Anorexia nervosa is the most severe eating disorder; it has a protracted course of illness and the highest mortality rate among all psychiatric illnesses. It is characterised by a restriction of energy intake followed by substantial weight loss, which can culminate in cachexia and related medical consequences. Anorexia nervosa is associated with high personal and economic costs for sufferers, their relatives and society. Evidence-based practice guidelines aim to support all groups involved in the care of patients with anorexia nervosa by providing them with scientifically sound recommendations regarding diagnosis and treatment. The German S3-guideline for eating disorders has been recently revised. In this paper, the new guideline is presented and changes, in comparison with the original guideline published in 2011, are discussed. Further, the German guideline is compared to current international evidence-based guidelines for eating disorders. Many of the treatment recommendations made in the revised German guideline are consistent with existing international treatment guidelines. Although the available evidence has significantly improved in quality and amount since the original German guideline publication in 2011, further research investigating eating disorders in general, and specifically anorexia nervosa, is still needed.

Background/Objectives: The primary aim of this study was to characterize athletes approaching an outpatient interdisciplinary and multidisciplinary consultation structure for athletes with a suspected relative energy deficiency in sport (REDs) cross-sectionally and longitudinally to prove treatment efficacy. Methods: Data of 58 athletes suspected of REDs were collected at the onset (t₀) and completion (t₁) of interdisciplinary and multidisciplinary REDs treatment (clinical practice) between January 2019 and December 2022. The data included extracted information from medical records, anthropometric characteristics, physical performance diagnostics, laboratory values, dietary records, and partially gynecological and psychosomatic diagnostics. Results: The sample primarily consisted of female athletes (97%) under 18 years of age (66%) who were underweight with a body mass index (BMI) < 18.5 kg/m² and BMI percentile below the 10th percentile for their age and gender-specific norms (59%), and experienced menstrual disorders (93%). The dietary behavior is characterized by plant-based and low-energy-dense foods. Eating disorders (anorexia nervosa and bulimia nervosa) were diagnosed in 40% of the athletes according to the International Statistical Classification of Diseases and Related Health Problems 11th revision criteria. During the program, 64% of the athletes exhibited a mean weight gain of 7 (±6) kg (p < 0.001), excluding those still undergoing treatment (36%). Conclusions: The proposed interdisciplinary and multidisciplinary treatment approach proved effective and holds promise for future evidence-based developments in REDs treatment.

Zusammenfassung: Ziel der Studie Verhaltenssüchte treten in der Regel mit komorbiden psychischen Störungen auf und werden immer noch unterdiagnostiziert. Ziel dieser multizentrischen Querschnittsuntersuchung war es, die geschätzte Punktprävalenz von Verhaltenssüchten bei konsekutiven Patient*innen, die wegen anderer Diagnosen in der Psychosomatik behandelt wurden, zu erheben. Methodik An der Studie nahmen 801 Patient*innen aus acht psychosomatischen Universitätskliniken teil. Die Erfassung von Verhaltenssüchten erfolgte anhand standardisierter Fragebögen. Ergebnisse Bei 24,1% der Patient*innen ergab sich der Verdacht auf mindestens eine Verhaltenssucht. Der überwiegende Teil dieser Patient*innen beschrieb Symptome einer isolierten Verhaltenssucht. Basierend auf den Fragebögen wurden folgende Prävalenzraten geschätzt: Störung durch Glücksspielen 3,4%, pathologische Internetnutzung 1,9%, pathologisches Kaufen 16,7%, hypersexuelle Störung 5,4% und suchtartiges Sporttreiben 3,5%. Hinweise auf einen Zentrumseffekt oder Einfluss des Settings (ambulant, tagesklinisch, stationär) waren nicht erkennbar. Diskussion Die vorliegende klinische Stichprobe deutet auf eine hohe Verbreitung von Kaufsuchtsymptomen bei Patient*innen in psychosomatisch-psychotherapeutischer Behandlung hin. Von Kaufsucht sind insbesondere Frauen betroffen. Demgegenüber leiden Männer eher an Glücksspiel- und Sexsucht. Insgesamt ergibt sich eine hohe Belastung durch Verhaltenssuchtsymptome. Bis dato werden Verhaltenssüchte häufig noch unterdiagnostiziert. Schlussfolgerung Patient*innen in psychosomatischer-psychotherapeutischer Versorgung leiden häufig unter Symptomen einer Verhaltenssucht, was in der Behandlung berücksichtigt werden sollte.

Standardised treatment manuals facilitate therapy planning and enhance comparability for research purposes. Within the Anorexia Nervosa Treatment of Out Patients (ANTOP) study, the largest multisite outpatient intervention trial in anorexia nervosa (AN) to date, manualised enhanced cognitive-behavioural therapy (CBT-E) was offered as one treatment modality. The manual consisted of 9 modules, of which Motivation, Nutrition, Formulation and Relapse Prevention were compulsory. Homework worksheets were provided, to ensure the transfer of therapeutic improvements to daily life. This study investigated the use of modules and worksheets in order to explore practice styles of trained therapists in the treatment of AN. This secondary analysis was based on log-sheets (n = 2604) CBT-E therapists completed after each session. Frequencies of modules and worksheets used across all sessions were calculated. Relationships, such as that between use of module and duration of illness, were examined. The most commonly used module was Motivation. In patients with longer illness duration, the module Self Esteem seemed to be particularly important. The worksheet Scales, balancing the pros and cons of AN, was prioritised by therapists. The results underline the importance of motivational work in the treatment of AN, including validating the ambivalence experienced by most AN patients. With increasing duration of illness, resource-oriented elements, such as self esteem stabilisation, should be of focus.

The treatment of patients with anorexia nervosa (AN) is often challenging, due to a high degree of ambivalence towards recovery and weight gain these patients often express. One part of the multimodal treatment is the utilization of treatment contracts (i.e., contingency contracts) that aim to motivate patients to gain weight by applying positive and negative consequences for the (non-)achievement of weight goals. The main aim of this study is to assess and analyze current standards of contingency contracts’ utilization in German eating disorder centers. n = 76 mental health professionals of twelve specialized university centers in Germany that are currently or were formerly treating patients with AN in an inpatient setting participated. Most experts use contingency contracts in their clinic with weekly weight goals ranging between 500 and 700 g. Overall effectiveness and significance of contingency contracts for the inpatient treatment of patients with AN was rated high. Typical characteristics of a contingency contract in specialized German university hospital centers, such as the most frequent consequences, are described. The survey results assist the planning of further studies aiming to improve the multimodal treatment of patients with AN. For clinical practice, using external motivators such as contingency contracts as well as targeting internal motivation (e.g., by using motivational interviewing) is proposed.