populations (e.g., Atypical Anorexia (AAN) [ 115 ]), and holding on to hope, with more longitudinal data indicating that recovery is possible, even after decades (e.g., [ 59 ]).

Future research directions

Based on the above studies, we suggest some potential areas for future research, ideally incorporating multi-method designs to provide different perspectives on ED recovery. Recently, several themes have been identified in the literature as promising lines of research that may improve our understanding of ED, and increase the clinical application of findings.

Predictors of outcomes

Within quantitative research, Bardone-Cone et al. [ 15 ] note that predictors of outcomes, biological/neuropsychological techniques, and a focus on the SEAN population are newer, more nuanced, areas of investigation. In their systematic review and meta-analysis of predictors of ED treatment outcomes (at end of treatment [EoT], and follow-up), Vall and Wade [ 26 ] reported that the most robust predictor at both time frames was greater symptom change earlier in treatment. Other baseline predictors of better outcomes included: higher BMI, fewer binge/purge behaviors, more functional relationships (e.g., with family, friends), and greater motivation to recover. Of note, it is important to understand that higher BMI is in the context of a “higher” thin BMI, as most people with BMI > 25 are not included in studies of recovery. This is another example of how our methods and design choices impact what we can know.

Relatedly, one potential area for future ED quantitative predictor research is to build a Risk Calculator (RC), which is a statistical tool that identifies risk factors, and determines how likely an event is to happen for a particular person [ 116 ]. Physicians have used RCs clinically across an array of medical conditions, including stroke [ 117 ] and cancer [ 118 ]. There has been a recent turn toward integrating RCs into charting psychiatric disorder outcomes and treatment approaches; they have been used for psychosis [ 116 ], depression [ 119 ], and bipolar disorder [ 120 , 121 , 122 , 123 ]. This same technique could be applied to build a RC for personalized risk of ED onset/relapse, utilizing variables collected in research/treatment. A statistical combination of factors that reliably predict the non-occurrence of ED relapse could be a valuable addition to, predictor of, or even criterion, for full recovery. As part of these research initiatives, it will be important for researchers to employ diverse and longitudinal methods in order to obtain long-term, dynamic data.

In line with this, narrative qualitative analysis may be useful in elucidating predictors/risk factors for individuals. In this way, the (narrative) story that the person tells themselves about their recovery, and what was helpful to them, also has importance alongside any quantitative measures. Indeed, this perspective perhaps has more personal meaning, especially in contexts where minute changes identifiable through quantitative studies may be less relevant in the daily lives of their ED recovery.

Biological and neurological markers

Recent developments in the understanding of biological and neurological markers have enabled us to parse out what features may be involved with the ED “state” (which resolves with recovery), what features may onset premorbid to the ED (and will potentially continue after recovery), and what features may be “scars” (consequences of the ED). In their functional Magnetic Resonance Imaging (fMRI) study on participants who had recovered from AN, Fuglset et al. [ 124 ] reported increased activation in visual processing regions in anticipation of seeing images of food, with corresponding reduced activation in decision-making regions. While they found some normalization of the brain regions during recovery, other differences related to longer periods of starvation that appear later in life remained (residual “scars”).

Future quantitative research which incorporates longitudinal designs following the same participant cohort may elucidate more closely the timepoints during which the “state” and “scar” markers begin to emerge, in order to provide earlier interventions. In this instance, qualitative longitudinal studies could be beneficial here too. For example, participant narrative descriptions of ongoing biological changes in their recovery (e.g., feeling hungrier, not being able to tolerate hunger as well) not only reaffirm that people are noticing these internal bio markers, but provide the opportunity for them to discuss their day to day experiences of these lasting changes.

Recovery criteria

From a post-positivist perspective, there has been a longstanding call for standardized ED recovery criteria, typically involving weight, behavioral, and cognitive criteria (e.g., [ 14 , 15 , 16 , 17 ]). Drawing from the above, we suggest that research looking into recovery criteria may benefit from more diverse methodological approaches which pull from a variety of sources (e.g., clinicians, researchers, individuals with lived experience). For example, BMI has historically been used as an indicator of recovery status because it is readily obtained by ED researchers (and clinicians). While weight monitoring can be helpful in specific cases (e.g., those who are severely underweight or have lost a lot of weight in a short period of time), it is limited in use. Namely, BMI is insufficient to determine medical stabilization, it fails to take into account individual differences, and it can have negative impacts on treatment when individuals are discharged on the basis of weight alone [ 125 ]. Given these concerns, future research could discontinue the use of BMI as the “core” recovery criterion, as suggested by Kenny and Lewis [ 126 ], and instead focus on other variables that are more indicative of recovery over follow-up (e.g., Vall and Wade’s systematic review and meta-analysis findings of early symptom change during treatment as the most robust predictor of outcomes) [ 26 ].

Similarly, standardized assessments (e.g., EDE-Q, EDE, ED-LIFE) have been the “go-to” for assessing recovery outcomes in comparison to statistical norms. However, these measures are often developed by clinicians/researchers (thus reflecting what they feel is important in recovery) and in line with particular therapeutic modalities (e.g., the EDE-Q has a cognitive orientation). Thus, scores on these measures may not always match the person’s particular recovery aims and goals, nor the relative importance of particular behaviors in their lives. Employing these measures as a part of multi-methods designs with other types of assessments for comparison may offer the potential to think differently about these measures, and their role in assessing outcomes. We also suggest the need for measures co-designed with folks with lived experience and which reflect the diverse recovery elements described in qualitative studies (e.g., [ 33 ]).

The recovery process

Future research could compile more comprehensive lived experience narratives of changes in thought patterns through the recovery journeys (e.g., descriptions of how the “ED” voice began to leave, if ED voice is a relevant construct for the person), which could provide a more realistic timeline of this portion of the process for individuals and their “supports.” To begin to employ these kinds of measures in a way that opens up new possibilities, it would also be important to explore whether the ED-related ideas being measured resonate with the person whose recovery is being explored. Co-design processes may also be particularly relevant here, inviting people in recovery to be a part of research teams and take a role in determining the kinds of measures that could be used to assess recovery.

As years of ED behaviors and thoughts tend to impair different areas of psychosocial functioning (e.g., relationships, school/work, recreation, household duties), improvement in these areas, along with related QOL, tends to also lag behind physical recovery (e.g., [ 43 ]). Future research could further elaborate the timelines for which recovery in the different areas occurs, both from a group (e.g., through life story, narrative, or thematic analysis), and an individual (e.g., personal recording of recovery progress, case study approach) level. This approach offers a shift in methodological perspective, providing opportunity to conceptualize recovery differently.

Other areas for future consideration

Several studies (and informal support groups) have successfully employed recovered mentors, providing hope in recovery (e.g., [ 127 ]). Future research could examine more of the nuances of the mentorship role, including the characteristics of the mentor, the stage of recovery that the individual is in, and the dynamics of the mentor relationship. Further, taking a truly co-designed approach and, in particular, working with those who have not been included and heard in either treatment or research (not only more diverse participants, but their “supports,” including mentors), could offer new insight into recovery processes. Indeed, going forwards, we need to conduct our research differently if we want to incorporate the perspectives of those that we do not usually hear from.

Another area of study has developed around online (e.g., social media) use among those who are at risk for developing an ED, struggling with an ED, and those who are on the path to ED recovery. Analyses of online websites, blogs, and social media posts, along with their related potentially triggering content, have been conducted (e.g., [ 128 ]). However, on a positive note, this medium allows us to explore other methodological possibilities, including potentially focusing on reducing participant burden, and engaging with content from spaces where people are more “organically” describing these experiences, to get a sense of recovery outside of a clinical perspective. One possibility for future research is to combine the use of EMA with exposure to a range of different ED blog content (e.g., from triggering to supportive posts), in order to provide more proximal individual reaction information (e.g., EMA before exposure, EMA at exposure time, EMA after exposure time).

Proposed future research model: Dialectical movement towards and away from a consensus

The aim of this paper is to offer a more diverse view of methodological perspectives (which stem from various ontological and epistemological stances) and ideas that might allow for forward movement in the field. As noted above, in a dialectal format, this can involve both movement toward and away from a consensus, including perspectives which do not seek to identify a single recovery definition. We believe that both can be simultaneously pursued, acknowledging that one does not discount the other. We have outlined several potential areas to explore which do not necessarily depend upon a consensus definition. Here, for balance, we would like to propose a future research model that could guide us in a direction that may eventually lead to a consensus definition–or definition s . In effect, we are advocating for: (1) transparency in researchers’ epistemological stances; (2) more varied approaches to research in order to “see” different aspects of recovery experiences; and (3) collaboration between researchers and other stakeholders to generate new methodological approaches and insights about recovery.

Our proposed future research model is detailed in Table 3 . Based upon the studies we cited above, we suggest a multi-methods design (e.g., quantitative, qualitative, creative methods, psycho/physiological, behavioral, laboratory, online observations), which incorporates different perspectives (e.g., expanding recruitment of participants that have been less represented in the literature, including “supportive” others), and extends the duration of studies to provide a more longitudinal outlook (e.g., capturing cognitive recovery, and improvement in psychosocial functioning/QOL, which often comes later, and noting how definitions of recovery may change over time for people). In this way, we hope to move the field towards different, more nuanced, and comprehensive perspectives on ED recovery.

In conclusion, we would like to encourage a creative, transparent, and thoughtful approach to ED recovery methodology, that considers what each of the methods allows us to engage with, or not, as the case may be. What we can (and do) know about recovery is intricately tied to our methodological and study design choices, which all have limits. Within this context, while there is a benefit to current pushes in the field to “come to consensus,“ these consensus definitions will necessarily leave out some people and experiences. This is especially the case for those who have not been meaningfully included in the research we have conducted to reach this consensus (e.g., people with lived experience, “non-traditional” patients, patients without access to treatment). Since there are so many different facets of recovery experiences, using different methodologies is imperative to develop a more complete understanding.

Indeed, it is important to acknowledge how the centrality of the method that is chosen to define ED recovery in turn influences how researchers and clinicians understand recovery, and how one moves towards it. New insights into recovery processes may depend on new methods of investigation. Thus, we suggest that some potential areas for future research ideally employ multi-method designs (e.g., quantitative, qualitative, creative methods, psycho/physiological, behavioral, laboratory, online observations), incorporate different perspectives (e.g., expanding recruitment of participants that have been less represented in the literature, including supportive others) and extend the duration of studies to provide a more longitudinal outlook (e.g., capturing cognitive recovery, which often comes later, and noting how definitions of recovery may change over time for people). In this way, we hope to move the field towards different, more nuanced, and comprehensive perspectives on ED recovery.

Availability of data and materials

Not applicable.

There are debates about the degree to which research can ever be truly objective or whether this is desirable. Here, we use objective and subjective in quotation marks to signal broader perceptions about these processes.

Abbreviations

Anorexia nervosa

Binge eating disorder

Body mass index

Bulimia Nervosa

Connectedness, hope and optimism, identity, meaning in life, empowerment

Dual energy X-ray absorptiometry

Eating attitudes test

Eating disorders

Eating Disorders Recovery Endorsement Questionnaire

Eating Disorders Recovery Questionnaire

Eating Disorders Quality of Life Scale

Eating Disorders Quality of Life

Electroencephalography

Ecological momentary assessment

Eye tracking

Functional magnetic resonance imaging

Generalized estimating equations

Health-Related Quality of Life in Eating Disorders Questionnaire

Hierarchical linear models

Interpretive phenomenological analysis

Multivariate analysis of variance

National Institutes of Health

Risk calculator

Substance Abuse and Mental Health Services Administration

Severe and enduring anorexia nervosa

Severe and enduring eating disorder

Quality of life for eating disorders

Barad K. Meeting the Universe Halfway. Durham: Duke University Press; 2007.

Book Google Scholar

Slevitch L. Qualitative and quantitative methodologies compared: ontological and epistemological perspective. J Qual Assur Hosp Tour. 2011;12(1):73–81.

Article Google Scholar

Tuli F. The basis of distinction between qualitative and quantitative research in social science: reflection on ontological, epistemological and methodological perspectives. Ethiop J Educ Sci. 2010;6(1).

Duncan C, Cloutier JD, Bailey PH. Concept analysis: the importance of differentiating the ontological focus. J Adv Nurs. 2007;58(3):293–300.

Article PubMed Google Scholar

Hofweber T. Logic and ontology. In: Zalta EN, editor. The Stanford encyclopedia of philosophy. Stanford: The Metaphysics Research Lab, Center for the Study of Language and Information; 2021.

Google Scholar

Hupcey JE, Penrod J. Concept analysis: examining the state of the science. Res Theory Nurs Pract. 2005;19(2):197–208.

Wilson J. Thinking with concepts. Cambridge: Cambridge University Press; 1963.

Setup M, Ram N. Epistemology. In: Zalta EN, editor. The Stanford encyclopedia of philosophy. Stanford: The Metaphysics Research Lab, Center for the Study of Language and Information; 2020.

Macionis JJ, Gerber LM, Sociology (7th Canadian). Pearson, Canada: Pearson Canada; 2011.

Larrain J. The concept of ideology. London: Hutchison; 1979.

Phillips DC, Burbules NC. Postpositivism and educational research. Lanham & Boulder: Rowman & LIttlefield Publishers; 2000.

Stanley J. Knowledge and practical interests. New York: Oxford University Press; 2005.

Cakir M. Constructivist approaches to learning in science and their implications for science pedagogy: a literature review. Int J Environ Sci Educ. 2008;3(4):193–206.

Bardone-Cone AM, Harney MB, Maldonado CR, Lawson MA, Robinson DP, Smith R, et al. Defining recovery from an eating disorder: conceptualization, validation, and examination of psychosocial functioning and psychiatric comorbidity. Behav Res Ther. 2010;48(3):194–202.

Bardone-Cone AM, Hunt RA, Watson HJ. An overview of conceptualizations of eating disorder recovery, recent findings, and future directions. Curr Psychiatry Rep. 2018;20(9):79.

Wade TD, Lock J. Developing consensus on the definition of remission and recovery for research. Int J Eat Disord. 2020;53(8):1204–8.

Attia E, Blackwood KL, Guarda AS, Marcus MD, Rothman DJ. Marketing residential treatment programs for eating disorders: a call for transparency. Psychiatr serv. 2016;67(6):664–6.

McGilley BS. J. Recipe for recovery: necessary ingredients for the client’s and clinician’s Success. In: Maine M, Bunnell, editors. New York: Elsevier; 2010.

Noordenbos G. Which criteria for recovery are relevant according to eating disorder patients and therapists? Eat Disord. 2011;19(5):441–51.

Solmi M, Wade TD, Byrne S, Del Giovane C, Fairburn CG, Ostinelli EG, et al. Comparative efficacy and acceptability of psychological interventions for the treatment of adult outpatients with anorexia nervosa: a systematic review and network meta-analysis. Lancet Psychiatry. 2021;8(3):215–24.

Treasure J, Duarte TA, Schmidt U. Eating disorders. Lancet. 2020;395(10227):899–911.

Waller G, Raykos B. Behavioral interventions in the treatment of eating disorders. Psychiatr Clin North Am. 2019;42(2):181–91.

Garner DM, Garfinkel PE. The eating attitudes test: an index of the symptoms of anorexia nervosa. Psychol Med. 1979;9(2):273–9.

Kenny TE, Trottier K, Lewis S. Lived experience perspectives on a model of eating disorder recovery in a sample of predominantly white women: a mixed method study. J Eat Disord. 2022;10(1):1–19.

McDonald S, Williams AJ, Barr P, McNamara N, Marriott M. Service user and eating disorder therapist views on anorexia nervosa recovery criteria. Psychol Psychother. 2021;94(3):721–36.

Article PubMed PubMed Central Google Scholar

Vall E, Wade TD. Predictors of treatment outcome in individuals with eating disorders: a systematic review and meta-analysis. Int J Eat Disord. 2015;48(7):946–71.

Dawson L, Rhodes P, Touyz S. “Doing the impossible”: the process of recovery from chronic anorexia nervosa. Qual Health Res. 2014;24(4):494–505.

Anthony WA. Recovery from mental illness: the guiding vision of the mental health service system in the 1990s. Psychosoc Rehabilit J. 1993;24(9):159–68.

Wetzler S, Hackmann C, Peryer G, Clayman K, Friedman D, Saffran K, et al. A framework to conceptualize personal recovery from eating disorders: a systematic review and qualitative meta-synthesis of perspectives from individuals with lived experience. Int J Eat Disord. 2020;53(8):1188–203.

Jarman M, Walsh S. Evaluating recovery from anorexia nervosa and bulimia nervosa: integrating lessons learned from research and clinical practice. Clin Psychol Rev. 1999;19(7):773–88.

Dawson L, Rhodes P, Touyz S. Defining recovery from anorexia nervosa: a Delphi study to determine expert practitioners’ views. Adv Eat Disord: Theory Res Pract. 2015;3:165–76.

’t Slof-OpLandt MCT, Dingemans AE, de la Torre YRJ, van Furth EF. Self-assessment of eating disorder recovery: absence of eating disorder psychopathology is not essential. Int J Eat Disord. 2019;52(8):956–61.

de Vos JA, Radstaak M, Bohlmeijer ET, Westerhof GJ. Having an eating disorder and still being able to flourish? Examination of pathological symptoms and well-being as two continua of mental health in a clinical sample. Front Psychol. 2018;9:2145.

Emanuelli F, Waller G, Jones-Chester M, Ostuzzi R. Recovery from disordered eating: sufferers’ and clinicians’ perspectives. Eur Eat Disord Rev. 2012;20(5):363–72.

Noordenbos G, Seubring A. Criteria for recovery from eating disorders according to patients and therapists. Eat Disord. 2006;14(1):41–54.

Engel SG, Wittrock DA, Crosby RD, Wonderlich SA, Mitchell JE, Kolotkin RL. Development and psychometric validation of an eating disorder-specific health-related quality of life instrument. Int J Eat Disord. 2006;39(1):62–71.

Abraham SF, Brown T, Boyd C, Luscombe G, Russell J. Quality of life: eating disorders. Aust N Z J Psychiatry. 2006;40(2):150–5.

Las Hayas C, Quintana JM, Padierna A, Bilbao A, Munoz P, Madrazo A, et al. The new questionnaire health-related quality of life for eating disorders showed good validity and reliability. J Clin Epidemiol. 2006;59(2):192–200.

Adair CE, Marcoux GC, Cram BS, Ewashen CJ, Chafe J, Cassin SE, et al. Development and multi-site validation of a new condition-specific quality of life measure for eating disorders. Health Qual Life Outcomes. 2007;5:23.

Bachner-Melman R, Lev-Ari L, Zohar AH, Linketsky M. The Eating Disorders Recovery Questionnaire: psychometric properties and validity. Eat Weight Disord. 2021;26(8):2633–43.

Noordenbos G. When have eating disordered patients recovered and what do the DSM-IV criteria tell about recovery? Eat Disord. 2011;19(3):234–45.

Bachner-Melman R, Lev-Ari L, Zohar AH, Lev SL. Can recovery from an eating disorder be measured? Toward a standardized questionnaire. Front Psychol. 2018;9:2456.

Accurso EC, Sim L, Muhlheim L, Lebow J. Parents know best: caregiver perspectives on eating disorder recovery. Int J Eat Disord. 2020;53(8):1252–60.

Richmond TK, Woolverton GA, Mammel K, Ornstein RM, Spalding A, Woods ER, et al. How do you define recovery? A qualitative study of patients with eating disorders, their parents, and clinicians. Int J Eat Disord. 2020;53(8):1209–18.

Harron D. Loving Someone with an Eating Disorder. Oakland: New Harbinger Publications, Inc.; 2019.

Milos G, Spindler A, Schnyder U, Fairburn CG. Instability of eating disorder diagnoses: prospective study. Br J Psychiatry. 2005;187:573–8.

Becker AE, Franko DL, Speck A, Herzog DB. Ethnicity and differential access to care for eating disorder symptoms. Int J Eat Disord. 2003;33(2):205–12.

Cachelin FM, Rebeck R, Veisel C, Striegel-Moore RH. Barriers to treatment for eating disorders among ethnically diverse women. Int J Eat Disord. 2001;30(3):269–78.

Cachelin FM, Striegel-Moore RH. Help seeking and barriers to treatment in a community sample of Mexican American and European American women with eating disorders. Int J Eat Disord. 2006;39(2):154–61.

Ali K, Farrer L, Fassnacht DB, Gulliver A, Bauer S, Griffiths KM. Perceived barriers and facilitators towards help-seeking for eating disorders: a systematic review. Int J Eat Disord. 2017;50(1):9–21.

Lebow J, Sim LA, Kransdorf LN. Prevalence of a history of overweight and obesity in adolescents with restrictive eating disorders. J Adolesc Health. 2015;56(1):19–24.

Harrop EN, Mensinger JL, Moore M, Lindhorst T. Restrictive eating disorders in higher weight persons: a systematic review of atypical anorexia nervosa prevalence and consecutive admission literature. Int J Eat Disord. 2021;54(8):1328–57.

Egbert AH, Hunt RA, Williams KL, Burke NL, Mathis KJ. Reporting racial and ethnic diversity in eating disorder research over the past 20 years. Int J Eat Disord. 2022;55(4):455–62.

Mikhail ME, Klump KL. A virtual issue highlighting eating disorders in people of black/African and indigenous heritage. Int J Eat Disord. 2021;54(3):459–67.

Conti JE. Recovering identity from anorexia nervosa: women’s constructions of their experiences of recovery from anorexia nervosa over 10 years. J Constructivist Psychol. 2018;31(1):72–94.

Kenny TE, Thomassin K, Trottier K, Lewis SP. Views on the term ‘recovery’ in a sample of primarily white treatment-experienced women with lived eating disorder experience. Int J Eat Disord. Under Review.

LaMarre A, Rice C. Healthcare providers’ engagement with eating disorder recovery narratives: opening to complexity and diversity. Med Humanit. 2020;47:78–86.

Fava GA. The concept of recovery in affective disorders. Psychother Psychosom. 1996;65(1):2–13.

Eddy KT, Tabri N, Thomas JJ, Murray HB, Keshaviah A, Hastings E, et al. Recovery from anorexia nervosa and bulimia nervosa at 22-year follow-up. J Clin Psychiatry. 2017;78(2):184–9.

Dawson L, Rhodes P, Touyz S. The recovery model and anorexia nervosa. Aust N Z J Psychiatry. 2014;48(11):1009–16.

Touyz S, Hay P. Severe and enduring anorexia nervosa (SE-AN): in search of a new paradigm. J Eat Disord. 2015;3:26.

Calugi S, Milanese C, Sartirana M, El Ghoch M, Sartori F, Geccherle E, et al. The eating disorder examination questionnaire: reliability and validity of the Italian version. Eat Weight Disord. 2017;22(3):509–14.

LaMarre A, Rice C, Rinaldi J tracing fatness through the eating disorder assemblage. Thickening fat, 1st Edition: Routledge; 2019. pp. 64–76.

Shohet MN, Anorexia. “Full” and “struggling.” Genres Recover Ethos. 2008;35(3):344–82.

Musolino C, Warin M, Wade T, Gilchrist P. Developing shared understandings of recovery and care: a qualitative study of women with eating disorders who resist therapeutic care. J Eat Disord. 2016;4:36.

Malterud K. Qualitative research: standards, challenges, and guidelines. Lancet. 2001;358(9280):483–8.

Gough B, Madill A. Subjectivity in psychological science: from problem to prospect. Psychol Methods. 2012;17(3):374–84.

Matthews B, Ross L. Research methods. a practical guide for the social sciences. Harlow: Pearson Education; 2010.

Couturier J, Lock J. What is recovery in adolescent anorexia nervosa? Int J Eat Disord. 2006;39(7):550–5.

Ackard DM, Richter SA, Egan AM, Cronemeyer CL. What does remission tell us about women with eating disorders? Investigating applications of various remission definitions and their associations with quality of life. J Psychosom Res. 2014;76(1):12–8.

Cogley CB, Keel PK. Requiring remission of undue influence of weight and shape on self-evaluation in the definition of recovery for bulimia nervosa. Int J Eat Disord. 2003;34(2):200–10.

Dimitropoulos G, McCallum L, Colasanto M, Freeman VE, Gadalla T. The effects of stigma on recovery attitudes in people with anorexia nervosa in intensive treatment. J Nerv Ment Dis. 2016;204(5):370–80.

Bachner-Melman R, Zohar AH, Ebstein RP. An examination of cognitive versus behavioral components of recovery from anorexia nervosa. J Nerv Ment Dis. 2006;194(9):697–703.

Braun VC, Can V. I use TA? Should I use TA? Should I not use TA? Comparing reflexive thematic analysis and other pattern-based qualitative analytic approaches. Couns Psychother Res. 2021;21(1):37–47.

Kidder LH, Fine M. Qualitative and quantitative methods: when stories converge. Eval Policy. 1987;1987(35):57–75.

Clarke V. Navigating the messy swamp of qualitative research: are generic reporting standards the answer? In: Levitt HM, editor. Reporting qualitative research in psychology: how to meet APA Style journal article reporting standards, revised edition. Washington: American Psychological Association; 2020.

Hardin PK. Social and cultural considerations in recovery from anorexia nervosa: a critical poststructuralist analysis. ANS Adv Nurs Sci. 2003;26(1):5–16.

Keski-Rahkonen A, Tozzi F. The process of recovery in eating disorder sufferers’ own words: an Internet-based study. Int J Eat Disord. 2005;37(Suppl):S80-6 discussion S7-9.

Maison H, Bailey L, Clarke S, Treasure J, Anderson G, Kohn M. Un/imaginable future selves: a discourse analysis of in-patients’ talk about recovery from an eating disorder. Eur Eat Disord Rev. 2011;19(a):25–36.

Moulding N. Gendered intersubjectivities in narratives of recovery from an eating disorder. J Women Soc Work. 2016;31(1):70–83.

LaMarre A, Rice C. Normal eating is counter-cultural: embodied experiences of eating disorder recovery. J Commun Appl Soc Psychol. 2016;26:136–49.

Matusek JA, Knudson RM. Rethinking recovery from eating disorders: spiritual and political dimensions. Qual Health Res. 2009;19(5):697–707.

Patching J, Lawler J. Understanding women’s experiences of developing an ED and recovery: a life-history approach. Nurs Inq. 2009;12(1):10–21.

Redenbach J, Lawler J. Recovery from disordered eating: what life histories reveal. Contemp Nurse. 2003;15(1–2):148–56.

Bjork T, Wallin K, Pettersen G. Male experiences of life after recovery from an eating disorder. Eat Disord. 2012;20(5):460–8.

Bjork T, Ahlstrom G. The patient’s perception of having recovered from an eating disorder. Health Care Women Int. 2008;29(8):926–44.

Jenkins J, Ogden J. Becoming ‘whole’ again: a qualitative study of women’s views of recovering from anorexia nervosa. Eur Eat Disord Rev. 2012;20(1):e23–31.

D’Abundo M, Chally P. Struggling with recovery: participant perspectives on battling an eating disorder. Qual Health Res. 2004;14(8):1094–106.

Krentz A, Chew J, Arthur N. Can J Couns. 2005;39(2):118–35.

Lamoureux MMH, Bottorff JL. “Becoming the real me”: Recovering from anorexia nervosa. Heatlh Care for Women International. 2005;26:170–88.

Woods S. Untreated recovery from eating disorders. Adolescence. 2004;39(154):361–71.

PubMed Google Scholar

Hay PJ, Cho K. A qualitative exploration of influences on the process of recovery from personal written accounts of people with anorexia nervosa. Women Health. 2013;53(7):730–40.

LaMarre A, Rice C. Hashtag recovery: #eating disorder recovery on instagram. Soc Sci. 2017;6(3):68.

Lord VM, Reiboldt W, Gonitzke D, Parker E, Peterson C. Experiences of recovery in binge-eating disorder: a qualitative approach using online message boards. Eat Weight Disord. 2018;23(1):95–105.

Arthur-Cameselle JN, Quatromoni PA. A qualitative analysis of female college athletes’ eating disorder recovery experiences. Sport Psychol. 2014;28:334–46.

Lindgren BM, Enmark A, Bohman A, Lundstrom M. A qualitative study of young women’s experiences of recovery from bulimia nervosa. J Adv Nurs. 2015;71(4):860–9.

Nilsson K, Hagglof B. Patient perspectives of recovery in adolescent onset anorexia nervosa. Eat Disord. 2006;14(4):305–11.

Pettersen G, Thune-Larsen KB, Wynn R, Rosenvinge JH. Eating disorders: challenges in the later phases of the recovery process: a qualitative study of patients’ experiences. Scand J Caring Sci. 2013;27(1):92–8.

Charmaz K. The power of constructivist grounded theory for critical inquiry. Res Methods Eval. 2016;23(1):34–45.

Williams K, King J, Fox JR. Sense of self and anorexia nervosa: a grounded theory. Psychol Psychother. 2016;89(2):211–28.

Smith JA. Reflecting on the development of interpretive phenomenological analysis and its contribution to qualitative research in psychology. Qual Res Psychol. 2008;1(1):39–54.

Fox AP, Larkin M, Leung N. The personal meaning of eating disorder symptoms: an interpretative phenomenological analysis. J Health Psychol. 2011;16(1):116–25.

Henry D, Dymnicki AB, Mohatt N, Allen J, Kelly JG. Clustering methods with qualitative data: a mixed-methods approach for prevention research with small samples. Prev Sci. 2015;16(7):1007–16.

Saunders JF, Eaton AA. Social comparisons in eating disorder recovery: using photovoice to capture the sociocultural influences on women’s recovery. Int J Eat Disord. 2018;51(12):1361–6.

Saunders JF, Eaton AA, Aguilar S. From self(ie)-objectification to self-empowerment: the meaning of selfies on social media in eating disorder recovery. Comput Human Beh. 2020;111:106420.

Wang C, Burris MA. Photovoice: concept, methodology, and use for participatory needs assessment. Health Educ Behav. 1997;24(3):369–87.

LaMarre A, Rice C. Embodying critical and corporeal methodology: digital storytelling With young women in eating disorder recovery. Forum Qual Soc Res. 2016;17:2.

Bartel H. A ‘Girls’ Illness?’ Using narratives of eating disorders in men and boys in healthcare education and research. In: Arts based health care research: a multidisciplinary perspective. Cham: Springer; 2022. p. 69-84.

Proszynski J. Interior designs: demolition and reconstruction of the self in eating disorder recovery through transformable collage book making (Doctoral dissertation, Pratt Institute). 2022.

Marzola E, Abbate-Daga G, Gramaglia C, Amianto F, Fassino S, Mobini S (ReviewingEditor). A qualitative investigation into anorexia nervosa: The inner perspective. Cogent Psychol 2015;2:1. https://doi.org/10.1080/23311908.2015.1032493 .

Stewart C, Konstantellou A, Kassamali F, McLaughlin N, Cutinha D, Bryant-Waugh R, et al. Is this the ‘new normal’? A mixed method investigation of young person, parent and clinician experience of online eating disorder treatment during the COVID-19 pandemic. J Eat Disord. 2021;9(1):78.

Leehr EJ, Schag K, Dresler T, Grosse-Wentrup M, Hautzinger M, Fallgatter AJ, et al. Food specific inhibitory control under negative mood in binge-eating disorder: Evidence from a multimethod approach. Int J Eat Disord. 2018;51(2):112–23.

Bartholome LT, Raymond NC, Lee SS, Peterson CB, Warren CS. Detailed analysis of binges in obese women with binge eating disorder: Comparisons using multiple methods of data collection. Int J Eat Disord. 2006;39(8):685–93.

Mehak A, Racine SE. Understanding “feeling fat” and its underlying mechanisms: the importance of multimethod measurement. Int J Eat Disord. 2020;53(9):1400–4.

Harrop E. “Maybe i really am too fat to have an eating disorder”: A mixed methods study of weight stigma and healthcare experiences in a diverse sample of patients with atypical anorexia (Doctoral dissertation). Seattle: University of Washington; 2020.

Fusar-Poli P, Rutigliano G, Stahl D, Davies C, Bonoldi I, Reilly T, et al. Development and validation of a clinically based risk calculator for the transdiagnostic prediction of psychosis. JAMA Psychiatry. 2017;74(5):493–500.

Nobel L, Mayo NE, Hanley J, Nadeau L, Daskalopoulou SS. MyRisk_stroke calculator: a personalized stroke risk assessment tool for the general population. J Clin Neurol. 2014;10(1):1–9.

Gail MH, Brinton LA, Byar DP, Corle DK, Green SB, Schairer C, et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst. 1989;81(24):1879–86.

Perlis RH. Pharmacogenomic testing and personalized treatment of depression. Clin Chem. 2014;60(1):53–9.

Hafeman DM, Merranko J, Goldstein TR, Axelson D, Goldstein BI, Monk K, et al. Assessment of a person-level risk calculator to predict new-onset bipolar spectrum disorder in youth at familial risk. JAMA Psychiatry. 2017;74(8):841–7.

Birmaher B, Merranko JA, Goldstein TR, Gill MK, Goldstein BI, Hower H, et al. A risk calculator to predict the individual risk of conversion from subthreshold bipolar symptoms to bipolar disorder I or II in youth. J Am Acad Child Adolesc Psychiatry. 2018;57(10):755–63 e4.

Birmaher B, Merranko JA, Gill MK, Hafeman D, Goldstein T, Goldstein B, et al. Predicting personalized risk of mood recurrences in youths and young adults with bipolar spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2020;59(10):1156–64.

Goldstein TR, Merranko J, Hafeman D, Gill MK, Liao F, Sewall C, et al. A risk calculator to predict suicide attempts among individuals with early-onset bipolar disorder. Bipolar Disord. 2022.

Fuglset TS, Landro NI, Reas DL, Ro O. Functional brain alterations in anorexia nervosa: a scoping review. J Eat Disord. 2016;4:32.

Phillipou A, Beilharz F. Should we shed the weight criterion for anorexia nervosa? Aust N Z J Psychiatry. 2019;53(6):501–2.

Kenny TE, Lewis SP. Reconceptualizing recovery: integrating lived experience perspectives into traditional eating disorder recovery frameworks. Psychiatr Serv. 2021;72(8):966–8.

Ramjan LM, Hay P, Fogarty S. Benefits of a mentoring support program for individuals with an eating disorder: a proof of concept pilot program. BMC Res Notes. 2017;10(1):709.

Wolf M, Thies F, Kordy H. Language use in eating disorder blogs: psychological implications of social online activity. J Lang Soc Psychol. 2013;32(2):212–26.

Download references

Acknowledgements

The authors wish to thank our colleagues in ED recovery.

None received.

Author information

Authors and affiliations.

Department of Psychiatry, Eating Disorders Center for Treatment and Research, University of California at San Diego School of Medicine, 4510 Executive Drive, San Diego, CA, 92121, USA

Heather Hower

Department of Health Services, Policy, and Practice, Hassenfeld Child Innovation Institute, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA

School of Psychology, Massey University, North Shore, Private Bag 102-904, Auckland, 0632, New Zealand

Andrea LaMarre

Clinical Psychology Graduate Program, Ruppin Academic Center, 4025000, Emek-Hefer, Israel

Rachel Bachner-Melman

School of Social Work, Hebrew University of Jerusalem, Mt. Scopus, 9190501, Jerusalem, Israel

Graduate School of Social Work, University of Denver, 2148 S High Street, Denver, CO, 80208, USA

Erin N. Harrop

University of Kansas School of Medicine, 1010 N Kansas St, Wichita, KS, 67214, USA

Beth McGilley

Department of Psychology, Clinical Child and Adolescent Psychology, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada

Therese E. Kenny

You can also search for this author in PubMed Google Scholar

Contributions

HH contributed to the conceptualization of the manuscript, the writing and editing of the abstract, introduction, quantitative text and table, mixed-methods, creative methods, multi-methods, future research, and conclusions sections, EndNote reference library/citations, formatting of the manuscript, and overall final revisions. AL contributed to the conceptualization of the manuscript, the writing and editing of the abstract, introduction, qualitative text and table, mixed-methods, creative methods, and conclusion sections, and overall final revisions. RBM contributed to the conceptualization of the manuscript, the writing and editing of the abstract, introduction, quantitative, and qualitative sections, and overall final revisions. EH contributed to the conceptualization of the manuscript, the writing and editing of the abstract, introduction, qualitative text and table sections, and overall final revisions. BM contributed to the conceptualization of the manuscript, the writing and editing of the abstract, introduction, qualitative, and mixed-methods sections, and overall final revisions. TK contributed to the conceptualization of the manuscript, the writing and editing of the epistemology and ontology sections, and discussion of these concepts through other sections, as well as overall final revisions. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Heather Hower .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests.

RBM is a Senior Editor of this Journal. All other authors declare that they have no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Hower, H., LaMarre, A., Bachner-Melman, R. et al. Conceptualizing eating disorder recovery research: Current perspectives and future research directions. J Eat Disord 10 , 165 (2022). https://doi.org/10.1186/s40337-022-00678-8

Download citation

Received : 05 September 2022

Accepted : 25 October 2022

Published : 15 November 2022

DOI : https://doi.org/10.1186/s40337-022-00678-8

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Quantitative research
Qualitative research
Multi-methods research

Journal of Eating Disorders

ISSN: 2050-2974

General enquiries: [email protected]

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

View all journals
Explore content
About the journal
Publish with us
Sign up for alerts
Published: 17 March 2022

Binge eating disorder

Katrin E. Giel ORCID: orcid.org/0000-0003-0938-4402 1 , 2 ,
Cynthia M. Bulik ORCID: orcid.org/0000-0001-7772-3264 3 , 4 , 5 ,
Fernando Fernandez-Aranda ORCID: orcid.org/0000-0002-2968-9898 6 , 7 , 8 ,
Phillipa Hay 9 , 10 ,
Anna Keski-Rahkonen 11 ,
Kathrin Schag 1 , 2 ,
Ulrike Schmidt 12 , 13 &
Stephan Zipfel 1 , 2

Nature Reviews Disease Primers volume 8 , Article number: 16 ( 2022 ) Cite this article

9101 Accesses

87 Citations

238 Altmetric

Metrics details

Feeding behaviour
Limbic system
Psychiatric disorders

Binge eating disorder (BED) is characterized by regular binge eating episodes during which individuals ingest comparably large amounts of food and experience loss of control over their eating behaviour. The worldwide prevalence of BED for the years 2018–2020 is estimated to be 0.6–1.8% in adult women and 0.3–0.7% in adult men. BED is commonly associated with obesity and with somatic and mental health comorbidities. People with BED experience considerable burden and impairments in quality of life, and, at the same time, BED often goes undetected and untreated. The aetiology of BED is complex, including genetic and environmental factors as well as neuroendocrinological and neurobiological contributions. Neurobiological findings highlight impairments in reward processing, inhibitory control and emotion regulation in people with BED, and these neurobiological domains are targets for emerging treatment approaches. Psychotherapy is the first-line treatment for BED. Recognition and research on BED has increased since its inclusion into DSM-5; however, continuing efforts are needed to understand underlying mechanisms of BED and to improve prevention and treatment outcomes for this disorder. These efforts should also include screening, identification and implementation of evidence-based interventions in routine clinical practice settings such as primary care and mental health outpatient clinics.

This is a preview of subscription content, access via your institution

Access options

Access Nature and 54 other Nature Portfolio journals

Get Nature+, our best-value online-access subscription

24,99 € / 30 days

cancel any time

Subscribe to this journal

Receive 1 digital issues and online access to articles

111,21 € per year

only 111,21 € per issue

Buy this article

Purchase on SpringerLink
Instant access to full article PDF

Prices may be subject to local taxes which are calculated during checkout

Sleep dysregulation in binge eating disorder and “food addiction”: the orexin (hypocretin) system as a potential neurobiological link

Genetics and neurobiology of eating disorders

What pharmacological interventions are effective in binge-eating disorder? Insights from a critical evaluation of the evidence from clinical trials

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5 350–353 (American Psychiatric Association, 2013).

World Health Organization. ICD-11: International Classification of Diseases 11th Revision. ICD https://icd.who.int/ (2019).

Treasure, J. et al. Anorexia nervosa. Nat. Rev. Dis. Primers 1 , 15074 (2015).

PubMed Google Scholar

Zipfel, S., Giel, K. E., Bulik, C. M., Hay, P. & Schmidt, U. Anorexia nervosa: aetiology, assessment, and treatment. Lancet Psychiatry 2 , 1099–1111 (2015).

Keski-Rahkonen, A. & Mustelin, L. Epidemiology of eating disorders in Europe: prevalence, incidence, comorbidity, course, consequences, and risk factors. Curr. Opin. Psychiatry 29 , 340–345 (2016).

Hoek, H. W. Review of the worldwide epidemiology of eating disorders. Curr. Opin. Psychiatry 29 , 336–339 (2016).

Udo, T. & Grilo, C. M. Prevalence and correlates of DSM-5-defined eating disorders in a nationally representative sample of U.S. adults. Biol. Psychiatry 84 , 345–354 (2018).

PubMed PubMed Central Google Scholar

Agh, T. et al. Epidemiology, health-related quality of life and economic burden of binge eating disorder: a systematic literature review. Eat. Weight. Disord. 20 , 1–12 (2015). This systematic review highlights what is known about quality of life and burden of people affected by BED .

Dawes, A. J. et al. Mental health conditions among patients seeking and undergoing bariatric surgery: a meta-analysis. JAMA 315 , 150–163 (2016).

CAS PubMed Google Scholar

NCD Risk Factor Collaboration. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet 387 , 1377–1396 (2016).

Google Scholar

World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 894 (WHO, 2000).

National Institute for Health and Care Excellence. Eating disorders: recognition and treatment (full guideline). NICE https://www.nice.org.uk/guidance/ng69/evidence/full-guideline-pdf-161214767896 (2017).

Herpertz, S. et al. S3-Leitlinie Diagnostik und Behandlung der Essstörungen. AWMF https://www.awmf.org/uploads/tx_szleitlinien/051-026l_S3_Essstoerung-Diagnostik-Therapie_2020-03.pdf (2018).

Gonzalez-Muniesa, P. et al. Obesity. Nat. Rev. Dis. Primers 3 , 17034 (2017).

Santomauro, D. F. et al. The hidden burden of eating disorders: an extension of estimates from the Global Burden of Disease Study 2019. Lancet Psychiatry 8 , 320–328 (2021). This paper, based on studies from the Global Burden of Disease (GBD) dataset provides up-to-date evidence on epidemiology and burden caused by eating disorders including BED, providing so far unrepresented GBD data .

Stice, E., Marti, C. N. & Rohde, P. Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. J. Abnorm. Psychol. 122 , 445–457 (2013).

Kessler, R. C. et al. The prevalence and correlates of binge eating disorder in the World Health Organization World Mental Health Surveys. Biol. Psychiatry 73 , 904–914 (2013).

Keski-Rahkonen, A. Epidemiology of binge eating disorder: prevalence, course, comorbidity, and risk factors. Curr. Opin. Psychiatry 34 , 525–531 (2021).

Mitchison, D. et al. DSM-5 full syndrome, other specified, and unspecified eating disorders in Australian adolescents: prevalence and clinical significance. Psychol. Med. 50 , 981–990 (2020).

Olsen, E. M., Koch, S. V., Skovgaard, A. M. & Strandberg-Larsen, K. Self-reported symptoms of binge-eating disorder among adolescents in a community-based Danish cohort–a study of prevalence, correlates, and impact. Int. J. Eat. Disord. 54 , 492–505 (2021).

Glazer, K. B. et al. The course of eating disorders involving bingeing and purging among adolescent girls: prevalence, stability, and transitions. J. Adolesc. Health 64 , 165–171 (2019).

Meule, A. The psychology of overeating: food and the culture of consumerism. Food Cult. Soc. 19 , 735–736 (2016).

Streatfeild, J. et al. Social and economic cost of eating disorders in the United States: evidence to inform policy action. Int. J. Eat. Disord. 54 , 851–868 (2021).

Silén, Y. et al. Detection, treatment, and course of eating disorders in Finland: a population-based study of adolescent and young adult females and males. Eur. Eat. Disord. Rev. 29 , 720–732 (2021).

Coffino, J. A., Udo, T. & Grilo, C. M. Rates of help-seeking in US adults with lifetime DSM-5 eating disorders: prevalence across diagnoses and differences by sex and ethnicity/race. Mayo Clin. Proc. 94 , 1415–1426 (2019).

Abbott, S., Dindol, N., Tahrani, A. A. & Piya, M. K. Binge eating disorder and night eating syndrome in adults with type 2 diabetes: a systematic review. J. Eat. Disord. 6 , 36 (2018).

Brownley, K. A. et al. Binge-eating disorder in adults: a systematic review and meta-analysis. Ann. Intern. Med. 165 , 409–420 (2016).

Wassenaar, E., Friedman, J. & Mehler, P. S. Medical complications of binge eating disorder. Psychiatr. Clin. North. Am. 42 , 275–286 (2019).

Harris, S. R., Carrillo, M. & Fujioka, K. Binge-eating disorder and type 2 diabetes: a review. Endocr. Pract. 27 , 158–164 (2021).

Tate, A. E. et al. Association and familial coaggregation of type 1 diabetes and eating disorders: a register-based cohort study in Denmark and Sweden. Diabetes Care 44 , 1143–1150 (2021).

Zhang, J. et al. Pilot study of the prevalence of binge eating disorder in non-alcoholic fatty liver disease patients. Ann. Gastroenterol. 30 , 664–669 (2017).

CAS PubMed PubMed Central Google Scholar

Forlano, R. et al. Binge-eating disorder is associated with an unfavorable body mass composition in patients with non-alcoholic fatty liver disease. Int. J. Eat. Disord. 54 , 2025–2030 (2021).

Cremonini, F. et al. Associations among binge eating behavior patterns and gastrointestinal symptoms: a population-based study. Int. J. Obes. 33 , 342–353 (2009).

CAS Google Scholar

Thornton, L. M. et al. Binge-eating disorder in the Swedish national registers: somatic comorbidity. Int. J. Eat. Disord. 50 , 58–65 (2017).

Kimmel, M. C., Ferguson, E. H., Zerwas, S., Bulik, C. M. & Meltzer-Brody, S. Obstetric and gynecologic problems associated with eating disorders. Int. J. Eat. Disord. 49 , 260–275 (2016).

Udo, T. & Grilo, C. M. Psychiatric and medical correlates of DSM-5 eating disorders in a nationally representative sample of adults in the United States. Int. J. Eat. Disord. 52 , 42–50 (2019). This paper provides a recent and comprehensive description of common co-occurring conditions with eating disorders based on a representative population sample .

Udo, T., Bitley, S. & Grilo, C. M. Suicide attempts in US adults with lifetime DSM-5 eating disorders. BMC Med. 17 , 120–123 (2019).

Fernandez-Aranda, F. et al. Impulse control disorders in women with eating disorders. Psychiatry Res. 157 , 147–157 (2008).

Jimenez-Murcia, S. et al. Pathological gambling in eating disorders: prevalence and clinical implications. Compr. Psychiatry 54 , 1053–1060 (2013).

Nazar, B. P. et al. The risk of eating disorders comorbid with attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Int. J. Eat. Disord. 49 , 1045–1057 (2016).

Schmidt, F., Körber, S., de Zwaan, M. & Müller, A. Impulse control disorders in obese patients. Eur. Eat. Disord. Rev. 20 , e144–e147 (2012).

Lydecker, J. A. & Grilo, C. M. Psychiatric comorbidity as predictor and moderator of binge-eating disorder treatment outcomes: an analysis of aggregated randomized controlled trials. Psychol. Med. https://doi.org/10.1017/S0033291721001045 (2021).

Article PubMed Google Scholar

West, C. E., Goldschmidt, A. B., Mason, S. M. & Neumark-Sztainer, D. Differences in risk factors for binge eating by socioeconomic status in a community-based sample of adolescents: findings from Project EAT. Int. J. Eat. Disord. 52 , 659–668 (2019).

Braun, J. et al. Trauma exposure, DSM-5 posttraumatic stress, and binge eating symptoms: results from a nationally representative sample. J. Clin. Psychiatry 80 , 19m12813 (2019).

Coffino, J. A., Udo, T. & Grilo, C. M. The significance of overvaluation of shape or weight in binge-eating disorder: results from a national sample of U.S. adults. Obesity 27 , 1367–1371 (2019).

& Borg, S. L. et al. Relationships between childhood abuse and eating pathology among individuals with binge-eating disorder: examining the moderating roles of self-discrepancy and self-directed style. Eat. Disord. https://doi.org/10.1080/10640266.2020.1864588 (2021).

Hazzard, V. M., Bauer, K. W., Mukherjee, B., Miller, A. L. & Sonneville, K. R. Associations between childhood maltreatment latent classes and eating disorder symptoms in a nationally representative sample of young adults in the United States. Child. Abus. Negl. 98 , 104171 (2019).

Hazzard, V. M., Loth, K. A., Hooper, L. & Becker, C. B. Food insecurity and eating disorders: a review of emerging evidence. Curr. Psychiatry Rep. 22 , 74–70 (2020).

& Hazzard, V. M. et al. Past-year abuse and eating disorder symptoms among U.S. college students. J. Interpers. Violence https://doi.org/10.1177/08862605211005156 (2021).

Masheb, R. M. et al. DSM-5 eating disorder prevalence, gender differences, and mental health associations in United States military veterans. Int. J. Eat. Disord. 54 , 1171–1180 (2021).

de Beaurepaire, R. Binge eating disorders in antipsychotic-treated patients with schizophrenia: prevalence, antipsychotic specificities, and changes over time. J. Clin. Psychopharmacol. 41 , 114–120 (2021).

Goode, R. W. et al. Binge eating and binge-eating disorder in Black women: a systematic review. Int. J. Eat. Disord. 53 , 491–507 (2020).

Marques, L. et al. Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: implications for reducing ethnic disparities in health care access for eating disorders. Int. J. Eat. Disord. 44 , 412–420 (2011).

Perez, M., Ohrt, T. K. & Hoek, H. W. Prevalence and treatment of eating disorders among Hispanics/Latino Americans in the United States. Curr. Opin. Psychiatry 29 , 378–382 (2016).

Kamody, R. C., Grilo, C. M. & Udo, T. Disparities in DSM-5 defined eating disorders by sexual orientation among US adults. Int. J. Eat. Disord. 53 , 278–287 (2020).

Nagata, J. M., Ganson, K. T. & Austin, S. B. Emerging trends in eating disorders among sexual and gender minorities. Curr. Opin. Psychiatry 33 , 562–567 (2020).

Beccia, A. L., Baek, J., Austin, S. B., Jesdale, W. M. & Lapane, K. L. Eating-related pathology at the intersection of gender, gender expression, sexual orientation, and weight status: an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) of the Growing Up Today Study cohorts. Soc. Sci. Med. 281 , 114092 (2021).

Cheah, S. L., Jackson, E., Touyz, S. & Hay, P. Prevalence of eating disorder is lower in migrants than in the Australian-born population. Eat. Behav. 37 , 101370 (2020).

Burt, A., Mitchison, D., Doyle, K. & Hay, P. Eating disorders amongst Aboriginal and Torres Strait Islander Australians: a scoping review. J. Eat. Disord. 8 , 73 (2020).

Puhl, R. & Suh, Y. Health consequences of weight stigma: implications for obesity prevention and treatment. Curr. Obes. Rep. 4 , 182–190 (2015).

Donnelly, B. et al. Neuroimaging in bulimia nervosa and binge eating disorder: a systematic review. J. Eat. Disord. 6 , 3 (2018).

Strubbe, J. H. & Woods, S. C. The timing of meals. Psychol. Rev. 111 , 128–141 (2004).

Berthoud, H. R. & Morrison, C. The brain, appetite, and obesity. Annu. Rev. Psychol. 59 , 55–92 (2008).

Rosenbaum, M. & Leibel, R. L. 20 years of leptin: role of leptin in energy homeostasis in humans. J. Endocrinol. 223 , T83–T96 (2014).

Muller, T. D. et al. Glucagon-like peptide 1 (GLP-1). Mol. Metab. 30 , 72–130 (2019).

Yu, Y., Fernandez, I. D., Meng, Y., Zhao, W. & Groth, S. W. Gut hormones, adipokines, and pro- and anti-inflammatory cytokines/markers in loss of control eating: a scoping review. Appetite 166 , 105442 (2021).

Hernandez, D., Mehta, N. & Geliebter, A. Meal-related acyl and des-acyl ghrelin and other appetite-related hormones in people with obesity and binge eating. Obesity 27 , 629–635 (2019).

Munsch, S., Biedert, E., Meyer, A. H., Herpertz, S. & Beglinger, C. CCK, ghrelin, and PYY responses in individuals with binge eating disorder before and after a cognitive behavioral treatment (CBT). Physiol. Behav. 97 , 14–20 (2009).

Voon, V. Cognitive biases in binge eating disorder: the hijacking of decision making. CNS Spectr. 20 , 566–573 (2015).

Avena, N. M., Bocarsly, M. E., Hoebel, B. G. & Gold, M. S. Overlaps in the nosology of substance abuse and overeating: the translational implications of “food addiction”. Curr. Drug Abus. Rev. 4 , 133–139 (2011).

& Steward, T. et al. What difference does it make? Risk-taking behavior in obesity after a loss is associated with decreased ventromedial prefrontal cortex activity. J. Clin. Med. 8 , 1551 (2019).

PubMed Central Google Scholar

Hege, M. A. et al. Attentional impulsivity in binge eating disorder modulates response inhibition performance and frontal brain networks. Int. J. Obes. 39 , 353–360 (2015).

Wolz, I. et al. Subjective craving and event-related brain response to olfactory and visual chocolate cues in binge-eating and healthy individuals. Sci. Rep. 7 , 41736 (2017).

Balodis, I. M. et al. Divergent neural substrates of inhibitory control in binge eating disorder relative to other manifestations of obesity. Obesity 21 , 367–377 (2013).

Frank, G. K. W., Shott, M. E., Stoddard, J., Swindle, S. & Pryor, T. L. Association of brain reward response with body mass index and ventral striatal-hypothalamic circuitry among young women with eating disorders. JAMA Psychiatry 78 , 1123–1133 (2021).

Leehr, E. J. et al. Emotion regulation model in binge eating disorder and obesity–a systematic review. Neurosci. Biobehav. Rev. 49 , 125–134 (2015).

Ansell, E. B., Grilo, C. M. & White, M. A. Examining the interpersonal model of binge eating and loss of control over eating in women. Int. J. Eat. Disord. 45 , 43–50 (2012).

Iceta, S. et al. Cognitive function in binge eating disorder and food addiction: a systematic review and three-level meta-analysis. Prog. Neuropsychopharmacol. Biol. Psychiatry 111 , 110400 (2021).

Giel, K. E., Teufel, M., Junne, F., Zipfel, S. & Schag, K. Food-related impulsivity in obesity and binge eating disorder–a systematic update of the evidence. Nutrients 9 , 1170 (2017).

Kessler, R. M., Hutson, P. H., Herman, B. K. & Potenza, M. N. The neurobiological basis of binge-eating disorder. Neurosci. Biobehav. Rev. 63 , 223–238 (2016). This review provides a comprehensive synthesis of the neurobiological findings in BED and develops hyopotheses for neurobiological pathomechanisms in the development and maintenance of BED .

Schag, K., Schonleber, J., Teufel, M., Zipfel, S. & Giel, K. E. Food-related impulsivity in obesity and binge eating disorder–a systematic review. Obes. Rev. 14 , 477–495 (2013).

Mallorqui-Bague, N. et al. Impulsivity and cognitive distortions in different clinical phenotypes of gambling disorder: profiles and longitudinal prediction of treatment outcomes. Eur. Psychiatry 61 , 9–16 (2019).

& Lozano-Madrid, et al.Impulsivity, emotional dysregulation and executive function deficits could be associated with alcohol and drug abuse in eating disorders. J. Clin. Med. 9 , 1936 (2020).

CAS PubMed Central Google Scholar

Grant, J. E. & Chamberlain, S. R. Neurocognitive findings in young adults with binge eating disorder. Int. J. Psychiatry Clin. Pract. 24 , 71–76 (2020).

Oliva, R., Morys, F., Horstmann, A., Castiello, U. & Begliomini, C. Characterizing impulsivity and resting-state functional connectivity in normal-weight binge eaters. Int. J. Eat. Disord. 53 , 478–488 (2020).

Lucas, I. et al. Neuropsychological learning deficits as predictors of treatment outcome in patients with eating disorders. Nutrients 13 , 2145 (2021).

Schag, K. et al. Food-related impulsivity assessed by longitudinal laboratory tasks is reduced in patients with binge eating disorder in a randomized controlled trial. Sci. Rep. 11 , 8225 (2021).

Dingemans, A. E., van Son, G. E., Vanhaelen, C. B. & van Furth, E. F. Depressive symptoms rather than executive functioning predict group cognitive behavioural therapy outcome in binge eating disorder. Eur. Eat. Disord. Rev. 28 , 620–632 (2020).

Mestre-Bach, G., Fernandez-Aranda, F., Jimenez-Murcia, S. & Potenza, M. N. Decision-making in gambling disorder, problematic pornography use, and binge-eating disorder: similarities and differences. Curr. Behav. Neurosci. Rep. 7 , 97–108 (2020).

Amlung, M. et al. Delay discounting as a transdiagnostic process in psychiatric disorders: a meta-analysis. JAMA Psychiatry 76 , 1176–1186 (2019).

Appelhans, B. M. et al. Inhibiting food reward: delay discounting, food reward sensitivity, and palatable food intake in overweight and obese women. Obesity 19 , 2175–2182 (2011).

Tang, J., Chrzanowski-Smith, O. J., Hutchinson, G., Kee, F. & Hunter, R. F. Relationship between monetary delay discounting and obesity: a systematic review and meta-regression. Int. J. Obes. 43 , 1135–1146 (2019).

Steward, T. et al. Delay discounting of reward and impulsivity in eating disorders: from anorexia nervosa to binge eating disorder. Eur. Eat. Disord. Rev. 25 , 601–606 (2017).

Steward, T. et al. Delay discounting and impulsivity traits in young and older gambling disorder patients. Addict. Behav. 71 , 96–103 (2017).

Miranda-Olivos, R. et al. The neural correlates of delay discounting in obesity and binge eating disorder. J. Behav. Addict. 10 , 498–507 (2021).

Fowler, S. & Bulik, C. Family environment and psychiatric history in women with binge eating disorder and obese controls. Behav. Change 14 , 106–112 (1997).

Hudson, J. et al. Familial aggregation of binge-eating disorder. Arch. Gen. Psychiatry 63 , 313–319 (2006).

Javaras, K. N. et al. Familiality and heritability of binge eating disorder: results of a case-control family study and a twin study. Int. J. Eat. Disord. 41 , 174–179 (2008).

Mitchell, K. S. et al. Binge eating disorder: a symptom-level investigation of genetic and environmental influences on liability. Psychol. Med. 40 , 1899–1906 (2010).

Reichborn-Kjennerud, T., Bulik, C., Tambs, K. & Harris, J. Genetic and environmental influences on binge eating in the absence of compensatory behaviours: a population-based twin study. Int. J. Eat. Disord. 36 , 307–314 (2004).

Manfredi, L., Accoto, A., Couyoumdjian, A. & Conversi, D. A systematic review of genetic polymorphisms associated with binge eating disorder. Nutrients 13 , 848 (2021).

Micioni Di Bonaventura, E. et al. The melanocortin system behind the dysfunctional eating behaviors. Nutrients 12 , 3502 (2020).

Qasim, A. et al. Gain-of-function variants in the melanocortin 4 receptor gene confer susceptibility to binge eating disorder in subjects with obesity: a systematic review and meta-analysis. Obes. Rev. 20 , 13–21 (2019).

Hübel, C. et al. One size does not fit all. Genomics differentiates among anorexia nervosa, bulimia nervosa, and binge-eating disorder. Int. J. Eat. Disord. 54 , 785–793 (2021). This study uses data from the UK Biobank to present the first molecular genetic evidence that the underlying biology differs between binge-type eating disorders, including bulimia nervosa and binge-eating disorder and anorexia nervosa, and these differences can be captured at the genomic level .

Dinan, T. G. & Cryan, J. F. The impact of gut microbiota on brain and behaviour: implications for psychiatry. Curr. Opin. Clin. Nutr. Metab. Care 18 , 552–558 (2015).

Basolo, A. et al. Effects of underfeeding and oral vancomycin on gut microbiome and nutrient absorption in humans. Nat. Med. 26 , 589–598 (2020).

David, L. A. et al. Diet rapidly and reproducibly alters the human gut microbiome. Nature 505 , 559–563 (2014).

Wu, G. D. et al. Linking long-term dietary patterns with gut microbial enterotypes. Science 334 , 105–108 (2011).

Ridaura, V. K. et al. Gut microbiota from twins discordant for obesity modulate metabolism in mice. Science 341 , 1241214 (2013).

Chen, L. L. et al. Gut microbiota in psychiatric disorders: a systematic review. Psychosom. Med. 83 , 679–692 (2021).

Reed, K. K., Abbaspour, A., Bulik, C. M. & Carroll, I. M. The intestinal microbiota and anorexia nervosa: cause or consequence of nutrient deprivation? Curr. Opin. Endocr. Metab. Res. 19 , 46–51 (2021).

Herman, A. & Bajaka, A. The role of the intestinal microbiota in eating disorders–bulimia nervosa and binge eating disorder. Psychiatry Res. 300 , 113923 (2021).

Alcock, J., Maley, C. C. & Aktipis, C. A. Is eating behavior manipulated by the gastrointestinal microbiota? Evolutionary pressures and potential mechanisms. Bioessays 36 , 940–949 (2014).

van de Wouw, M., Schellekens, H., Dinan, T. G. & Cryan, J. F. Microbiota-gut-brain axis: modulator of host metabolism and appetite. J. Nutr. 147 , 727–745 (2017).

Glenny, E. M., Bulik-Sullivan, E. C., Tang, Q., Bulik, C. M. & Carroll, I. M. Eating disorders and the intestinal microbiota: mechanisms of energy homeostasis and behavioral influence. Curr. Psychiatry Rep. 19 , 51 (2017).

Madison, A. & Kiecolt-Glaser, J. K. Stress, depression, diet, and the gut microbiota: human–bacteria interactions at the core of psychoneuroimmunology and nutrition. Curr. Opin. Behav. Sci. 28 , 105–110 (2019).

Rantala, M. J., Luoto, S., Krama, T. & Krams, I. Eating disorders: an evolutionary psychoneuroimmunological approach. Front. Psychol. 10 , 2200 (2019).

Leyrolle, Q. et al. Specific gut microbial, biological, and psychiatric profiling related to binge eating disorders: a cross-sectional study in obese patients. Clin. Nutr. 40 , 2035–2044 (2021).

Reas, D. L. Public and healthcare professionals’ knowledge and attitudes toward binge eating disorder: a narrative review. Nutrients 9 , 1267 (2017).

Kazdin, A. E., Fitzsimmons-Craft, E. E. & Wilfley, D. E. Addressing critical gaps in the treatment of eating disorders. Int. J. Eat. Disord. 50 , 170–189 (2017).

Kornstein, S. G. Epidemiology and recognition of binge-eating disorder in psychiatry and primary care. J. Clin. Psychiatry 78 (Suppl. 1), 3–8 (2017).

Wolfe, B. E., Baker, C. W., Smith, A. T. & Kelly-Weeder, S. Validity and utility of the current definition of binge eating. Int. J. Eat. Disord. 42 , 674–686 (2009).

Lindvall Dahlgren, C. & Wisting, L. Transitioning from DSM-IV to DSM-5: a systematic review of eating disorder prevalence assessment. Int. J. Eat. Disord. 49 , 975–997 (2016).

Dakanalis, A., Colmegna, F., Riva, G. & Clerici, M. Validity and utility of the DSM-5 severity specifier for binge-eating disorder. Int. J. Eat. Disord. 50 , 917–923 (2017).

Grilo, C. M., Ivezaj, V. & White, M. A. Evaluation of the DSM-5 severity indicator for binge eating disorder in a clinical sample. Behav. Res. Ther. 71 , 110–114 (2015).

Ali, K. et al. Perceived barriers and facilitators towards help-seeking for eating disorders: a systematic review. Int. J. Eat. Disord. 50 , 9–21 (2017).

Bohon, C. Binge eating disorder in children and adolescents. Child. Adolesc. Psychiatr. Clin. N. Am. 28 , 549–555 (2019).

Citrome, L. Binge eating disorder revisited: what’s new, what’s different, what’s next. CNS Spectr. 24 , 4–13 (2019).

Morgan, J. F., Reid, F. & Lacey, J. H. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ 319 , 1467–1468 (1999).

Parker, K. & Brennan, L. Measurement of disordered eating in bariatric surgery candidates: a systematic review of the literature. Obes. Res. Clin. Pract. 9 , 12–25 (2015).

Klein, D. A., Sylvester, J. E. & Schvey, N. A. Eating disorders in primary care: diagnosis and management. Am. Fam. Physician 103 , 22–32 (2021).

O’Loghlen, E., Grant, S. & Galligan, R. Shame and binge eating pathology: a systematic review. Clin. Psychol. Psychother. https://doi.org/10.1002/cpp.2615 (2021).

Alberti, K. G. et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120 , 1640–1645 (2009).

Heriseanu, A. I., Hay, P., Corbit, L. & Touyz, S. Grazing in adults with obesity and eating disorders: a systematic review of associated clinical features and meta-analysis of prevalence. Clin. Psychol. Rev. 58 , 16–32 (2017).

Pope, H. G. Jr. et al. Binge eating disorder: a stable syndrome. Am. J. Psychiatry 163 , 2181–2183 (2006).

Wadden, T. A., Brownell, K. D. & Foster, G. D. Obesity: responding to the global epidemic. J. Consult. Clin. Psychol. 70 , 510–525 (2002).

Kass, A. E. et al. Universal prevention efforts should address eating disorder pathology across the weight spectrum: implications for screening and intervention on college campuses. Eat. Behav. 25 , 74–80 (2017).

Ewart-Pierce, E., Mejia Ruiz, M. J. & Gittelsohn, J. “Whole-of-community” obesity prevention: a review of challenges and opportunities in multilevel, multicomponent interventions. Curr. Obes. Rep. 5 , 361–374 (2016).

Swinburn, B., Egger, G. & Raza, F. Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity. Prev. Med. 29 , 563–570 (1999).

Booth, S. L. et al. Environmental and societal factors affect food choice and physical activity: rationale, influences, and leverage points. Nutr. Rev. 59 , S21–S39; discussion S57–S65 (2001).

Micha, R. et al. Effectiveness of school food environment policies on children’s dietary behaviors: a systematic review and meta-analysis. PLoS ONE 13 , e0194555 (2018).

Pike, K. M. et al. Antecedent life events of binge-eating disorder. Psychiatry Res. 142 , 19–29 (2006).

Stice, E., Desjardins, C. D., Rohde, P. & Shaw, H. Sequencing of symptom emergence in anorexia nervosa, bulimia nervosa, binge eating disorder, and purging disorder and relations of prodromal symptoms to future onset of these disorders. J. Abnorm. Psychol. 130 , 377–387 (2021).

Harrer, M. et al. Internet interventions for mental health in university students: a systematic review and meta-analysis. Int. J. Methods Psychiatr. Res. 28 , e1759 (2019).

Le, L. K., Barendregt, J. J., Hay, P. & Mihalopoulos, C. Prevention of eating disorders: a systematic review and meta-analysis. Clin. Psychol. Rev. 53 , 46–58 (2017).

Stice, E., Onipede, Z. A. & Marti, C. N. A meta-analytic review of trials that tested whether eating disorder prevention programs prevent eating disorder onset. Clin. Psychol. Rev. 87 , 102046 (2021).

Hay, P. et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. Aust. N. Z. J. Psychiatry 48 , 977–1008 (2014).

Hilbert, A., Hoek, H. W. & Schmidt, R. Evidence-based clinical guidelines for eating disorders: international comparison. Curr. Opin. Psychiatry 30 , 423–437 (2017).

Peat, C. M. et al. Comparative effectiveness of treatments for binge-eating disorder: systematic review and network meta-analysis. Eur. Eat. Disord. Rev. 25 , 317–328 (2017).

Hay, P. J. et al. Inpatient versus outpatient care, partial hospitalisation and waiting list for people with eating disorders. Cochrane Database Syst. Rev. 1 , CD010827 (2019).

Fairburn, C. G. Cognitive Behavior Therapy and Eating Disorders (Guilford Press, 2008).

Wilfley, D. E., Mackenzie, K. R., Welch, R. R., Ayres, V. E. & Weissman, M. M. Interpersonal Psychotherapy for Group (Basic Books, 2008).

Safer, D. L., Telch, C. F. & Chen, E. Y. Dialectical Behavior Therapy for Binge Eating and Bulimia (Guilford Press, 2009).

Wilson, G. T. & Zandberg, L. J. Cognitive-behavioral guided self-help for eating disorders: effectiveness and scalability. Clin. Psychol. Rev. 32 , 343–357 (2012).

Kenny, T. E., Carter, J. C. & Safer, D. L. Dialectical behavior therapy guided self-help for binge-eating disorder. Eat. Disord. 28 , 202–211 (2020).

Hilbert, A. et al. Meta-analysis of the efficacy of psychological and medical treatments for binge-eating disorder. J. Consult. Clin. Psychol. 87 , 91–105 (2019).

Wilson, G. T., Wilfley, D. E., Agras, W. S. & Bryson, S. W. Psychological treatments of binge eating disorder. Arch. Gen. Psychiatry 67 , 94–101 (2010).

Hilbert, A. et al. Long-term efficacy of psychological treatments for binge eating disorder. Br. J. Psychiatry 200 , 232–237 (2012).

Rozakou-Soumalia, N., Darvariu, S. & Sjogren, J. M. Dialectical behaviour therapy improves emotion dysregulation mainly in binge eating disorder and bulimia nervosa: a systematic review and meta-analysis. J. Pers. Med. 11 , 931 (2021).

Lammers, M. W., Vroling, M. S., Crosby, R. D. & van Strien, T. Dialectical behavior therapy adapted for binge eating compared to cognitive behavior therapy in obese adults with binge eating disorder: a controlled study. J. Eat. Disord. 8 , 27 (2020).

Vall, E. & Wade, T. D. Predictors of treatment outcome in individuals with eating disorders: a systematic review and meta-analysis. Int. J. Eat. Disord. 48 , 946–971 (2015). This review and meta-analysis provides comprehensive information on predictors of outcome in the treatment of eating disorders .

Grilo, C. M., Thompson-Brenner, H., Shingleton, R. M., Thompson, D. R. & Franko, D. L. Clinical moderators and predictors of cognitive-behavioral therapy by guided-self-help versus therapist-led for binge-eating disorder: analysis of aggregated clinical trials. Int. J. Eat. Disord. 54 , 1875–1880 (2021).

Hazzard, V. M. et al. Treatment outcomes of psychotherapy for binge-eating disorder in a randomized controlled trial: examining the roles of childhood abuse and post-traumatic stress disorder. Eur. Eat. Disord. Rev. 29 , 611–621 (2021).

Hilbert, A. et al. Meta-analysis on the long-term effectiveness of psychological and medical treatments for binge-eating disorder. Int. J. Eat. Disord. 53 , 1353–1376 (2020). This meta-analysis synthesizes current evidence on the efficacy of psychotherapy and pharmacotherapy for the treatment of BED .

Ghaderi, A. et al. Psychological, pharmacological, and combined treatments for binge eating disorder: a systematic review and meta-analysis. PeerJ 6 , e5113 (2018).

Reas, D. L. & Grilo, C. M. Psychotherapy and medications for eating disorders: better together? Clin. Ther. 43 , 17–39 (2021).

Heo, Y. A. & Duggan, S. T. Lisdexamfetamine: a review in binge eating disorder. CNS Drugs 31 , 1015–1022 (2017).

Gasior, M. et al. A phase 3, multicenter, open-label, 12-month extension safety and tolerability trial of lisdexamfetamine dimesylate in adults with binge eating disorder. J. Clin. Psychopharmacol. 37 , 315–322 (2017).

Hudson, J. I., McElroy, S. L., Ferreira-Cornwell, M. C., Radewonuk, J. & Gasior, M. Efficacy of lisdexamfetamine in adults with moderate to severe binge-eating disorder: a randomized clinical trial. JAMA Psychiatry 74 , 903–910 (2017).

Grilo, C. M. et al. Efficacy and safety of dasotraline in adults with binge-eating disorder: a randomized, placebo-controlled, fixed-dose clinical trial. CNS Spectr. 26 , 481–490 (2021).

McElroy, S. L. et al. Efficacy and safety of dasotraline in adults with binge-eating disorder: a randomized, placebo-controlled, flexible-dose clinical trial. J. Clin. Psychiatry 81 , 19m13068 (2020).

Palavras, M. A., Hay, P., Filho, C. A. & Claudino, A. The efficacy of psychological therapies in reducing weight and binge eating in people with bulimia nervosa and binge eating disorder who are overweight or obese–a critical synthesis and meta-analyses. Nutrients 9 , 299 (2017).

Munsch, S., Meyer, A. H. & Biedert, E. Efficacy and predictors of long-term treatment success for cognitive-behavioral treatment and behavioral weight-loss-treatment in overweight individuals with binge eating disorder. Behav. Res. Ther. 50 , 775–785 (2012).

Ulian, M. D. et al. Effects of health at every size(R) interventions on health-related outcomes of people with overweight and obesity: a systematic review. Obes. Rev. 19 , 1659–1666 (2018).

Grilo, C. M. et al. Randomized controlled trial testing the effectiveness of adaptive “SMART” stepped-care treatment for adults with binge-eating disorder comorbid with obesity. Am. Psychol. 75 , 204–218 (2020).

Palavras, M. A. et al. Integrated weight loss and cognitive behavioural therapy (CBT) for the treatment of recurrent binge eating and high body mass index: a randomized controlled trial. Eat. Weight. Disord. 26 , 249–262 (2021).

David, L. A., Sijercic, I. & Cassin, S. E. Preoperative and post-operative psychosocial interventions for bariatric surgery patients: a systematic review. Obes. Rev. 21 , e12926 (2020).

Kops, N. L. et al. Preoperative binge eating and weight loss after bariatric surgery: a systematic review and meta-analysis. Obes. Surg. 31 , 1239–1248 (2021).

Spirou, D., Raman, J. & Smith, E. Psychological outcomes following surgical and endoscopic bariatric procedures: a systematic review. Obes. Rev. 21 , e12998 (2020).

Taba, J. V. et al. The development of feeding and eating disorders after bariatric surgery: a systematic review and meta-analysis. Nutrients 13 , 2396 (2021).

Masheb, R. M., Dorflinger, L. M., Rolls, B. J., Mitchell, D. C. & Grilo, C. M. Binge abstinence is associated with reduced energy intake after treatment in patients with binge eating disorder and obesity. Obesity 24 , 2491–2496 (2016).

Pacanowski, C. R. et al. Weight change over the course of binge eating disorder treatment: relationship to binge episodes and psychological factors. Obesity 26 , 838–844 (2018).

Preuss, H., Pinnow, M., Schnicker, K. & Legenbauer, T. Improving inhibitory control abilities (ImpulsE)–a promising approach to treat impulsive eating? Eur. Eat. Disord. Rev. 25 , 533–543 (2017).

Schag, K. et al. IMPULS: impulsivity-focused group intervention to reduce binge eating episodes in patients with binge eating disorder–a randomised controlled trial. Psychother. Psychosom. 88 , 141–153 (2019).

Eichen, D. M., Matheson, B. E., Appleton-Knapp, S. L. & Boutelle, K. N. Neurocognitive treatments for eating disorders and obesity. Curr. Psychiatry Rep. 19 , 62 (2017).

Ince, B. et al. Can we change binge eating behaviour by interventions addressing food-related impulsivity? A systematic review. J. Eat. Disord. 9 , 38 (2021).

Raman, J., Hay, P., Tchanturia, K. & Smith, E. A randomised controlled trial of manualized cognitive remediation therapy in adult obesity. Appetite 123 , 269–279 (2018).

Brockmeyer, T. et al. Approach bias modification training in bulimia nervosa and binge-eating disorder: a pilot randomized controlled trial. Int. J. Eat. Disord. 52 , 520–529 (2019).

Chami, R. et al. Targeting binge eating in bulimia nervosa and binge eating disorder using inhibitory control training and implementation intentions: a feasibility trial. Psychol. Med. https://doi.org/10.1017/S0033291720002494 (2020).

Giel, K. E., Speer, E., Schag, K., Leehr, E. J. & Zipfel, S. Effects of a food-specific inhibition training in individuals with binge eating disorder–findings from a randomized controlled proof-of-concept study. Eat. Weight. Disord. 22 , 345–351 (2017).

Lewer, M. et al. Effects of a cognitive-behavioral exposure-based body image therapy for overweight females with binge eating disorder: a pilot study. J. Eat. Disord. 5 , 43 (2017).

Schyns, G., van den Akker, K., Roefs, A., Houben, K. & Jansen, A. Exposure therapy vs lifestyle intervention to reduce food cue reactivity and binge eating in obesity: a pilot study. J. Behav. Ther. Exp. Psychiatry 67 , 101453 (2020).

Low, T. L., Ho, R., Ho, C. & Tam, W. The efficacy of virtual reality in the treatment of binge-purging eating disorders: a meta-analysis. Eur. Eat. Disord. Rev. 29 , 52–59 (2021).

Manzoni, G. M. et al. Virtual reality-enhanced cognitive-behavioral therapy for morbid obesity: a randomized controlled study with 1 year follow-up. Cyberpsychol Behav. Soc. Netw. 19 , 134–140 (2016).

Peterson, C. B. et al. Comparing integrative cognitive-affective therapy and guided self-help cognitive-behavioral therapy to treat binge-eating disorder using standard and naturalistic momentary outcome measures: a randomized controlled trial. Int. J. Eat. Disord. 53 , 1418–1427 (2020).

Runfola, C. D. et al. A pilot open trial of UNITE-BED: a couple-based intervention for binge-eating disorder. Int. J. Eat. Disord. 51 , 1107–1112 (2018).

Chao, A. M. et al. Effects of liraglutide and behavioral weight loss on food cravings, eating behaviors, and eating disorder psychopathology. Obesity 27 , 2005–2010 (2019).

Da Porto, A. et al. Dulaglutide reduces binge episodes in type 2 diabetic patients with binge eating disorder: a pilot study. Diabetes Metab. Syndr. 14 , 289–292 (2020).

Dalton, B., Bartholdy, S., Campbell, I. C. & Schmidt, U. Neurostimulation in clinical and sub-clinical eating disorders: a systematic update of the literature. Curr. Neuropharmacol. 16 , 1174–1192 (2018).

Dalton, B., Campbell, I. C. & Schmidt, U. Neuromodulation and neurofeedback treatments in eating disorders and obesity. Curr. Opin. Psychiatry 30 , 458–473 (2017).

Zeng, B. Y. et al. Efficacy and acceptability of noninvasive brain stimulation interventions for weight reduction in obesity: a pilot network meta-analysis. Int. J. Obes. 45 , 1705–1716 (2021).

Max, S. M., Plewnia, C., Zipfel, S., Giel, K. E. & Schag, K. Combined antisaccade task and transcranial direct current stimulation to increase response inhibition in binge eating disorder. Eur. Arch. Psychiatry Clin. Neurosci. 271 , 17–28 (2021).

Gordon, G., Brockmeyer, T., Schmidt, U. & Campbell, I. C. Combining cognitive bias modification training (CBM) and transcranial direct current stimulation (tDCS) to treat binge eating disorder: study protocol of a randomised controlled feasibility trial. BMJ Open 9 , e030023 (2019).

WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol. Med. 28 , 551–558 (1998).

Topp, C. W., Ostergaard, S. D., Sondergaard, S. & Bech, P. The WHO-5 well-being index: a systematic review of the literature. Psychother. Psychosom. 84 , 167–176 (2015).

Ware, J. Jr, Kosinski, M. & Keller, S. D. A 12-item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med. Care 34 , 220–233 (1996).

Bohn, K. & Fairburn, C. in Cognitive Behavior Therapy and Eating Disorders: The Clinical Impairment Assessment Questionnaire (CIA). Appendix III (ed. Fairburn, C. G.) (Guilford Press, 2008).

Sepulveda, A. R., Whitney, J., Hankins, M. & Treasure, J. Development and validation of an Eating Disorders Symptom Impact Scale (EDSIS) for carers of people with eating disorders. Health Qual. Life Outcomes 6 , 28 (2008).

Li, N., Mitchison, D., Touyz, S. & Hay, P. Cross-sectional comparison of health-related quality of life and other features in people with and without objective and subjective binge eating using a general population sample. BMJ Open 9 , e024227 (2019).

Le, L. K. et al. Burden and health state utility values of eating disorders: results from a population-based survey. Psychol. Med. 51 , 130–137 (2021). This paper provides important data on the burden associated with BED, which is based on a representative population sample .

Tannous, W. K. et al. The economic cost of bulimia nervosa and binge eating disorder: a population-based study. Psychol. Med. https://doi.org/10.1017/S0033291721000775 (2021).

Watson, H. J. et al. A register-based case-control study of health care utilization and costs in binge-eating disorder. J. Psychosom. Res. 108 , 47–53 (2018).

Hart, L. M., Granillo, M. T., Jorm, A. F. & Paxton, S. J. Unmet need for treatment in the eating disorders: a systematic review of eating disorder specific treatment seeking among community cases. Clin. Psychol. Rev. 31 , 727–735 (2011).

Hay, P. et al. General practitioner and mental healthcare use in a community sample of people with diagnostic threshold symptoms of bulimia nervosa, binge-eating disorder, and other eating disorders. Int. J. Eat. Disord. 53 , 61–68 (2020).

Gearhardt, A. N. & Schulte, E. M. Is food addictive? A review of the science. Annu. Rev. Nutr. 41 , 387–410 (2021).

Hebebrand, J. et al. “Eating addiction”, rather than “food addiction”, better captures addictive-like eating behavior. Neurosci. Biobehav. Rev. 47 , 295–306 (2014).

van Hoeken, D. & Hoek, H. W. Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden. Curr. Opin. Psychiatry 33 , 521–527 (2020).

Giel, K., Schmidt, U., Fernandez-Aranda, F. & Zipfel, S. The neglect of eating disorders. Lancet 388 , 461–462 (2016).

Schmidt, U. et al. Eating disorders: the big issue. Lancet Psychiatry 3 , 313–315 (2016).

Bulik, C. et al. The Binge Eating Genetics Initiative (BEGIN) study. BMC Psychiatry 20 , 307 (2020).

Bulik, C. M. et al. The Eating Disorders Genetics Initiative (EDGI): study protocol. BMC Psychiatry 21 , 234 (2021).

Krug, I. et al. A proof-of-concept study applying machine learning methods to putative risk factors for eating disorders: results from the multi-centre European project on healthy eating. Psychol. Med. https://doi.org/10.1017/S003329172100489X (2021).

Leme, A. C. B. et al. Impact of strategies for preventing obesity and risk factors for eating disorders among adolescents: a systematic review. Nutrients 12 , 3134 (2020).

Wilfley, D. E. et al. Training models for implementing evidence-based psychological treatment: a cluster-randomized trial in college counseling centers. JAMA Psychiatry 77 , 139–147 (2020).

Taylor, C. B., Fitzsimmons-Craft, E. E. & Graham, A. K. Digital technology can revolutionize mental health services delivery: the COVID-19 crisis as a catalyst for change. Int. J. Eat. Disord. 53 , 1155–1157 (2020).

Herman, B. K. et al. Development of the 7-item binge-eating disorder screener (BEDS-7). Prim. Care Companion CNS Disord. https://doi.org/10.4088/PCC.15m01896 (2016).

Article PubMed PubMed Central Google Scholar

Gormally, J., Black, S., Daston, S. & Rardin, D. The assessment of binge eating severity among obese persons. Addict. Behav. 7 , 47–55 (1982).

van Strien, T., Frijters, J. E. R., Bergers, G. P. A. & Defares, P. B. The Dutch Eating Behaviour Questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. Int. J. Eat. Disord. 5 , 295–315 (1986).

Fairburn, C. G. & Beglin, S. J. Eating Disorder Examination Questionnaire (6.0). in Cognitive Behaviour Therapy and Eating Disorders (ed. Fairburn, C. G.) (Guilford Press, 2008).

Garner, D. Eating Disorder Inventory-3 (EDI-3) Professional Manual (PAR, 2004).

Maguen, S. et al. Screen for disordered eating: improving the accuracy of eating disorder screening in primary care. Gen. Hosp. Psychiatry 50 , 20–25 (2018).

Stunkard, A. J. & Messick, S. The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J. Psychosom. Res. 29 , 71–83 (1985).

Yanovski, S. Z., Marcus, M. D., Wadden, T. A. & Walsh, B. T. The Questionnaire on Eating and Weight Patterns-5: an updated screening instrument for binge eating disorder. Int. J. Eat. Disord. 48 , 259–261 (2015).

Fairburn, C. G., Cooper, Z., & O’Connor, M. in Cognitive Behaviour Therapy and Eating Disorders (ed. Fairburn, C. G.) (Guilford Press, 2008).

First, M. B., Williams, J. B. W., Karg, R. S. & Spitzer, R. L. Structured Clinical Interview for DSM-5–Research Version (SCID-5 for DSM-5, Research Version; SCID-5-RV) (American Psychiatric Association, 2015).

Stunkard, A. J. Eating patterns and obesity. Psychiatr. Q. 33 , 284–295 (1959).

Hamburger, W. W. Emotional aspects of obesity. Med. Clin. North. Am. 35 , 483–499 (1951).

American Psychiatric Association. Diagnostic and statistical manual of mental disorders 3rd edn (American Psychiatric Association, 1980).

American Psychiatric Association. Diagnostic and statistical manual of mental disorders 4th edn (American Psychiatric Association, 1994).

Kolar, D. R., Rodriguez, D. L., Chams, M. M. & Hoek, H. W. Epidemiology of eating disorders in Latin America: a systematic review and meta-analysis. Curr. Opin. Psychiatry 29 , 363–371 (2016).

Smink, F. R., van Hoeken, D., Oldehinkel, A. J. & Hoek, H. W. Prevalence and severity of DSM-5 eating disorders in a community cohort of adolescents. Int. J. Eat. Disord. 47 , 610–619 (2014).

Faravelli, C. et al. Clinical epidemiology of eating disorders: results from the Sesto Fiorentino study. Psychother. Psychosom. 75 , 376–383 (2006).

Bagaric, M., Touyz, S., Heriseanu, A., Conti, J. & Hay, P. Are bulimia nervosa and binge eating disorder increasing? Results of a population-based study of lifetime prevalence and lifetime prevalence by age in South Australia. Eur. Eat. Disord. Rev. 28 , 260–268 (2020).

De Silva, A., Salem, V., Matthews, P. M. & Dhillo, W. S. The use of functional MRI to study appetite control in the CNS. Exp. Diabetes Res. 2012 , 764017 (2012).

Heal, D. J. & Smith, S. L. Prospects for new drugs to treat binge-eating disorder: insights from psychopathology and neuropharmacology. J. Psychopharmacol. https://doi.org/10.1177/02698811211032475 (2021).

Quilty, L. C., Allen, T. A., Davis, C., Knyahnytska, Y. & Kaplan, A. S. A randomized comparison of long acting methylphenidate and cognitive behavioral therapy in the treatment of binge eating disorder. Psychiatry Res. 273 , 467–474 (2019).

Download references

Acknowledgements

U.S. acknowledges salary support from the National Institute of Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at the South London and Maudsley NHS Foundation Trust and King’s College London. She is also supported by an NIHR Senior Investigator Award. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. C.M.B. is supported by NIMH (R01MH120170, R01MH124871, R01MH119084, R01MH118278, R01 MH124871); Brain and Behavior Research Foundation Distinguished Investigator Grant; Swedish Research Council (Vetenskapsrådet, award 538-2013-8864); Lundbeck Foundation (grant no. R276-2018-4581). S.Z. was supported by the publicly funded project INTERBED (01GV0601) of the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung (BMBF)). F.F.-A. is supported by CERCA Programme/Generalitat de Catalunya for institutional support, and by research grants from PERIS (SLT006/17/00246), Instituto Salud Carlos III (PI17/01167, PI20/132, CIBERobn) and EU-H2020 grants (Eat2beNICE/H2020-SFS-2016-2, ref. 728018; and PRIME/H2020-SC1-BHC-2018-2020, ref. 847879) and COST Action (CA19115). K.S. is supported by a grant from the Margarete von Wrangell Program by the Federal Ministry of Science and Education Baden-Württemberg. K.E.G. acknowledges grants from the Federal Ministry of Education and Research (BMBF) (01KG2009) and the German Research Foundation (DFG) (GI 878/4-1). The authors thank the patient for anonymously sharing personal experiences of BED.

Author information

Authors and affiliations.

Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany

Katrin E. Giel, Kathrin Schag & Stephan Zipfel

Center of Excellence for Eating Disorders (KOMET), Tübingen, Germany

Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

Cynthia M. Bulik

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain

Fernando Fernandez-Aranda

Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain

Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain

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

Phillipa Hay

Camden and Campbelltown Hospitals, SWSLHD, Campbelltown, NSW, Australia

Department of Public Health, University of Helsinki, Helsinki, Finland

Anna Keski-Rahkonen

Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK

Ulrike Schmidt

South London and Maudsley NHS Foundation Trust, London, UK

You can also search for this author in PubMed Google Scholar

Contributions

Introduction (K.E.G.); Epidemiology (A.K.-R.); Mechanisms/pathophysiology (C.M.B. and F.F.-A.); Diagnosis, screening and prevention (K.S., K.E.G. and S.Z.); Management (P.H. and U.S.); Quality of life (P.H.); Outlook (K.E.G.); Overview of Primer (K.E.G.).

Corresponding author

Correspondence to Katrin E. Giel .

Ethics declarations

Competing interests.

C.M.B. received a grant from Shire, was a member of the Shire Scientific Advisory Board, acted as a consultant for Idorsia, received a grant from Lundbeckfonden, acted as an author for and received a grant from Pearson, and was a member of the Equip Health Inc. Clinical Advisory Board. F.F.-A. received consultancy honorarium from Novo Nordisk and an editorial honorarium as editor-in-chief from Wiley. P.H. is a consultant to Takeda Pharmaceuticals, receives or has received sessional fees and lecture fees from the Australian Medical Council, Therapeutic Guidelines publication, and New South Wales Institute of Psychiatry, and royalties/honoraria from Hogrefe and Huber, McGraw Hill Education, Blackwell Scientific Publications, BioMed Central and PLOS Medicine, and has received research grants from the NHMRC and ARC. She is Chair of the National Eating Disorders Collaboration Steering Committee in Australia and was a member of the ICD-11 Working Group for Eating Disorders and was Chair of the Clinical Practice Guidelines Project Working Group (Eating Disorders) of RANZCP. All views expressed in this paper are her own. All other authors declare no competing interests.

Peer review

Peer review information.

Nature Reviews Disease Primers thanks M. Fennig, A. C. Grammer, C. Segura-Garcia, F. Thomas, D. Wilfey and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Cite this article.

Giel, K.E., Bulik, C.M., Fernandez-Aranda, F. et al. Binge eating disorder. Nat Rev Dis Primers 8 , 16 (2022). https://doi.org/10.1038/s41572-022-00344-y

Download citation

Accepted : 28 January 2022

Published : 17 March 2022

DOI : https://doi.org/10.1038/s41572-022-00344-y

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

This article is cited by

The cost of the perfect body: influence mechanism of internalization of media appearance ideals on eating disorder tendencies in adolescents.

BMC Psychology (2024)

Comorbidity of binge eating disorder and other psychiatric disorders: a systematic review

Ewelina Kowalewska
Magdalena Bzowska
Michał Lew-Starowicz

BMC Psychiatry (2024)

A subset of dopamine receptor-expressing neurons in the nucleus accumbens controls feeding and energy homeostasis

Yiqiong Liu

Nature Metabolism (2024)

Obesità e Binge Eating Disorder: nutriamo il corpo o la mente?

Marco Verrastro
Silvia Tempia Valenta
Anna Rita Atti

L'Endocrinologo (2024)

Experiences of living with binge eating disorder and facilitators of recovery processes: a qualitative study

Marit Fjerdingren Bremer
Lisa Garnweidner-Holme
Marianne Molin

Journal of Eating Disorders (2023)

Quick links

Explore articles by subject
Guide to authors
Editorial policies

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Publications
Account settings

The PMC website is updating on October 15, 2024. Learn More or Try it out now .

Advanced Search
Journal List
Singapore Med J
v.63(6); 2022 Jun

Eating disorders in children and adolescents

Juliet sher kit tan.

1 Adolescent Medicine Service, Department of Paediatric Medicine, KK Women’s and Children’s Hospital, Singapore

Lynnette Ee Sing Tan

2 Singhealth Polyclinics – Bedok, Singapore

Courtney Davis

Chu shan elaine chew, associated data.

14-year-old Melissa visited your clinic with her mother for concerns of secondary amenorrhoea of six months. She did not have any headaches or visual disturbances and was not on any long-term medication. She also had dry skin and constipation. Her mother mentioned that Melissa had lost 8 kg of body weight in the past six months, leading to her current weight of 38 kg, citing school-related stress as a major factor. Melissa skipped meals in school and was unable to eat more than half a portion at dinner as she felt bloated and full easily, and got angry when her mother encouraged her to eat more. Her mother had noticed that she was more withdrawn and irritable recently. On examination, Melissa was 165 cm tall and weighed 38 kg. Her blood pressure was 92/58 mmHg, and her heart rate was 56 beats/min. You suspected the possibility of an eating disorder and decided to seek a more detailed history and targeted physical examination .

WHAT IS AN EATING DISORDER?

Eating disorders are complex illnesses related to abnormal eating behaviours that can affect the biopsychosocial health and functioning of the affected individuals. Most eating disorders involve an obsessive focus on body image, body weight and food, leading to dangerous eating patterns that have deleterious effects on the young person’s nutrition, growth and development. Other types of eating disorders may not necessarily centre around body image concerns, but can also involve behaviours that impede weight gain, or involve a compulsive drive to pursue health and fitness.

The more common type of eating disorders that may present to a general practitioner or paediatrician include anorexia nervosa (AN) and bulimia nervosa (BN), both of which can lead to medical complications associated with malnutrition or purging. Features of AN include a significant restriction of intake relative to daily requirements and presence of body image disturbance with undue influence of body weight/shape on self-evaluation. BN similarly stems from obsessive concerns over body shape and weight but is distinguished from AN by the presence of binge eating and recurrent compensatory behaviour to prevent weight gain, such as purging and the use of laxatives or diuretics.( 1 ) It is important to note that individuals with eating disorders do not necessarily have a low weight or body mass index (BMI).

While it is developmentally normal for adolescents to develop an increased interest in their appearance and body image, significant weight loss or overly restrictive dietary habits are not a normal phase of adolescence, and adolescents exhibiting such behaviour should be evaluated for serious conditions such as an eating disorder.

In our local context, many patients with eating disorders may not present with concerns of weight loss or specifically for evaluation of an eating disorder, but may instead present with physical manifestations and complications of malnutrition such as bloating, abdominal pain, early satiety, constipation, giddiness, secondary amenorrhoea and low mood.( 2 )

HOW COMMON IS THIS IN MY PRACTICE?

Eating disorders commonly develop in adolescence, with conditions such as AN and BN having an average age of onset of 14 years.( 2 ) They present more commonly in females, but also occur in the male population. Studies conducted worldwide have estimated the lifetime prevalence of AN to be between 0.5% and 2.0%, and that of BN to be between 0.9% and 3.0%. A Singapore-based study by Ho et al( 3 ) found that 7.4% of females (aged 12–26 years) are at risk of developing an eating disorder.

Eating disorders are serious illnesses and have the highest mortality rate among all psychiatric disorders, with mortality stemming from both the physical and psychiatric complications.( 4 ) Eating disorders are underdiagnosed and undertreated, as most affected patients have poor insight and deny the severity of their illness.( 5 ) The primary care physician is uniquely positioned to detect the warning signs of early eating disorders, as adolescents commonly present to primary care for concerns or complications resulting from eating disorders.( 6 ) Early identification and diagnosis of eating disorders by primary care physicians is critical, as timely intervention is associated with a higher likelihood of successful treatment. Studies have shown that early intervention is associated with higher rates of recovery.( 5 , 7 )

Studies have found that female gender, concurrent psychiatric disorders such as mood and anxiety disorders, and premorbid perfectionistic personality traits are risk factors for developing eating disorders. A family history of a close relative with an eating disorder or psychiatric illness has also been found to be associated with a higher risk of developing an eating disorder. It is important to note that eating disorders can also occur in individuals with no significant risk factors and in males. In males, body image concerns may involve fitness, muscularity, and engaging in muscle-enhancing behaviours such as eating more or differently or taking supplements to build muscles.( 8 , 9 )

WHAT CAN I DO IN MY PRACTICE?

When symptoms of weight loss, disordered eating or medical complications of malnutrition have been identified, a more detailed assessment should follow. History should be obtained in a non-judgemental, empathetic manner to understand the adolescent’s experience, and to determine whether he/she may require further evaluation by an eating disorder specialist. A history of weight loss should be explored, focusing on intentionality and the ways in which the weight loss was achieved (e.g. by use of laxatives or purging). Commonly, adolescents may report a strong interest in healthy eating and behaviours as opposed to body image, but excessive exercise, change in eating behaviours, restrictive eating patterns and the presence of binge-purge activity may still point towards an underlying eating disorder ( Box 1 ). A targeted physical examination to look out for signs of eating disorder, complications from malnutrition and a systemic examination to rule out other medical causes of weight loss are important ( Box 2 ).

An external file that holds a picture, illustration, etc.
Object name is SMJ-63-294-g001.jpg

Relevant history to screen for an eating disorder:

An external file that holds a picture, illustration, etc.
Object name is SMJ-63-294-g002.jpg

Possible physical examination findings of patients with eating disorders:

Many patients with eating disorders often present with non-specific symptoms such as headaches or complications of malnutrition. Complications of malnutrition include abdominal discomfort and bloating, alopecia, dry skin, easy bruising, constipation, dizziness, recurrent headaches, secondary amenorrhoea or persistent primary amenorrhoea, or other disruptions of normal pubertal events. It is important to consider other medical conditions (e.g. gastrointestinal or autoimmune conditions) that can lead to weight loss through careful history-taking and targeted physical examination. Diagnosing eating disorders in primary care practice can, thus, be challenging and some common pitfalls may be encountered in clinical practice.

(a) Owing to the rapid increase in height during the pubertal growth spurt period, absolute weight loss may not appear drastic, although there is a significant change in BMI. It can often be challenging to establish a weight trajectory, as adolescents may not have a history of documented weights.
(b) Adolescents may not always express body image issues or a fear of weight gain, as their underlying motivations for the weight loss may be different, and some younger adolescents may not be developmentally able to express these concerns. They may present with non-specific symptoms or complications of malnutrition.
(c) Some younger adolescents may not have achieved menarche owing to their age; hence, secondary amenorrhoea may not be present.
(d) Dieting behaviours and body image concerns are highly prevalent in adolescents and may be dismissed as a normal phase of adolescent development.
(e) Restrictive eating disorders occur not only in thin or underweight adolescents but also in patients with BMIs in the normal or overweight range. (4) Despite having a normal or high BMI at presentation, they are similarly at risk of medical complications from rapid weight loss. (10) In fact, adolescents with obesity are at an increased risk of eating disorders.
(f) While eating disorders are more common in females, males can also be affected, with more muscularity-oriented eating disorder symptoms. (8)

Management of patients with eating disorders

In the primary care setting, the physician’s priority is to ensure that the patient is medically stable and does not have significant complications from eating disorders that necessitate an urgent referral to the emergency department of a tertiary medical centre ( Box 3 ). In our study on children and adolescents with restrictive eating disorders, 69% of patients were medically unstable at presentation, requiring admission for medical stabilisation, with bradycardia being the most common reason for admission.( 2 )

An external file that holds a picture, illustration, etc.
Object name is SMJ-63-294-g003.jpg

Complications that would necessitate admission for medical stabilisation:

For medically stable patients, early referral to an eating disorder specialist is warranted. A multidisciplinary team will be involved in the care of the child, and commonly includes paediatricians, specialist nurses, psychologists, psychiatrists, dietitians and social workers.

Upon referral to an eating disorder specialist, the adolescent will be assessed for medical mimics and evaluated for complications of eating disorder ( Box 4 ). Investigations may include (but are not limited to) a full blood count, renal panel and electrolytes test (e.g. magnesium and phosphate), liver function test, thyroid function test, hormonal profile, erythrocyte sedimentation rate, electrocardiogram and bone mineral density scan. These will be done in conju nction with nutritional rehabilitation, as well as psychological assessment and intervention as indicated. Inpatient treatment goals are to medically stabilise the patient through nutritional rehabilitation and to monitor for any signs of refeeding syndrome. Refeeding syndrome is a rare complication marked by electrolyte derangements, and cardiac and neurological complications. The average length of inpatient stay is ten days for medical stabilisation.( 2 )

An external file that holds a picture, illustration, etc.
Object name is SMJ-63-294-g004.jpg

Complications of eating disorders and malnutrition:

Outpatient treatment goals are medical and psychological recovery from the eating disorder. Family-based therapy (FBT), also known as the Maudsley approach, is the first-line, evidence-based psychological treatment used in most tertiary care centres for AN and has been shown to have the best treatment outcomes, including protection against relapse. FBT adopts a non-blaming approach to eating disorders, and focuses on empowering and engaging parents in the refeeding process. The FBT process emphasises early restoration of weight and nutrition, and resumption of regular meal patterns and eating habits.( 5 ) In our local study, patients with AN treated with FBT had faster and improved rates of weight restoration compared to patients treated without FBT.( 11 )

While awaiting specialist care, the family physician can inform both the adolescent and the family about the complications of restrictive eating and malnutrition, and start them on eating regular-sized meals more frequently. It is important to reinforce that neither the parent nor the teen caused the development of an eating disorder. Frequent monitoring of the adolescent’s physical health is also important, as a medical instability can occur while awaiting the involvement of a specialist team in cases of rapid weight loss and food restriction. Important early messages for families when there are concerns about restrictive eating disorders are: (a) encouraging the family to provide and support three main meals and three snacks a day; (b) excusing the adolescent from all co-curricular activities, physical education classes and excessive physical activity; and (c) seeking timely consultation with an eating disorder specialist or team.

TAKE HOME MESSAGES

Eating disorders are challenging to diagnose and the common pitfalls should be noted. They should be diagnosed early in the disease process to reduce morbidity and improve chances of recovery.
A targeted history and physical examination while looking out for signs, symptoms and complications of eating disorder are important for early detection of eating disorders.
Primary care physicians should be familiar with medical complications of eating disorders and assessment of medical stability.
Management of an eating disorder is multidisciplinary, involving doctors, nurses, dietitians and social workers or psychologists. Referral to specialist care is indicated for adolescent patients suspected to have an eating disorder.

On further history-taking, Melissa shared that she had intentionally been trying to lose weight by counting calories, restricting her diet and exercising more. There was no purging or laxative use. You spoke to Melissa and her mother about your concerns regarding an eating disorder, informed them about the complications, and referred Melissa to an eating disorder programme in a tertiary centre. In the meantime, Melissa and her mother agreed to work on increasing her meal portion sizes. You wrote a memo to excuse her from physical education and co-curricular activities, and arranged to see her again in a week to review her weight and vitals. Melissa was subsequently seen by a specialist and diagnosed with anorexia nervosa. She started family-based therapy and experienced good weight gain and restoration of her menses .

IMAGES

Learn More about Eating Disorder Research Studies
(PDF) Eating disorders: A review of the literature with emphasis on medical complications and
Eating Disorder
(PDF) Eating disorders
(PDF) Eating disorder and culture article 2
⭐ Eating disorders essay. College Eating Disorders Essay Essay Example. 2022-11-03

VIDEO

Three ways we can improve eating disorder treatments
PMGR: Eating Disorder Case Studies
AED Eating Disorder Research in a nutshell: Wildes
PMGR: Signs and Symptoms: Presenting Features of Eating Disorders
ACUTE Center for Eating Disorders at Denver Health
“Silver Linings Playbook”: Analysis of Pat Solitano's Character

COMMENTS

Current Discoveries and Future Implications of Eating Disorders
2. Methods. A rapid scoping review focused on eating disorders was conducted. The definition adopted here was to map the existing literature to determine the volume and coverage of the topic, ascertain the types of literature available, and identify the gaps in the current eating disorder research.
(PDF) Overview on eating disorders
The empirical research identified 247 (31.8%) respondents displaying symptoms of eating disorders at least in one of four examined dimensions of the EDE-Q scale (Restraint, Eating Concerns, Shape ...
Current approach to eating disorders: a clinical update
For all eating disorders (including ARFID), the main treatment as delineated in the current national and international guidelines is a form of psycho‐behavioural therapy which can most usually be provided on an outpatient basis.9, 10, 11 People with more severe symptoms, or who are not improving with less restrictive care may be treated in a ...
Articles
Although eating disorders (EDs) are among the most stigmatised mental illnesses, a number of individuals break past this stigma and engage in ED advocacy by sharing their recovery stories. Little is known, how... Kiana Habibagahi and Michel Ferrari. Journal of Eating Disorders 2024 12:145. Research Published on: 19 September 2024.
An overview of the treatment of eating disorders in adults and
In the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the most significant changes are represented by the expansion of the ED chapter to "feeding and eating disorders", in which the feeding and ED of infancy or early childhood were added, along with the listing of binge eating disorder (BED) for the ...
PDF Eating Disorders: A Guide to Medical Care
errides the diagnosis of bulimia nervosa.Binge Eating Disorder (BED): Binge eating, in the absence of compensatory behavior, at l. ast once a week for three months or more. Binge eating episodes are associated with eating rapidly, regardless of hunger, until extreme fullness, and/or a.
Home page
Aims and scope. Journal of Eating Disorders is the first open access, peer-reviewed journal publishing leading research in the science and clinical practice of eating disorders. It disseminates research that provides answers to the important issues and key challenges in the field of eating disorders and to facilitate translation of evidence ...
Eating disorders
Abstract. 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 ...
PDF Eating disorders
Introduction. Eating disorders are serious psychiatric disorders characterised by abnormal eating or weight-control behaviours. Disturbed attitudes towards weight, body shape, and eating play a key role in their origin and maintenance. The form of these concerns varies by gender; in men for example, body image concerns might focus on ...
Eating disorder outcomes: findings from a rapid review of over a decade
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 ...
The American Psychiatric Association Practice Guideline for the
With Eating Disorders seeks to enhance the assessment, treatment, and quality of care in adolescents, young adults, and adults with an eating disorder. The guideline focuses on evidence-based pharmacological, psychotherapeutic, and other nonpharmacological treatments for eating disorders, primarily anorexia nervosa, bulimia nervosa, and binge-
(PDF) EATING DISORDERS IN ADOLESCENTS
rank as the third most common chronic condition among adolescent females [2] Anorexia. nervosa, characterized by severe food restriction, and bulimia nervosa, characterized b y binge. eating ...
(PDF) Explanation of Eating Disorders: A Critical Analysis
W ellington, 6012, New Zealand. EXPLANA TION OF EA TING DISORDERS 1. Abstract. Eating disorders (EDs) are one of the most severe and complex mental health problems. facing researchers and ...
International Journal of Eating Disorders
Meet the Editor. Ruth Weissman is a Walter Crowell University Professor of Social Sciences, Emerita, at Wesleyan University, USA. She is a clinical psychologist with research expertise in eating and weight disorders. Her scholarship focuses on reducing the burden of suffering associated with eating and weight problems, and past projects have included work on defining and classifying eating ...
Understanding Eating Disorders in Children and Adolescent Population
Eating disorders (EDs) are characterized by disordered eating behaviors, distorted body image, and an intense fear of weight gain or becoming overweight. EDs can occur in children, adolescents, and adults, but the prevalence and nature of these disorders differ across age groups.
Prevalence of eating disorders over the 2000-2018 period: a systematic
There are many forms of EDs, which are described in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases and Related Health Problems (ICD) classifications. The most widely used classification is the DSM classification. EDs appeared in 1980 within the DSM-III, their criteria were revised in 1987, and evolved over time with DSM-IV in 1994 ...
Risk factors for eating disorders: findings from a rapid review
In the current study we reviewed studies published between 2009 and 2021 which had researched risk factors associated with EDs. This study is one review of a wider Rapid Review series conducted as part the development of Australia's National Eating Disorders Research and Translation Strategy 2021-2031.
Current Discoveries and Future Implications of Eating Disorders
Eating disorders (EDs) are characterized by severe disturbances in eating behaviors and can sometimes be fatal. Eating disorders are also associated with distressing thoughts and emotions. They can be severe conditions affecting physical, psychological, and social functions. Preoccupation with food, body weight, and shape may also play an important role in the regulation of eating disorders ...
PDF Volume 1
Volume I. This volume comprises two parts. The first part is a review of the literature regarding the. role of attachment processes in the eating disorders. The second part is a qualitative study. that investigates the personal meaning of eating disorder symptoms. The literature review.
Conceptualizing eating disorder recovery research: Current perspectives
Background How we research eating disorder (ED) recovery impacts what we know (perceive as fact) about it. Traditionally, research has focused more on the "what" of recovery (e.g., establishing criteria for recovery, reaching consensus definitions) than the "how" of recovery research (e.g., type of methodologies, triangulation of perspectives). In this paper we aim to provide an ...
Risk factors for eating disorders: Findings from a rapid review
Background: Risk factors represent a range of complex variables associated with the onset, development, and course of eating disorders. Understanding these risk factors is vital for the refinement of aetiological models, which may inform the development of targeted, evidence-based prevention, early intervention, and treatment programs. This Rapid Review aimed to identify and summarise research ...
Eating disorders
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.
Binge eating disorder
Abstract. Binge eating disorder (BED) is characterized by regular binge eating episodes during which individuals ingest comparably large amounts of food and experience loss of control over their ...
Eating disorders in children and adolescents
A Singapore-based study by Ho et al (3) found that 7.4% of females (aged 12-26 years) are at risk of developing an eating disorder. Eating disorders are serious illnesses and have the highest mortality rate among all psychiatric disorders, with mortality stemming from both the physical and psychiatric complications.

Save citation to file

Add to My Bibliography

Eating disorders

Similar articles

Publication types

Related information

LinkOut - more resources

Research Materials

Miscellaneous

JavaScript disabled

Information

Initiatives

Article Menu

JSmol Viewer

1. Introduction

Share and Cite

Article Metrics

Conceptualizing eating disorder recovery research: Current perspectives and future research directions

Plain English summary

Ontological and epistemological stances in ED recovery research

ED recovery research approaches: A brief overview

Conceptual and methodological challenges in ED recovery research

Positioning ourselves

Overview and analysis of ED research methods

Quantitative methods

Qualitative methods

Exploration of mixed-methods, creative methods, and multi-methods research

Mixed-methods (weaving of quantitative and qualitative)

Creative methods (photovoice, digital/verbal storytelling, collages, drawings)

Multi-methods (complimentary use of multiple methods)

Additional methodological approaches/considerations

Longitudinal research design

Future research directions

Predictors of outcomes

Biological and neurological markers

Recovery criteria

The recovery process

Other areas for future consideration

Proposed future research model: Dialectical movement towards and away from a consensus

Availability of data and materials

Abbreviations

Acknowledgements

Author information

Contributions

Corresponding author

Ethics declarations

Additional information

Rights and permissions

About this article

Share this article

Journal of Eating Disorders

Binge eating disorder

Access options

Similar content being viewed by others

Sleep dysregulation in binge eating disorder and “food addiction”: the orexin (hypocretin) system as a potential neurobiological link

Genetics and neurobiology of eating disorders

What pharmacological interventions are effective in binge-eating disorder? Insights from a critical evaluation of the evidence from clinical trials

Acknowledgements

Author information

Contributions

Corresponding author

Ethics declarations

Peer review

Additional information

Rights and permissions

About this article

Share this article

This article is cited by

Comorbidity of binge eating disorder and other psychiatric disorders: a systematic review

A subset of dopamine receptor-expressing neurons in the nucleus accumbens controls feeding and energy homeostasis

Obesità e Binge Eating Disorder: nutriamo il corpo o la mente?

Experiences of living with binge eating disorder and facilitators of recovery processes: a qualitative study

Quick links

Eating disorders in children and adolescents

Lynnette Ee Sing Tan

Courtney Davis

WHAT IS AN EATING DISORDER?

HOW COMMON IS THIS IN MY PRACTICE?

WHAT CAN I DO IN MY PRACTICE?

Management of patients with eating disorders