Academic journal article Journal of Eating Disorders

Identifying Fundamental Criteria for Eating Disorder Recovery: A Systematic Review and Qualitative Meta-Analysis

Academic journal article Journal of Eating Disorders

Identifying Fundamental Criteria for Eating Disorder Recovery: A Systematic Review and Qualitative Meta-Analysis

Article excerpt

Author(s): Jan Alexander de Vos[sup.1,2], Andrea LaMarre[sup.3], Mirjam Radstaak[sup.1], Charlotte Ariane Bijkerk[sup.2], Ernst T. Bohlmeijer[sup.1,4] and Gerben J. Westerhof[sup.1]

Plain English summary

In this study, we examined the perspective on criteria for eating disorder recovery among recovered patients. We searched in scientific databases for all published qualitative studies on eating disorder recovery. Eighteen studies were included after meeting rigorous inclusion criteria. The results sections of these studies were analyzed by extracting relevant themes for eating disorder recovery. After calculating effect sizes for the criteria, we found high effect sizes for: self-acceptance, positive relations with others, personal growth, eating disorder remission, self-adaptability, and autonomy, indicating that these are important criteria according to recovered individuals. In addition to the remission of the eating disorder symptoms, dimensions of psychological well-being and self-adaptability/resilience are found as important criteria for eating disorder recovery. This study, among others, shows relevant criteria for eating disorder recovery in addition to the remission of eating disorder symptoms.


Eating disorders (EDs) are serious mental disorders that impact all facets of people's lives, including quality of life at home and work, personal functioning, and social life [1-3]. Anorexia Nervosa (AN) has the highest mortality rate of all mental illnesses [4, 5]. Eating disorders are often chronic and refractory [6].

In the last decade, clinical guidelines have been established with treatment options based on evidence (evidence-based care) [7-9]. These treatment options, however, work only for a percentage of patients; for AN in particular, there is no single superior treatment option [10-12]. Effectiveness and efficacy studies, herein called outcome studies, are critical for establishing guidelines for evidence-based care. Outcome studies use measures to examine which treatments are effective, based on the degree of recovery from an ED on certain criteria. There is significant disagreement in the field around the definition of ED recovery, and the relevant criteria that must be present in order to claim "recovery"; see for instance McGilley & Szablewski for an overview [13-18]. As a result, rates of recovery within outcome studies vary widely, ranging from 3% to 96% depending on the criteria used [19]. Recovery is usually measured as the remission of ED symptoms [20]. In a systematic review of 119 patient outcome studies on AN, Steinhausen [20] concluded that remission from all essential clinical symptoms could be considered as recovery; however, he also noted substantial variation in outcome criteria between studies. In a systematic review of predictors of ED outcomes by Vall and Wade [21], over 80% of the 126 included studies reported outcomes based solely on symptom remission [21]. Commonly-used measures were: frequency or absence of binging/purging, change or reaching cut off scores on a questionnaire/interview for measuring ED symptoms (Fairburn & Beglin [22]), changes or remission from overall ED symptoms, or change in BMI or reaching a specific cut off point [21]. In sum, outcome studies generally frame recovery around clinically relevant changes in ED symptoms, or remission.

Simultaneously, a growing body of literature in the ED field highlights that ED symptom change (remission) is not sufficient for understanding, capturing and measuring ED recovery and emphasizes the importance of additional criteria, related to (mental) health, such as quality of life, well-being, psychological, social and emotional functioning [16, 23-26]. This study aims to identify fundamental criteria for recovery from eating disorders focusing on criteria related to clinical symptoms and additional criteria, related to mental health and well-being.

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