Anne Bryde Christensen

The transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is known to be difficult. For young persons

Objective: Research on mentalization‐based treatment (MBT) for adolescents with borderline personality disorder (BPD) has yielded mixed results. This qualitative study aimed to explore the experiences of adolescents who participated in a group‐based MBT (MBT‐G) programme 5 years earlier, to uncover the pitfalls, potentials and long‐term effects of MBT within this population. Methods: Eleven participants were included in the study. They were interviewed 5 years after completing a 1‐year MBT‐G programme designed for adolescents with BPD or subthreshold BPD. At the time of the interviews, participants were between 19 and 23 years old. Data were analysed using Interpretative Phenomenological Analysis (IPA). Findings: The study revealed weak working alliances, as many participants reported feeling uncertain about the goals of treatment and expressed a desire for more concrete therapeutic ‘tools’ and opportunities to address past trauma in individual sessions. Additionally, most participants described a lack of group cohesion, with group participation often experienced as burdensome and anxiety‐provoking. Some participants perceived therapists as distant and lacking empathy, which negatively affected their engagement. In contrast, positive treatment experiences were associated with a clear understanding of the treatment rationale, strong group cohesion and therapists who actively and supportively facilitated the group. Research Implications: The findings suggest that establishing effective MBT groups for adolescents with BPD can be challenging and working specifically on establishing group cohesion and uncovering the rationale for the treatment are pivotal. Further quantitative and qualitative studies are recommended to investigate MBT programmes that integrate both individual and group therapy for this population.

Background: There is a growing interest in developing novel psychological interventions for eating disorders, with an emphasis on targeting maintaining factors. One hypothesized mechanism underlying illness maintenance is the experience of an “inner eating disorder voice,” which reinforces maladaptive thoughts, emotions, and behaviors. Preliminary studies suggest that the eating disorder voice is common among patients and is linked to greater illness severity. Objective: This single-arm, mixed methods pilot feasibility study aimed to evaluate a novel virtual reality (VR)–based therapy targeting the eating disorder voice. The intervention was adapted from AVATAR therapy for psychosis and was examined as an adjunct to treatment as usual in individuals with eating disorders. In this adaptation, participants engaged with a therapist-controlled avatar representing their inner eating disorder voice in VR. The primary objectives were to assess the feasibility, acceptability, and safety of the intervention and to provide preliminary estimates of its clinical efficacy. Methods: Adults with anorexia nervosa (9/10, 90%) or bulimia nervosa (1/10, 10%) took part in a 7-session VR-based therapy course at the Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark, alongside their treatment as usual. Quantitative measures of feasibility (recruitment, retention rates, and satisfaction scores), safety, and eating disorder–related outcomes were collected at baseline and after treatment between June 2023 and January 2024. Qualitative interviews conducted after the intervention (October 2023 to November 2023) explored participants’ experiences. Descriptive statistics, paired t tests, and thematic analysis were conducted, and the analyses were finalized in October 2025. Results: Recruitment targets were met: 14 individuals were referred, and 11 provided consent well within the prespecified time frame. Treatment completion rate was 80% (8/10; 95% CI 44%-97%), and no serious adverse events occurred. Participants reported high satisfaction (7/10, 70%; mean 9, SD 1.15 on a 10-point Likert scale; median 9, IQR 8.5-10.0; range 7-10), and qualitative data (8/10, 80%) suggested that they valued the immersive virtual representation of their eating disorder voice. Exploratory analyses indicated improvements in eating disorder symptoms (Hedges g=−0.99, 95% CI −1.74 to −0.24; P=.01), power dynamics associated with the eating disorder voice (Hedges g=−1.63, 95% CI −2.59 to −0.67; P=.002), and emotion regulation via cognitive reappraisal (Hedges g=0.87, 95% CI 0.08-1.66; P=.04). Conclusions: The VR-based avatar intervention for eating disorders was feasible, acceptable, and safe, with preliminary signals of clinical improvement. These findings support further development and evaluation of the intervention in a randomized clinical trial.

Objective: The International Classification of Diseases (ICD) was recently updated to an 11th edition, introducing significant changes to the diagnostic criteria for Anorexia Nervosa (AN). Little is known about how these updated criteria impact diagnostic classification in previously diagnosed populations. This study aims to examine how a Danish youth sample previously diagnosed with ICD-10 AN or Atypical AN (atypAN) would classify under ICD-11 criteria, including the application of the new subtype specifier. Furthermore, it investigates how ICD-11 diagnoses and subtypes relate to ED symptom severity compared to ICD-10 diagnoses. Methods: a prior ICD-10 AN and atypAN sample (N = 895) was reclassified under ICD-11 criteria, categorising those not meeting AN criteria as OSFED. AN cases were subtyped into Restrictive (AN-R) or Binge-Purge (AN-BP). Multiple linear models examined associations between 1) ICD-10 diagnoses; 2) ICD-11 diagnoses; and 3) AN subtypes, and EDE scores, while controlling for age and sex. Results: ICD-11 reclassification led to all ICD-10 AN and 127 atypAN cases meeting AN criteria. Only ICD-11 diagnosis was significantly associated with ED symptom severity, with AN showing greater severity than OSFED. AN-BP exhibited greater severity than AN-R. Discussion: ICD-11 increased number of full-threshold diagnoses and may thus aid in providing adequate treatment, and findings supported the subtyping introduced in ICD-11. However, a substantial amount of prior atypAN cases were not captured in ICD-11 diagnostic criteria.

Research has established that borderline personality disorder (BPD) can be diagnosed before the age of 18. However, many clinicians are apprehensive about using the diagnosis and treating BPD in adolescence. Specialized treatments have been developed and evaluated for BPD in adolescence. Mentalization-based therapy (MBT) is one of these. However, long-term follow-up studies are lacking, and the potential effects of getting the BPD diagnosis and treatment in adolescence are not yet well understood. We set out to explore the experiences of MBT group treatment for BPD five years later. The aim was to understand how they experienced the treatment and how it may have influenced them since. Twelve women aged 19–23 were included in the study. The women had participated in a randomized controlled trial investigating group MBT five years earlier. Qualitative data was collected through semi-structured interviews. The data were analyzed using a narrative, phenomenological framework by an interdisciplinary research group. The results showed a common narrative consisting of four themes: (1) patients without influence, (2) the process of getting diagnosed in adolescence, (3) group therapy: dynamics & alliance, and (4) frustration & alternative coping strategies. The four themes were intertwined by two cross-cutting themes: (1) the system, (2) the life outside. The results showed that the BPD diagnosis had impacts on the participants’ identity and self-understanding. Feeling like a patient without influence made the participants unwilling to seek help from mental health services later in life. The MBT group treatment was generally experienced as unhelpful due to a range of treatment specific-, common- and systemic factors. The participants developed maladaptive coping strategies to deal with serious mental health problems to stay out of touch with the mental health services.

Objective: Inpatient treatment aimed at weight restoration and psychiatric stabilization is often required for individuals with anorexia nervosa (AN). This study aimed to identify distinct trajectories of change in body mass index (BMI) and depressive symptoms during inpatient treatment, examine clinical predictors and outcomes, and test reciprocal associations between BMI and depressive symptom changes. Method: Weekly BMI and depressive symptom data were collected from 156 inpatients with AN (mean treatment duration = 11.6 weeks). Growth mixture modeling identified trajectory classes. Baseline clinical variables were examined as predictors, and discharge outcomes were compared across classes. A joint Bayesian growth model was used to examine longitudinal associations between BMI and depressive symptoms. Results: Three BMI trajectories were identified: steady increase (58.3%; higher baseline BMI with consistent gains), gradual weight gain (28.9%; low baseline BMI with steady gains), and rapid response (12.8%; low baseline BMI with early rapid gain followed by slowing or decline). Two depressive symptom trajectories emerged: severe‐stable and moderate‐improving. The severe‐stable group was predicted by higher trauma‐related comorbidity (OR 11.11, p = 0.009) and eating psychopathology (OR 3.23, p < 0.001). Depressive symptom class was associated with initial BMI but not BMI change, while BMI classes predicted the curvature of depressive symptom trajectories. No credible week‐to‐week associations emerged between BMI and depressive symptom changes. Discussion: Findings highlight substantial heterogeneity in treatment response. Rapid early weight gain in patients with extremely low BMI and high severity may not indicate sustained improvement. Persistent depressive symptoms, especially in those with trauma histories, underscore the need for trauma‐informed care alongside weight restoration.

Transitioning between mental health services is a vulnerable process that can challenge treatment outcomes. This study explores the experience of moving from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) from the perspective of young people with anorexia nervosa. Qualitative interviews were conducted with three women undergoing this transition, focusing on their motivation, ambivalence and the changing role of the family. The data were analysed using interpretative phenomenological analysis. Four themes emerged: Sudden shift of responsibility; relational needs unmet during transitioning; the changing role of the family; and transitioning to treatment with peers. The findings highlight two novel aspects of this process: the lasting impact of family‐based treatment on parental involvement and the dual role of peer treatment as both maintaining and motivating. Trial Registration: ClinicalTrials.gov identifier: NCT05956366

Children of parents with eating disorders (EDs) are at greater risk of developing an ED, likely due to an interplay of genetic and environmental factors. The familial high-risk (FHR) study design offers a valuable framework for studying development of EDs in individuals at increased risk over time. The study aimed to (1) to explore mothers’ with EDs perspectives on the intergenerational transmission of EDs and (2) to explore mothers’ with EDs perspective on FHR research related to EDs. Three focus group interviews were conducted in October and November 2023 with a total of eight mothers with a current ED, comprising groups of two, three, and three participants, respectively. All participants had a child of at least five years. Data were analyzed using thematic framework analysis. The first theme focused on navigating motherhood with an ED including experiences and reflections on how having an ED can impact children and had the subtheme: Communicating with children about EDs. The second theme was advancing prevention and early detection of EDs incorporating the promising impact of research on early detection of EDs and targeted preventive interventions and had two subthemes: Protecting children’s emotional well-being and willingness to participate in research. Overall, mothers with EDs were deeply concerned about intergenerational transmission and the implications of disclosing their ED to their children, yet they remained highly motivated to participate in prevention research, offering valuable insights into how to engage families more effectively in ED research.

BACKGROUND There is a growing interest in developing novel psychological interventions for eating disorders, with an emphasis on targeting maintaining factors. One hypothesized mechanism underlying illness maintenance is the experience of an “inner eating disorder voice,” which reinforces maladaptive thoughts, emotions, and behaviors. Preliminary studies suggest that the eating disorder voice is common among patients and is linked to greater illness severity. OBJECTIVE This single-arm, mixed methods pilot feasibility study aimed to evaluate a novel virtual reality (VR)–based therapy targeting the eating disorder voice. The intervention was adapted from AVATAR therapy for psychosis and was examined as an adjunct to treatment as usual in individuals with eating disorders. In this adaptation, participants engaged with a therapist-controlled avatar representing their inner eating disorder voice in VR. The primary objectives were to assess the feasibility, acceptability, and safety of the intervention and to provide preliminary estimates of its clinical efficacy. METHODS Adults with anorexia nervosa (9/10, 90%) or bulimia nervosa (1/10, 10%) took part in a 7-session VR-based therapy course at the Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark, alongside their treatment as usual. Quantitative measures of feasibility (recruitment, retention rates, and satisfaction scores), safety, and eating disorder–related outcomes were collected at baseline and after treatment between June 2023 and January 2024. Qualitative interviews conducted after the intervention (October 2023 to November 2023) explored participants’ experiences. Descriptive statistics, paired t tests, and thematic analysis were conducted, and the analyses were finalized in October 2025. RESULTS Recruitment targets were met: 14 individuals were referred, and 11 provided consent well within the prespecified time frame. Treatment completion rate was 80% (8/10; 95% CI 44%-97%), and no serious adverse events occurred. Participants reported high satisfaction (7/10, 70%; mean 9, SD 1.15 on a 10-point Likert scale; median 9, IQR 8.5-10.0; range 7-10), and qualitative data (8/10, 80%) suggested that they valued the immersive virtual representation of their eating disorder voice. Exploratory analyses indicated improvements in eating disorder symptoms (Hedges g=−0.99, 95% CI −1.74 to −0.24; P=.01), power dynamics associated with the eating disorder voice (Hedges g=−1.63, 95% CI −2.59 to −0.67; P=.002), and emotion regulation via cognitive reappraisal (Hedges g=0.87, 95% CI 0.08-1.66; P=.04). CONCLUSIONS The VR-based avatar intervention for eating disorders was feasible, acceptable, and safe, with preliminary signals of clinical improvement. These findings support further development and evaluation of the intervention in a randomized clinical trial.

Identifying the mechanisms of change in first-line cognitive behavioral therapy (CBT) protocols for adult anxiety and depression could enhance outcomes for the individual. We explored (a) the effect of four group CBT protocols on general emotion regulation skills, (b) the effect of specific emotion regulation skills on next-session symptom outcomes, and (c) the potential differences in these outcomes across the included protocols. This secondary analysis used data from the TRACT-RCT trial investigating the relative efficacy of 14 sessions of transdiagnostic versus disorder-specific CBT group protocols for adult anxiety or depression (n = 291). We assessed the relative changes in general emotion regulation skills measured with the Emotion Regulation Skills Questionnaire at the end of treatment using multilevel modeling. We used cross-lagged panel modeling to test if changes in the use of five specific emotion regulation skills predicted changes in symptoms in the subsequent sessions, adjusting for depression/anxiety symptoms in the previous two sessions. Symptoms were assessed with the Overall Anxiety Severity and Impairment Scale and the Overall Depression Severity and Impairment Scale. Participants' general emotion regulation skills increased in the included CBT protocols, F(2, 767.1) = 32.59, p < .001. We found a significant cross-lagged effect of the emotion exposure skill on next-session symptoms (coefficient = -.25, 95% CI [-0.43, -0.07], p = .005). The effects were similar across CBT protocols. This study used a rigorous methodology to identify emotion exposure as a relevant transdiagnostic and transtheoretical treatment outcome and a potential mechanism of change across group CBT protocols for adult anxiety and depression. (PsycInfo Database Record (c) 2025 APA, all rights reserved).