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Comparing Operationalizations of Eating Disorder Recovery Using a Comprehensive Lens: Physical, Behavioral, and

Anna M Bardone-Cone1, Hunna J Watson2,3,4, Emily C Walsh1

  • 1Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

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|October 22, 2025
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Summary
This summary is machine-generated.

Defining eating disorder (ED) recovery is crucial for research. This study identified a standardized operationalization combining physical, behavioral, and cognitive criteria, showing high stability and low relapse rates for ED recovery.

Keywords:
behavioralcognitiveeating disorderphysicalrecovery

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Eating Disorder Research

Background:

  • Standardized definitions of recovery are essential for advancing eating disorder (ED) treatment outcome research.
  • Current research lacks a universally accepted operationalization of ED recovery, hindering comparative analysis and progress.

Purpose of the Study:

  • To identify the most empirically supported operationalization of ED recovery by examining combinations of physical, behavioral, and cognitive recovery criteria.
  • To assess the concurrent and predictive validity of different ED recovery definitions.

Main Methods:

  • A cohort of 223 females with a history of ED and 105 controls were assessed at baseline and 1-year follow-up.
  • Physical recovery criteria included BMI ≥ 18.5 kg/m² or ≥ 19 kg/m².
  • Behavioral recovery involved no binge eating, purging, or fasting in the past 3 or 6 months.
  • Cognitive recovery was assessed using EDE-Q subscale or global scores within 1 SD of norms.

Main Results:

  • Operationalizations of ED recovery demonstrated high similarity.
  • Recovery rates showed significant stability over time, ranging from 77% to 86%.
  • Relapse rates were consistently low, between 7% and 15%.

Conclusions:

  • A proposed standardized operationalization for ED recovery in research includes BMI ≥ 18.5 or 19 kg/m² (physical), no disordered behaviors in the past 3 months (behavioral), and cognitive criteria met via EDE-Q subscale scores within 1 SD of norms.
  • This definition integrates physical, behavioral, and cognitive domains for a holistic assessment of recovery.
  • The findings support a robust and stable definition of ED recovery for research applications.