Treatment for adults with eating disorders often requires specialist psychological care that is tailored to the individual's specific diagnosis and needs. Below are the evidence-based psychological treatment options for adults with eating disorders, focusing on the most common diagnoses: anorexia nervosa, atypical anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant/restrictive food intake disorder (ARFID).

1. Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
MANTRA (Maudsley Model of Anorexia Nervosa Treatment for Adults) is a structured, evidence-based psychological therapy specifically developed for adults with Anorexia Nervosa. It is recommended as a first-line treatment in the UK and internationally due to its strong clinical effectiveness.

Key Features:

• Person-centred and collaborative: MANTRA focuses on building a strong
  therapeutic relationship and tailoring treatment to the individual’s values, needs and experiences.

• Addresses maintaining factors: It targets the cognitive, emotional, interpersonal, 
  and biological factors that maintain anorexia, such as perfectionism, rigid thinking styles, social avoidance, and emotional regulation difficulties.

• Modular and flexible: The treatment uses a workbook-based approach that incorporates modules on nutrition, emotional processing, social relationships, identity, and motivation to change.

• Carer involvement: Where appropriate, MANTRA includes support and involvement for family members or carers to enhance recovery.

• Therapy structure: Typically delivered over 20–40 sessions, MANTRA combines 
  psychoeducation, guided self-reflection, and experiential tasks to support behavioural and psychological change.

Outcomes:
Clinical trials have shown that MANTRA is as effective, if not more acceptable, than other treatments like Specialist Supportive Clinical Management (SSCM), with improvements in weight, motivation, and overall functioning.

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2. Specialist Supportive Clinical Management (SSCM)
Specialist Supportive Clinical Management (SSCM) is an evidence-based psychological treatment originally developed for adults with Anorexia Nervosa. It was designed as a comparison treatment in clinical trials but has since been recognised as a valid standalone therapy, particularly for individuals who may not respond well to more structured approaches like CBT-E or MANTRA.

Key Features:

• Combination of clinical management and supportive psychotherapy: SSCM integrates practical, symptom-focused guidance with non-directive supportive therapy.

• Focus on eating behaviour and physical health: It aims to restore healthy eating patterns and weight while addressing medical complications related to the eating disorder.

• Client-led sessions: Unlike highly structured therapies, SSCM is more flexible and tailored to the individual's current concerns and motivations.

• Supportive therapeutic relationship: The therapist provides empathy, encouragement, and non-judgemental support, fostering autonomy and internal motivation for recovery.

• Focus shifts over time: Initially, SSCM emphasises nutritional rehabilitation and physical recovery. As this stabilises, the focus naturally shifts to broader life issues that may maintain the disorder (e.g., relationships, self-esteem).

Goals:

• Restore weight and normalize eating.

• Improve quality of life and psychosocial functioning.

• Foster motivation and readiness for change.

Suitability:

• Primarily used for adults with Anorexia Nervosa

• Can be helpful when individuals are ambivalent about change or overwhelmed by more intensive therapies.

• Often used as an alternative or second-line treatment when other approaches are not effective or preferred.

​Evidence Base:

SSCM has demonstrated comparable outcomes to other first-line treatments like CBT and MANTRA in some clinical trials, particularly in terms of weight restoration and general symptom reduction.

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3. Cognitive Behavioural Therapy for Eating Disorders (CBT-ED/ CBT-E)
CBT-E (Enhanced Cognitive Behaviour Therapy) is a an evidence-based treatment for adults and older adolescents with eating disorders, developed by Professor Christopher Fairburn. It is a transdiagnostic approach, meaning it is designed to treat all forms of eating
disorders, including:

• Anorexia Nervosa

• Bulimia Nervosa

• Binge Eating Disorder

• Other Specified Feeding or Eating Disorders (OSFED)

Core Principles
CBT-E is based on the premise that over-evaluation of shape, weight, and control over eating is the central maintaining mechanism in eating disorders. It aims to help individuals identify and change the thoughts, feelings, and behaviours that sustain their disorder.
Key Features

• Individualised: Tailored to the specific needs, maintaining mechanisms, and challenges of the person.

• Time-limited: Typically delivered over 20 sessions for bulimia and binge eating, or up to 40 sessions for underweight individuals (e.g., with anorexia).

• Phased treatment model: Usually delivered in four stages:

1. Engagement & Behavioural Change (Stage 1): Establish regular eating
patterns, reduce disordered behaviours, and build motivation.
2. Review of Progress (Stage 2): Assess response to treatment and plan for
next steps.
3. Addressing Maintaining Mechanisms (Stage 3): Focus on cognitive and
behavioural factors like body image, perfectionism, low self-esteem, and
interpersonal issues.
4. Relapse Prevention (Stage 4): Consolidate gains and develop tools to
prevent relapse.

Suitability
CBT-E is suitable for adults and older adolescents and is especially effective when the individual is medically stable and willing to engage in psychological therapy.

Evidence Base
CBT-E is highly recommended internationally and endorsed by guidelines such as NICE (UK). It has been shown to produce sustained improvement in eating disorder symptoms, including reductions in bingeing, purging, and restrictive behaviours, as well as improvements in body image and quality of life.

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4. Dialectical Behaviour Therapy (DBT) for Eating Disorders
Dialectical Behaviour Therapy (DBT) is a structured, evidence-based psychological treatment originally developed for individuals with complex trauma and chronic emotion dysregulation. It has since been adapted for individuals with eating disorders, especially those with complex presentations, including high emotional dysregulation, impulsivity, self- harm, and co-occurring disorders such as substance use or personality disorders.
Target Diagnoses:

• Bulimia Nervosa

• Binge Eating Disorder

• Anorexia Nervosa (particularly when co-occurring with high emotional dysregulation or self-harm)

• Eating disorder not otherwise specified (EDNOS)

• Individuals with frequent crises or high-risk behaviours

Core Features of DBT for Eating Disorders:
1. Emotion Regulation Focus: DBT addresses the role of intense, poorly regulated emotions in maintaining disordered eating behaviours.
2. Behavioural Strategies: Aims to reduce life-threatening behaviours (e.g., self-harm, severe restriction or purging), therapy-interfering behaviours, and quality-of-life- interfering behaviours.
3. Skills Training Modules: DBT includes four main skills modules:

1. Mindfulness: Increasing awareness and acceptance of the present moment.

2. Distress Tolerance: Building tools to survive crises without making thingsworse.

3. Emotion Regulation: Understanding and reducing vulnerability to intense emotions.

4. Interpersonal Effectiveness: Improving communication and relationship skills.

4. Adaptation for EDs: In eating disorder-specific DBT, skills are applied directly to managing urges to binge, purge, or restrict; tolerating distress related to body image; and developing more balanced relationships with food and emotions.
Evidence Base:

• DBT has demonstrated effectiveness particularly in reducing binge eating and purging behaviours, especially among individuals with bulimia nervosa or binge eating disorder who present with significant emotion dysregulation.

• Emerging evidence supports its use in anorexia nervosa, particularly in inpatient or day program settings for individuals with high-risk behaviours.

When to Use DBT for Eating Disorders:

• When emotional dysregulation, impulsivity, or suicidality is prominent

• When standard treatments (e.g., CBT-E) have not been effective

• In individuals with co-occurring disorders or trauma histories

• In intensive treatment settings (e.g., day programs or inpatient units)

Target diagnoses: Binge eating disorder, bulimia nervosa, and those with co-occurring emotional dysregulation (e.g., self-harm, borderline personality disorder).

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5. Family-Based Therapy (FBT) – Adapted for Adults
While Family-Based Treatment (FBT) was originally developed for adolescents with eating disorders—particularly anorexia nervosa—it has been adapted for use with adults, especially young adults still embedded in family or support systems. This adapted approach is sometimes referred to as FBT for young adults or modified FBT for adults.
Key Principles of FBT for Adults:

• Empowerment of supports: Similar to adolescent FBT, the adult version involves parents, partners, or other close supports in taking an active role in helping the adult recover, particularly with re-nourishment and interrupting eating disorder behaviours.

• Developmentally appropriate modifications: Greater emphasis is placed on collaborative decision-making and autonomy, reflecting the adults developmental stage.

• Flexibility: Unlike traditional adolescent FBT, the adult model often adapts the level of support to suit the individuals independence, living situation, and preferences.

• Focus on functional support: Treatment emphasises restoring physical health andreducing symptoms, while also addressing how support people can help the adult engage in life roles (e.g., work, study, relationships).

Structure:

• Treatment typically occurs over 20–40 sessions.

• The first phase focuses on weight restoration or symptom reduction with support from family or significant others.

• Later phases work toward increased autonomy, relapse prevention, and addressing psychosocial recovery.

Evidence Base:

• Emerging research suggests that adapted FBT for adults can be beneficial, particularly for young adults with Anorexia Nervosa.

• Outcomes are better when adults are willing to involve supports and when the approach is tailored to developmental needs.

• However, the evidence base remains smaller than for adolescent FBT, and FBT is not considered the first-line treatment for all adults with eating disorders.

When It’s Most Suitable:

• Young adults still closely connected to family or willing to engage support people.

• Early-stage illness or transition-aged individuals (e.g., 18–25 years).

• When traditional individual therapies have not been effective, and support systems are available.

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Multidisciplinary Approach
For all eating disorders, best practice involves a multidisciplinary team, including:

• Clinical psychologist specialised in eating disorder treatment and psychiatrist if required

• Dietitian specialised in eating disorder treatment

• GP or medical doctor experienced with eating disorder medical management

• Psychiatric nurse or care coordinator

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Additional Considerations

• Inpatient or day-patient treatment may be required for severe cases (especially with medical risk).

• Trauma-informed care may be critical for those with a history of abuse or PTSD.

• Medication (like SSRIs) may be used for co-occurring conditions such as depression or anxiety.

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