Recent advances and future directions in the management of eating disorders

Author/s
Janet Treasure, Hubertus Himmerich, Johanna Louise Keeler, Rebecca Morris
Citation
Focus Issue 6: Eating disorders
CEPiP.2024.1.271-280
Abstract

The aim of this paper is to describe recent and future advances in eating disorder treatment. The development of new treatments represents a pressing issue, given that current treatments, which are predominantly forms of psychotherapy or inpatient treatment (for those at high medical risk), have variable and limited efficacy, with short-term recovery levels between 30% to 50% for the first stage of treatment. If initial treatment efforts fail, there is uncertainty about what strategy should be next considered. Developments in aetiological understanding, through defining biomarkers, working with animal models and neurobiological investigations, have encouraged the consideration of a broader range of treatments. Brain-directed strategies such as neurostimulation, exposure-based learning, psychedelics, metabolically targeted treatments including leptin and incretin receptor agonists, and the therapeutic use of the arts have been recently investigated. New technologies such as virtual reality–based and brain training–based interventions have been found to enhance standard forms of treatment. Unfortunately, the limited funding for eating disorder research has meant that advances into clinical practice have been limited. However, given the size of the problem and its protracted nature, it is important that work to progress and evaluate new treatment pathways, such as that in depression or schizophrenia, is prioritised.

Cite as: Cutting Edge Psychiatry in Practice 2025, 6(1):271-280; https://doi.org/10.65031/jnzn5917

References

  1. Monteleone AM, Pellegrino F, Croatto G, Carfagno M, Hilbert A, Treasure J, et al. Treatment of eating disorders: a systematic meta-review of meta-analyses and network meta-analyses. Neuroscience and Biobehavioral Reviews. 2022;142:104857. https://doi.org/10.1016/j.neubiorev.2022.104857
  2. Hübel C, Abdulkadir M, Herle M, Loos RJ, Breen G, Bulik CM, et al. One size does not fit all. Genomics differentiates among anorexia nervosa, bulimia nervosa, and binge‐eating disorder. International Journal of Eating Disorders. 2021;54(5):785-93. https://doi.org/10.1101/2020.03.24.20042648
  3. Watson HJ, Yilmaz Z, Thornton LM, Hübel C, Coleman JR, Gaspar HA, et al. Genome-wide association study identifies eight risk loci and implicates metabo-psychiatric origins for anorexia nervosa. Nature Genetics. 2019;51(8):1207-14. https://doi.org/10.1530/ey.17.15.18
  4. Walton E, Bernardoni F, Batury V-L, Bahnsen K, Larivière S, Abbate-Daga G, et al. Brain structure in acutely underweight and partially weight-restored individuals with anorexia nervosa: a coordinated analysis by the ENIGMA Eating Disorders Working Group. Biological Psychiatry. 2022;92(9):730-8.           
  5. Keeler JL, Kan C, Treasure J, Himmerich H. Novel treatments for anorexia nervosa: Insights from neuroplasticity research. European Eating Disorders Review. 2023;32(6):1069-84. https://doi.org/10.1002/erv.3039
  6. Schienle A, Schäfer A, Hermann A, Vaitl D. Binge-eating disorder: reward sensitivity and brain activation to images of food. Biological Psychiatry. 2009;65(8):654-61. https://doi.org/10.1016/j.biopsych.2008.09.028
  7. Glashouwer KA, Bloot L, Veenstra EM, Franken IH, de Jong PJ. Heightened sensitivity to punishment and reward in anorexia nervosa. Appetite. 2014;75:97-102. https://doi.org/10.1016/j.appet.2013.12.019
  8. Russell G. Bulimia nervosa: an ominous variant of anorexia nervosa. Psychological Medicine. 1979;9(3):429-48. https://doi.org/10.1017/s0033291700031974
  9. van Eeden AE, van Hoeken D, Hendriksen JM, Hoek HW. Increase in incidence of anorexia nervosa among 10‐to 14‐year‐old girls: a nationwide study in the Netherlands over four decades. International Journal of Eating Disorders. 2023;56(12):2295-303. https://doi.org/10.1002/eat.24064
  10. Trafford AM, Carr MJ, Ashcroft DM, Chew-Graham CA, Cockcroft E, Cybulski L, et al. Temporal trends in eating disorder and self-harm incidence rates among adolescents and young adults in the UK in the 2 years since onset of the COVID-19 pandemic: a population-based study. The Lancet Child an d Adolescent Health. 2023;7(8):544-54. https://doi.org/10.2139/ssrn.4335152
  11. Keeler JL, Konyn CY, Treasure J, Cardi V, Himmerich H, Tchanturia K, et al. "Your mind doesn't have room for anything else": a qualitative study of perceptions of cognitive functioning during and after recovery from anorexia nervosa. Journal of Eating Disorders. 2022;10(1):201. https://doi.org/10.1186/s40337-022-00723-6
  12. Herpertz-Dahlmann B, Dahmen B. Alternatives to Inpatient Treatment of Anorexia Nervosa in Childhood and Adolescence - Day Patient Treatment and Home Treatment. Handbook of Eating Disorders and Obesity. Springer (2024). p. 295-301. https://doi.org/10.1007/978-3-662-67662-2_39
  13. Schmidt U, Treasure J, Allen K. The Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA). Eating Disorders: An International Comprehensive View. Springer (2023). p. 1-15. https://doi.org/10.1007/978-3-030-97416-9_61-1
  14. Schmidt U, Startup H, Treasure J. A Cognitive-Interpersonal Therapy Workbook for Treating Anorexia Nervosa: The Maudsley Model. Routledge (2018). https://doi.org/10.4324/9781315728483
  15. Stedal K, Funderud I, Wierenga CE, Knatz-Peck S, Hill L. Acceptability, feasibility and short-term outcomes of temperament based therapy with support (TBT-S): a novel 5-day treatment for eating disorders. Journal of Eating Disorders. 2023;11(1):156. https://doi.org/10.1186/s40337-023-00878-w
  16. Wonderlich JA, Dodd DR, Sondag C, Jorgensen M, Blumhardt C, Evanson AN, et al. Clinical and scientific review of severe and enduring anorexia nervosa in intensive care settings: introducing an innovative treatment paradigm. Journal of Eating Disorders. 2024;12(1):131. https://doi.org/10.1186/s40337-024-01079-9
  17. Startup H, Franklin-Smith M, Barber W, Gilbert N, Brown Y, Glennon D, et al. The Maudsley Anorexia Nervosa Treatment for Adults (MANTRA): a feasibility case series of an integrated group based approach. Journal of Eating Disorders. 2021;9(1):70. https://doi.org/10.21203/rs.3.rs-231319/v1
  18. Pugh M, Bibby-Jones A-M, Coyle-Stewart A, Hayward M. Relating therapy for distressing voices in the context of anorexia nervosa: a case series. The Journal of Nervous and Mental Disease. 2023;211(10):784-90. https://doi.org/10.1097/nmd.0000000000001690
  19. Cardi V, Ward T, Aya V, Calissano C, Thompson A, Treasure J. A proof-of-concept study for the use of a computerised avatar to embody the eating disorder voice in anorexia nervosa. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity. 2022;27(8):3499-506. https://doi.org/10.1007/s40519-022-01487-3
  20. Thompson A, Calissano C, Treasure J, Ball H, Montague A, Ward T, et al. A case series to test the acceptability, feasibility and preliminary efficacy of AVATAR therapy in anorexia nervosa. Journal of Eating Disorders. 2023;11(1):181 https://doi.org/10.21203/rs.3.rs-2747578/v1
  21. Fey M, Peperkorn N, Borchert T, Meyer ML, Raacke J, Shiban Y. Computer-assisted avatar-based treatment for dysfunctional beliefs and eating-disorder symptomatology: a randomized control pilot study. International Journal of Cognitive Therapy. 2024;17(2):251-78. https://doi.org/10.1007/s41811-023-00186-w
  22. Steinglass JE, Albano AM, Simpson HB, Wang Y, Zou J, Attia E, et al. Confronting fear using exposure and response prevention for anorexia nervosa: a randomized controlled pilot study. International Journal of Eating Disorders. 2014;47(2):174-80. https://doi.org/10.1002/eat.22214
  23. Essayli JH, Forrest LN, Zickgraf HF, Stefano EC, Keller KL, Lane‐Loney SE. The impact of between‐session habituation, within‐session habituation, and weight gain on response to food exposure for adolescents with eating disorders. International Journal of Eating Disorders. 2023;56(3):637-45. https://doi.org/10.1002/eat.23894
  24. Cardi V, Leppanen J, Mataix‐Cols D, Campbell IC, Treasure J. A case series to investigate food‐related fear learning and extinction using in vivo food exposure in anorexia nervosa: a clinical application of the inhibitory learning framework. European Eating Disorders Review. 2019;27(2):173-81. https://doi.org/10.1002/erv.2639
  25. Cardi V, Krug I, Perpiñá C, Mataix‐Cols D, Roncero M, Treasure J. The use of a nonimmersive virtual reality programme in anorexia nervosa: a single case‐report. European Eating Disorders Review. 2012;20(3):240-5. https://doi.org/10.1002/erv.1155
  26. Perpiñá C, Roncero M, Fernández-Aranda F, Jiménez-Murcia S, Forcano L, Sánchez I. Clinical validation of a virtual environment for normalizing eating patterns in eating disorders. Comprehensive Psychiatry. 2013;54(6):680-6. https://doi.org/10.1016/j.comppsych.2013.01.007
  27. Natali L, Meregalli V, Rowlands K, Di Pietro J, Treasure J, Collantoni E, et al. Virtual food exposure with positive mood induction or social support to reduce food anxiety in anorexia nervosa: a feasibility study. International Journal of Eating Disorders. 2024;57(3):703-15. https://doi.org/10.1002/eat.24155
  28. Meschberger-Annweiler F-A, Ascione M, Porras-Garcia B, Ferrer-Garcia M, Moreno-Sanchez M, Miquel-Nabau H, et al. An attentional bias modification task, through virtual reality and eye-tracking technologies, to enhance the treatment of anorexia nervosa. Journal of Clinical Medicine. 2023;12(6):2185. https://doi.org/10.3390/jcm12062185
  29. Porras-Garcia B, Ferrer-Garcia M, Serrano-Troncoso E, Carulla-Roig M, Soto-Usera P, Miquel-Nabau H, et al. AN-VR-BE. A randomized controlled trial for reducing fear of gaining weight and other eating disorder symptoms in anorexia nervosa through virtual reality-based body exposure. Journal of Clinical Medicine. 2021;10(4):682. https://doi.org/10.3390/jcm10040682
  30. Melles H, Duijvis S, Jansen A. Inhibitory learning during exposure treatment in anorexia nervosa: a practical guide. Behavioral Sciences. 2023;13(5):370. https://doi.org/10.3390/bs13050370
  31. Butler RM, Crumby EK, Christian C, Brosof LC, Vanzhula IA, Levinson CA. Facing eating disorder fears: an open trial adapting prolonged exposure to the treatment of eating disorders. Behavior Therapy. 2024;55(2):347-60. https://doi.org/10.1016/j.beth.2023.07.008
  32. Levinson CA, Christian C, Ram SS, Vanzhula I, Brosof LC, Michelson LP, et al. Eating disorder symptoms and core eating disorder fears decrease during online imaginal exposure therapy for eating disorders. Journal of Affective Disorders. 2020;276:585-91. https://doi.org/10.1016/j.jad.2020.07.075
  33. De Carvalho MR, Dias TRdS, Duchesne M, Nardi AE, Appolinario JC. Virtual reality as a promising strategy in the assessment and treatment of bulimia nervosa and binge eating disorder: a systematic review. Behavioral Sciences. 2017;7(3):43. https://doi.org/10.3390/bs7030043
  34. Di Natale AF, Pizzoli SFM, Brizzi G, Di Lernia D, Frisone F, Gaggioli A, et al. Harnessing immersive virtual reality: a comprehensive scoping review of its applications in assessing, understanding, and treating eating disorders. Current Psychiatry Reports. 2024;26(9):470-86. https://doi.org/10.1007/s11920-024-01523-2
  35. Low TL, Ho R, Ho C, Tam W. The efficacy of virtual reality in the treatment of binge‐purging eating disorders: a meta‐analysis. European Eating Disorders Review. 2021;29(1):52-9. https://doi.org/10.1002/erv.2804
  36. Ferrer-Garcia M, Pla-Sanjuanelo J, Dakanalis A, Vilalta-Abella F, Riva G, Fernandez-Aranda F, et al. A randomized trial of virtual reality-based cue exposure second-level therapy and cognitive behavior second-level therapy for bulimia nervosa and binge-eating disorder: outcome at six-month followup. Cyberpsychology, Behavior, and Social Networking. 2019;22(1):60-8. https://doi.org/10.1089/cyber.2017.0675
  37. Gallop L, Flynn M, Campbell I, Schmidt U. Neuromodulation and eating disorders. Current Psychiatry Reports. 2022;24(1):61-9.           
  38. Hall PA, Vincent CM, Burhan AM. Non-invasive brain stimulation for food cravings, consumption, and disorders of eating: a review of methods, findings and controversies. Appetite. 2018;124:78-88. https://doi.org/10.1016/j.appet.2017.03.006
  39. Chmiel J, Stępień-Słodkowska M. Efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of bulimia nervosa (BN): a review and insight into potential mechanisms of action. Journal of Clinical Medicine. 2024;13(18):5364. https://doi.org/10.3390/jcm13185364
  40. Kan RL, Padberg F, Giron CG, Lin TT, Zhang BB, Brunoni AR, et al. Effects of repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex on symptom domains in neuropsychiatric disorders: a systematic review and cross-diagnostic meta-analysis. The Lancet Psychiatry. 2023;10(4):252-9. https://doi.org/10.1016/s2215-0366(23)00026-3
  41. Kim JH, Kaushal S, Khan S, Blum B. Repetitive transcranial magnetic stimulation strategies in the treatment of anorexia nervosa: a literature review. American Journal of Psychiatry Residents' Journal. 2023;18(3):3-7. https://doi.org/10.1176/appi.ajp-rj.2023.180302
  42. Dalton B, Bartholdy S, Robinson L, Solmi M, Ibrahim MA, Breen G, et al. A meta-analysis of cytokine concentrations in eating disorders. Journal of Psychiatric Research. 2018;103:252-64. https://doi.org/10.1016/j.jpsychires.2018.06.002
  43. Dalton B, Foerde K, Bartholdy S, McClelland J, Kekic M, Grycuk L, et al. The effect of repetitive transcranial magnetic stimulation on food choice‐related self‐control in patients with severe, enduring anorexia nervosa. International Journal of Eating Disorders. 2020;53(8):1326-36. https://doi.org/10.1002/eat.23267
  44. Dalton B, Lewis YD, Bartholdy S, Kekic M, McClelland J, Campbell IC, et al. Repetitive transcranial magnetic stimulation treatment in severe, enduring anorexia nervosa: an open longer‐term follow‐up. European Eating Disorders Review. 2020;28(6):773-81. https://doi.org/10.1002/erv.2766
  45. Dalton B, Austin A, Ching BC, Potterton R, McClelland J, Bartholdy S, et al. 'My dad was like "it's your brain, what are you doing?"': Participant experiences of repetitive transcranial magnetic stimulation treatment in severe enduring anorexia nervosa. European Eating Disorders Review. 2022;30(3):237-49. https://doi.org/10.1002/erv.2890
  46. Chmiel J, Kurpas D, Rybakowski F, Leszek J. the effectiveness of transcranial direct current stimulation (tDCS) in binge eating disorder (BED) - review and insight into the mechanisms of action. Nutrients. 2024;16(10):1521. https://doi.org/10.3390/nu16101521
  47. Sauvaget A, Trojak B, Bulteau S, Jimenez-Murcia S, Fernandez-Aranda F, Wolz I, et al. Transcranial direct current stimulation (tDCS) in behavioral and food addiction: a systematic review of efficacy, technical, and methodological issues. Frontiers in Neuroscience. 2015;9:349. https://doi.org/10.3389/fnins.2015.00349
  48. Beaumont JD, Smith NC, Starr D, Davis D, Dalton M, Nowicky A, et al. Modulating eating behavior with transcranial direct current stimulation (tDCS): a systematic literature review on the impact of eating behavior traits. Obesity Reviews. 2022;23(2):e13364. https://doi.org/10.1111/obr.13364
  49. Mostafavi S-A, Khaleghi A, Mohammadi MR, Akhondzadeh S. Is transcranial direct current stimulation an effective modality in reducing food craving? A systematic review and meta-analysis. Nutritional Neuroscience. 2020;23(1):55-67. https://doi.org/10.1080/1028415x.2018.1470371
  50. Schroeder PA, Schwippel T, Wolz I, Svaldi J. Meta-analysis of the effects of transcranial direct current stimulation on inhibitory control. Brain Stimulation. 2020;13(5):1159-67. https://doi.org/10.1016/j.brs.2020.05.006
  51. Gallop L, Westwood SJ, Lewis Y, Campbell IC, Schmidt U. Effects of transcranial direct current stimulation in children and young people with psychiatric disorders: a systematic review. European Child and Adolescent Psychiatry. 2023;33(9):3003-23. https://doi.org/10.1101/2022.03.17.22272541
  52. Potes MI, Joaquin C, Wiecks N, Phan S, Hassan O. The utility of deep brain stimulation surgery for treating eating disorders: a systematic review. Surgical Neurology International. 2021;12:169. https://doi.org/10.25259/sni_730_2020
  53. Shaffer A, Naik A, Bederson M, Arnold PM, Hassaneen W. Efficacy of deep brain stimulation for the treatment of anorexia nervosa: a systematic review and network meta-analysis of patient-level data. Neurosurgical Focus. 2023;54(2):E5. https://doi.org/10.3171/2022.11.focus22616
  54. İnce B, Schlatter J, Max S, Plewnia C, Zipfel S, Giel KE, et al. Can we change binge eating behaviour by interventions addressing food-related impulsivity? A systematic review. Journal of Eating Disorders. 2021;9(1):1-15. https://doi.org/10.1186/s40337-021-00384-x
  55. Chami R, Cardi V, Lawrence N, MacDonald P, Rowlands K, Hodsoll J, et al. Targeting binge eating in bulimia nervosa and binge eating disorder using inhibitory control training and implementation intentions: a feasibility trial. Psychological Medicine. 2022;52(5):874-83. https://doi.org/10.1017/s0033291720002494
  56. Keeler JL, Chami R, Cardi V, Hodsoll J, Bonin E, MacDonald P, et al. App-based food-specific inhibitory control training as an adjunct to treatment as usual in binge-type eating disorders: a feasibility trial. Appetite. 2022;168:105788. https://doi.org/10.1016/j.appet.2021.105515
  57. Giel KE, Schag K, Max SM, Martus P, Zipfel S, Fallgatter AJ, et al. Inhibitory control training enhanced by transcranial direct current stimulation to reduce binge eating episodes: findings from the randomized phase II ACCElect trial. Psychotherapy and Psychosomatics. 2023;92(2):101-12. https://doi.org/10.1159/000529117
  58. Matheson E, Wade TD, Yiend J. Utilising cognitive bias modification to remedy appearance and self-worth biases in eating disorder psychopathology: a systematic review. Journal of Behavior Therapy and Experimental Psychiatry. 2019;65:101482. https://doi.org/10.1016/j.jbtep.2019.101482
  59. Rowlands K, Wilson E, Simic M, Harrison A, Cardi V. A critical review of studies assessing interpretation bias towards social stimuli in people with eating disorders and the development and pilot testing of novel stimuli for a cognitive bias modification training. Frontiers in Psychology. 2020;11:538527. https://doi.org/10.3389/fpsyg.2020.538527
  60. Himmerich H, Lewis YD, Conti C, Mutwalli H, Karwautz A, Sjögren JM, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines update 2023 on the pharmacological treatment of eating disorders. The World Journal of Biological Psychiatry. 2023:1-64. https://doi.org/10.1080/15622975.2023.2179663
  61. Andries A, Frystyk J, Flyvbjerg A, Støving RK. Dronabinol in severe, enduring anorexia nervosa: a randomized controlled trial. International Journal of Eating Disorders. 2014;47(1):18-23. https://doi.org/10.1002/eat.22173
  62. Andries A, Frystyk J, Flyvbjerg A, Støving RK. Changes in IGF-I, urinary free cortisol and adipokines during dronabinol therapy in anorexia nervosa: results from a randomised, controlled trial. Growth Hormone and IGF Research. 2015;25(5):247-52. https://doi.org/10.1016/j.ghir.2015.07.006
  63. Daniel J, Haberman M. Clinical potential of psilocybin as a treatment for mental health conditions. Mental Health Clinician. 2017;7(1):24-8. https://doi.org/10.9740/mhc.2017.01.024
  64. Riva G. Neurobiology of anorexia nervosa: serotonin dysfunctions link self-starvation with body image disturbances through an impaired body memory. Frontiers in Human Neuroscience. 2016;10:600. https://doi.org/10.3389/fnhum.2016.00600
  65. Carhart-Harris R, Nutt D. Serotonin and brain function: a tale of two receptors. Journal of Psychopharmacology. 2017;31(9):1091-120. https://doi.org/10.1177/0269881117725915
  66. Ledwos N, Rodas JD, Husain MI, Feusner JD, Castle DJ. Therapeutic uses of psychedelics for eating disorders and body dysmorphic disorder. Journal of Psychopharmacology. 2023;37(1):3-13. https://doi.org/10.1177/02698811221140009
  67. Carhart-Harris RL, Bolstridge M, Rucker J, Day CM, Erritzoe D, Kaelen M, et al. Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study. The Lancet Psychiatry. 2016;3(7):619-27. https://doi.org/10.1016/s2215-0366(16)30065-7
  68. Goodwin GM, Aaronson ST, Alvarez O, Arden PC, Baker A, Bennett JC, et al. Single-dose psilocybin for a treatment-resistant episode of major depression. New England Journal of Medicine. 2022;387(18):1637-48. 
  69. Goodwin GM, Aaronson ST, Alvarez O, Atli M, Bennett JC, Croal M, et al. Single-dose psilocybin for a treatment-resistant episode of major depression: Impact on patient-reported depression severity, anxiety, function, and quality of life. Journal of Affective Disorders. 2023;327:120-7. https://doi.org/10.1016/j.jad.2023.01.108
  70. Peck SK, Shao S, Gruen T, Yang K, Babakanian A, Trim J, et al. Psilocybin therapy for females with anorexia nervosa: a phase 1, open-label feasibility study. Nature Medicine. 2023;29(8):1947-53. https://doi.org/10.1038/s41591-023-02455-9
  71. Keeler JL, Treasure J, Juruena MF, Kan C, Himmerich H. Ketamine as a treatment for anorexia nervosa: a narrative review. Nutrients. 2021;13(11):4158. https://doi.org/10.3390/nu13114158
  72. Elwyn R, Mitchell J, Kohn MR, Driver C, Hay P, Lagopoulos J, et al. Novel ketamine and zinc treatment for anorexia nervosa and the potential beneficial interactions with the gut microbiome. Neuroscience and Biobehavioral Reviews. 2023:105122. https://doi.org/10.1016/j.neubiorev.2023.105122
  73. Mitchell JS, Hermens DF, Bennett MR, Can AT, Lagopoulos J. Ketamine and zinc: treatment of anorexia nervosa via dual NMDA receptor modulation. CNS Drugs. 2023;37(2):159-80. https://doi.org/10.1007/s40263-022-00984-4
  74. Goodwin-Groen S, Dong Y, Aoki C. Three daily intraperitoneal injections of sub-anesthetic ketamine ameliorate activity-based anorexia vulnerability of adult female mice. International Journal of Eating Disorders. 2024;57(7):1447-64. https://doi.org/10.1002/eat.24036
  75. Mills I, Park G, Manara A, Merriman R. Treatment of compulsive behaviour in eating disorders with intermittent ketamine infusions. QJM. 1998;91(7):493-503. https://doi.org/10.1093/qjmed/91.7.493
  76. Dechant E, Boyle B, Ross RA. Ketamine in a patient with comorbid anorexia and MDD. Journal of Women's Health and Development. 2020;3(3):373-5. https://doi.org/10.26502/fjwhd.2644-28840044
  77. Keeler JL, Treasure J, Himmerich H, Brendle M, Moore C, Robison R. Case report: intramuscular ketamine or intranasal esketamine as a treatment in four patients with major depressive disorder and comorbid anorexia nervosa. Frontiers in Psychiatry. 2023;14:1181447. https://doi.org/10.3389/fpsyt.2023.1181447
  78. Schwartz T, Trunko ME, Feifel D, Lopez E, Peterson D, Frank GKW, et al. A longitudinal case series of IM ketamine for patients with severe and enduring eating disorders and comorbid treatment-resistant depression. Clinical Case Reports. 2021;9(5):e03869. https://doi.org/10.1002/ccr3.3869
  79. Ragnhildstveit A, Jackson LK, Cunningham S, Good L, Tanner Q, Roughan M, et al. Case report: unexpected remission from extreme and enduring bulimia nervosa with repeated ketamine assisted psychotherapy. Frontiers in Psychiatry. 2021;12:764112. https://doi.org/10.3389/fpsyt.2021.764112
  80. Peters T, Antel J, Naaresh R, Laabs B-H, Föcker M, Albers N, et al. Suggestive evidence for causal effect of leptin levels on risk for anorexia nervosa: results of a mendelian randomization study. Frontiers in Genetics. 2021;12:733606. https://doi.org/10.3389/fgene.2021.733606
  81. Exner C, Hebebrand J, Remschmidt H, Wewetzer C, Ziegler A, Herpertz S, et al. Leptin suppresses semi-starvation induced hyperactivity in rats: implications for anorexia nervosa. Molecular Psychiatry. 2000;5(5):476-81. https://doi.org/10.1038/sj.mp.4000771
  82. Milos G, Antel J, Kaufmann L-K, Barth N, Koller A, Tan S, et al. Short-term metreleptin treatment of patients with anorexia nervosa: rapid onset of beneficial cognitive, emotional, and behavioral effects. Translational Psychiatry. 2020;10(1):303. https://doi.org/10.1038/s41398-020-00977-1
  83. Antel J, Tan S, Grabler M, Ludwig C, Lohkemper D, Brandenburg T, et al. Rapid amelioration of anorexia nervosa in a male adolescent during metreleptin treatment including recovery from hypogonadotropic hypogonadism. European Child and Adolescent Psychiatry. 2021:1-7. https://doi.org/10.1007/s00787-021-01778-7
  84. Gradl-Dietsch G, Milos G, Wabitsch M, Bell R, Tschöpe F, Antel J, et al. Rapid emergence of appetite and hunger resulting in weight gain and improvement of eating disorder symptomatology during and after short-term off-label metreleptin treatment of a patient with anorexia nervosa. Obesity Facts. 2023;16(1):99-107. https://doi.org/10.1159/000527386
  85. Dardennes R, Tolle V, Lavoisy G, Grouselle D, Alanbar N, Duriez P, et al. Lower leptin level at discharge in acute anorexia nervosa is associated with early weight‐loss. European Eating Disorders Review. 2021;29(4):634-44. https://doi.org/10.1002/erv.2830
  86. Kim Y, Hersch J, Bodell LP, Schebendach J, Hildebrandt T, Walsh BT, et al. The association between leptin and weight maintenance outcome in anorexia nervosa. International Journal of Eating Disorders. 2021;54(4):527-34. https://doi.org/10.1002/eat.23407
  87. Robert SA, Rohana AG, Shah SA, Chinna K, Mohamud WNW, Kamaruddin NA. Improvement in binge eating in non-diabetic obese individuals after 3 months of treatment with liraglutide - a pilot study. Obesity Research and Clinical Practice. 2015;9(3):301-4. https://doi.org/10.1016/j.orcp.2015.03.005
  88. Richards J, Bang N, Ratliff EL, Paszkowiak MA, Khorgami Z, Khalsa SS, et al. Successful treatment of binge eating disorder with the GLP-1 agonist semaglutide: a retrospective cohort study. Obesity Pillars. 2023;7:100080. https://doi.org/10.1016/j.obpill.2023.100080
  89. Da Porto A, Casarsa V, Colussi G, Catena C, Cavarape A, Sechi L. Dulaglutide reduces binge episodes in type 2 diabetic patients with binge eating disorder: a pilot study. Diabetes and Metabolic Syndrome: Clinical Research and Reviews. 2020;14(4):289-92. https://doi.org/10.1016/j.dsx.2020.03.009
  90. Allison KC, Chao AM, Bruzas MB, McCuen‐Wurst C, Jones E, McAllister C, et al. A pilot randomized controlled trial of liraglutide 3.0 mg for binge eating disorder. Obesity Science and Practice. 2023;9(2):127-36. https://doi.org/10.1002/osp4.619
  91. Richards J, Khalsa SS. Highway to the danger zone? A cautionary account that GLP-1 receptor agonists may be too effective for unmonitored weight loss. Obesity Reviews. 2024;25(5):e13709 https://doi.org/10.31234/osf.io/uxa78
  92. Hemmings A, Sharpe H, Allen K, Bartel H, Campbell IC, Desrivières S, et al. EDIFY (Eating Disorders: Delineating Illness and Recovery Trajectories to Inform Personalised Prevention and Early Intervention in Young People): project outline. BJPsych Bulletin. 2023;47(6):328-36. https://doi.org/10.1192/bjb.2022.83
  93. Krishna Priya A, Applewhite B, Au K, Oyeleye O, Walton E, Norton C, et al. Attitudes surrounding music of patients with anorexia nervosa: a survey-based mixed-methods analysis. Frontiers in Psychiatry. 2021;12:639202. https://doi.org/10.3389/fpsyt.2021.639202
  94. Testa F, Arunachalam S, Heiderscheit A, Himmerich H. A systematic review of scientific studies on the effects of music in people with or at risk for eating disorders. Psychiatria Danubina. 2020;32(3-4):334-45. https://doi.org/10.31219/osf.io/xwv7e
  95. Heiderscheit A. Feasibility of the Bonny Method of Guided Imagery and Music in eating disorder treatment: clients' perceived benefits and challenges. The Arts in Psychotherapy. 2023;86:102086. https://doi.org/10.1016/j.aip.2023.102086
  96. Cardi V, Lounes N, Kan C, Treasure J. Meal support using mobile technology in anorexia nervosa. Contextual differences between inpatient and outpatient settings. Appetite. 2013;60:33-9. https://doi.org/10.1016/j.appet.2012.10.004
  97. Griffin C, Fenner P, Landorf KB, Cotchett M. Effectiveness of art therapy for people with eating disorders: a mixed methods systematic review. The Arts in Psychotherapy. 2021;76:101859. https://doi.org/10.1016/j.aip.2021.101859
  98. Treasure J, Eid L. Eating disorder animal model. Current Opinion in Psychiatry. 2019;32(6):471-7. https://doi.org/10.1097/yco.0000000000000550
  99. Igudesman D, Abbaspour A, Reed KK, Flatt RE, Becken B, Thornton LM, et al. Laxative abuse is associated with a depleted gut microbial community structure among women and men with binge-eating disorder or bulimia nervosa: the binge eating genetics initiative. Psychosomatic Medicine. 2023;85(8):727-35. https://doi.org/10.1097/psy.0000000000001226
  100. Keeler JL, Robinson L, Keeler-Schaeffeler R, Dalton B, Treasure J, Himmerich H. Growth factors in anorexia nervosa: a systematic review and meta-analysis of cross-sectional and longitudinal data. The World Journal of Biological Psychiatry. 2022;23(8):582-600. https://doi.org/10.1080/15622975.2021.2015432
  101. Hellerhoff I, Bernardoni F, Bahnsen K, King JA, Doose A, Pauligk S, et al. Serum neurofilament light concentrations are associated with cortical thinning in anorexia nervosa. Psychological Medicine. 2023;53(15):7053-61. https://doi.org/10.1017/s0033291723000387
  102. Kaufmann L-K, Hänggi J, Jäncke L, Baur V, Piccirelli M, Kollias S, et al. Disrupted longitudinal restoration of brain connectivity during weight normalization in severe anorexia nervosa. Translational Psychiatry. 2023;13(1):136. https://doi.org/10.1038/s41398-023-02428-z
  103. Arold D, Bernardoni F, Geisler D, Doose A, Uen V, Boehm I, et al. Predicting long-term outcome in anorexia nervosa: a machine learning analysis of brain structure at different stages of weight recovery. Psychological Medicine. 2023;53(16):7827-36. https://doi.org/10.1017/s0033291723001861
  104. Brack. KF, Steegers CP, van der Harst T, Dremmen MH, Vernooij MW, White TJ, et al. Can neuroimaging measures differentiate the disease course of anorexia nervosa? A systematic review. Journal of Psychiatric Research. 2023;163:337-49. https://doi.org/10.1016/j.jpsychires.2023.05.059
  105. Tolle V, Tezenas du Montcel C, Mattioni J, Schéle E, Viltart O, Dickson SL. To eat or not to eat: a role for ghrelin and LEAP2 in eating disorders? Neuroscience Applied. 2024;3:104045. https://doi.org/10.1016/j.nsa.2024.104045
  106. Mani BK, Puzziferri N, He Z, Rodriguez JA, Osborne-Lawrence S, Metzger NP, et al. LEAP2 changes with body mass and food intake in humans and mice. The Journal of Clinical Investigation. 2019;129(9):3909-23. https://doi.org/10.1172/jci125332
  107. Tezenas du Montcel C, Duriez P, Cao J, Lebrun N, Ramoz N, Viltart O, et al. The role of dysregulated ghrelin/LEAP-2 balance in anorexia nervosa. iScience. 2023;26(11):107996. https://doi.org/10.1016/j.isci.2023.107996
  108. Conti E, Tremolizzo L, Bomba M, Uccellini O, Rossi MS, Raggi ME, et al. Reduced fasting plasma levels of diazepam-binding inhibitor in adolescents with anorexia nervosa. International Journal of Eating Disorders. 2013;46(6):626-9. https://doi.org/10.1002/eat.22129
  109. Bravo-San Pedro JM, Sica V, Martins I, Pol J, Loos F, Maiuri MC, et al. Acyl-CoA-binding protein is a lipogenic factor that triggers food intake and obesity. Cell Metabolism. 2019;30(4):754-67.e9. https://doi.org/10.1016/j.cmet.2019.07.010
  110. Chen H, Moriceau S, Joseph A, Mailliet F, Li S, Tolle V, et al. Acyl-CoA binding protein for the experimental treatment of anorexia. Science Translational Medicine. 2024;16(760):eadl0715.      
  111. Favier M, Janickova H, Justo D, Kljakic O, Runtz L, Natsheh JY, et al. Cholinergic dysfunction in the dorsal striatum promotes habit formation and maladaptive eating. The Journal of Clinical Investigation. 2020;130(12):6616-30. https://doi.org/10.1172/jci138532
  112. Favier M, Martin Garcia E, Icick R, de Almeida C, Jehl J, Desplanque M, et al. The human VGLUT3-pT8I mutation elicits uneven striatal DA signaling, food or drug maladaptive consumption in male mice. Nature Communications. 2024;15(1):5691. https://doi.org/10.1038/s41467-024-49371-1
  113. Pinhas L, Woodside B, El Mestikawy S, Pietrancosta N, Duriez P, Daumes S, et al. Chronic treatment of AN patients with low doses of donezepil: a case series. (abstract EDRS). 2024.
  114. Touyz S, Le Grange D, Lacey H, Hay P, Smith R, Maguire S, et al. Treating severe and enduring anorexia nervosa: a randomized controlled trial. Psychological Medicine. 2013;43(12):2501-11. https://doi.org/10.1017/s0033291713000949
  115. McDaid D, Treasure J, Fernandez-Aranda F, Herpertz-Dahlmann B, Quoidbach V, Dickson S, et al. Quantifying the economic value of earlier and enhanced management of anorexia nervosa for adults in England, Germany and Spain: improving the care pathway. European Psychiatry. 2024:1-39. https://doi.org/10.1192/j.eurpsy.2024.1751