Since the mid-1980s, I have had the privilege of treating eating disorders and earning recognition as an expert in the field. Over the years, the approach to treatment has evolved significantly, although some important aspects of theory and treatment have either remained consistent or stalled. We have seen advancements in evidence-based treatment modalities beyond Family-Based Therapy (FBT), Cognitive Behavioral Therapy (CBT), and Dialectical Behavior Therapy (DBT). These include Focal Psychodynamic Therapy (FPT) and Acceptance and Commitment Therapy (ACT). However, many of the approaches tend to oversimplify the complexities of eating disorders, often reducing them to fit within manualized protocols, which can hinder a nuanced understanding and more effective treatment.

Family-Based Treatment (FBT), when used in conjunction with Cognitive Behavioral Therapy (CBT), and particularly when not used exclusively for treating anorexia in adolescents, still reports only a 40 to 60 percent remission rate within two years after treatment concludes, with rates diminishing after that period. (Wergeland)
"Restrictive EDs are consistently associated with the poorest prognosis. This review identified recovery rates in the range of 18 to 60 percent for AN and an average length of illness of between 6.5 and 14 years," researchers write. (Montelone)

The mortality rate associated with eating disorders remains alarmingly high, now second only to deaths from fentanyl overdose. A meta-analysis of treatment outcomes published in 2024 revealed that, despite the high lethality linked to eating disorders (approximately 10,200 deaths per year) and a prevalence of 28.8 million Americans affected, improvements in treatment outcomes have been modest, ranging between 18 and 33 percent. Furthermore, for those who fully remit at the end of treatment, up to one-third experience relapse. The stalled outcomes highlight the urgent need for greater investment and exploration to understand etiology, conduct research, and develop treatment protocols and manuals.

Research outcomes vary widely, primarily due to fluctuating assessments of disorder severity, symptoms, and co-morbid conditions, and further underscores the need for consensus to improve treatment consistency and effectiveness (Miskovic-Wheatley)

Treatment increasingly acknowledges and better addresses co-occurring mental health issues, such as anxiety and depression, which can complicate recovery, rather than treating the eating disorder in isolation. However, the nuances of eating disorder diagnoses that precede treatment decisions pose significant challenges for both individuals struggling with these disorders and their clinicians. For instance, treatment options and manuals........

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