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Long waiting times and transient populations are just two elements that delay early intervention for eating disorders
Although intervening early to treat psychiatric disorders has many benefits, as many as 80% of persons with an eating disorder do not receive evidence-based treatment (Int J Eat Disord. 2017. 50:170), and early intervention is not well established.
What is early intervention? According to Dr. Karina L. Allen, of the Outpatients Service at Maudsley Hospital and the Maudsley NHS Foundation Trust, London, and a team of researchers, early intervention is detection of an illness at the “earliest stage” during the course of a diagnosed disorder. This is followed by stage-specific, targeted, evidence-based treatment–as long as it is necessary and effective (JAMA Psychiatry. 2018. 75:545). Dr. Allen and her colleagues surveyed early intervention patterns in the United Kingdom, Australia, Canada, and the US, and then developed suggested recommendations to improve early intervention (Eur Eat Disorders Rev. 2023. 31:32).
Key recommendations for early intervention
For services and policy makers, the researchers noted that in some countries, access to treatment depends on insurance or and/or other forms of “gatekeeping” around the diagnosis. Some of these processes may delay care and prevent treatment early in an eating disorder, particularly if symptoms are thought to occur “too early” or to be “too mild.” Early intervention depends on having enough clinicians available to provide evidence-based eating disorders treatment. The COVID-19 pandemic increased the use of online treatment via video/telehealth, and this offers another option for flexible treatment delivery that could aid access to early intervention efforts.
Dr. Allen and her team highlight a major challenge in providing treatment services: often there is a division between child/adolescent (younger than 18 years) and adult services. In many settings there is a change of providers and treatment settings as one transitions to adulthood, and this can be disruptive to treatment and communication.
A few programs now in action
Because research into early intervention is in its infancy, multi-model neurobiological studies (including genetic, neuroimaging, and neurobiological studies) are needed, according to the authors. They also listed studies in Canada, Australia, and the United Kingdom that are analyzing and promoting early intervention in eating disorders.
Canada is studying early intervention through primary care settings. In the United Kingdom, the 4-year EDIFY Project (About EDIFY (edifyresearch.co.uk), begun in late 2021, is bringing together researchers, clinicians, and young people to develop a evidence-based, interdisciplinary project to learn how eating disorders develop and are maintained. The FREED project is using a pilot study of a FREED-on-Mobile (FREED-M) app to encourage young people with eating disorders to seek help. This app delivers youth-friendly psychoeducation through animation and downloadable resources, with the goal of encouraging youth to seek help for their eating disorders. In Australia, the Strategic Training Initiative for Prevention of EDs (STRIPED) (www.hsph.harvard.edu/striped/) calls for patient-centered and community-based access to care. Finally, the European ProYouth initiative (EPA-1485) is an ongoing online project that encourages help-seeking and promotes reducing eating disorder symptoms.