Motivation and Manualized Treatment for Eating Disorders

"We have seen advancements in evidence-based treatment modalities beyond Family-Based Therapy (FBT), Cognitive Behavioral Therapy (CBT), and Dialectical Behavior Therapy (DBT). These include Focal Psychodynamic Therapy (FPT) and Acceptance and Commitment Therapy (ACT). However, many of the approaches tend to oversimplify the complexities of eating disorders, often reducing them to fit within manualized protocols, which can hinder a nuanced understanding and more effective treatment."

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

"The mortality rate associated with eating disorders remains alarmingly high, now second only to deaths from fentanyl overdose. A meta-analysis of treatment outcomes published in 2024 revealed that, despite the high lethality linked to eating disorders (approximately 10,200 deaths per year) and a prevalence of 28.8 million Americans affected, improvements in treatment outcomes have been modest, ranging between 18 and 33 percent."

Treatment approaches for eating disorders have expanded beyond FBT, CBT, and DBT to include modalities such as Focal Psychodynamic Therapy and Acceptance and Commitment Therapy. Many contemporary approaches risk oversimplifying complex presentations by conforming to manualized protocols, potentially limiting effectiveness. Combined FBT and CBT report only 40–60% remission within two years, with restrictive disorders showing recovery rates between 18–60% and average illness durations of 6.5–14 years. Mortality from eating disorders remains extremely high, with roughly 10,200 deaths per year and 28.8 million Americans affected. Overall treatment outcome improvements are modest (18–33%), and relapse affects up to one-third of those who remit.

Read at Psychology Today