Stage-specific therapeutic strategies in eating disorders: translating clinical staging into tailored care pathways
R. J. Bou KhalilBackground
Eating disorders (EDs) are clinically heterogeneous and often evolve from early risk states to persistent, recurrent, and severe/enduring courses. While evidence-based treatments exist, outcomes remain variable, partly because most interventions are tested and delivered without systematic consideration of illness stage, medical risk, chronicity, and treatment history. Clinical staging offers a developmentally informed framework to align therapeutic intensity, targets, and outcomes with the patient’s position along the illness trajectory.
Aims
This presentation proposes a pragmatic, stage-linked therapeutic framework for EDs to (1) match interventions to clinical need and risk, (2) reduce delays to effective care, and (3) support stepped, measurement-based treatment planning across settings.
Approach
Drawing on transdiagnostic ED principles and staging approaches in psychiatry, I will map core interventions to illustrative stages (from risk/subthreshold presentations to severe and enduring illness), integrating medical stabilization, psychological mechanisms (e.g., cognitive rigidity, emotion dysregulation), family/system factors, and comorbidity.
Key proposals
Early stages prioritize rapid access, engagement, brief evidence-based interventions, family involvement, and prevention of entrenchment. Established/recurrent stages emphasize multidisciplinary care, targeted psychotherapy (e.g., CBT-based approaches, family interventions where appropriate), relapse prevention, and optimized management of comorbid mood/anxiety, substance use, and personality pathology. Severe and enduring stages shift toward collaborative, recovery-oriented goals that balance medical safety with quality of life, functional restoration, and harm-reduction-informed decision-making when full symptom remission is not immediately attainable. Across stages, shared decision-making and measurement-based care are highlighted to guide step-up/step-down decisions and to operationalize stage transitions.
Conclusions
A stage-informed therapeutic model can clarify “what works for whom, when,” improve resource allocation, and define stage-appropriate outcomes beyond symptom counts alone. Future directions include trials stratified by stage, validated staging indicators, and service models that embed early detection, stepped care, and continuity across transitions.
Disclosure of Interest
None Declared