Best Practices: The Evidence Base for Eating Disorder Treatment

For our 2022 review of the evidence base for eating disorder treatment, click here. To start, what does evidence-based treatment mean? Evidence-based treatments are interventions ("therapies") that are supported by published research demonstrating effectiveness (the "evidence"). In other words, these are treatments that have been well tested, compared against other established treatments, and then highlighted as producing the best outcomes. So what is the evidence base for eating disorder treatment?

The Evidence Base for Eating Disorder Treatment for Anorexia, Bulimia, and Binge Eating Disorder

There was a recent exhaustive review[i] of the most current treatments for feeding and eating disorders like anorexia, bulimia, and binge eating disorder in adults and adolescents. Here are the headlines:

1. In the majority of clinical trials, Enhanced Cognitive Behavioral Therapy (CBT-E) has been shown to be the most effective treatment for adult anorexia, bulimia and binge eating disorder.

Enhanced CBT (CBT-E) was designed specifically for eating disorders. It is a very structured, time-limited treatment with three distinct phases. The primary focus of the treatment - regardless of the condition - is to establish a regular pattern of stable, flexible eating and addressing the different factors (things like extreme focus on shape and weight or mood-related eating) that keep the eating problem going.

2. There is broad agreement that, whenever possible, patients should be treated in the least restrictive setting.

In other words, more restrictive settings, like hospitals and residential treatment centers, are for those with the most severe symptoms or medical complications. Day Treatment Programs, Partial Hospital, Intensive Outpatient Programs, are more intensive and structured settings if the individual is not progressing in standard outpatient care. For those who are medically stable and able to participate in outpatient treatment, it is in their best interest to do so.

3. Children and adolescents with anorexia or bulimia should be treated with Family-Based Treatment (Maudsley).

Research studies have consistently shown FBT to be the best treatment for children and adolescents with anorexia. An emerging body of evidence is showing similar effectiveness for children and adolescents with bulimia. The beauty of FBT is that not only is it so effective, but it is also time-efficient (once weekly meetings), cost-effective (a fraction of the cost of intensive residential programs), and delivered in a “real-life” setting (home).

4. According to a recent paper in the American Journal of Psychotherapy[ii], there is good evidence to support the use of DBT skills training with adult bulimia and binge eating patients.

The evidence on anorexia is less compelling, but encouraging. There is promising evidence to support the use of DBT with any eating disorder patient who also has Borderline Personality Disorder. According to one study, about 20 percent of eating disorders patients have co-morbid BPD[iii]; given the effectiveness of DBT with BPD, it makes sense that DBT would be effective for this subpopulation.References:[i] Hay P, Chinn D, Forbes D, Madden S, Newton R, Sugenor L, Touyz S, Ward W. Australian & New Zealand Journal of Psychiatry 2014, Vol. 48(11) 977–1008[ii]Wisniewski, L & Ben-Porath, D. D. (2015). Dialectical Behavior Therapy and Eating Disorders: The Use of Contingency Management Procedures to Manage Dialectical Dilemmas. American Journal of Psychotherapy, Vol 69, No. 2, 129-140[iii]Milos, G. F., Spindler, A. M., Buddeberg, C., & Crameri, A. (2003). Axes I and II comorbidity and treatment experiences in eating disorder subjects. Psychotherapy and Psychosomatics, 72, 276-285