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

A standardized definition of recovery would advance treatment outcome research. This study examined combinations of different physical, behavioral, and cognitive recovery criteria to identify the operationalization of eating disorder (ED) recovery with the most empirical support based on concurrent and predictive validity.

Participants included 223 females with a history of an ED and 105 age-matched female controls who completed questionnaires, interviews, and weight/height measurements at baseline and ~1-year follow-up. To examine different comprehensive operationalizations of recovery, we considered two approaches to assessing each of the following domains of recovery: physical (BMI ≥ 18.5 kg/m²; BMI ≥ 19 kg/m²), behavioral (no binge eating, purging, or fasting in the past 3 months; none of these ED behaviors in the past 6 months), and cognitive (all four EDE-Q subscale scores within 1 SD of age- and gender-matched norms; Global EDE-Q scores within 1 SD of norms). Allowing for all possible combinations across these domains yielded eight operationalizations of comprehensive ED recovery to test.

Results showed that operationalizations were more similar than different, with high rates of stability in recovery (77%-86%) and low relapse rates (7%-15%) over time.

Based on the holistic consideration of the patterns of findings, we propose using BMI ≥ 18.5 or 19 kg/m² (physical recovery), no binge eating, purging, or fasting over the past 3 months (behavioral recovery), and all four EDE-Q subscale scores within 1 SD of age- and gender-matched norms (cognitive recovery) as a standardized operationalization of recovery for research purposes.