Developmentally-informed care for emerging adults with eating disorders
: a mixed-methods exploration of current approaches and future directions

Student thesis: Doctoral ThesisDoctor of Philosophy

Abstract

Background: Eating disorders are mental illnesses characterised by persistent disturbance of eating or eating-related behaviour. Incidence and prevalence of eating disorders peak during late adolescence and emerging adulthood (~16-25 years of age), yet there are indications that this age-group’s treatment needs are not well met. Emerging adulthood is a life-stage associated with distinctive characteristics (e.g. identity, autonomy and brain development; proliferation of life-events and transitions) and “developmentally-informed care” (i.e. service models and treatments adapted to meet developmental needs) may improve care for this age-group. 
Aims: This thesis aimed to assess current approaches to developmentally-informed care for emerging adults with eating disorders, and to explore directions for continued innovation of such service models. Methods: The thesis adopted a mixed-method approach (i.e. utilised both quantitative and qualitative methods). Chapter 1 outlines i) the rationale for innovation in eating disorder services for emerging adults, and ii) the concept of care informed by the developmental theory of emerging adulthood. Chapter 2 comprises a systematic scoping review of existing knowledge of eating disorders during emerging adulthood (e.g. epidemiology, aetiology, treatment approaches). Chapters 3 and 4 report qualitative evaluations of First Episode Rapid Early Intervention for Eating Disorders (FREED), a developmentally-informed service model for emerging adults with eating disorders. Chapters 5 and 6 comprise investigations of the relationship between distinctive characteristics of emerging adulthood (i.e. identity development; life-events) and eating disorder symptoms. Chapter 7 is a discussion of the thesis’ findings and their clinical implications, its strengths and limitations, and suggestions for future research. 
Results: Findings indicated that the concept of emerging adulthood has yet to be widely adopted in eating disorder research. Some tentative evidence of associations between emerging adulthood’s unique characteristics (e.g. identity exploration) and eating disorders symptoms exists. There is a dearth of current approaches to developmentally informed care for emerging adults, such that just one existing service model – FREED - adapts care to the developmental needs of emerging adults with eating disorders (Chapter 2). Emerging adults experienced FREED treatment as helpful and believed that FREED’s focus on their developmental needs (e.g. managing life-transitions; balancing inclusion of family / friends with self-sufficiency) had been integral to psychological and behavioural changes (Chapter 3). Delayed help-seeking remains an issue in the FREED model, and development-related influences (e.g. life-events; preference for selfsufficiency) on help-seeking were evident amongst emerging adults (Chapter 4). Scarce high-quality research has explored relationships between identity development and eating disorder symptoms, but there is some low-quality evidence of bidirectional relationships between these variables (Chapter 5). Negative life-events were not associated with eating disorder recovery amongst emerging adults (Chapter 6). There was some preliminary evidence that positive life-events may increase the likelihood of recovery. 
Conclusions: Developmentally-informed care for emerging adults with eating disorders is in its infancy. However, one such service model (FREED) has produced promising results. Support with life-transitions, identity-focused work and the sensitive inclusion of family or friends in treatment may be particularly impactful developmental adaptations. There is a clear need for more high-quality research to further guide developmental adaptations to standard evidence-based services and treatments for eating disorders.
Date of Award1 Apr 2021
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorUlrike Schmidt (Supervisor), Vanessa Lawrence (Supervisor) & Karina Allen (Supervisor)

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