Established and emerging treatments for eating disorders

Abstract

Eating disorders (EDs) are common mental health conditions that carry exceedingly high morbidity and mortality rates. Evidence-based treatment options include a range of psychotherapies and some, mainly adjunctive, pharmacological interventions. However, around 20-30% of people fail to respond to the best available treatments and develop a persistent treatment-refractory illness. Novel treatments for these disorders are emerging, but their efficacy and clinical relevance need further investigation. In this review article, we first outline the evidence-base for the established treatments of the three 'classical' EDs [anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED)]. We then review research on some of the most promising emerging treatment modalities, discussing the questions and challenges that remain.

Keywords: eating disorders; metreleptin; neuromodulation; psychedelics; treatment; virtual reality.

Figure 1

An illustration of the types of eating disorder (ED) treatments and their novelty. The schematic illustrates the different types of ED treatments that are discussed in the review. The left-hand column refers to established evidence-based psychological therapies, while the right relates to neurobiological and/or technological treatments. Virtual reality therapies are placed in between the two columns to acknowledge that these treatments apply common principles from psychological therapies in a novel technology. The letters in brackets refer to the ED diagnoses that these interventions are recommended/used for, in the case of the established treatments, or are the topic of current research for the emerging treatments. Finally, ‘*’ is used to denote the established treatments that are recommended to be used as adjuncts to psychological therapies, while ‘†’ is used to denote the emerging treatments that have been designed with the intention to assist psychological therapies. This figure was created using (https://biorender.com/). Abbreviations: AN, anorexia nervosa; BED, binge eating disorder; BN, bulimia nervosa.