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      Developing a protocol to address co‐occurring mental health conditions in the treatment of eating disorders

      1 , 2 , 3 , 4
      International Journal of Eating Disorders
      Wiley

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          Abstract

          Objective

          While co‐occurring mental health conditions are the norm in eating disorders, no testable protocol addresses management of these in psychotherapy.

          Method

          The literature on managing mental health conditions that co‐occur with eating disorders is outlined and reviewed.

          Results

          In the absence of clear evidence to inform managing co‐occurring mental health conditions, we advocate for use of an iterative, session‐by‐session measurement to guide practice and research. We identify three data‐driven treatment approaches (focus solely on the eating disorder; multiple sequential interventions either before or after the eating disorder is addressed; integrated interventions), and the indications for their use. Where a co‐occurring mental health condition/s impede effective treatment of the eating disorder, and an integrated intervention is required, we outline a four‐step protocol for three broad intervention approaches (alternate, modular, transdiagnostic). A research program is suggested to test the usefulness of the protocol.

          Discussion

          Guidelines that provide a starting point to improving outcomes for people with eating disorders that can be evaluated/researched are offered in the current paper. These guidelines require further elaboration with reference to: (1) whether any difference in approach is required where the co‐occurring mental health condition is a comorbid symptom or condition; (2) the place of biological treatments within these guidelines; (3) precise guidelines for selecting among the three broad intervention approaches when adapting care for co‐occurring conditions; (4) optimal approaches to involving consumer input into identifying the most relevant co‐occurring conditions; (5) detailed specification on how to determine which adjuncts to add.

          Public significance

          Most people with an eating disorder also have another diagnosis or an underlying trait (e.g., perfectionism). Currently no clear guidelines exist to guide treatment in this situation, which often results in a drift away from evidence‐based techniques. This paper outlines data‐driven strategies for treating eating disorders and the accompanying comorbid conditions and a research program that can test the usefulness of the different approaches suggested.

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          Author and article information

          Contributors
          Journal
          International Journal of Eating Disorders
          Intl J Eating Disorders
          Wiley
          0276-3478
          1098-108X
          June 06 2023
          Affiliations
          [1 ] Blackbird Initiative, Flinders Institute for Mental Health and Wellbeing Flinders University Bedford Park South Australia Australia
          [2 ] UCL Great Ormond Street Institute of Child Health University College London London UK
          [3 ] Yale School of Medicine New Haven Connecticut USA
          [4 ] Department of Psychiatry Oxford University Oxford UK
          Article
          10.1002/eat.24008
          37278186
          be398b29-8918-4ade-b5ac-3c974e741436
          © 2023

          http://creativecommons.org/licenses/by/4.0/

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