Effectiveness of psychosocial interventions in eating disorders: an overview of Cochrane systematic reviews.

Einstein (Sao Paulo, Brazil). 2020;14(2):235-77

Plain language summary

Eating disorders are mental health conditions that can have implications both physiologically and also on psychological and emotional wellbeing. Eating disorders broadly fit into one of three disorders (although there are others); anorexia nervosa (AN) which is characterised by extreme energy intake restriction and disturbances in body weight/shape perceptions. Bulimia nervosa (BN) is characterised by recurred episodes of binging followed by compensatory behaviours such as laxative use, vomiting and/or excessive exercising. Binge-eating disorder (BEN) involved frequent periods of binging without compensatory behaviours and is considered to be more common than AN and/or BN. There is a need for effective psychosocial treatments of eating disorders that enable sufferers to achieve long-term recovery. This paper reviews 101 primary research papers and 30 systematic, meta-analysis and narrative reviews. It concludes that cognitive behavioural therapy (CBT), which incorporates nutritional education, psychoeducation, cognitive, behavioural and self-monitoring interventions to be the most effective treatment for eating disorders, particularly BN and BED. Family-based therapy, based on the Maudsley approach where the family plays a key role in recovery, is considered to be most effective for AN. There may also be a role for low dose antipsychotic medications to help anxious and/or obsessive symptoms. Interpersonal therapy and dialectic behavioural therapy (DBT) may also be effective, where the latter aims to improve emotional regulation and reduce binging in BN and BED.


Eating disorders are psychiatric conditions originated from and perpetuated by individual, family and sociocultural factors. The psychosocial approach to treatment and prevention of relapse is crucial. To present an overview of the scientific evidence on effectiveness of psychosocial interventions in treatment of eating disorders. All systematic reviews published by the Cochrane Database of Systematic Reviews - Cochrane Library on the topic were included. Afterwards, as from the least recent date of these reviews (2001), an additional search was conducted at PubMed with sensitive search strategy and with the same keywords used. A total of 101 primary studies and 30 systematic reviews (5 Cochrane systematic reviews), meta-analysis, guidelines or narrative reviews of literature were included. The main outcomes were: symptomatic remission, body image, cognitive distortion, psychiatric comorbidity, psychosocial functioning and patient satisfaction. The cognitive behavioral approach was the most effective treatment, especially for bulimia nervosa, binge eating disorder and the night eating syndrome. For anorexia nervosa, the family approach showed greater effectiveness. Other effective approaches were interpersonal psychotherapy, dialectic behavioral therapy, support therapy and self-help manuals. Moreover, there was an increasing number of preventive and promotional approaches that addressed individual, family and social risk factors, being promising for the development of positive self-image and self-efficacy. Further studies are required to evaluate the impact of multidisciplinary approaches on all eating disorders, as well as the cost-effectiveness of some effective modalities, such as the cognitive behavioral therapy. RESUMO Transtornos alimentares são doenças psiquiátricas originadas de e perpetuadas por fatores individuais, familiares e socioculturais. A abordagem psicossocial é essencial para o tratamento e a prevenção de recaídas. Apresentar uma visão geral das evidências científicas sobre a efetividade das intervenções psicossociais no tratamento de transtornos alimentares. Foram incluídas todas as revisões sistemáticas publicadas no Banco de Dados de Revisões Sistemáticas da Cochrane Library. Posteriormente, a partir da data menos recente destas revisões (2001), realizou-se uma busca adicional no PubMed, com estratégia de busca sensibilizada e com os mesmos descritores utilizados antes. No total, foram incluídos 101 estudos primários e 30 revisões sistemáticas (5 revisões sistemáticas da Cochrane), metanálises, diretrizes ou revisões narrativas da literatura. Os principais desfechos foram remissão de sintomas, imagem corporal, distorção cognitiva, comorbidade psiquiátrica, funcionamento psicossocial e satisfação do paciente. A abordagem cognitivo-comportamental foi o tratamento mais efetivo, principalmente para bulimia nervosa, transtorno da compulsão alimentar periódica e síndrome do comer noturno. Para anorexia nervosa, a abordagem familiar demonstrou maior efetividade. Outras abordagens efetivas foram psicoterapia interpessoal, terapia comportamental dialética, terapia de apoio e manuais de autoajuda. Além disso, houve um número crescente de abordagens preventivas e promocionais que contemplaram fatores de risco individuais, familiares e sociais, sendo promissoras para o desenvolvimento da autoimagem positiva e autoeficácia. São necessários mais estudos que avaliem o impacto de abordagens multidisciplinares em todos transtornos alimentares, além da relação custo-efetividade de algumas modalidades efetivas, como a terapia cognitivo-comportamental.

Lifestyle medicine

Fundamental Clinical Imbalances : Neurological
Patient Centred Factors : Mediators/Eating disorders
Environmental Inputs : Diet ; Psychosocial influences ; Mind and spirit
Personal Lifestyle Factors : Nutrition ; Psychological
Functional Laboratory Testing : Not applicable

Methodological quality

Allocation concealment : Not applicable
Publication Type : Journal Article ; Review