Journal of Clinical Child & Adolescent Psychology

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/hcap20

Evidence Based Update on Psychosocial

Treatments for Eating Disorders in Children and
Adolescents

Nandini Datta, Brittany E. Matheson, Kyra Citron, Eliza Margaret Van Wye &
James D. Lock

To cite this article: Nandini Datta, Brittany E. Matheson, Kyra Citron, Eliza Margaret Van Wye &
James D. Lock (2023) Evidence Based Update on Psychosocial Treatments for Eating Disorders
in Children and Adolescents, Journal of Clinical Child & Adolescent Psychology, 52:2, 159-170,
DOI: 10.1080/15374416.2022.2109650

To link to this article: https://doi.org/10.1080/15374416.2022.2109650

Published online: 11 Aug 2022.

Submit your article to this journal

Article views: 4793

View related articles

View Crossmark data

Citing articles: 3 View citing articles

Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=hcap20
JOURNAL OF CLINICAL CHILD & ADOLESCENT PSYCHOLOGY
2023, VOL. 52, NO. 2, 159–170
https://doi.org/10.1080/15374416.2022.2109650

EVIDENCE BASE UPDATE

Evidence Based Update on Psychosocial Treatments for Eating Disorders in

Children and Adolescents
Nandini Datta, Brittany E. Matheson, Kyra Citron, Eliza Margaret Van Wye, and James D. Lock
Department of Psychiatry and Behavioral Science, Stanford University School of Medicine

ABSTRACT
Eating disorders (EDs) are life-threatening psychiatric illnesses that occur in adolescents.
Unfortunately, limited randomized controlled trials exist to address EDs in this vulnerable popula­
tion. The current review updates a prior Journal of Clinical Child and Adolescent Psychology review
from 2015. The recommendations in this review build upon those that were previously published.
This update was completed through a systematic search of three major scientific databases
(PsychInfo, Pubmed, and Cochrane) from 2015 to 2022 (inclusively) from three databases, employ­
ing relevant medial subject headings. Additionally, expert colleagues were asked for additional
literature to include. Thirty-one new studies were added to this review. Psychosocial treatments
included family therapies, individual therapy, cognitive-behavioral therapy, interpersonal psy­
chotherapy, cognitive training, dialectical behavioral therapy, and more recently, virtual or tele­
health-based practices and guided self-help modalities for carers of youth with EDs. Using the
Journal of Clinical Child and Adolescent Psychology’s methodological review criteria, this update
found behavioral family-based treatment modalities (FBT) for both adolescent anorexia nervosa
and bulimia nervosa met well-established treatment criteria. To date, there were no well-
established treatments found for child and adolescent avoidant-restrictive food intake disorder,
or binge eating disorder. Internet facilitated cognitive-behavioral therapy and family-based therapy
were found to be possibly efficacious for binge eating disorder. Family-based treatment was found
to be possibly efficacious for avoidant restrictive food intake disorder, with other clinical trials for
cognitive treatment modalities under way. Ongoing research examining treatments for eating
disorders in children and adolescents broadly is needed.

Introduction
Eating disorders are life-threatening psychological ill­
nesses that onset most frequently during adolescence.
The lifetime prevalence of anorexia nervosa (AN) is
approximately .48–1.7% in adolescent females (Hoek &
van Hoeken, 2003; Lucas et al., 1991; Pinhas et al., 2011;
Smink et al., 2014; Van Son et al., 2006), and the pre­
valence of bulimia nervosa (BN) is approximately 1–2%
in females (Ahs et al., 2006; Fairburn & Beglin, 1990).
The data reporting prevalence rates of AN in males is
limited, but BN rates are approximately .5% in male
youth (Carlat et al., 1997). The estimated female-to-
male ratio of ED diagnoses is 10:1 (Lock, 2009).
Notably, there are a significant number of subthreshold
cases of eating disorders amongst adolescents, demon­
strating ED behaviors, and psychopathology comparable
to those with DSM-5 diagnoses. Rates of binge eating
disorder in youth are approximately 2.3% in females and
2.6% in males (Swanson et al., 2011). The most recently
incorporated ED diagnosis, Avoidant Restrictive Food
Intake Disorder (ARFID), more frequently onsets in
early childhood and has higher prevalence rates of
approximately 7.2–17.4%. Sex-specific prevalence rates
have not yet been determined given the relative newness
of the diagnosis (Wons Thomas et al., 2018). Altogether,
comorbid diagnoses are frequent in adolescents with
EDs, with 50% of adolescents reporting a comorbid
affective disorder and 35% reporting a comorbid anxiety
disorder (Godart et al., 2002; Holtkamp et al., 2005).
The health consequences of eating disorders can be
severe and result in medical stabilization hospitalization.
The aggregate mortality rate per decade in EDs has been
found to be an alarming 5.6% (Arcelus et al., 2011;
Franko et al., 2013). The medical instability seen within
the context of an eating disorder involves the physiolo­
gical impacts of behaviors that maintain EDs (including,
but not limited to, restrictive or selective eating, over-
exercise, and/or purging) and can result in bradycardia,
hypotension, and orthostatic hypotension (Modan-
Moses et al., 2003; Olmos et al., 2010). In AN, cardiac

CONTACT Nandini Datta nandinid@stanford.edu Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, 401 Quarry
Rd, Stanford CA 94305-5719
© 2022 Society of Clinical Child and Adolescent Psychology, Division 53, American Psychological Association. All Rights Reserved
160 N. DATTA ET AL.
arrest accounts for mortality in 50% of cases of EDs,
while suicidality accounts for the other 50%
(Birmingham et al., 2005). Mortality rates for the other
ED categories are less studied, although some research
suggests BN and AN have similar mortality rates (Crow
et al., 2009).
EDs can be marked by other significant medical pro­
blems that arise during a crucial period of adolescent
development. These problems include growth retarda­
tion, pubertal delay or interruption, peak bone mass
reduction, and psychosocial interference. Taken
together, both the medical and psychological impact of
these illnesses highlight the importance of early inter­
vention to disrupt the course of illness and optimize
recovery rates (Treasure & Russell, 2011).
The current review consists of studies completed after
the prior review by Lock (2015), which was an update to
the original review by Keel and Haedt (2008). This
review follows the guidelines in Lock (2015), focusing
exclusively on outpatient psychosocial evidence-based
practices for children and adolescents (younger than
19 years of age) with EDs, and does not consider adult
psychosocial or hospital-based intervention studies.
Methods
The updates in this review are informed by a literature
search across PsycInfo, Cochrane, and PubMed. For
PsycInfo, we employed the relevant medical subject
headings (MeSH terms) “eating disorders,” adding lim­
itations including age (6–12 years) and adolescent (13–
18 years); “clinical trial,” and a period from 2015 to
2022 inclusive (this yielded 76 citations before elimina­
tion, with zero duplicates identified). For Cochrane, the
same qualifiers and limitations were used, yielding 108
citations before elimination. Six duplicates were iden­
tified. Lastly, for PubMed, using the aforementioned
qualifiers and limitations, 214 citations were accrued
before elimination. Thirty-seven duplicates were iden­
tified. Across search engines, delimiters, and filters
(such as English language only, human subjects, and
randomized clinical trial) helped narrow the results,
along with the use of Boolean operators (AND, OR,
and NOT) to include the following: family therapy,
psychopharmacology, comorbid, treatment outcome.
In total, 347 articles were eliminated due to being
classified as adult studies, single-case reports, inpatient
samples, protocol papers, and anything else deemed
irrelevant to the scope of this review (e.g., an article
about seizures). The search was done by two indepen­
dent reviews for each search engine, and two meetings
were held to review and consolidate the total list of
articles. This extra step was taken to ensure that, to the
best of our knowledge, all relevant articles were cap­
tured and included in this update.
Expert colleagues were consulted to identify any addi­
tional studies that may have been missed within this
search, which yielded 10 additional articles. For this
evidence-based update, two authors systematically
reviewed 83 publications for possible inclusion in this
manuscript. Of these, 31 articles were deemed to fit the
previously described criteria and are included below in
Table 1.
For this manuscript, remission is defined as >95%
EBW with EDE global scores within one SD of published
norms, which is 1.73 (Couturier & Lock, 2006). We have
highlighted whether studies included in this manuscript
used different remission criteria.
Summary of Empirically Supported Psychosocial
Interventions
There are 31 additional empirically supported psycho­
social interventions for eating disorders published in the
last seven years that we identified through the aforemen­
tioned literature search (Table 1). A review of these
studies is broken down below by disorder subtype.
Anorexia Nervosa
Of these 31 total studies, nine covered review of rando­
mized clinical trials (RCTs) for adolescent AN, spanning
641 adolescents aged 12–20 years (Le Grange et al., 2016;
Herbrich et al., 2017; Herscovici et al., 2017; Hodsoll
et al., 2017; Jaite et al., 2020; Lock et al., 2021, 2015;
Timko et al., 2015). An additional 162 adolescents with
AN or atypical AN were included in six case series
(Accurso et al., 2018; Dalle Grave et al., 2019; Hurst &
Zimmer-Gembeck, 2019; Peterson et al., 2020; Timko
et al., 2015; Wade et al., 2022). Two studies examined
eating disorders more broadly within the same study,
using samples of adolescents with AN or an unspecified
eating disorder diagnosis (Eisler et al., 2016) and another
case series inclusive of AN, Atypical AN, or OSFED
(Peterson et al., 2020). Of note, Eisler et al. (2016) used
lower weight-related thresholds in their sample (>85%
EBW vs. >95% EBW) to categorize “good outcomes.”
Additionally, one quasi-randomization structure inter­
vention study for parents/carers of 102 adolescents aged
10–19 years old with AN was identified (Philipp et al.,
2021). According to the previous review, there were 12
completed RCTs of 1,060 adolescents with AN aged 12–
20. For this update, we add nine additional RCTs to this
number, which are reviewed in additional detail in this
manuscript.
Table 1. Outpatient psychosocial treatment studies for child and adolescent eating disorders.
Authors ED Type Sample Treatments Trial Type Results
Accurso et al. AN N = 11 adolescents FBT+DBT skills Case series Improvements in weight (large effect size for %mBMI change) and parent-
(2018) 11–18 years reported eating disorder symptoms but not adolescent-reported; 2
participants met remission criteria at EOT.
Craig et al. (2019) AN, atypical AN, N = 54 adolescents CBT-ED Case series Improvements in ED cognitions (EDE-Q; large effect size) and clinical impairment
BN, atypical BN 13–18 years levels (moderate effect size) at EOT; AN/atypical AN adolescents had
significant increases in %EBW.
Dalle Grave et al. BN, BED, or other N = 68 adolescents CBT-E Case series Reduced eating disorder psychopathology (EDE-Q; large effect size); decreased
(2015) specified ED 13–19 years binge eating and purging frequency; two-thirds of sample had EDE-Q scores
below 1SD of community norms by EOT.
Dalle Grave et al. AN N = 49 adolescents CBT-E Case series Improvements in weight gain (83% IBW to 100.6% at EOT and 100.4% at FU) and
(2019) 11–18 years decreased clinical impairment and ED cognitions at EOT and maintained at
20-week follow-up.
Eisler et al. (2016) AN or EDNOS N = 169 FT-AN or MFT-AN RCT 60% in FT-AN vs 75% in MFT-AN achieved good-intermediate outcomes (weight,
adolescents 13– mood, ED psychopathology†.
20 years
Fischer and BED, EDNOS N = 10 adolescents DBT Case series Reduction in binge eating episodes, purging, and disordered eating cognitions
Peterson 14–17 years (moderate effect sizes) at EOT.
(2015)
Glashouwer et al. AN, BN, EDNOS N = 51 females 12– Evaluative conditioning or placebo control Crossover design No differences between groups in primary outcome measures of self-reported
(2018) 18 years body satisfaction, weight/shape concern, and self-esteem. Findings do not
support the use of evaluative conditioning as an intervention for adolescents
with EDs.
Herbrich et al. AN N = 48 adolescents CRT or TAU RCT CRT (10 weekly sessions) had a higher completion rate of 79.2% vs. 58.3% in TAU
(2017) 12–17.11 years (10 weekly sessions). BMI showed a trend toward significance for CRT. No
other differences in clinical or neuropsycho-logical variables.
Herscovici et al. AN N = 23 adolescents Outpatient Family Therapy with and without Exploratory Both groups improved significantly at EOT and 6-month FU on weight,
(2017) 12–20 years Family Meal longitudinal psychological (SCL90) and ED symptoms (EDI-2), with no difference between
investigation – groups. The family meal did not appear to have any weight-related benefit.
only one therapist Full weight remission was defined as >95% EBW, and partial was >85%.
Hilbert et al. BED N = 73 females 12– CBT or waitlist (WL) RCT Fewer monthly binge episodes in CBT versus WL; CBT received higher rates of
(2020) 20 years abstinence from binge eating (51% vs. 33%) and remission from BED (57% vs
33%), and lower ED psychopathology.
Hodsoll et al. AN N = 149 TAU vs. TAU+ career intervention (ECHO) with RCT ECHO groups showed moderate increase in carer skills and reduction in
(2017) adolescents 12– telephone guidance or without telephone accommodating and enabling behavior. Patients had minor improvement in
21 years guidance (3 conditions) BMI in ECHO groups vs. not. Little additional benefit in telephone guidance
with ECHO vs. not.
Hurst and AN N = 21 adolescents FBT+CBT-P (CBT module on perfectionism) Case series Full remission at EOT in 11 of the 21 participants; Increases in weight and
Zimmer- 12–17 years decreases in ED symptoms and perfectionism scores; Improvements in
Gembeck perfectionism correlated with improvements in eating disorder symptoms.
(2019)
Jaite et al. (2020) AN N = 50 females 12– CBT or DBT RCT ED symptoms (EDI-2) decreased, and BMI increased significantly from BL to EOT
18 years in both treatments (CBT: EDI-2 d = -0.61, BMI d = 1.04; DBT: EDI-2 d = -0.55,
BMI d = 0.7). No differences between treatments.
Kamody et al. Subthreshold BED N = 15 adolescents DBT skills group Case series Reduction in binge eating and emotional eating; Three of the six participants
(2019) 14–18 years that met criteria for BED at BL did not by EOT.
Le Grange et al. BN N = 130 FBT-BN or CBT-A RCT FBT-BN achieved higher abstinence rates (no binging and purging for 4 weeks
JOURNAL OF CLINICAL CHILD & ADOLESCENT PSYCHOLOGY

(2015) adolescents 12– prior to EDE assessment) than CBT-A at EOT (39 vs 20%, p = .04) and 6-month
18 years FU (44 vs 25% p = .03). No difference at 12-month FU.
(Continued)
161
 162

Table 1. (Continued).
Authors ED Type Sample Treatments Trial Type Results
Le Grange et al. AN N = 107 FBT or PFT RCT Remission higher in PFT than FBT (43% vs. 22%, p = .016) at the six month time-
(2016) adolescents 12– point defined in this study as EOT, but not at 6-month FU (12 month time
18 years point – the comparative EOT in most other FBT-AN studies; 39 vs. 22%,
p = .05) or 12-month FU (37 vs. 29%, p = .44)
Le Grange et al. AN, BN, BED, N = 97 adolescents FBT or CBT-E Case series No difference in ED cognitions between groups at any time; faster weight gain
(2020) Unspecified 12–19 years achieved in FBT compared to CBT at EOT only.
N. DATTA ET AL.

Eating Disorder
Lock et al. (2015) AN N = 45 adolescents FBT or FBT + IPC RCT Poor early responders (<2.4 kg by session 4) who received IPC achieved full
12–18 years weight restoration (>95% of expected mean BMI) by EOT at similar rates as
those who had responded early.
Lock et al. (2018) AN + obsessive- N = 30 adolescents FBT+CRT (Cognitive Remediation Therapy) or FBT RCT Both treatments rated acceptable; Both groups demonstrated correlational
compulsive 12–18 years +AT (Art Therapy) changes in obsessive-compulsive traits and cognitive inefficiency; Greater
features change in cognitive inefficiencies in FBT+AT group; No difference in clinical
outcomes between groups.
Lock et al. (2019) ARFID N = 28 children 5– FBT-ARFID or Usual Care (UC) RCT FBT-ARFID had greater change %EBW and weight from BL to EOT compared to
12 years UC (large effect size) as well as parental self-efficacy.
Lock et al. (2021) AN N = 40 adolescents GSH-FBT or FBT-V RCT Both treatments resulted in improvements in weight, EDE, parental self-efficacy
12–18 years (medium to large ES); Comparable acceptability ratings.
Mazzeo et al. LOC-Eating N = 45 adolescent DBT-based intervention or weight management RCT No difference between groups; Reductio-ns in eating disorder cognitions, dietary
(2016) Disorder or BED females 13– groups restraint, and eating due to negative affect reported across both groups.
17 years
Peterson et al. AN, Atypical AN, N = 18 adolescents FBT + DBT skills Case series Small to medium effect sizes for decrease in binge eating and eating disorder
(2020) OSFED 13–18 years cognitions and increase in %EBW from BL To EOT.
Philipp et al. AN N = 102 caregivers Supporting Carers of Children and Adolescents Quasi-randomization No overall difference between groups at EOT; There were similar improvements
(2021) of adolescents with Eating Disorders in Austria (SUCCEAT) – (allocated to in BMI, psychopathology, and quality of life for youth with AN across both
10–19 years comparing workshop group to online group groups groups. At 12-month f/up, higher rates of remission in online group (48.4%)
with AN alternatively) compared to workshop group (28.1%) but not statistically significant.
Salerno et al. AN N = 149 dyads ECHO (Experienced Carer Helping Others) or RCT BL distress predicted post-treatment distress, regardless of group; In TAU
(2016) parent- Treatment as Usual condition, patient distress at BL related to carer distress at 12-month FU; Carer
adolescent with distress did not predict patient weight change in either condition.
AN
Spettigue et al. EDNOS, AN, BN N = 51 parents/ Intervention (2-hour initial psychoeducation RCT Intervention group reported higher parental self-efficacy on Parents Versus
(2015) carers and 36 session with bi-weekly phone calls until Anorexia Scale (PVAN) after psychoeducation session and at assessment, and
adolescents assessment) or control (no intervention) greater knowledge of eating disorders at assessment than control group; No
awaiting ED difference in patient outcomes (depression, anxiety, eating disorder
assessment cognitions/behaviors, BMI).
Stefini et al. BN or partial BN N = 81 adolescents CBT or psychodynamic therapy (PDT) RCT Remission rates did not differ between groups; Improvements for secondary
(2017) 14–20 years outcome measures in both groups; Small effect size between group
differences on purging and binge eating which favored CBT and eating
concern which favored PDT.
J. J. Thomas et al. ARFID N = 20 youth 10– CBT (CBT-ARFID) Case series PARDI (Pica, ARFID, Rumination Disorder Interview) scores improved; Added 16.7
(2020) 17 years new foods; Average weight gain of 11.5 pounds for underweight subgroup;
70% participants did not meet ARFID criteria at post-treatment.
Timko et al. AN or subthreshold N = 47 adolescent Acceptance-based Separated Family Treatment Case series Almost half (48%) of sample met criteria for full remission (95% EBW and EDE
(2015) AN 12–18 years (ASFT) scores within 1SD of population norms) at EOT with another third meeting
partial remission criteria (90% EBW).
Wade et al. (2022) AN or atypical AN N = 16 parents of Guided self help family based treatment (GSH- Case series Low uptake (7% of eligible families completed protocol); Improvements in
adolescent 13– FBT) weight, reduced eating disorder behaviors, improvements in mood, and
15 years on increases in parental knowledge, skills, and confidence.
waitlist for FBT
†
For Eisler et al. (2016), “good outcomes” were defined as patients whose weight was >85% EBW. Of note, this is lower than remission used in the majority of the studies included in this manuscript (Couturier & Lock, 2006).

Table 2. Evidence-based psychosocial interventions for eating disorders in adolescents.
AN
Level 1. Well- Family-based treatment
Established
Treatments
Level 2. Probably Family Therapy-Systemic; Insight Oriented-
Efficacious Psychotherapy (individual); Adolescent-Focused
Treatments Therapy (individual), Parent-Focused therapy
Level 3. Possibly GSH, Telephone assisted therapy (Experienced Carer
Efficacious Helping Others, or ECHO); Family-based treatment
Treatments +Cognitive Remediation Training and Family-based
treatment +Art Therapy
Level 4. Cognitive Behavioral Therapy-Broad (Individual);
Experimental Cognitive Remediation Training (individual), Family-
Treatments based treatment-Intensive Parental Coaching; DBT
skills group; Family-based treatment + Dialectical
Behavioral Therapy Skills; Family-based treatment-
Guided Self-Help for waitlist
Level 5. Outpatient Family Therapy with/without Family Meal Guided Self-Help-Waitlist
Treatments of
Questionable
Efficacy
No new studies met criteria as a Level 1 (well-
established) treatment (Table 2). Currently, the gold-
standard treatment for adolescent anorexia nervosa
remains family therapy with a behavioral focus, typically
referred to as family-based treatment (FBT); (Lock & Le
Grange, 2015). Several of the studies included in this
review, however, made adjustments to FBT (such as
delivery with and without a family meal); (Herscovici
et al., 2017), or assessed a parent-only format of FBT
(Hodsoll et al., 2017; Salerno et al., 2016) or a guided
self-help version (Lock et al., 2021). To that end,
a parent-focused treatment (PFT) demonstrated higher
remission rates compared to FBT at EOT at six months,
but not at 12-and 18-month follow-up time points; thus,
the outcome in this study used a different assessment
time point than others (which used nine or 12 months),
and comparisons to EOT outcomes in other studies need
to take this into account. This study fell under a Level 2
(probably efficacious) category (Le Grange et al., 2016).
The adaptations of PFT to FBT included having adoles­
cents attend a 15-min session with a nurse to discuss
weight and medical stability, and to receive brief sup­
portive counseling, before their parents’ session with the
therapist. Results provide preliminary support for the
efficacy of a separated model of FBT as an alternative
therapeutic platform for rapid weight restoration in
adolescent AN.
Guided-self-help therapies and telephone-based
treatments fell within the Level 3 (possibly efficacious)
categories (Hodsoll et al., 2017; Lock et al., 2021), with
both emphasizing treatment delivery/guidance/coaching
to caregivers of patients with AN rather than to patients
directly. Level 3 (possibly efficacious) treatments also
include adjunctive treatments to FBT, such as adding
JOURNAL OF CLINICAL CHILD & ADOLESCENT PSYCHOLOGY 163
BN BED ARFID
Family-based treatment – None None
Bulimia Nervosa
None None
Cognitive Behavioral Internet Facilitated Cognitive Family-based
Therapy (Guided Self- Behavior Therapy (Self Help); treatment
Help) (Individual) CBT; FBT
Cognitive Behavioral Interpersonal Psychotherapy Cognitive
Therapy – (Individual); (Individual); Dialectical Behavioral
Supportive Psychotherapy Behavior Therapy (Individual Therapy
(Individual) and Family)
Cognitive Remediation Training (CRT) or Art Therapy
(AT) to FBT for adolescents with AN and obsessive-
compulsive features (Lock et al., 2018).
Level 4 experimental treatments in this update included
studies of Cognitive Remediation Training (CRT) and
a feasibility study assessing the efficacy of adding intensive
parent coaching to standard FBT (Herbrich et al., 2017).
Case series studies investigating CBT-E (Dalle Grave et al.,
2019), Acceptance-based Separated Family Therapy
(ASFT); (Timko et al., 2015) and GSH-FBT for carers/
parents on a waitlist for FBT (Wade et al., 2022) fall within
the Level 4 (experimental treatment) category due to the
non-randomized study design. Additional adaptations to
FBT for adolescent AN (e.g., combining modules and skills
from CBT and DBT) are classified as level 4 (experimental
treatment) due to limited case series data available at this
time (Accurso et al., 2018; Hurst & Zimmer-Gembeck,
2019; Peterson et al., 2020). One study of 21 adolescents
that added a CBT-based perfectionism module to FBT
(Hurst & Zimmer-Gembeck, 2019) reported correlations
between improvements in perfectionism and improve­
ments in eating disorder symptoms, but the limited case
series data classifies this FBT treatment adaptation as Level
4 (experimental treatment). Similarly, large effect sizes
for percent median BMI change from BL to EOT were
reported in a study adding DBT skills to FBT among 11
adolescents with AN (Accurso et al., 2018); although par­
ent-reported eating disorder symptoms improved, adoles­
cent-report of their symptoms did not. Further, only two
participants met remission criteria at EOT (Accurso et al.,
2018).
Lastly, one exploratory longitudinal study (one thera­
pist across both arms) assessed family therapy con­
ducted with and without a family meal; the limitations
164 N. DATTA ET AL.
of this exploratory study design make it a Level 5 (treat­
ment of questionable efficacy) category (Herscovici
et al., 2017).
Bulimia Nervosa
At the time of the previously published reviews (Keel &
Haedt, 2008; Lock, 2015) only two published RCTs
involving 165 adolescent participants existed. These stu­
dies examined FBT for BN, a guided self-help version of
CBT, and individual supportive therapy (Le Grange
et al., 2007; Schmidt et al., 2007). Since the earlier review,
only two additional RCTs were conducted examining
psychosocial interventions for BN, spanning an addi­
tional 211 adolescents aged 12–20. These studies exam­
ined FBT-BN or CBT-A, finding FBT-BN superior in
achieving remission rates (Level 1, well established); (Le
Grange et al., 2015) and CBT or psychodynamic therapy
(PDT), finding no significant differences between the
two groups on remission rates (Level 3, possibly effica­
cious); (Stefini et al., 2017). This second RCT on FBT-
BN by Le Grange and colleagues in 2015 found it super­
ior to comparative treatments, thus making FBT-BN
a Level 1 treatment, which is an improvement from its
categorization in the prior review. This makes FBT the
only Level 1 RCT for BN adolescents to our knowledge.
Compared to adult literature, relatively little is known
about treatments for BN in adolescents.
Binge Eating Disorder
RCTs for adult BED have gained considerable attention,
finding CBT and IPT useful (Wilson et al., 2010), and
showing preliminary support for DBT (Safer et al.,
2010). In adolescents with BED, the prior review reports
the use of IPT having preliminary success along with
internet-delivery of CBT self-help (Jones et al., 2008;
Tanofsky-Kraff et al., 2010). The current review adds
two RCTs to this relatively small pool of trials, spanning
an additional 118 youth with BED aged 12–20. Hilbert
et al. (2020) found CBT for adolescent BN superior to
a waitlist comparison group; this study classifies as
a Level 3 (possibly efficacious treatment). Mazzeo et al.
(2016) found both DBT-based intervention and a weight
management intervention for adolescents with LOC-ED
or BED reduced disordered eating cognitions, suggest­
ing these treatments may be possibly efficacious
(Level 3). However, the outcomes regarding reduction
in binge eating episodes for either treatment group were
not reported (Mazzeo et al., 2016); thus, it is hard to
determine what level of efficacy these interventions
might have for binge eating episodes specifically. Two
case series using DBT for BED or subthreshold BED
were identified (Fischer & Peterson, 2015; Kamody
et al., 2019), both Level 4 (experimental treatments);
these studies jointly noted reductions in binge eating
episodes by EOT. Fischer and Peterson (2015) reported
moderate effect size estimates for reductions in disor­
dered eating cognitions, and Kamody et al. (2019)
observed decreases in self-reported emotional eating.
Among the six participants that met full criteria for
BED at BL, three no longer met criteria following the
DBT skills group intervention at EOT (Kamody et al.,
2019). However, these data obtained from small samples
limit generalizability, and larger scale randomized con­
trolled trials are needed to better evaluate the role of
DBT in adolescent BED.
Avoidant Restrictive Food Intake Disorder
Research on treatments for youth with ARFID is in its
infancy. Very few studies have examined psychosocial
treatments for ARFID in children and adolescents. Only
one ARFID RCT (Lock et al., 2019) fell at a Level 3
(Possibly Efficacious). There was also one case series
(J. J. Thomas et al., 2020) that fell within a Level 4
(Experimental Treatments). In total, both these preli­
minary studies encompassed 48 youth aged 5–17 years
old. No ARFID studies were identified in the prior
review (Lock, 2015). Although outcome data from ran­
domized clinical trials are limited, published treatment
manuals are available for both CBT-ARFID (Thomas &
Eddy, 2019) and FBT-ARFID (Lock, 2022).
Transdiagnostic
Three case series studies investigating CBT-E included
participants with eating disorders or sub-threshold eat­
ing disorder symptoms across diagnostic categories
(Craig et al., 2019; Dalle Grave et al., 2015; Le Grange
et al., 2020). Although these studies include a substantial
number of youths with a range of reported eating dis­
order diagnoses and symptoms (n = 219), these studies
all fall under Level 4 (experimental treatment), as they
have not been tested in an RCT. Further, one study
allowed adolescents/families to choose which treatment
option they would prefer (FBT or CBT-E), which could
impact intervention outcomes and findings (Le Grange
et al., 2020). Although no differences were observed in
ED cognitions between the groups at any time point, by
EOT only, participants in FBT gained weight at a faster
rate than participants in CBT (Le Grange et al., 2020).
Further, the authors found that older patients and those
with greater eating disorder symptom severity chose
CBT-E more often than FBT, suggesting these factors
could be important moderators to consider in clinical

settings where patients are requesting specific treatment
modalities. Another study using a crossover design ran­
domized adolescent females with AN, BN, and an
unspecified eating disorder diagnosis to a placebo-
control or an experimental condition using a computer-
based evaluative conditioning intervention. There were
no differences between outcome measures of body dis­
satisfaction, shape/weight concern, or self-esteem
between conditions at the end of treatment and at 3-
and 11-week follow-up time points (Glashouwer et al.,
2018).
We also identified a study for parents/carers of
patients waiting to be assessed for an eating disorder
(Spettigue et al., 2015). In this RCT, authors compared
a two-hour initial psychoeducation session plus bi-
weekly phone calls until assessment compared to
a control (no intervention) condition and found that
the intervention group reported higher parental self-
efficacy and greater knowledge of eating disorders than
the control group, although no differences in patient
outcomes, such as depression, anxiety, BMI, and eating
disorder cognitions, were observed. Because of high wait
times, studies of interventions to assist parents and
children are an important future research area.
Highlighted New Studies [Since 2015]
Several studies included in the current review encompass
feasibility studies, setting the stage for larger, adequately
powered treatment studies. For instance, the ARFID pilot
done by Lock et al. (2019) demonstrated a greater change in
%EBW for the FBT cohort from BL to EOT relative to the
UC; this difference was accompanied by a large effect size.
Informed by these novel findings, a larger RCT is currently
underway. Additionally, given ARFID’s nascent introduc­
tion to the DSM-5, a case series investigating treatment
efficacy by J. J. Thomas et al. (2020) found CBT for
ARFID useful – specifically, symptom improvement and
weight gain. They report that 70% of participants did not
meet ARFID criteria at a post-treatment time point.
A feasibility study demonstrating acceptability and identi­
fying potential mechanisms would be a logical next step to
see if this approach warrants further study using a fully
powered RCT.
In the context of the COVID-19 pandemic, there were
several treatment efforts pivoting care to virtual delivery.
This has been both a necessary and innovative way to
meet the needs of ED patients during a time of crisis, and
has led to several trials adapting known, evidence-based
treatments (such as FBT and CBT) to various virtual
modalities (virtual delivery versus a guided self-help
modality). The benefits of telehealth modalities include
ease of access and decreased burden related to travel for
JOURNAL OF CLINICAL CHILD & ADOLESCENT PSYCHOLOGY 165
carers or parents (Hodsoll et al., 2017; Lock et al., 2021).
Initial data is promising, revealing that the use of tele­
conferencing is feasible and that its treatment effects
appear similar to in-person intervention.
Moderators and Mediators of Treatment Effect
for Level 1 and 2 Studies
Few additional studies have added to a systematic eva­
luation of moderators and mediators of treatment effects
for eating disorders in youth. Some previous studies
have explored the role of expressed emotion (parental
criticism) on treatment outcomes in FBT for AN
(Rienecke, 2017; Rienecke et al., 2021); however, high
parental expressed emotion at baseline did not predict
negative outcomes four years later. A secondary data
analysis found that driven exercise at BL predicts
worse outcomes (greater ED severity) for adolescents
with AN but not adolescents with BN at EOT (Eisler
et al., 2000; Stiles-Shields et al., 2015), but this was
a nonspecific predictor not associated with treatment
type.
In a separate investigation of mediators, parental self-
efficacy was examined as a potential mechanism for
change, particularly early response (or weight gain of
at least 2.4 kg within the first four sessions) in FBT for
AN (White et al., 2017). Here, direct and non-direct
parent eating prompts during family meal sessions in
FBT for AN resulted in more weight gain at EOT,
though this was not associated with disordered eating
severity in the adolescent. Understanding mechanisms is
an important area for continued research but is ham­
pered by few RCTs with sufficient numbers to allow for
mediator assessment (Kraemer et al., 2002).
Emerging Treatments
As cited in the prior review by Lock (2015), recovery
amongst adolescent eating disorders remains 30–40%
despite the rise in RCTs and efforts to identify effective
interventions. This highlights the ongoing need to both
optimize existing treatments as well as identify novel
treatments targeting EDs. One promising transdiagnostic
approach includes guided self-help modalities. Such
modalities are not only useful for carers, but they also
minimize therapist time and streamline the delivery of
salient treatment materials. Lock et al. (2021) provided
preliminary data (included in this review) demonstrating
that a guided self-help modality of FBT (including 20–30
min guided self-help sessions with parents or carers) had
comparable outcomes (improvements in weight, cogni­
tions, and parental self-efficacy) to FBT delivered vir­
tually (FBT-V). A follow-up mixed methods study
166 N. DATTA ET AL.

looking at parent and clinician perspectives within this Limitations

RCT found that parents reported improvement in their
child’s AN symptoms regardless of treatment condition,
while clinicians reported lower competency and comfort
metrics within the guided self-help modality versus FBT
(Matheson et al., 2022). In a case series done by Wade
et al. (2022), GSH-FBT for families on a waitlist for ED
treatment demonstrated improvements in mood, weight,
and ED behaviors – highlighting the important utility of
GSH modalities to help the increasing need for treatment
nationally. Waitlists have continued to grow during the
COVID-19 pandemic, and jointly, these preliminary stu­
dies provide hope for offering evidence-based treatments
widely at reduced clinician time and cost.
In addition to guided self-help modalities, the pan­
demic’s need to transition services to telehealth has led to
a rise in telehealth treatments. Indeed, virtual delivery of
treatments has been found to have comparable clinical
outcomes to in-person services; recent research has help­
fully outlined how to effectively pivot gold-standard treat­
ments to video-conferencing (Matheson et al., 2020). Some
research has also highlighted the benefits of virtual delivery,
including reduction of travel time, ability to access more
remote areas that are not near academic medical centers,
and greater insight into patient’s lives (Smith et al., 2020).
Indeed, the prior review predicted emerging treatments
“will likely evolve utilizing internet or phone application
supported/delivered treatments,” and we are certainly noti­
cing a rise in such treatments both in the context of the
pandemic and finding their utility in its aftermath. Further
developments in using phone messaging and app interfaces
may be beneficial in providing real-time feedback of skills
in the moment, for example, delivering emotion regulation
during times of distress for ED patients.
Lastly, there has been a notable rise in ARFID treat­
ment development, given ARFID’s relatively new inclu­
sion in the DSM-5. Over the past decade, ARFID
mechanistic and treatment research has been of great
interest. Several RCTs are currently underway to help
treat ARFID symptoms in youth. Included in this
review are both a case series and feasibility RCT for
ARFID, adapting two known, evidence-based treat­
ments for ARFID presentations – CBT and FBT,
respectively (J. J. Thomas et al., 2020; Lock et al.,
2019). While case studies were not included in this
review, Zucker et al. (2019) mentions the adaptation
of a prior RCT for youth with functional abdominal
pain for children with ARFID – The “Feeling and Body
Investigators.” This case series describes the utility of
an interoceptive-exposure-based treatment for a four-
year-old with ARFID and may necessitate larger-scale
investigation.
Lock (2015) summarizes limitations in the prior review,
noting some improvements in the 2008–2015 timeframe
from limitations addressed in the original manuscript
(Keel & Haedt, 2008). These included expanding samples
to include males, increased racial and ethnic diversity,
and generally increased number of child and adolescent
RCTs broadly in EDs (specifically, the number of adoles­
cents included in RCTs was reported as tripling from 302
in 2008 to 1060 in 2014). This number has continued to
grow in the past seven years, with the addition of 21
RCTs. Male participants and more diverse samples have
been included in these trials, but there is still a large skew
toward Caucasian females in ED RCTs transdiagnosti­
cally. Additionally, the criticism from Lock (2015) regard­
ing treatments for AN still stands: “Large studies have
examined only two types of family therapy (family-based
treatment and systemic family therapy) and one type of
individual therapy (adolescent focused therapy), whereas
other potentially effective interventions have a more lim­
ited database of support in this age group.” However, one
notable improvement over the past seven years is the
inclusion of telehealth or guided-self-help modalities for
AN and BN alike. Potentially a focus of interest in the
context of the COVID-19 pandemic, virtual treatment
delivery, and guided self-help modalities have become
both a necessity and a convenient way of relaying salient
treatment information to vulnerable groups and their
carers.
Recommendations for Best Practice
To echo conclusions drawn from both the prior reviews
of the literature (Keel & Haedt, 2008; Lock, 2015), FBT
for adolescents with AN and BN remains the only treat­
ment meeting the “well-established treatment criteria.”
These conclusions continue to be supported by case
series data finding faster weight gain in FBT relative to
CBT-E at EOT (Le Grange et al., 2020). Of note, several
studies included in this review have added adjunctive
treatments to FBT (such as FBT+ DBT skills, or FBT +
adaptive interventions for those who do not demon­
strate early response), potentially optimizing and tailor­
ing the treatment to different presentations of AN.
Additionally, efforts to optimize FBT treatment delivery
and access have been underway and discussed in prior
sections, such as adaptive and guided self-help versions
of FBT. Future investigation of how to integrate tech­
nology (both phone and app-based delivery) may be
useful to continue to optimize access to gold-standard
treatments while reducing cost.

Additionally, this review includes several case series
studies that report improvements in clinical outcomes
accompanied by medium-to-large effect sizes (Craig
et al., 2019; Dalle Grave et al., 2015; Fischer &
Peterson, 2015; Peterson et al., 2020). These provide
important data on the potential utility of these inter­
ventions, though larger-scale studies are needed for
generalizability and replication. The use of different
diagnostic criteria for inclusion/exclusion as well as
remission criteria (e.g., weight cutoffs, cognition) can
make it challenging to interpret intervention results
across samples (Wade & Lock, 2020). To that end,
there is an additional need for studies to look specifi­
cally at unspecified eating disorders or subclinical
categories (Dalle Grave et al., 2015). These groups
often go unstudied due to not “neatly” falling into
a diagnostic category but may still well benefit from
interventions.
There is a need to increase diversity in samples to
ensure both cultural sensitivity and efficacy across popu­
lations – including, but not limited to, racial and ethnic
minorities, LGBTQ+, and transgender populations.
A recent call to action paper suggests actionable steps
to increase the diversity of underrepresented racial and
ethnic groups to address justice, equity, diversity, and
inclusion in the ED field (Goel et al., 2022). Some of
these steps include community-engaged practices and
purposeful sampling, employing culturally sensitive lan­
guage during recruitment and consent, and using cultu­
rally appropriate measures that have been normed on
the population of interest. Future studies may benefit
from consideration of these steps to improve represen­
tation of historically excluded racial/ethnic populations
in research.
Disclosure Statement
James D. Lock has the following commercial relationship(s) to
disclose: National Institute of Mental Health for research
funding, ownership interest in the Training Institute for
Child and Adolescent Eating Disorders, royalties from
Oxford Press, Guilford Press, Taylor & Francis, Routledge,
and American Association Press.
References
Accurso, E. C., Astrachan-Fletcher, E., O’Brien, S.,
McClanahan, S. F., & Le Grange, D. (2018). Adaptation
and implementation of family-based treatment enhanced
with dialectical behavior therapy skills for anorexia nervosa
in community-based specialist clinics. Eating Disorders, 26
(2), 149–163. https://doi.org/10.1080/10640266.2017.
1330319
JOURNAL OF CLINICAL CHILD & ADOLESCENT PSYCHOLOGY 167
Ahs, F., Furmark, T., Michelgard, A., Langstrom, B., Appel, L.,
Wolf, O. T., Kirschbaum, C., & Fredrikson, M. (2006,
November–December). Hypothalamic blood flow corre­
lates positively with stress-induced cortisol levels in subjects
with social anxiety disorder. Psychosomatic Medicine, 68(6),
859–862. https://doi.org/10.1097/01.psy.0000242120.91030.
d8
Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011, July).
Mortality rates in patients with anorexia nervosa and other
eating disorders a meta-analysis of 36 studies. Archives of
General Psychiatry, 68(7), 724–731. https://doi.org/10.1001/
archgenpsychiatry.2011.74
Birmingham, C. L., Su, J., Hlynsky, J. A., Goldner, E. M., &
Gao, M. (2005, September). The mortality rate from anor­
exia nervosa. International Journal of Eating Disorders, 38
(2), 143–146. https://doi.org/10.1002/eat.20164
Carlat, D. J., Camargo, C. A., & Herzog, D. B. (1997, August).
Eating disorders in males: A report on 135 patients.
American Journal of Psychiatry, 154(8), 1127–1132.
https://doi.org/10.1176/ajp.154.8.1127
Couturier, J., & Lock, J. (2006, April). What is remission in
adolescent anorexia nervosa? A review of various conceptuali­
zations and quantitative analysis. International Journal of
Eating Disorders, 39(3), 175–183. https://doi.org/10.1002/eat.
20224
Craig, M., Waine, J., Wilson, S., & Waller, G. (2019, May).
Optimizing treatment outcomes in adolescents with eating
disorders: The potential role of cognitive behavioral
therapy. International Journal of Eating Disorders, 52(5),
538–542. https://doi.org/10.1002/eat.23067
Crow, S. J., Peterson, C. B., Swanson, S. A., Raymond, N. C.,
Specker, S., Eckert, E. D., & Mitchell, J. E. (2009, December).
Increased mortality in bulimia nervosa and other eating
disorders. American Journal of Psychiatry, 166(12),
1342–1346. https://doi.org/10.1176/appi.ajp.2009.09020247
Dalle Grave, R., Calugi, S., Sartirana, M., & Fairburn, C. G.
(2015). Transdiagnostic cognitive behaviour therapy for
adolescents with an eating disorder who are not
underweight. Behaviour Research and Therapy, 73, 79–82.
https://doi.org/10.1016/j.brat.2015.07.014
Dalle Grave, R., Sartirana, M., & Calugi, S. (2019, September).
Enhanced cognitive behavioral therapy for adolescents with
anorexia nervosa: Outcomes and predictors of change in a
real-world setting. International Journal of Eating Disorders,
52(9), 1042–1046. https://doi.org/10.1002/eat.23122
Eisler, I., Dare, C., Hodes, M., Russell, G., Dodge, E., & Le
Grange, D. (2000, September). Family therapy for adoles­
cent anorexia nervosa: The results of a controlled compar­
ison of two family interventions. Journal of Child Psychology
and Psychiatry, and Allied Disciplines, 41(6), 727–736.
https://doi.org/10.1017/s0021963099005922
Eisler, I., Simic, M., Hodsoll, J., Asen, E., Berelowitz, M.,
Connan, F., Ellis, G., Hugo, P., Schmidt, U., Treasure, J.,
Yi, I., & Landau, S. (2016, November). A pragmatic rando­
mised multi-centre trial of multifamily and single family ther­
apy for adolescent anorexia nervosa. BMC Psychiatry, 16(1),
104–131. https://doi.org/10.1186/s12888-016-1129-6
Fairburn, C. G., & Beglin, S. J. (1990, April). Studies of the
epidemiology of bulimia-nervosa. American Journal of
Psychiatry, 147(4), 401–408. https://doi.org/10.1176/ajp.
147.4.401
168 N. DATTA ET AL.
Fischer, S., & Peterson, C. (2015, March). Dialectical behavior
therapy for adolescent binge eating, purging, suicidal beha­
vior, and non-suicidal self-injury: A pilot study.
Psychotherapy, 52(1), 78–92. https://doi.org/10.1037/
a0036065
Franko, D. L., Keshaviah, A., Eddy, K. T., Krishna, M.,
Davis, M. C., Keel, P. K., & Herzog, D. B. (2013, August).
A longitudinal investigation of mortality in anorexia nervosa
and bulimia nervosa. American Journal of Psychiatry, 170(8),
917–925. https://doi.org/10.1176/appi.ajp.2013.12070868
Glashouwer, K. A., Neimeijer, R. A. M., de Koning, M. L.,
Vestjens, M., & Martijn, C. (2018, December). Evaluative
conditioning as a body image intervention for adolescents
with eating disorders. Journal of Consulting and Clinical
Psychology, 86(12), 1046–1055. https://doi.org/10.1037/
ccp0000311
Godart, N. T., Flament, M. F., Perdereau, F., & Jeammet, P. (2002,
November). Comorbidity between eating disorders and anxi­
ety disorders: A review. International Journal of Eating
Disorders, 32(3), 253–270. https://doi.org/10.1002/eat.10096
Goel, N. J., Mathis, K. J., Egbert, A. H., Petterway, F.,
Breithaupt, L., Eddy, K. T., Franko, D. L., &
Graham, A. K. (2022, April). Accountability in promoting
representation of historically marginalized racial and ethnic
populations in the eating disorders field: A call to action.
International Journal of Eating Disorders, 55(4), 463–469.
https://doi.org/10.1002/eat.23682
Herbrich, L., van Noort, B., Pfeiffer, E., Lehmkuhl, U.,
Winter, S., & Kappel, V. (2017, March). Follow-up assess­
ment of cognitive remediation therapy in adolescent anor­
exia nervosa: A pilot study. European Eating Disorders
Review, 25(2), 104–113. https://doi.org/10.1002/erv.2501
Herscovici, C. R., Kovalskys, I., & Orellana, L. (2017, June). An
exploratory evaluation of the family meal intervention for
adolescent anorexia nervosa. Family Process, 56(2),
364–375. https://doi.org/10.1111/famp.12199
Hilbert, A., Petroff, D., Neuhaus, P., & Schmidt, R. (2020,
January). Cognitive-behavioral therapy for adolescents with
an age-adapted diagnosis of binge-eating disorder:
A randomized clinical trial. Psychotherapy and
Psychosomatics, 89(1), 51–53. https://doi.org/10.1159/
000503116
Hodsoll, J., Rhind, C., Micali, N., Hibbs, R., Goddard, E.,
Nazar, B. P., Schmidt, U., Gowers, S., Macdonald, P.,
Todd, G., Landau, S., & Treasure, J. (2017, November).
A pilot, multicentre pragmatic randomised trial to explore
the impact of carer skills training on carer and patient
behaviours: Testing the cognitive interpersonal model in
adolescent anorexia nervosa. European Eating Disorders
Review: The Journal of the Eating Disorders Association, 25
(6), 551–561. https://doi.org/10.1002/erv.2540
Hoek, H. W., & van Hoeken, D. (2003, December). Review of
the prevalence and incidence of eating disorders.
International Journal of Eating Disorders, 34(4), 383–396.
https://doi.org/10.1002/eat.10222
Holtkamp, K., Muller, B., Heussen, N., Remschmidt, H., &
Herpertz-Dahlmann, B. (2005, March). Depression, anxi­
ety, and obsessionality in long-term recovered patients with
adolescent-onset anorexia nervosa. European Child &
Adolescent Psychiatry, 14(2), 106–110. https://doi.org/10.
1007/s00787-005-0431-5
Hurst, K., & Zimmer-Gembeck, M. (2019, March). Family-
based treatment with cognitive behavioural therapy for
anorexia. Clinical Psychologist, 23(1), 61–70. https://doi.
org/10.1111/cp.12152
Jaite, C., Pfeiffer, A., Pfeiffer, E., Thurn, C., Bierbaum, T.,
Winter, S. M., Lehmkuhl, U., & Salbach, H. (2020,
April). Subjective evaluation of outpatient treatment
for adolescent patients with anorexia nervosa. Eating
and Weight Disorders-Studies on Anorexia Bulimia and
Obesity, 25(2), 445–452. https://doi.org/10.1007/s40519-
018-0620-0
Jones, M., Luce, K. H., Osborne, M. I., Taylor, K., Cunning, D.,
Doyle, A. C., Wilfley, D. E., & Taylor, C. B. (2008, March).
Randomized, controlled trial of an internet-facilitated inter­
vention for reducing binge eating and overweight in
adolescents. Pediatrics, 121(3), 453–462. https://doi.org/10.
1542/peds.2007-1173
Kamody, R. C., Thurston, I. B., Pluhar, E. I., Han, J. C.,
Burton, E. T., Jaite, C., Pfeiffer, A., Pfeiffer, E., Thurn, C.,
Bierbaum, T., Winter, S. M., Lehmkuhl, U., & Salbach, H.
(2019, April). Implementing a condensed dialectical beha­
vior therapy skills group for binge-eating behaviors in
adolescents. Eating and Weight Disorders-Studies on
Anorexia Bulimia and Obesity, 24(2), 367–372. https://doi.
org/10.1007/s40519-018-0580-4
Keel, P. K., & Haedt, A. (2008, January-March). Evidence-
based psychosocial treatments for eating problems and eat­
ing disorders. Journal of Clinical Child and Adolescent
Psychology, 37(1), 39–61. https://doi.org/10.1080/
15374410701817832
Kraemer, H. C., Wilson, G. T., Fairburn, C. G., & Agras, W. S.
(2002, October). Mediators and moderators of treatment
effects in randomized clinical trials. Archives of General
Psychiatry, 59(10), 877–883. https://doi.org/10.1001/arch
psyc.59.10.877
Le Grange, D., Crosby, R. D., Rathouz, P. J., & Leventhal, B. L.
(2007, September). A Randomized controlled comparison
of family-based treatment and supportive psychotherapy
for adolescent bulimia nervosa. Archives of General
Psychiatry, 64(9), 1049–1056. https://doi.org/10.1001/arch
psyc.64.9.1049
Le Grange, D., Eckhardt, S., Dalle Grave, R., Crosby, R. D.,
Peterson, C. B., Keery, H., Lesser, J., & Martell, C. (2020,
December 3). Enhanced cognitive-behavior therapy and
family-based treatment for adolescents with an eating dis­
order: A non-randomized effectiveness trial. Psychological
Medicine, 1–11. https://doi.org/10.1017/s0033291720
004407
Le Grange, D., Hughes, E. K., Court, A., Yeo, M.,
Crosby, R. D., & Sawyer, S. M. (2016, August).
Randomized clinical trial of parent-focused treatment and
family-based treatment for adolescent anorexia nervosa.
Journal of the American Academy of Child and Adolescent
Psychiatry, 55(8), 683–692. https://doi.org/10.1016/j.jaac.
2016.05.007
Le Grange, D., Lock, J., Agras, W. S., Bryson, S. W., & Jo, B.
(2015, November). Randomized clinical trial of
family-based treatment and cognitive-behavioral therapy
for adolescent bulimia nervosa. Journal of the American
Academy of Child and Adolescent Psychiatry, 54(11),
886–894. https://doi.org/10.1016/j.jaac.2015.08.008

Lock, J. D. (2009, February). Trying to fit square pegs in round
holes: Eating disorders in males. Journal of Adolescent
Health, 44(2), 99–100. https://doi.org/10.1016/j.jadohealth.
2008.11.001
Lock, J. (2015, September). An update on evidence-based
psychosocial treatments for eating disorders in children
and adolescents. Journal of Clinical Child and Adolescent
Psychology, 44(5), 707–721. https://doi.org/10.1080/
15374416.2014.971458
Lock, J. (2022). Family-based treatment for avoidant/restrictive
food intake disorder. Routledge.
Lock, J., Couturier, J., Matheson, B. E., Datta, N., Citron, K.,
Sami, S., Welch, H., Webb, C., Doxtdator, K., & John-
Carson, N. (2021, November). Feasibility of conducting
a randomized controlled trial comparing family-based
treatment via videoconferencing and online guided
self-help family-based treatment for adolescent anorexia
nervosa. International Journal of Eating Disorders, 54(11),
1998–2008. https://doi.org/10.1002/eat.23611
Lock, J., Fitzpatrick, K. K., Agras, W. S., Weinbach, N., & Jo, B.
(2018, January). Feasibility study combining art therapy or
cognitive remediation therapy with family-based treatment
for adolescent anorexia nervosa. European Eating Disorders
Review, 26(1), 62–68. https://doi.org/10.1002/erv.2571
Lock, J., & Le Grange, D. (2015). Treatment manual for anor­
exia nervosa: A family-based approach. The Guilford Press.
http://www.vlebooks.com/vleweb/product/openreader?id=
none&isbn=9781462531219
Lock, J., Le Grange, D., Agras, W. S., Fitzpatrick, K. K., Jo, B.,
Accurso, E., Forsberg, S., Anderson, K., Arnow, K., &
Stainer, M. (2015, October). Can adaptive treatment
improve outcomes in family-based therapy for adolescents
with anorexia nervosa? Feasibility and treatment effects of a
multi-site treatment study. Behaviour Research and Therapy,
44(5), 90–95. https://doi.org/10.1016/j.brat.2015.07.015
Lock, J., Sadeh-Sharvit, S., & L’Insalata, A. (2019, June).
Feasibility of conducting a randomized clinical trial
using family-based treatment for avoidant/restrictive
food intake disorder. International Journal of Eating
Disorders, 52(6), 746–751. https://doi.org/10.1002/eat.
23077
Lucas, A. R., Beard, C. M., Ofallon, W. M., & Kurland, L. T.
(1991, July). 50-Year trends in the incidence of
anorexia-nervosa in Rochester, Mn – A population-based
study. American Journal of Psychiatry, 148(7), 917–922.
https://doi.org/10.1176/ajp.148.7.917
Matheson, B. E., Bohon, C., & Lock, J. (2020, July). Family-
based treatment via videoconference: Clinical recom­
mendations for treatment providers during COVID-19
and beyond. International Journal of Eating Disorders, 53
(7), 1142–1154. https://doi.org/10.1002/eat.23326
Matheson, B. E., Datta, N., Welch, H., Citron, K.,
Couturier, J., & Lock, J. D. (2022). Parent and clinician
perspectives on virtual guided self-help family-based
treatment (GSH-FBT) for adolescents with anorexia
nervosa. Eating and Weight Disorders: EWD, 1–11.
Advance online publication. https://doi.org/10.1007/
s40519-022-01401-x
Mazzeo, S. E., Lydecker, J., Harney, M., Palmberg, A. A.,
Kelly, N. R., Gow, R. W., Bean, M. K., Thornton, L. M.,
Tanofsky-Kraff, M., Bulik, C. M., Latzer, Y., & Stern, M.
(2016, August). Development and preliminary effectiveness
JOURNAL OF CLINICAL CHILD & ADOLESCENT PSYCHOLOGY 169
of an innovative treatment for binge eating in racially
diverse adolescent girls. Eating Behaviors, 22, 199–205.
https://doi.org/10.1016/j.eatbeh.2016.06.014
Modan-Moses, D., Yaroslavsky, A., Novikov, I., Segev, S.,
Toledano, A., Miterany, E., & Stein, D. (2003, February).
Stunting of growth as a major feature of anorexia nervosa in
male adolescents. Pediatrics, 111(2), 270–276. https://doi.
org/10.1542/peds.111.2.270
Olmos, J. M., Valero, C., Del Barrio, A. G., Amado, J. A.,
Hernandez, J. L., Menendez-Arango, J., & Gonzalez-Macias,
J. (2010, September). Time course of bone loss in patients with
anorexia nervosa. International Journal of Eating Disorders, 43
(6), 537–542. https://doi.org/10.1002/eat.20731
Peterson, C. M., Van Diest, A. M. K., Mara, C. A., &
Matthews, A. (2020, January). Dialectical behavioral ther­
apy skills group as an adjunct to family-based therapy in
adolescents with restrictive eating disorders. Eating
Disorders, 28(1), 67–79. https://doi.org/10.1080/10640266.
2019.1568101
Philipp, J., Franta, C., Zeiler, M., Truttmann, S., Wittek, T.,
Imgart, H., Zanko, A., Auer-Welsbach, E., Mairhofer, D.,
Mitterer, M., Laczkovics, C., Schofbeck, G., Jilka, E.,
Egermann, W. B., Treasure, J., Karwautz, A. F. K., &
Wagner, G. (2021, May). Does a skills intervention for
parents have a positive impact on adolescents’ anorexia
nervosa Outcome? Answers from a quasi-randomised fea­
sibility trial of succeat. International Journal of
Environmental Research and Public Health, 18(9), 4656.
Article 4656. https://doi.org/10.3390/ijerph18094656
Pinhas, L., Morris, A., Crosby, R. D., & Katzman, D. K. (2011,
October). Incidence and age-specific presentation of restric­
tive eating disorders in children a Canadian paediatric
surveillance program study. Archives of Pediatrics &
Adolescent Medicine, 165(10), 895–899. https://doi.org/10.
1001/archpediatrics.2011.145
Rienecke, R. D. (2017). Family-based treatment of eating dis­
orders in adolescents: Current insights. Adolescent Health,
Medicine and Therapeutics, 2017(8), 69–78. https://doi.org/
10.2147/ahmt.S115775
Rienecke, R. D., Gorrell, S., Blalock, D. V., Smith, K., Lock, J.,
& Le Grange, D. (2021, November). Expressed emotion and
long-term outcome among adolescents with anorexia
nervosa. International Journal of Eating Disorders, 54(11),
2019–2024. https://doi.org/10.1002/eat.23613
Safer, D. L., Robinson, A. H., & Jo, B. (2010, March). Outcome
from a randomized controlled trial of group therapy for
binge eating disorder: Comparing dialectical behavior ther­
apy adapted for binge eating to an active comparison group
therapy. Behavior Therapy, 41(1), 106–120. https://doi.org/
10.1016/j.beth.2009.01.006
Salerno, L., Rhind, C., Hibbs, R., Micali, N., Schmidt, U.,
Gowers, S., Macdonald, P., Goddard, E., Todd, G.,
Tchanturia, K., Lo Coco, G., & Treasure, J. (2016,
December). A longitudinal examination of dyadic distress
patterns following a skills intervention for carers of adoles­
cents with anorexia nervosa. European Child & Adolescent
Psychiatry, 25(12), 1337–1347. https://doi.org/10.1007/
s00787-016-0859-9
Schmidt, U., Lee, S., Beecham, J., Perkins, S., Treasure, J., Yi, I.,
Winn, S., Robinson, P., Murphy, R., Keville, S., Johnson-
Sabine, E., Jenkins, M., Frost, S., Dodge, L., Berelowitz, M.,
& Eisler, I. (2007, April). A randomized controlled trial of
170 N. DATTA ET AL.
family therapy and cognitive behavior therapy guided
self-care for adolescents with bulimia nervosa and related
disorders. American Journal of Psychiatry, 164(4), 591–598.
https://doi.org/10.1176/appi.ajp.164.4.591
Smink, F. R. E., van Hoeken, D., Oldehinkel, A. J., &
Hoek, H. W. (2014, September). Prevalence and severity
of DSM-5 eating disorders in a community cohort of
adolescents. International Journal of Eating Disorders, 47
(6), 610–619. https://doi.org/10.1002/eat.22316
Smith, K., Ostinelli, E., Macdonald, O., & Cipriani, A. (2020,
August). COVID-19 and telepsychiatry: Development of
evidence-based guidance for clinicians. JMIR Mental
Health, 7(8), Article e21108. https://doi.org/10.2196/21108
Spettigue, W., Maras, D., Obeid, N., Henderson, K. A.,
Buchholz, A., Gomez, R., & Norris, M. L. (2015). A
psycho-education intervention for parents of adolescents
with eating disorders: A randomized controlled trial.
Eating Disorders, 23(1), 60–75. https://doi.org/10.1080/
10640266.2014.940790
Stefini, A., Salzer, S., Reich, G., Horn, H., Winkelmann, K.,
Bents, H., Rutz, U., Frost, U., von Boetticher, A., Ruhl, U.,
Specht, N., & Kronmuller, K. T. (2017, April). Cognitive-
behavioral and psychodynamic therapy in female adoles­
cents with bulimia nervosa: A randomized controlled trial.
Journal of the American Academy of Child and Adolescent
Psychiatry, 56(4), 329–335. https://doi.org/10.1016/j.jaac.
2017.01.019
Stiles-Shields, C., Bamford, B., Lock, J., & Le Grange, D. (2015,
May). The effect of driven exercise on treatment outcomes
for adolescents with anorexia and bulimia nervosa.
International Journal of Eating Disorders, 48(4), 392–396.
https://doi.org/10.1002/eat.22281
Swanson, S. A., Crow, S. J., Le Grange, D., Swendsen, J., &
Merikangas, K. R. (2011, July). Prevalence and correlates of
eating disorders in adolescents results from the national
comorbidity survey replication adolescent supplement.
Archives of General Psychiatry, 68(7), 714–723. https://doi.
org/10.1001/archgenpsychiatry.2011.22
Tanofsky-Kraff, M., Wilfley, D. E., Young, J. F., Mufson, L.,
Yanovski, S. Z., Glasofer, D. R., Salaita, C. G., &
Schvey, N. A. (2010, December). A pilot study of interper­
sonal psychotherapy for preventing excess weight gain in
adolescent girls at-risk for obesity. International Journal of
Eating Disorders, 43(8), 701–706. https://doi.org/10.1002/
eat.20773
Thomas, J. J., Becker, K. R., Kuhnle, M. C., Jo, J. H.,
Harshman, S. G., Wons, O. B., Keshishian, A. C.,
Hauser, K., Breithaupt, L., Liebman, R. E., Misra, M.,
Wilhelm, S., Lawson, E. A., & Eddy, K. T. (2020, October).
Cognitive-behavioral therapy for avoidant/restrictive food
intake disorder: Feasibility, acceptability, and proof-of-
concept for children and adolescents. International
Journal of Eating Disorders, 53(10), 1636–1646. https://doi.
org/10.1002/eat.23355
Thomas, J. J., & Eddy, K. T. (2019). Cognitive-behavioral
therapy for avoidant/restrictive food intake disorder:
Children, adolescents, and adults. Cambridge University
Press. https://doi.org/10.1017/9781108233170
Thomas, W., Olivia, W., & Eddy, K. T. (2018). Cognitive-
behavioral treatment of avoidant/restrictive food intake
disorder. Current Opinion in Psychiatry, 31(6), 425–430.
https://doi.org/10.1097/YCO.0000000000000454
Timko, C. A., Zucker, N. L., Herbert, J. D., Rodriguez, D., &
Merwin, R. M. (2015, June). An open trial of
Acceptance-based Separated Family Treatment (ASFT) for
adolescents with anorexia nervosa. Behaviour Research and
Therapy, 69, 63–74. https://doi.org/10.1016/j.brat.2015.03.
011
Treasure, J., & Russell, G. (2011, July). The case for early
intervention in anorexia nervosa: Theoretical explora­
tion of maintaining factors. British Journal of
Psychiatry, 199(1), 5–7. https://doi.org/10.1192/bjp.bp.
110.087585
van Son, G. E., van Hoeken, D., Bartelds, A. I. M., van
Furth, E. F., & Hoek, H. W. (2006, November). Time trends
in the incidence of eating disorders: A primary care study in
the Netherlands. International Journal of Eating Disorders,
39(7), 565–569. https://doi.org/10.1002/eat.20316
Wade, T. D., Byrne, S., Fursland, A., Steele, A., Wilksch, S.,
Anderson, J., Zhou, Y., Datta, N., Matheson, B. M., &
Lock, J. (2022). Is guided self-help family-based treatment
for parents of adolescents with anorexia nervosa on treat­
ment waitlists feasible? A pilot trial. International Journal of
Eating Disorders, 55(22), 832–837. https://doi.org/10.1002/
eat.23720
Wade, T. D., & Lock, J. (2020, August). Developing consensus
on the definition of remission and recovery for research.
International Journal of Eating Disorders, 53(8), 1204–1208.
https://doi.org/10.1002/eat.23165
White, H. J., Haycraft, E., Madden, S., Rhodes, P., Miskovic-
Wheatley, J., Wallis, A., Kohn, M., & Meyer, C. (2017,
April). Parental strategies used in the family meal session
of family-based treatment for adolescent anorexia nervosa:
Links with treatment outcomes. International Journal of
Eating Disorders, 50(4), 433–436. https://doi.org/10.1002/
eat.22647
Wilson, G. T., Wilfley, D. E., Agras, W. S., &
Bryson, S. W. (2010, January). Psychological treatments
of binge eating disorder. Archives of General Psychiatry,
67(1), 94–101. https://doi.org/10.1001/archgenpsychia
try.2009.170
Zucker, N. L., LaVia, M. C., Craske, M. G., Foukal, M.,
Harris, A. A., Datta, N., Savereide, E., & Maslow, G. R.
(2019, April). Feeling and body investigators (FBI):
ARFID division–An acceptance-based interoceptive expo­
sure treatment for children with ARFID. International
Journal of Eating Disorders, 52(4), 466–472. https://doi.
org/10.1002/eat.22996