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

• Change in motivational bias during treatment predicts outcome in anorexia nervosa
• Sophie R. Abber MS, Susan M. Murray PhD, Carina S. Brown MS, Christina E. Wierenga PhD
• doi: 10.1002/eat.24156. Epub 2024 February 01.
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• The acceptability, feasibility, and possible benefits of a neurobiologically-informed 5-day multifamily treatment for adults with anorexia nervosa
• Christina E. Wierenga, Laura Hill, Stephanie Knatz Peck, Jason McCray, Laura Greathouse, Danika Peterson, Amber Scott, Ivan Eisler, Walter H. Kaye
• oi: 10.1002/eat.22876. Epub 2018 May 2.
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40 years of research on eating disorders in domain-specific journals: Bibliometrics, network analysis, and topic modeling

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation School of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Perú

• Carlos A. Almenara

• Published: December 15, 2022
• https://doi.org/10.1371/journal.pone.0278981
• Peer Review
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Previous studies have used a query-based approach to search and gather scientific literature. Instead, the current study focused on domain-specific journals in the field of eating disorders. A total of 8651 documents (since 1981 to 2020), from which 7899 had an abstract, were retrieved from: International Journal of Eating Disorders (n = 4185, 48.38%), Eating and Weight Disorders (n = 1540, 17.80%), European Eating Disorders Review (n = 1461, 16.88%), Eating Disorders (n = 1072, 12.39%), and Journal of Eating Disorders (n = 393, 4.54%). To analyze these data, diverse methodologies were employed: bibliometrics (to identify top cited documents), network analysis (to identify the most representative scholars and collaboration networks), and topic modeling (to retrieve major topics using text mining, natural language processing, and machine learning algorithms). The results showed that the most cited documents were related to instruments used for the screening and evaluation of eating disorders, followed by review articles related to the epidemiology, course and outcome of eating disorders. Network analysis identified well-known scholars in the field, as well as their collaboration networks. Finally, topic modeling identified 10 major topics whereas a time series analysis of these topics identified relevant historical shifts. This study discusses the results in terms of future opportunities in the field of eating disorders.

Citation: Almenara CA (2022) 40 years of research on eating disorders in domain-specific journals: Bibliometrics, network analysis, and topic modeling. PLoS ONE 17(12): e0278981. https://doi.org/10.1371/journal.pone.0278981

Editor: Alberto Baccini, University of Siena, Italy, ITALY

Received: February 5, 2021; Accepted: November 27, 2022; Published: December 15, 2022

Copyright: © 2022 Carlos A. Almenara. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data that support the findings of this study are publicly available from the OSF repository: https://osf.io/5yzvd/ (DOI: 10.17605/OSF.IO/5YZVD ).

Funding: Funding for this study was obtained from Universidad Peruana de Ciencias Aplicadas (A-006-2021).

Competing interests: The author has no competing interest to declare.

Introduction

There are a large and growing number of scientific publications on eating disorders (ED) [ 1 – 3 ]. ED are mental disorders characterized by a continuous disturbance in eating behavior, such as Anorexia Nervosa [ 4 ]. ED are usually defined according to manuals like the Diagnostic and Statistical Manual of Mental Disorders (DSM) [ 4 ]. The spectrum of ED can share some symptoms (e.g., fear of fatness ), and these symptoms negatively impact psychosocial functioning and physical health. Due to the complexity of ED like Anorexia Nervosa, scholar literature about them covers different disciplines, such as ED related to: visual arts (e.g., art history) [ 5 ], sociology (e.g., social history) [ 6 ] and even dentistry (e.g., oral health) [ 7 ]. Thus, ED literature has a broad diversity.

Previous bibliometric studies about ED have focused on: identifying the distribution by language, region and country, as well as topics and their trends [ 1 ], productivity trends and collaboration patterns [ 2 ], most cited works in Anorexia Nervosa research [ 8 ], cross-cultural aspects of ED [ 3 ], comparison of citations between types of journals [ 9 ], female authorship [ 10 ], secular trends in the scientific terminology [ 11 , 12 ], the gap between scientific research and clinical practice [ 13 ], the use of keywords [ 14 ], and network analyses of common terms used in the field [ 15 ]. In particular, the current study complements the work by He et al. [ 1 ].

A standard practice of these studies is to retrieve the literature by performing a systematic search in databases like Web of Science or Scopus (i.e., employing a query-based approach), although there are some caveats worth mentioning. As noted elsewhere [ 16 , 17 ], those two databases differ in journal coverage and their use can introduce bias favoring science publications (e.g., biomedicine) in detriment of arts and humanities, other than overrepresenting English-language journals. Second, databases in general (including others like PubMed, Dimensions, JSTOR), differ in their search engine functionality and information retrieval capabilities.

For example, some databases offer a controlled vocabulary like a thesaurus or taxonomy from which to choose the search terms (e.g., the Medical Subject Headings [MeSH] in PubMed), whereas others offer a full text search. Regarding the latter, indexing scanned documents to offer a full text search, requires pre-processing methods like optical character recognition (OCR), known to include typos, and post-OCR processing, both affecting information retrieval accuracy [ 18 – 23 ].

In other words, a query-based approach, although widely used, can be affected by several factors, including: domain expertise to design the most appropriate search strategy, the characteristics of the selected database(s), including indexation accuracy (e.g., due to OCR typos). The former is particularly important because scholars are not always consistent in using the terminology [ 24 ]. In fact, their selection of keywords is not systematic, but rather influenced by factors like their background knowledge and previous experience [ 25 ]. In this regard, within the field of ED, scholars are encouraged to use appropriate terminology [ 26 , 27 ], usually a controlled vocabulary such as the Thesaurus of Psychological Index Terms. This helps to optimize the Knowledge Organization Systems (KOS) of journals and databases, such as a controlled vocabulary for information retrieval [ 14 , 28 ].

In sum, most previous studies have employed a query-based search, being compelled to choose among different databases, search terms, and search strategies [ 29 ]. Nevertheless, this approach not necessarily recognizes the boundaries and limitations of both databases and we as humans interacting with machines, using diverse information retrieval strategies, and dealing with information overload [ 30 , 31 ].

An alternative to the query-based approach is the one proposed in this study: to select a set of specialty journals exclusively devoted to the study of ED. Although this sampling could seem arbitrary, it was adopted: (1) to complement the findings of previous studies [ 1 , 2 ] and (2) because it has in fact a sound base: the intellectual and social structure of knowledge [ 32 – 36 ]. We must recognize that documents need to be understood with regard to "the broader contexts in which they are produced, used, and cited" [ 37 , p. 42]. Thus, the following sections will explain how domain-specific journals are tightly tied to an organized social and disciplinary structure. Moreover, I will explain how this approach does not necessarily exclude all ED literature from non-domain-specific journals, but rather incorporates part of it into their citations. Finally, from a complex systems perspective, I will show how domain-specific journals can be conceived as a specialized subset from the larger and more complex network comprising all ED literature.

Domain-specific journals and its social structure

From a scientometric perspective, science, metaphorically conceived as a knowledge space or knowledge landscapes , can be defined in terms of a network of scholars that produce a network of knowledge [ 35 ]. In the former case, the social function of science has long been recognized (e.g., by Thomas Kuhn): scholars produce and communicate scientific knowledge and this organized activity has the characteristics of a social process [ 36 , 38 ]. More importantly, the patterns of interactions and communication within this social organization are tightly tied, rather than isolated, to the knowledge they produce [ 36 ].

An exemplary case is the role of journal editors as gatekeepers, with studies identifying editorial gatekeeping patterns [ 39 , 40 ]. According with the Network Gatekeeping Theory, inspired by the work of Kurt Lewin, gatekeeping refers to the control in the flow of information [ 41 , 42 ]. In the field of ED, this intellectual and social organization of knowledge can be seen in professional societies like the Academy of Eating Disorder, which since 1981 publishes the most renowned scientific journal: The International Journal of Eating Disorders. Within its editorial board, there are distinguished scholars that can act as gatekeepers to ensure quality control and that manuscripts published by the journal are in line with the aims and scope of it.

In sum, domain-specific journals have the goal of publishing information within the boundaries of their aims and scope, allowing the diffusion of specialized knowledge.

Domain-specific journals and its disciplinary organization

From a network perspective, specialty journals are also indicators of disciplinary organization [ 43 ], which exerts a non-trivial influence at both the global and local level of the network. To be more precise, if we visualize a network [e.g., 2 , 44 , 45 ], the local density of specialty journals evidence emerging patterns such as citation patterns by articles from the same journal or group of journals [ 43 ]. At the author level, these patterns reflect the local influence of specialty journals on scholars who adhere to their research tradition and their contributions help to advance a research agenda [ 46 ].

For example, domain-specific journals on ED often publish curated information from conferences [e.g., 47 ] or special issues about a specialized topic [e.g., 48 ], which commonly include a research agenda [ 48 ], setting the stage for future research. As we mentioned above, similar literature, such as special issues about ED published in other journals [e.g., 49 ], is not necessarily excluded in the analysis of domain-specific journals. Rather, such literature is commonly cited in documents from domain-specific journals and can be included in a citation analysis. Importantly, these citation patterns suggest that the former intellectual and social structure of knowledge constrains what is being studied in the future [ 46 ]. Thus, in the upcoming years, most of this specialized literature is expected to become an active research front [ 32 ], as evidenced by its high number of citations.

Finally, it is worth mentioning that the analysis of these patterns can reveal latent hierarchies and topological properties of journal networks. In fact, domain-specific journals can be identified through the study of the hierarchical organization of journal networks. When hierarchical network analysis is used to identify the capability of journals to spread scientific ideas, multidisciplinary journals are found at the top of the hierarchy, whereas more specialized journals are found at the bottom [ 50 , 51 ]. Similarly, significant articles from a specific domain have unique topological properties that can affect the dynamic evolution of the network [ 52 ]. In sum, it is important to recognize the topological properties of networks and their latent hierarchies, both at the journal level and document level. In our case, focusing on domain-specific journals, it would be like zooming into the most central part (core) of the network topology to analyze its organization and distinctive features. Indeed, this approach is commonly employed, for example, when studying network subsets such as niches or communities in complex systems.

Domain-specific journals and complex adaptive systems

Domain-specific journals can also be comprehended from a complex systems standpoint, as the aggregation of the intellectual, social, and citation patterns outlined above. According to the Structural Variation Theory [ 53 ], the body of scientific knowledge can be conceived as a complex adaptive system (CAS). As such, it can be described and studied as a complex network with a series of characteristics like non-linearity, emergence, and self-organization; and a series of social, conceptual, and material elements that evolve over time [ 46 ]. Ideally, we must study CAS holistically to understand the properties of the system at the macrolevel [ 54 ]. In our case, this would require including all scholar literature on ED, which could be attempted using a query-based approach and employing ad hoc methodologies (e.g., iterative citation expansion) [ 45 ]. However, complex systems emerge from rules and behavior of lower-level components, and there is growing interest in understanding complexity from its simplest and fundamental elements and patterns [ 55 , 56 ]. In our case, this can be accomplished by zooming into domain-specific patterns that emerge from the relational structure and organization of journals and papers [ 46 ], rather than focusing on the whole system which comprises all the scientific literature on ED.

This approach can be described in terms of modularity , a structural property of systems: the local density of specialty journals is indicative of a structural module or subsystem [ 57 ]. This property of complex systems is important because it recognizes, as we did above, the existence of subsets within networks. Indeed, scientometric studies usually attempt to detect communities based on the principle of modularity by grouping similar literature (i.e., clustering) [ 44 , 58 ]. However, in the approach used in this study, rather than using bibliographic connections (e.g., through co-citation analysis) to detect domain-specific literature, we can use logical connections [ 59 ], to identify modules that operate as domain-specific representations [ 60 ]. In other words, domain-specific journals can be seen as clusters of articles that are logically linked because they all pertain to a given domain, which is explicitly stated in the aims and scope of the journals.

This modular organization has some advantages over others such as a hierarchy (e.g., Scimago categorization of journals) or a cluster obtained by literature partitioning algorithms. First, it has the advantage of reducing both complexity bias and hierarchical bias . The former is the tendency to assume and adopt a more complex system (the opposite to Occam’s Razor: prefer the simplest explanation), which means to analyze all ED literature. The latter assumes that behavior is directed in a hierarchical fashion, where a central authority passes instructions to all agents in the system [ 54 ]. Second, although it still recognizes a hierarchical structure composed by diverse classes of subsystems, it assumes heterarchy [ 43 , 61 ], which means that both hierarchical and nonhierarchical elements can be present in a system; holarchy , which means that systems are composed of components that can be recognized as subsystems [ 62 ]; and glocal control , which means that local and global phenomena in a system are achieved by local actions [ 63 ]. In simple words, sampling a set of domain-specific journals reduces complexity without affecting assumptions such as a categorical hierarchy of journals.

The current study

To expand on previous studies [ 1 , 2 ], the current study aims to answer the following research questions:

Which are the most cited documents in this domain-specific corpus of articles?

Which are the most important authors and their collaboration networks?

Which are the most relevant topics in this domain-specific corpus of articles?

How have the identified topics evolved over time (since 1981 to 2020)?

To answer these questions, this study employs a hybrid methodology. First, basic bibliometrics will be performed to identify the most cited documents. Second, network analysis will be employed to identify the most important authors and their networks of collaboration. Third, text mining, natural language processing, and machine learning algorithms will be used to identify the most relevant topics (i.e., topic modeling). Finally, a simple time series analysis will be performed to examine the evolution of these topics over time. The procedure employed for the analyses is detailed in the methods section below (and S5 File ), whereas the dataset and the code to perform the analyses are shared in a public repository ( https://doi.org/10.17605/OSF.IO/5YZVD ), allowing the reproducibility of results [ 64 ].

Data collection

The methodology workflow is presented in Fig 1 .

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

https://doi.org/10.1371/journal.pone.0278981.g001

First, in May 2020, a search of journals was performed in Scimago Journal Reports (SJR, https://www.scimagojr.com/ ), using the term “eating disorders”. In this step, the following five journals were identified: International Journal of Eating Disorders (ISSNs: 0276–3478, 1098-108X), European Eating Disorders Review (ISSNs: 1072–4133, 1099–0968), Eating Disorders (ISSNs: 1064–0266, 1532-530X), Eating and Weight Disorders (ISSNs: 1124–4909, 1590–1262), and Journal of Eating Disorders (ISSN: 2050-2974). The official website of each journal was then visited to confirm that the scope of the journal specifically includes the publication of research articles on eating disorders. It should be noted that the journal Advances in Eating Disorders (ISSNs: 2166–2630, 2166–2649) was not included because it was not found in SJR, it was published only between 2013 and 2016, it was incorporated into the journal Eating Disorders , and by the time of writing this article, it was not indexed neither in Scopus ( https://www.scopus.com ) nor in Web of Science ( https://www.webofknowledge.com ).

Next, also in May 2020, the Scopus database was chosen to retrieve the document records from the aforementioned journals. The election was made for no other reason than the capability of Scopus to retrieve several structured information (metadata, such as the abstract), and the file types for download are easy to manage, such as comma-separated values (CSV). Therefore, all document records published by these journals were searched in Scopus using the ISSN as the search term (e.g., ISSN (0276–3478) OR ISSN (02763478) OR ISSN (1098-108X) OR ISSN (1098108X) ). A total of 8651 documents between 1981 and 2020 were retrieved (of which 7899 had an abstract): 4185 (48.38%) from the International Journal of Eating Disorders, 1540 (17.80%) from Eating and Weight Disorders, 1461 (16.88%) from the European Eating Disorders Review, 1072 (12.39%) from Eating Disorders, and 393 (4.54%) from the Journal of Eating Disorders. These 8651 documents included a total of 213,744 references. It should be noted that the International Journal of Eating Disorders is the oldest of these journals, established in 1981. The S7 and S8 Files provide the number of documents per year and per journal. The document records were downloaded from Scopus both as comma separated values (CSV) and as BibTex ( http://www.bibtex.org/ ), and selecting all fields available (i.e., title, author, abstract, etc.). Due to copyright, the full text of all documents was not retrieved but rather their metadata (i.e, title, author, date, abstract), whilst the dataset shared online ( https://doi.org/10.17605/OSF.IO/5YZVD ) is the one obtained after the preprocessing procedures detailed below.

Analyses were performed using open software: R Statistical Software 4.0.3 (Bunny-Wunnies Freak Out) [ 65 ], and Python programming language version 3.9.1 ( https://www.python.org/ ).

Bibliometric analysis and network analysis in R

The biblioshiny application from the R package bibliometrix [ 66 ] was used to preprocess the CSV file. Next, it was used to identify the most cited documents. Local citations (i.e., citations only from documents whithin the dataset), and global citations (i.e., citations made by any document from the whole Scopus database), were computed. Biblioshiny was also used for network analysis as described by Batagelj & Cerinšek [ 67 ], and Aria & Cuccurullo [ 66 ]. Regarding the network, it is defined as a pair of sets: a set of nodes or vertices and a set of edges (link between nodes) [ 68 ]. In this study, when authors were treated as nodes, a link would represent co-authorship or collaboration [see 69 ]. More precisely, the Louvain algorithm for community detection [ 70 ] was used to identify communities within the collaboration network. This algorithm identifies densely connected nodes within the network (i.e., communities) [e.g., 71 ]. It works unconstrained to automatically extract a number of clusters although it requires basic network parameters as input. These network parameters were: up to 100 nodes, a minimum of two edges by node, and the removal of isolated nodes. For network layout visualization, the Fruchterman & Reingold [ 72 ] algorithm was chosen. Finally, common centrality measures were calculated: betweenness, closeness, and PageRank. Betweenness centrality refers to “the frequency that a node is located in the shortest path between other nodes” [ 73 , p. 772]. Closeness centrality refers to nodes that can easily reach others in the network, whilst PageRank , originally created to rank websites [ 74 ], has been used to rank authors because it takes into account the weight of influential nodes [ 75 ].

Topic modeling: Dimensionality reduction and matrix factorization

As can be seen in the workflow ( Fig 1 ), once network analysis was finished, a series of steps (detailed in S5 File ) were necessary to preprocess the dataset prior to topic modeling. Topic modeling refers to applying machine learning techniques to find topics by extracting semantic information from unstructured text in a corpus [ 76 ]. As we explain in S5 File , to this point we end up with a high-dimensional and sparse document-term matrix. In other words, we have many features (columns) each corresponding to a term in our corpus, and for a given document (rows) we have many columns with zero values meaning the term of that column is not in the given document. To deal with sparsity, we can perform dimensionality reduction to obtain a representation that effectively captures the variability in the data. In summary, dimensionality reduction can be categorized in feature extraction and feature selection ; the former combines the original feature space into a new one, whereas the latter selects a subset of features [ 77 ].

As explained in S5 File , the term frequency (TF) and the term frequency-inverse document frequency (TF-IDF) were used as feature extraction for vectorization. Then, the following machine learning algorithms were applied for topic modeling: Latent Dirichlet Allocation (LDA) [ 78 ], Latent Semantic Analysis (LSA or Latent Semantic Indexing) [ 79 ], Hierarchical Dirichlet Process (HDP) [ 80 ], and Non-negative Matrix Factorization (NMF) [ 81 ]. LDA is a generative probabilistic model that decomposes the document-term matrix into a topic-term matrix and a document-topic matrix, and it is commonly used for topic discovering from a corpus [e.g., 82 ]. LSA utilizes a truncated Singular Value Decomposition for decomposition and can work efficiently on TF or TF-IDF sparse matrices. In a fully unsupervised framework, the HDP model is characterized by inferring the number of topics on its own. Finally, NMF is an alternative approach that implements the Nonnegative Double Singular Value Decomposition, an algorithm suitable for sparse factorization [ 83 ].

First, the GENSIM library [ 84 ] was used for topic modeling because it provides a way to calculate topic coherence , an index to compare models based on measures of segmentation, probability estimation, confirmation measure, and aggregation [see 85 ]. Therefore, based on a TF matrix, HDP, LSA, NMF, and LDA were performed in GENSIM and compared in topic coherence. Once identified the topic modeling algorithms with the highest topic coherence, scikit-learn [ 86 ] was used because it provides an Exhaustive Grid Search option for ensemble learning the models (i.e., automatically fine-tuning the parameters to find the most optimal). Finally, once the topics were extracted, a simple time series analysis was performed to visualize the changes over time in the topics found. This analysis consisted of simply plotting the number of documents for each topic across years, from 1981 to 2020.

First, bibliometric analyses were performed to identify the most cited documents. Local citations are presented in Table 1 (and the S1 File ), whereas global citations are in Table 2 (and the S2 File ).

https://doi.org/10.1371/journal.pone.0278981.t001

https://doi.org/10.1371/journal.pone.0278981.t002

Next, a network analysis was performed to identify the most important authors ( Table 3 ) and their collaboration networks ( Fig 2 , see also S3 File , a dataset, and S4 File , an interactive visualization in HTML and JavaScript, also available online: https://osf.io/5yzvd/ ). This collaboration network analysis identified eight clusters with 96 authors: (1) red color, 4 authors; (2) blue, 15 authors; (3) green, 17 authors; (4) purple 21 authors; (5) orange, 2 authors; (6) brown, 18 authors; (7) pink, 2 authors; (8) grey, 17 authors.

https://doi.org/10.1371/journal.pone.0278981.g002

https://doi.org/10.1371/journal.pone.0278981.t003

Regarding the most relevant topics, LDA and NMF were superior to HDP and LSA in topic coherence. Then, when ensemble learning was used for LDA (based on TF) and NMF (based on TF-IDF), NMF provided the most meaningful results, and 10 topics were identified ( Table 4 ).

https://doi.org/10.1371/journal.pone.0278981.t004

The labels for the topics were manually added based on the top 10 keywords and their respective weights. Thus, each topic was manually labeled as follows: (1) risk factors for eating disorders, (2) body image dissatisfaction, (3) Binge Eating Disorder diagnosis, (4) weight loss, weight control, and diet, (5) clinical groups, (6) treatment outcome, (7) family and parent-child, (8) binge and purge episodes, (9) gender and subgroups, (10) EDNOS.

To examine how these topics have evolved over time, a simple time series analysis plot was created ( Fig 3 and S6 File ).

Note . Values in the y-axis are the sum of the weight values from the NMF analysis for topic dominance, per year and per topic. Values go from minimum 0 to maximum 11.2 (see S6 File ).

https://doi.org/10.1371/journal.pone.0278981.g003

This study analyzed 8651 documents between 1981 and 2020 from domain-specific journals in the field of eating disorders. The aims were: to identify the most cited documents, the most important authors and their collaboration networks, and the most relevant topics and their evolution over time. The results expand previous findings of studies that employed a query-based approach and included articles dating back as far as 1900 [ 13 ]. In particular the results expand the studies by Jinbo He et al. (2022) and Juan-Carlos Valderrama-Zurián, et al. (2017), which employed a similar methodology [ 1 , 2 ]. For example, He et al. (2022) created a collaboration network, although it was based on countries rather than authors [ 1 ]. Therefore, the results obtained here (e.g., author centrality measures, author clusters) provide a more fine grained understanding of the relevance and contribution of individual authors and their collaboration networks. Furthermore, He et al. (2022) [ 1 ] identified top authors based on traditional performance metrics (e.g., h-index), and it should be noted that there is some criticism towards their use and a claim to shift towards more responsible metrics of research excellence [ 87 ]. Then, He et al. (2022) [ 1 ] employed LDA for topic modeling, whilst this study employed NMF. Although LDA is largely used, in this study NMF outperformed LDA in interpretability, reproducibility, and as we said above, it suits better for short texts, as is the case of article abstracts used here. Finally, the top journals identified by He et al. (2022) confirmed that the five journals selected for this study are in fact among the most important in the field of eating disorders [ 1 ]. In the case of Valderrama-Zurián, et al. (2017) [ 2 ], they also focused on authors’ productivity trends whereas their social network analysis was focused on network metrics such as the number of nodes and edges over time, which precludes to inspect the social network at the author level. Therefore, this study also expands on the findings of Valderrama-Zurián, et al. (2017) [ 2 ].

Below, we discuss in more detail the results of the analysis employed to answer the four research questions outlined in the introduction.

Bibliometric analysis

The top cited documents were all from the International Journal of Eating Disorders. As noted above, this journal is the oldest one (it started in 1981), and it has the largest number of articles per year, with the exception of the year 2019 when it was outperformed by the Eating and Weight Disorders journal (see S7 and S8 Files). The majority of top cited documents were related to the development of instruments for the assessment of eating disorders or the course and outcome of eating disorders. For example, we can see in the results the most common instruments used for the screening of eating disorders, as well as the evaluation of its core symptoms: Eating Disorder Inventory (EDI), Body Shape Questionnaire (BSQ), Dutch Eating Behavior Questionnaire (DEBQ), and Eating Disorder Examination Questionnaire (EDE-Q). These instruments are widely used to screen the general population, as well as in clinical settings, together with more recent instruments [ 88 ]. It should be noted, however, that in clinical practice settings the use of instruments for the diagnosis and the different phases of the treatment process is not necessarily widespread [ 89 , 90 ]. To reduce this gap, some authors suggest to provide assessment training and/or assessment guidelines for mental health professionals and general practitioners in primary health care [ 91 , 92 ]. This can help obtain a comprehensive clinical assessment, particularly of individuals with higher risk such as young adolescents with restrictive Anorexia Nervosa [ 93 ]. The instruments mentioned above are reliable measures, and they could be used online for a quick screening or session by session for ongoing monitoring, although further research is necessary [e.g., 94 – 96 ].

The rest of most cited documents include important review articles on epidemiology (Hoek & van Hoeken, 2003, in Table 1 ); the course and outcome of eating disorders (Berkman, Lohr & Bulik, 2007; Strober, Freeman & Morrell, 1997; in Table 1 ); and the diagnosis of Binge Eating Disorder (Spitzer et al., 1992, 1993, in Table 1 ). These results are similar to previous studies in which measurement methods (including instrument development), epidemiology, and review articles were the most common type of document [ 8 , 9 ].

Finally, the large number of articles on the diagnosis of Binge Eating Disorder, which was not fully recognized as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) until its fifth edition [ 4 ], reveal that the recognition of Binge Eating Disorder as an own disorder took several years. To reach expert consensus in a shorter time, eating disorder professionals should pay special attention to emerging eating problems, such as Orthorexia Nervosa [ 97 ].

Network analysis

The network analysis identified eight clusters with 96 authors. Previous studies have examined the network of authors in the field in terms of network statistics such as number of edges or network density [ 2 ]. By contrast, this study provides a more fine-grained network analysis, identifying experts and group of experts in the field of eating disorders. As seen in the results section, the majority are distinguished authors with contributions dating back to the early 1980s.

The author with the largest betweenness centrality was Ross D Crosby (Sanford Center for Biobehavioral Research, United States), followed by James E Mitchell (University of North Dakota, United States) which has the largest value in PageRank. Authors with high betweenness centrality can act as both enablers and gatekeepers of information flow between communities [ 75 ]. Moreover, it has been found that authors with high betweenness centrality establish more collaborations than those high in closeness centrality [ 75 ]. In summary, the results of centrality measures can help to identify experts in the field of eating disorders, particularly authors that can quickly reach other authors in the network (high in closeness), act as gatekeepers (high in betweenness), or relate to influential others (high in PageRank).

Regarding the clusters identified by the network analysis, in the same cluster of Ross D Crosby and James E Mitchell are found other renowned authors like Daniel Le Grange (University of California, San Francisco, United States), Stephen A Wonderlich (Sanford Center for Biobehavioral Research, United States), and Carol B Peterson (University of Minnesota, United States). Among the most relevant results of collaboration of this cluster we can find studies on the ecological momentary assessment of eating disorders [ 98 ], the psychometric properties of the EDE-Q [ 99 ], and the diagnosis of Binge Eating Disorder [ 100 ].

The second largest cluster includes authors like Cynthia M Bulik (University of North Carolina at Chapel Hill, United States), Walter H Kaye (University of California, San Diego, United States), and Katherine A Halmi (Weill Cornell Medical College, United States). The results of their collaboration include studies related to the phenotypic characterization of eating disorders, such as the International Price Foundation Genetic Study, a multisite study that included a large sample of patients with eating disorders and their families [e.g., 101 ].

Finally, the third largest cluster includes authors like Janet Treasure (King’s College London, England), Ulrike Schmidt (King’s College London, England), and Tracey D Wade (Flinders University, Australia), which are widely recognized by the Maudsley Model for Treatment of Adults with Anorexia Nervosa (MANTRA) [ 102 , 103 ]. Interestingly, this is the only cluster that includes collaborations with authors from non-English speaking countries, more specifically from Spain. Examples of these collaborations include studies resulting from the Wellcome Trust Case Control Consortium 3 (WTCCC3) and the Genetic Consortium for AN (GCAN) [ 104 ], and other studies with clinical samples in Spain [e.g., 105 ].

On the other hand, the results reveal the importance of multisite studies that strengthen collaboration and originate in relevant outcomes for the prevention and treatment of eating disorders. Research groups could look for opportunities to collaborate in multisite studies and strengthen both their interdisciplinary and transdisciplinary collaboration, and their collaboration with less common partners such as stakeholders and policy makers [ 106 , 107 ]. By establishing these integrative and strategic collaborations we can promote translational research, and thus helping to reach broader public health goals [ 108 ].

Topic modeling

The combination of TF-IDF and NMF provided meaningful results, identifying 10 topics. After labeling these topics based on the first 10 keywords and their respective weights, we can see that most of the research on eating disorders done in the past 40 years has focused on their prevention and treatment. Interestingly, the time trend analysis of these topics revealed a noticeable change in the first lustrum of the 1990s. Whereas during the early 1980s the study of clinical groups (topic 5) was the most dominant topic, from the mid-1990s, this topic was surpassed by the study of risk factors of eating disorders (topic 1). This indicates an increasing interest for the prevention rather than solely the treatment of eating disorders. This result is consistent with the historical shift that occurred in the United States when in 1992 the Institute of Medicine (IOM) Committee on Prevention of Mental Disorders was created [ 109 ]. Then two years later, a report on reducing risk factors for mental disorders and promoting a preventive approach in research was published [ 110 ]. As expected, this shift had echo in several scholars at the time, became a research front, and relevant publications started to include more information on the prevention of eating disorders, including a special issue [ 111 ], book chapters [ 112 ], and progressively entire books [ 113 ]. It is important to note that this historical shift, as well as later others like in 2017 [ 114 ], were favorable, because in other cases like obesity, it took more time to focus on its prevention due to different issues, including the pressure of the weight loss industry and its commercial interest [ 115 ].

Another interesting finding was that the outcome of the treatment of eating disorders (topic 6), is the second most important topic of 2013, and this finding has important aspects to discuss. First, the surge of state-of-the-art machine learning algorithms provide several opportunities to build intelligent systems for precision medicine. Thus, the treatment course and outcome of eating disorders can be more personalized, guided, and enhanced with the help of predictive technologies and intelligent systems [e.g., 116 ]. Second, as suggested elsewhere [ 117 ], the advantages of technology can be particularly relevant for certain age groups like adolescents, and when a digital intervention is employed [ 118 ]. In summary, treatment outcome is currently an important topic, and future studies can deploy digital interventions and machine learning algorithms for a more precise treatment planning.

Limitations and conclusions

Although this study has strengths, such as using data and code that allows the reproducibility of the results, readers should consider some limitations. First, the analysis of most cited documents is for all the time span, and more recent highly cited documents are underrepresented. Moreover, the journal Advances in Eating Disorders was not included due to indexing issues. Nevertheless, this study provides the code and a detailed procedure to allow researcher to perform further analyses, such as document co-citation analysis. Future studies can also evaluate the Mexican Journal of Eating Disorders ( Revista Mexicana de Trastornos Alimentarios , ISSN 2007-1523), which has published articles primarily in Spanish [ 119 ]. Second, the network analysis included close to 100 scholars mostly with a long trajectory in the field, and this can be a limitation in representing more younger scientists or newcomers [ 2 ]. Future studies can focus on a larger number of scholars and apply different techniques in network analysis, such as other community detection techniques [e.g., 120 ]. Finally, the results of topic modeling suggested a solution of 10 topics out of up to 30 topics solution models tested. Although there is not a universally accepted approach to establish the number of topics, this study relied on several strategies, including ensemble learning, to automatically fine-tune the parameters of the machine learning algorithms, stability, and heuristic approaches [ 121 ]. Future studies can try other machine learning algorithms and techniques to retrieve topics [ 121 ].

In conclusion, this study analyzed 40 years of research on eating disorders, identified the most cited articles, networks of collaboration, experts in the field, and the 10 major topics in the field.

Supporting information

S1 file. most local cited documents..

https://doi.org/10.1371/journal.pone.0278981.s001

S2 File. Most global cited documents.

https://doi.org/10.1371/journal.pone.0278981.s002

S3 File. Network statistics.

https://doi.org/10.1371/journal.pone.0278981.s003

S4 File. Network of collaboration including close to one hundred authors.

https://doi.org/10.1371/journal.pone.0278981.s004

S5 File. Data preprocessing and text representation in Python.

https://doi.org/10.1371/journal.pone.0278981.s005

S6 File. Sum of NMF results for topic dominance per year and per topic.

https://doi.org/10.1371/journal.pone.0278981.s006

S7 File. Number of documents per year and per journal.

https://doi.org/10.1371/journal.pone.0278981.s007

S8 File. Trends over time in number of documents per journal.

https://doi.org/10.1371/journal.pone.0278981.s008

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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.

Copyright © 2020 Elsevier Ltd. All rights reserved.

Publication types

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

• Open access
• Published: 30 May 2023

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

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

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

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

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

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

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

Plain English summary

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

Introduction

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

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

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

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

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

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

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

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

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

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

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

Overall outcomes

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

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

Remission, recovery, and relapse

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

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

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

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

Diagnostic crossover

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

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

Anorexia nervosa (AN)

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

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

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

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

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

Bulimia nervosa (BN)

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

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

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

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

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

Binge eating disorder (BED)

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

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

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

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

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

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

EDNOS, OSFED and UFED

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

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

Avoidant/Restrictive Food Intake Disorder (ARFID)

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

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

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

Community outcomes

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

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

Factors relating to outcomes

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

Age of presentation

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

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

Clinical features and co-occurring conditions

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

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

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

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

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

Psychosocial, environmental and health factors

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

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

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

Treatment factors

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

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

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

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

Self-esteem, self-compassion, and motivation

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

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

Relapse prevention programs

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

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

Online relapse prevention programs

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

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

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

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

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

Standardised, weighted, and crude mortality

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

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

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

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

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

Years of life lost/years lived with disability

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

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

Risk factors

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

Cause of death

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

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

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

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

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

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

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

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

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

Key findings

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

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

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

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

Strengths and limitations

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

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

Availability of data and materials

Not applicable—all citations provided.

Abbreviations

Atypical anorexia nervosa

Adolescent focused therapy

• Anorexia nervosa

Anorexia nervosa binge/purge subtype

Anorexia nervosa restricting subtype

Avoidant restrictive food intake disorder

• Binge eating disorder

Body mass index

• Bulimia nervosa

Behavioural weight loss therapy

Cognitive behaviour therapy

Enhanced cognitive behavioural therapy

Crude mortality rate

Diagnostic and statistical manual of mental disorders

Expected body weight

• Eating disorders

Eating disorder examination questionnaire

Eating disorder not otherwise specified

Eating disorder not otherwise specified-anorectic type

Eating disorder not otherwise specified-bulimic type

End of treatment

Family-based therapy

Healthcare management advisors

Health related quality of life

Integrative cognitive-affective therapy

InsideOut Institute

Interpersonal therapy

Major depressive disorder

Objective binge eating

Obsessive compulsive disorder

Other specified feeding or eating disorder

Quality of life

Randomised controlled trial

National eating disorder research & translation strategy rapid review

Standardised mortality ratio

Substance use disorder

Treatment as usual

Unspecified feeding or eating disorder

Weighted mortality ratio

Years of life lost

Years lived with a disability

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Acknowledgements

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

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

Author information

Authors and affiliations.

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

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

Sydney Local Health District, Sydney, Australia

Healthcare Management Advisors, Melbourne, Australia

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

Robert Boakes, Rebecca Pinkus & Paul Rhodes

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

Leah Brennan & Eleanor Wertheim

School of Psychology, Perth, Western Australia, Australia

Susan Byrne

Eating Disorders Victoria, Victoria, Australia

Belinda Caldwell

Perth, Australia

Shannon Calvert

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

David Castle

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

Ian Caterson

Eating Disorders Queensland, Brisbane, QLD, Australia

Belinda Chelius

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

Westmead Hospital, Sydney, NSW, Australia

Simon Clarke

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

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

Brisbane, Australia

Lexi Crouch

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

Jasmine Fardouly & Lenny Vartanian

University of Sydney, Sydney, NSW, Australia

Carmen Felicia & Amber-Marie Firriolo

New South Wales Health, Sydney, NSW, Australia

John Feneley & Karen Rockett

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

Mathew Fuller-Tyszkiewicz & Ross King

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

Anthea Fursland

Hollywood Clinic, Ramsay Health Care, Perth, Australia

Bethanie Gouldthorp & Jake Linardon

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

Scott Griffiths & Isabel Krug

Queensland Eating Disorder Service, Brisbane, QLD, Australia

Amy Hannigan

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

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

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

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

Francis Kay-Lambkin

Westmead Hospital, Sydney, Australia

Michael Kohn

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

Randall Long

Exchange Consultancy, Redlynch, NSW, Australia

Amanda Long

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

Sloane Madden

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

Sian McLean

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

Thy Meddick

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

Richard O’Kearney & Elizabeth Rieger

ADHD and BED Integrated Clinic, Melbourne, VIC, Australia

Roger Paterson

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

Susan Paxton

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

Genevieve Pepin

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

Andrea Phillipou

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

Judith Piccone

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

Bronwyn Raykos

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

Janice Russell

Ramsay Health Care, Perth, Australia

Fiona Salter

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

Susan Sawyer

National Eating Disorders Collaboration, Victoria, Australia

Beth Shelton

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

Urvashnee Singh

Sydney, Australia

Sophie Smith

The Butterfly Foundation, Sydney, Australia

Sarah Squire, Juliette Thomson & Ranjani Utpala

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

Andrew Wallis

Department of Psychiatry, University of Queensland, Brisbane, Australia

Warren Ward

University of Tasmania, Hobart, TAS, Australia

Sarah Wells

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

Simon Wilksch

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

Michelle Williams

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National Eating Disorder Research Consortium

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

Contributions

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

Corresponding author

Correspondence to Jane Miskovic-Wheatley .

Ethics declarations

Ethics approval and consent to participate.

Not applicable.

Consent for publication

Competing interests.

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

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Supplementary Information

Additional file 1: fig. s1..

PRISMA flow diagram.

Additional file 2: Table S1.

Studies included in the Rapid Review.

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

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Received : 28 February 2023

Accepted : 05 May 2023

Published : 30 May 2023

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

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Thesis Helpers

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

154 In Depth Eating Disorder Research Topics For Your Dissertation

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

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

Characteristics Of A Good Thesis Research Paper

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

• Top-Notch Research: Your work will cover real-life data and examples which must be true. Researching is a rigorous effort that could get you discouraged. However, you must focus on providing a comprehensive and reliable paper for future references. You must also be knowledgeable to embody basic features which you’ll need to show that you’re a skilled researcher.
• Accurate Analysis: When you analyze an existing literature, ensure to achieve accuracy. You will need to establish hypotheses but you must reference authority literature to back them up. When your facts are wrong, they could disapprove of everything you’ve written in your paper. Thus, you must review all you write to ensure that you’re still on the right path.
• Clear and Precise: You want to communicate with people, not flex your vocabulary prowess. If you want to achieve clarity, write in simple language. You should also consider adding only relevant details to your paper. This will help you avoid unnecessary detailing and explanation of scientific terms.
• Original and Coherent: While your paper can contain studies from other authors, you must ensure that you credit them. You must also ensure that you input your thoughts into what you write. Doing this makes you possess the good qualities of a trustworthy and reliable researcher. You must not compromise on originality, and you must also be coherent with your writing.

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

Research Questions About Eating Disorders

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

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

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

Eating Disorders Research Paper

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

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

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

Research Topics On Eating Disorders

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

You can consider the following research topics in eating disorders:

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

Thesis About Eating Disorders

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

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

Review the following books:

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

Eating Disorder Body Image Research Topics

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

To discuss this, you can consider these topics:

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

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