Abstract Introduction Despite growing interest, empirical evidence remains limited for the efficacy of intensive outpatient programmes (IOPs) for eating disorders (EDs), particularly outside the USA. No prior studies have examined the delivery or effectiveness of IOPs for children and young people in the UK. This study addresses this gap by presenting pilot data from a UK-based community IOP embedded within an existing child and adolescent ED service. Methods We conducted a prospective cohort study of young people aged 12–18 years referred to the IOP at the Maudsley Centre for Child and Adolescent Eating Disorders between February 2024 and August 2025. Eligible participants had a diagnosis of an ED according to ICD-11 criteria, or disordered eating requiring acute admission, and completed the IOP treatment. Data were collected on referral pathways, demographic and clinical characteristics, treatment course, and outcomes, including change in weight and self-reported ED/mental health symptoms. Results During the recruitment period the IOP served a heterogeneous cohort of 68 young people with high rates of psychiatric and neurodevelopmental comorbidity. Treatment delivery included outreach on paediatric wards, intensified outpatient treatment, and consultation with wider care networks. Mean duration of the IOP was 24 days (SD = 10.7). Most participants demonstrated improved weight trajectory (mean weight gain = 4.5% mBMI, SD = 6.8, p < 0.001). ED symptom psychopathology did not significantly improve over the short IOP duration. Conclusion Findings indicate that a brief IOP intervention is effective for weight restoration in underweight adolescents with EDs, functioning as both an intensification of outpatient treatment and an effective way of keeping young people in the community who are at high risk of an inpatient admission. Future research would benefit from controlled designs, explore long-term outcomes, and examine adaptations for neurodiverse populations.

AIMS:Eating disorders (EDs) are serious illnesses and a better understanding of initial symptom phases could inform early intervention. This study aims to evaluate duration of untreated eating disorder (DUED) and duration/characteristics of the preceding prodrome period in young people diagnosed with an ED. METHODS:Fifty-four young people (28 adolescents aged 13-17 and 26 emerging adults aged 18-25) with recent onset EDs (< 3 years) completed a retrospective onset interview and life chart. DUED, prodrome duration and prodrome characteristics (ED-specific and more broad psychiatric symptoms) were compared according to developmental stage and diagnosis. The relationships between DUED and prodrome duration with early outcomes were evaluated. RESULTS:Emerging adults had a longer DUED than adolescents. This group also had a longer prodrome but only when broad psychiatric symptoms (i.e., not ED-specific) were considered. Those with bulimia-type EDs had a longer ED-specific and broad psychiatric prodrome compared to those with anorexia-type EDs. There were no significant developmental stage or diagnosis-related differences in symptom severity during prodrome. In those who were underweight at presentation to services, a shorter broad prodrome duration was associated with greater weight gain after 3 months of treatment. CONCLUSIONS:When both ED and broad psychiatric symptoms are considered, DUED and prodromal symptoms of EDs differ according to developmental stage and diagnosis. Duration of prodrome may also impact early outcomes but further research is needed.

Objective Parents of young people with anorexia nervosa (AN) often experience significant psychological distress, including elevated levels of anxiety and depression, as well as impaired daily functioning and low self-efficacy. This study examined changes in self-reported levels of anxiety, depression, functional impairment, and self-efficacy in parents of young people attending an intensive day treatment programme (ITP) for adolescents with AN.Method Participants were 71 parents of young people enrolled in ITP. Parents completed standardised outcome measures at assessment and discharge, including the Hospital Anxiety and Depression Scale (HADS), the Work and Social Adjustment Scale (WSAS), and the General Self-Efficacy Scale (GSE).Results Parents reported significant reductions in anxiety, depression, and functional impairment from assessment to discharge. No significant change was found in self-efficacy scores. No baseline factors for the young people of these parents predicted change in parental wellbeing or functioning.Conclusions Findings suggest that ITP may contribute to modest but significant improvements in parents' mental health and daily functioning. These quantitative outcomes align with prior qualitative findings and highlight the potential value of structured, parent-inclusive day treatment in supporting families affected by AN.

BACKGROUND:Intensive Outreach Programmes (IOP) for eating disorders (ED) were established to reduce the need for inpatient admissions by providing intensive support to families of young people at high risk of hospitalisation, thereby facilitating ongoing community treatment and decreasing the use of inpatient services. This study investigates patient and carer experiences of treatment in IOP with the aim of identifying perceived benefits, challenges, and changes during treatment and generating recommendations for enhancing outreach services. METHODS:Nine adolescent patients and 13 caregivers participated in individual semi-structured interviews at 1-month post-discharge from the IOP. Open-ended questions guided the discussions, which were recorded and transcribed verbatim. Data were analysed using the 6-stages of reflexive thematic analysis. RESULTS:The analysis generated three key themes: (1) From Despair to Direction (2) Rock Bottom (3) No Quick Fix. Various shared insights were reported, such as beginning during an acute crisis and viewing IOP as a catalyst to change. Parents reflected on feeling supported by professionals to take a more assertive role during treatment and young people reflecting on the firm but necessary boundaries that shaped and supported their engagement with the treatment. DISCUSSION:Families recognised prompt structured support, collaboration, individualised approaches as key facilitators for change. Recommendations include enhancing communication between ED services and families, ensuring flexibility in appointments, and maintaining a structured, patient-centred approach to optimise the efficacy of intensive outreach interventions for young people with ED.

Background:In clinical practice, olanzapine is commonly used in young people with anorexia nervosa, although the underpinning evidence-base is limited. However, its efficacy, tolerability, acceptability and adherence rate, and the patients', carers' and clinicians' views of olanzapine treatment are unclear. This synopsis article summarises the methods and results of the OPEN feasibility study, overarching the findings and drawing comprehensive conclusions from a quantitative feasibility outcome paper and two qualitative research papers. Methods:The OPEN study assessed the feasibility of a future randomised controlled trial on olanzapine in young people with anorexia nervosa in an open-label, one-armed feasibility study. In this study, we aimed to include 55 patients with anorexia nervosa or atypical anorexia nervosa aged 12-24 who gained < 2 kg within at least 1 month of treatment as usual. Time points for assessments were at baseline, 8 weeks, 16 weeks, and 6 or 12 months. We estimated recruitment, adherence and attrition rates and mean changes in body weight, body mass index and eating disorder psychopathology. In addition, we explored the views on and experiences with olanzapine treatment within a clinical trial setting using qualitative interviews with young people with anorexia nervosa, their families and clinicians. Results:Fifty-two people were pre-screened, 35 were eligible and 20 participants were recruited and started olanzapine. Of these, 15 continued olanzapine for ≥ 16 weeks. Participants experienced, on average, a decrease in their eating disorder psychopathology, and body weight and body mass index increased during treatment with olanzapine as an adjunct to treatment as usual. Important themes derived from semi-structured qualitative interviews with young people and their parents were: moving away from the illness towards recovery, evaluating information on olanzapine, consent and trust in shared decision-making and the ambivalence around recovery. The main themes expressed by clinicians included: acknowledging the concerns of young people with anorexia nervosa and their families, prioritising person-centred care, the limited service capacity and strict study eligibility criteria. Limitations:The study failed to meet the recruitment target and showed low adherence rates for treatment with olanzapine. Possible reasons for the recruitment difficulties and the low adherence rate include the high clinical workload of eating disorder services during and after the COVID-19 pandemic, the heterogeneity of eating disorder service setup across the country, and the reluctance of patients to agree to take olanzapine under the relatively restricted conditions of a clinical study. Conclusions:A realistic time schedule for site-preparation, recruitment, treatment and follow-up, realistic recruitment targets and easy access to medical and laboratory examinations may improve the success of future feasibility studies and randomised controlled trials in this patient group. Future work:The difficulties in conducting the OPEN study will inform the planning for future pharmacological and non-pharmacological studies in anorexia nervosa. Therefore, we developed a checklist with action points for the planning of pharmacological trials in eating disorders. Furthermore, novel pharmacological options such as typical and atypical psychedelic drugs (e.g. psilocybin and ketamine) might be more acceptable for people with anorexia nervosa as they do not have the side effect of immediate weight gain. Funding:This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR130780.

Although intensive outpatient programmes (IOPs) are becoming more prevalent, the evidence base, particularly within the UK, remains limited. Given clinicians' central role in developing, delivering, and adapting these emerging models of care, their perspectives are essential to understanding how IOPs function in practice. This study therefore aims to address a significant gap in the literature by exploring clinicians' experiences of working with an IOP and the strengths and opportunities arising from this. Fifteen experienced clinicians participated in individual semi-structured interviews after working with the IOP. Open-ended questions guided the discussions, which were recorded and transcribed verbatim. Data were analysed using the six stages of reflexive thematic analysis. The analysis generated three key themes: (1) Tri-directional Collaboration, (2) Creating Space for Change, and (3) Transitions as Turning Points. Clinicians felt that the IOP provided a structure that strengthened and reinforced the therapeutic alliance between parents and clinicians, helped arrest rapid deterioration, and created space for thoughtful planning. Embedding IOPs within stepped-care frameworks may offer an effective and scalable means of expanding system capacity while delivering enhanced, flexible support during periods of heightened risk. However, longitudinal, mixed-methods evaluations are needed to clarify the sustainability of progress post-IOP and to identify predictors of positive transitions.

A significant proportion of young people do not respond to NICE recommended treatment for anorexia nervosa: Family Therapy (FT-AN). Evidence is building for the effectiveness of day programmes as an alternative to inpatient admissions for young people whom traditional community treatment has not benefited. One day programme that has been found to be effective is the Intensive Treatment Programme (ITP) of the Maudsley Centre for Child Adolescent Eating Disorders in London, UK. However, limited data are available on how caregivers of young people attending experience such a day programme. Anonymous feedback was completed via online survey by 64 caregivers over a 5-year period (2018–2023) on discharge from ITP. Five main themes emerged: (1) Clarity and consistency are key; (2) Skills and practical support; (3) Collaborative relationships; (4) Layers of change; (5) It wasn’t all great. Expanding our understanding of caregiver experiences is important given the FT-AN model holds expectations that “the family is needed as a resource” and that caregivers should “take a lead in managing their child’s eating”. It is hoped that increased understanding will lead to services continuing to improve the support they provide.

Objective: Despite the UK national guidance for Managing Emergencies in Eating Disorders (MEED) being widely used, little is known about how the guidance has been embedded into clinical practice or implemented across services. Methods: Clinicians (n = 13) working in community child and adolescent eating disorder services and medical wards were interviewed about their experience of using the MEED guidance in their clinical practice. Open-ended questions were used. Reflexive thematic analysis was used to analyse interview data. Results: Reflexive thematic analysis of responses identified three main themes. These were the following: (1) a common language, (2) looking beneath the surface, and (3) refeeding syndrome—a rare event in youth. These themes evidenced the important role of the MEED guidance in child and adolescent eating disorders and highlighted both the benefits and limitations of the current guidance. Conclusions: This study demonstrated that MEED was most helpful as a tool to clearly communicate acuity of medical risks between services, aiding multi-agency working required to manage both physical and mental health risks of young people with AN. The absence of parameter risk stratification and the lack of consistency on refeeding guidance across adolescent and adult guidance were highlighted as areas that future research should focus on.

Abstract This chapter introduces Radically Open Dialectical Behavior Therapy (RO DBT) in relation to the ICD-11 classification of personality disorders (PD) and related traits, and briefly summarizes its empirical support. RO DBT is presented as a psychotherapy approach that focuses on maladaptive overcontrol, a transdiagnostic factor underlying many forms of psychopathology, including PD features. Furthermore, the chapter details a treatment strategy based on the ICD-11 classification of PD severity, including subdiagnostic personality difficulty, and describes how overcontrol relates to each of the trait domains, offering several examples of how RO DBT addresses aspects of personality functioning, global severity, and trait domains.

While the efficacy of family therapy for adolescents with anorexia nervosa is well documented, the process of change across treatment is less well understood. Emerging research has looked at the young person experience, however, little is known about the parent/caregiver perspective. This study aimed to understand factors that parents/caregivers perceive as facilitating change in family therapy for anorexia nervosa (FT-AN). Twenty-three parents/caregivers of young people (age 12–18 years) with anorexia nervosa who had completed FT-AN participated in individual semi-structured interviews online. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. Five interconnected themes were generated: Not alone, Strong foundations, Commitment, Both/and rather than either/or, and Strengthening family connection. Parents /caregivers highlighted the importance of collaboration—both within the family and with the clinical team—in building a support network. This collaborative foundation was seen as central to facilitating change, initially through structure and boundaries, and later through increased flexibility and safe risk-taking. Maintaining a life outside the illness and ensuring a balance between physical and emotional needs across all stages of treatment emerged as critical to the recovery journey. This qualitative study explored parental experiences of supporting a young person through FT-AN. Themes generated in this study closely mirror the change processes reported by young people and align with the theoretical underpinnings of FT-AN. Parents reported that change was supported through collaboration with knowledgeable clinicians, setting clear expectations and reduced isolation. A holistic, person-centred approach to treatment that considered life outside the illness was considered as key in promoting change and building commitment from the young person and family. Additionally, finding the right balance in safe risks taking, flexibility within the approach and gradual spacing out of sessions were all described as key to promoting change. Family therapy for anorexia nervosa (FT-AN) is a first-line recommended treatment for adolescents with anorexia nervosa. While it is helpful for most, there are many who require more or something different to reach recovery. This study aimed to understand factors that parents/caregivers perceive as impacting change in FT-AN. Twenty-three parents/caregivers of young people (age 12-18 years) with anorexia nervosa who had completed FT-AN participated in individual semi-structured interviews. Analysis of transcripts using reflexive thematic analysis generated five interconnected themes: 1) Not alone, 2) Strong foundations, 3) Commitment, 4) Both/and rather than either/or, and 5) Strengthening family connection. Parents/caregivers highlighted the importance of collaboration—both within the family and with the clinical team—in building a support network. This collaborative foundation was seen as central to facilitating change, initially through structure and boundaries, and later through increased flexibility and safe risktaking. Parents/caregivers reported that change was supported through collaboration with knowledgeable clinicians, setting clear expectations and reduced isolation. A holistic, person-centred approach to treatment that considered life outside the illness was considered as key in promoting change and building commitment from the young person and family.

BACKGROUND:Olanzapine is a second-generation antipsychotic medication often prescribed for young people with Anorexia Nervosa (AN), though supporting evidence is limited. The OPEN feasibility trial of olanzapine for young people (12-24 years) with AN, explored the feasibility of a future definitive trial on olanzapine in young people. Qualitative interviews examined the acceptability of olanzapine and trial design among young people with AN and their families. Here, we explore: what does taking olanzapine mean to young people with AN and their families, specifically regarding decisions to take or decline it? METHODS:Twelve young people who agreed to take olanzapine, two who declined, and four parents took part in semi-structured qualitative interviews, which were conducted and analysed by lived-experience researchers using reflexive thematic analysis. Four young people who agreed to take olanzapine also took part in follow-up interviews, totalling 23 interviews with 16 participants. Of the interviewed parents, three had a child who consented to olanzapine and one had a child who declined. Lived-experience-led analysis, influenced by the survivor research tradition, is novel as applied to this topic. RESULTS:We constructed four themes: (1) Moving away from illness in contexts of desperation, moving towards recovery as broader life goals; (2) Parents and young people critically evaluate multiple information sources on olanzapine; (3) Consent versus coercion in olanzapine decision-making are determined by treatment history and clinical power dynamics; (4) Ambivalence around recovery can be heightened regarding medication. Across themes, young people and parents showed their decision-making to be careful and context-bound, factoring in: concerns around treatment delays; trusting or mistrustful relationships to clinicians or the broader system; peer experiences; and fears around recovery alongside goals for improved quality-of-life. Reported clinical conversations about weight gain did not always reflect olanzapine's evidence base. Important risks included unsupervised olanzapine cessation where wishes to stop were not accommodated clinically, and increased food restriction on starting olanzapine. CONCLUSIONS:Views and experiences of olanzapine are inseparable from young people's clinical and social contexts. Clinicians should consider discussing these contexts alongside medication, bearing in mind clinical encounters' complex power dynamics, and should be clear about olanzapine's association with weight gain. TRIAL REGISTRATION:ISRCTN80075010.

Overcontrol is a transdiagnostic phenotype which has been associated with restrictive eating disorders and depression. It is characterised by traits such as cognitive and behavioural inflexibility, risk aversion, suppression of emotional expression, reduced reward sensitivity and higher temperamental anxiety. Two aspects of the overcontrol phenotype (inflexibility and the suppression of emotional expression) have been particularly linked with poorer mental health. Additionally, social connectedness has been shown to protect against mental health symptom severity. The current study aimed to test whether the relationship between these factors and mental health symptom severity, namely, eating disorder and depression, is mediated by social connectedness. Routine data were collected for adolescents with restrictive eating disorders presenting to either outpatient or intensive day programme treatment in a specialist eating disorder service. Four cross-sectional mediation analyses were planned. The first two models aimed to test the mediating role of social connectedness on the relationship between inflexibility (model 1) and the suppression of emotional expression (model 2) on eating disorder symptom severity. The second two models aimed to test the mediating role of social connectedness on the relationship between inflexibility (model 3) and the suppression of emotional expression (model 4) on depression symptom severity. Baseline weight and comorbid mental health symptom severity were controlled for in each model. The sample consisted of 109 adolescents (mean age = 15.21 years, 96.3

OBJECTIVE:Family therapy for anorexia nervosa (FT-AN) is the first-line recommended treatment for young people with anorexia nervosa. There is variability in treatment length across studies and evidence suggests treatment length and outcome are not necessarily linearly related. This makes it difficult to identify the optimum length of treatment in clinical practice. This study aimed to explore young people's perspectives on the timing of discharge and how this relates to recovery. METHOD:Twenty three young people (age 12-18) diagnosed with anorexia (or atypical anorexia) nervosa participated. All had completed FT-AN with or without adjunctive multi-family therapy. Semi-structured individual qualitative interviews were conducted. Recordings were transcribed verbatim and analysed using reflexive thematic analysis. RESULTS:Four inter-connected themes were generated; (1) who decides?, (2) knowing what's coming, (3) things that need to be in place, (4) discharge is a necessary step towards recovery. DISCUSSION:Young people said that remaining in treatment for longer than necessary may impede recovery. Establishing clear expectations about discharge and recovery, helping young people to commit to ongoing behaviour change, and building their support network were all described as important components in helping them to feel confident about discharge and to take ownership of continuing the recovery journey post-discharge.

OBJECTIVE:We present the protocol of a feasibility randomised controlled trial (RCT) of intermittent theta burst stimulation (iTBS) for young people with anorexia nervosa (AN). Effective first-line psychological therapies exist for young people with AN, but little is known about how to treat those who do not respond. Non-invasive neuromodulation, such as iTBS, could address unmet treatment needs by targeting neurocircuitry associated with the development and/or maintenance of AN. DESIGN:Sixty-six young people (aged 13-30 years) with persistent AN will be randomly allocated to receive 20 sessions of real or sham iTBS over the left dorsolateral prefrontal cortex in addition to their usual treatment. Outcomes will be measured at baseline, post-treatment (1-month post-randomisation) and 4-months post-randomisation (when unblinding will occur). Additional open follow-ups will be conducted at 12- and 24-months post-randomisation. The primary feasibility outcome is the proportion of participants retained in the study at 4-months. Secondary outcomes include AN symptomatology, other psychopathology, quality of life, service utilisation, neurocognitive processes, and neuroimaging measures. DISCUSSION:Findings will inform the development of a future large-scale RCT. They will also provide exploratory data on treatment efficacy, and neural and neurocognitive predictors and correlates of treatment response to iTBS in AN.

Multi‐family therapy for children and adolescents with anorexia nervosa (MFT‐AN) draws on the same principles as family therapy for AN (FT‐AN), but is delivered in a more intensive format to help families overcome a sense of isolation and stigmatisation and to maximise their own resources. In Japan, the main treatment for AN is inpatient care, and family‐based treatment that is based on the practice at the Maudsley Hospital in the 1980s has started to be introduced at an inpatient level in Japan. MFT‐AN could offer more opportunities to practice managing AN symptoms and reduce the family's anxiety. It may also act as a step‐down intervention during transition from inpatient to outpatient care or a step‐up in intensity if outpatient treatment is stalling. This article reports on MFT‐AN's theoretical underpinnings, the current Japanese eating disorder treatment context, and the way MFT‐AN may be adapted for the unique Japanese socio‐cultural context.

Abstract Background The OPEN feasibility trial testing olanzapine in anorexia nervosa (AN) in young people (YP) was not successful due to poor recruitment. This study aims to understand clinicians’ views and experiences of using olanzapine in AN and the challenges in implementing the trial in National Health Service (NHS) clinical settings. Methods We conducted qualitative interviews with eating disorders (ED) clinicians involved with the study (n = 11). Framework analysis was applied to qualitative data to identify barriers and facilitators to recruitment and study implementation. A web-based semi-structured Qualtrics survey was administered to ED clinicians (n = 24). Findings from the survey were used to corroborate and expand on the information derived from qualitative interviews. Results Qualitative analysis identified four main themes: (1) Acknowledging Service User (SU) / Family Concerns, (2) Prioritising person-centred care, (3) Limited Service Capacity and (4) Study eligibility criteria. Subthemes are outlined accordingly. Clinicians appeared confident addressing SU concerns around olanzapine in clinical discussions, but timing was critical, and olanzapine was considered one aspect of treatment that needed to align with their holistic approach. Service pressures restricted opportunities for recruitment and the ability to offer regular review. At the same time, some YP were ineligible for the trial, as they were already taking olanzapine, or needed to be prescribed it more promptly than the study procedures allowed. Survey findings underlined confidence in prescribing and informing on olanzapine, the various possible benefits of olanzapine besides weight gain, and the importance of therapeutic alliances and informed consent. Both data sets highlight the need for further evidence on long-term safety, side effects and efficacy of olanzapine use for AN. Where clinical service capacity is at a premium, research implementation is not prioritised, particularly in intensive clinical settings. Conclusions Findings provide first-hand insight into individual and systemic challenges with research implementation in the NHS, which need to be considered when designing future clinical research studies. We emphasise a person-centred approach when discussing olanzapine to consider a holistic recovery from AN beyond weight-gain as an isolated outcome for improvement.

Despite the availability of evidence-based treatments for anorexia nervosa (AN), remission rates are moderate, and mortality is high. Olanzapine is used as adjunct therapy for AN in case of insufficient response to first-line treatments, even though the evidence is limited. Its effect on eating disorder (ED) psychopathology, its efficacy and tolerability, and its acceptability and adherence rate are unclear. We assessed the feasibility of a future definitive trial on olanzapine in young people with AN in an open-label, one-armed feasibility study that aimed to include 55 patients with AN or atypical AN aged 12–24 who gained < 2 kg within at least one month of treatment as usual (TAU) during outpatient, inpatient, or day-care treatment. Time points for assessments were at baseline, 8 weeks, 16 weeks, and 6 or 12 months. We estimated the following planning parameters: Recruitment rate (number of patients who agreed to take olanzapine/number eligible), adherence rate (number adhering to treatment/number recruited) and attrition rate (number completing study assessments/number recruited). In addition, two exploratory effect size parameters were estimated: Mean change in body mass index (BMI) and mean change in ED psychopathology. Fifty-two people were pre-screened (June 2022 to May 2023; 10 study sites in England). 13 were ineligible at pre-screening . Of the 39 approached, 4 were found ineligible at screening. Of the remaining 35 eligible, 10 declined and 5 did not take part for other reasons. Thus, 20 participants were recruited and started olanzapine (recruitment rate: 20/35 = 57

Background: Despite dietitians being important members of the multidisciplinary team delivering family therapy for anorexia nervosa (FT-AN), their specific responsibilities and roles are unclear and their involvement in the treatment can be a contentious issue. Methodology: Clinicians (n = 20) experienced in the delivery of FT-AN who were working at a specialist child and adolescent eating disorder service responded to an online survey about their experience of including a dietitian in FT-AN and how they understand the role. Both categorical and open-ended questions were used. Reflexive thematic analysis was used to analyse the qualitative free-text responses of clinician perspectives on the role of the dietitian in FT-AN. Results: All clinicians agreed that dietetics had a role within FT-AN and most frequently sought dietetic involvement in the early phases of FT-AN. Reflexive thematic analysis of responses identified three main themes. These were (1) collaboration is key, (2) confidence as a core consideration and (3) case-by-case approach. These themes evidenced the role of the dietitian within FT-AN and highlighted both the benefits and concerns of this involvement. Conclusions: This study demonstrated that dietitians can take a core role as collaborators within therapy-led teams that facilitate joint working and sharing of expertise. However, dietetic input should be considered on a case-by-case basis, given its potential for creating an over-focus on nutrition and potentially diminishing parental confidence in feeding. When indicated for selected cases, nutritional counselling should be offered in joint sessions with the therapist rather than separately. The findings of the study were limited by the small sample size of participants recruited from a single centre and heterogeneity in the professional background of respondents. Although the integration of dietetics within the multidisciplinary team and the ability of dietitians to individualise patient care can enhance FT-AN treatment, potential benefits and disbenefits should be considered for each case.

BACKGROUND:Recognition of atypical anorexia nervosa (AAN) has challenged underweight as a defining factor of illness severity in anorexia nervosa (AN). The present study aimed to compare rates of medical instability in adolescents with underweight (AN) and non-underweight (AAN) anorexia nervosa. METHODS:The study examined assessment data from specialist eating disorder services in the UK between January and December 2022. Participants (n = 205) aged 11-18 years were recruited across eight eating disorder clinics and diagnosed with AN (n = 113) or AAN (n = 92) after clinical assessment. Parameters associated with risk of medical instability were compared between AN and AAN groups, using t tests and regression analysis. RESULTS:Rates of bradycardia and hypotension did not differ significantly between AN and AAN groups (p = 0.239 and p = 0.289). Although white blood cell counts were lower in the AN group, rates of leukopaenia could not be statistically compared as a result of there being too few counts in at least one group. No incidences of hypophosphataemia were found in the sample. A significant regression equation was found for percentage median body mass index, but not rate of weight loss, as a predictor of blood pressure, serum phosphorous and magnesium. CONCLUSIONS:Our findings indicate that medical instability occurs across a range of body weights in young people with AN and AAN. Although certain parameters of risk such as blood pressure, serum phosphorous and magnesium may be worsened at lower weight, both AN and AAN are serious mental health conditions that can lead to medical instability.