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Eating Disorders Clinical and Research Program

The mission of the Eating Disorders Clinical and Research Program is to provide the highest quality patient care, clinical research, professional training and public education about eating disorders.

Explore This Treatment Program

Clinical Program

The Eating Disorders Clinical and Research Program (EDCRP) at Massachusetts General Hospital provides outpatient evaluation and treatment for adults, adolescents and children ages ten and up with feeding and eating disorders.

Multidisciplinary Coordination of Care

In order to provide optimal care for our patients, we deliver mental health treatment within a multidisciplinary team. We have found that patient interests are best served when primary care and mental health clinicians practice within the same hospital system and can communicate easily with one another about treatment progress and planning.

We offer a detailed diagnostic evaluation with each new patient who is seeking to begin treatment for an eating disorder or related concerns. This comprehensive evaluation will:

  • Evaluate current and past eating disorder symptoms
  • Review previous psychiatric care
  • Identify immediate and long-term medical concerns
  • Formulate a treatment plan based on current evidence-based approaches

We give patients immediate feedback on the recommended treatment plan.

Treatment Options

The Eating Disorders Clinical and Research Program (EDCRP) provides comprehensive evaluation and a variety of outpatient treatment options for individuals ages ten and up struggling with eating disorders from compassionate and knowledgeable leaders in the field.

Our treatments have been shown to be effective in large-scale research studies to give you the best chance of symptom improvement. Our clinicians will recommend the treatment best matched to your individual needs.

Cognitive Behavioral Therapy for Eating Disorders

Cognitive behavioral therapy (CBT) is based on the premise that many of the psychological features of eating disorders are actually caused by under-eating—regardless of whether you are underweight, overweight or anywhere in between. CBT is designed to help you understand how all of your eating disorder symptoms fit together and then identify strategies for targeting each one. By recording your food intake, you can identify your own unique triggers for engaging in eating disorder behaviors such as restricting, binge eating or purging. If the scale or mirror dictates how you feel about yourself, CBT can help you improve your body image and identify alternate sources of self-esteem. Later sessions focus on relapse prevention so you feel properly equipped to handle setbacks.

CBT is designed to last 20 sessions over six months.

To learn more about CBT, read Overcoming Binge Eating by Christopher Fairburn.

Cognitive Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder

We also offer a new CBT program for individuals with avoidant/restrictive food intake disorder (CBT-AR) ages ten and up. CBT-AR developed here at Mass General focuses on normalizing eating, increasing macronutrient intake via food intake rather than dietary supplements and (if needed) restoring weight and growth. CBT-AR also targets the maintaining mechanisms of avoidant/restrictive eating, including sensory sensitivities, lack of interest in eating and/or fear of aversive consequences of eating (e.g., vomiting or choking) using exposure-based techniques.

CBT-AR can be delivered in an individual or family-supported format depending on patient age and treatment goals. CBT-AR is designed to last 20-30 sessions over 6-12 months.

CBT for Rumination Disorder

We offer brief CBT for rumination disorder (CBT-RD) for both children and adults. CBT-RD is designed to last five to eight sessions and involves general CBT techniques tailored specifically for RD. Primary interventions include psychoeducation and self-monitoring to enhance patient awareness of regurgitation timing and triggers, diaphragmatic breathing as a habit reversal strategy, patient-specific strategies for reducing residual regurgitation episodes and relapse prevention.

Family-Based Treatment for Eating Disorders

For underweight children, adolescents and young adults, family-based treatment (FBT) empowers parents to take charge of normalizing their child’s eating. Rather than focusing solely on the patient, the therapist meets with the entire family (including both parents and siblings) to mobilize them to fight back against the eating disorder. FBT features specialized coaching deigned to absolve parents of blame, separate the child from the illness and help parents re-nourish their child at home.

Later sessions gradually transition eating opportunities back to the adolescent and help the adolescent return to the developmentally appropriate task of growing up—from which he or she has typically been derailed by the eating disorder.

FBT is a time-limited treatment designed to last 20 sessions over the course of 6-12 months.

To learn more about FBT, read Help Your Teen Beat an Eating Disorder by James Lock and Daniel Le Grange.

Guided Self-Help for Binge Eating Disorder

Guided self-help (GSH) based on CBT is an excellent option for adults who struggle with recurrent binge eating. In GSH, you will access tools to break the binge-eating cycle by collaboratively working through the workbook Overcoming Binge Eating with an EDCRP clinician. Key components include self-monitoring, identifying binge triggers, eliminating harmful dieting, enhancing body image and preventing relapse.

GSH is designed to last ten 25-minute sessions over the course of four months.

Group Treatment for Eating Disorders

Some individuals find group therapy helpful, either instead of or in addition to individual or family-based treatment. We currently offer both CBT and dialectical behavioral therapy (DBT) groups for binge eating and purging. These 10-week skills-based groups are appropriate for adults (18 and up) seeking therapist and peer support to reduce bingeing and/or purging behaviors.

The group runs three to four times per year.

Pharmacotherapy

If needed, we also offer medication treatment in combination with therapy. Although medications are not a standalone cure against eating disorders, they can improve treatment response and help prevent future relapses. Eating disorders are often diagnosed along with other psychiatric conditions, which can be effectively managed with medication. We approach each case with a personalized plan based on the individual’s needs, backed by cutting-edge expertise in psychopharmacology.

Higher Levels of Care

Some individuals find that they are not able to beat their eating disorder through outpatient support alone. To learn more about treatment options, see these medical guidelines from the Academy for Eating Disorders.

While the EDCRP is an outpatient program, we often collaborate with our Harvard Medical School affiliates that offer high levels of care for eating disorders including:

Appointments at the EDCRP

In order to be seen for a diagnostic evaluation, you MUST have a primary care physical at Mass General. Exceptions are made only for individuals interested in receiving treatment through a research study. If you have already established care with a primary care provider at Mass General, we may be able to provide ongoing care. However, we currently have a waiting list of several months, and our ability to follow patients depends on the capacity of our clinicians.

Please Note: We are an exclusively outpatient service. Our experience has taught us that some patients will benefit from either a partial hospitalization program or inpatient care to address urgent medical and nutritional issues prior to outpatient care in our program in order to achieve their therapeutic goals.

We are happy to provide feedback about the recommended clinical setting for initiating care in the pre-appointment screening.

Team Approach and Specialty Services

Our patients with an eating disorder often encounter medical problems and nutritional concerns that benefit from specialty care. We focus on treating the individual with a team approach, identifying appropriate clinical services to coordinate care.

Research

Our research efforts have been supported by the National Institutes of Health, the Rubenstein Foundation, the Hilda and Preston Davis Foundation, the Klarman Family Foundation and other generous patrons. We have cultivated research collaborations with national and international leaders in the eating disorder field within the United States, United Kingdom, Hong Kong and Fiji.

Because a comprehensive diagnostic system is critical for etiological inquiry, clinical communication, case detection and treatment planning, our classification research explores how eating disorder categories can be improved by refining specific diagnostic criteria or adding new diagnoses. Our ongoing classification studies are done in partnership with investigators in the Mass General Neuroendocrine Unit. This work focuses on neurobiological, endocrine and genetic underpinnings of these disorders.

Studies Open to Enrollment

REACT: Restrictive Eating and Athlete Cognition Trial

Research has shown that females with eating disorders have lower levels of estrogen, leading to irregular or missed periods. Estrogen is involved in mental flexibility and reward responsiveness. This study aims to investigate whether replacing estrogen levels in young females with restrictive eating and/or athletes who have irregular periods will improve mental flexibility and reward responsiveness.

The CARE Study: Children and Adolescents with Avoidant/Restrictive Eating

We are recruiting healthy young people between the ages of 10-17 years (males and females) who do not have “picky” or restrictive eating for the CARE (Children and Adolescents with Avoidant/Restrictive Eating) study. This study examines the hormones and regions in the brain involved in emotion, fear, and sensory processing using brain imaging techniques (fMRI) and serial blood draws in individuals with eating difficulties in comparison to healthy volunteers.

Learn more about ARFID in this recent news story from WCVB Boston: "Is your 'picky eater' actually struggling with an eating disorder?"

Additional Research: Genetic and Neuroendocrine Studies

In addition to our diagnostic classification studies, EDCRP and Neuroendocrine Unit studies aim to understand and treat osteopenia and osteoporosis, which are common consequences of anorexia nervosa and other low weight eating disorders. This research endeavors to develop and test novel hormonal treatments for anorexia nervosa and the common comorbid symptoms of depression and anxiety.

Hormonal Factors in the Treatment of Anorexia Nervosa
Principal Investigator: Anne Klibanski, MD
Funded by: National Institute of Mental Health
Closed to enrollment

Effects of Anorexia Nervosa on Peak Bone Mass
Principal Investigator: Anne Klibanski, MD
Funded by: National Institute of Diabetes and Digestive and Kidney Diseases
Closed to enrollment

IGF-I and Bone Loss in Women with Anorexia Nervosa
Principal Investigator: Anne Klibanski, MD
Funded by: National Institute of Diabetes and Digestive and Kidney Diseases
Closed to enrollment

Genetics and Neurobiology of Food Motivation Pathways in Anorexia Nervosa
Principal Investigator: Elizabeth A. Lawson, MD
Funded by: National Institute of Mental Health, Claflin Fellowship, Behavior Research Foundation NARSAD Young Investigator award
Closed to enrollment

Fat Mediated Modulation of Reproductive and Endocrine Function in Young Athletes
Principal Investigator: Madhu Misra, MD, MPH
Funded by: National Institute of Child Health and Human Development
Closed to enrollment

Recently Completed Projects

Field Trial of DSM-5 Feeding and Eating Disorders
This study was conducted in three clinical settings: the Klarman Eating Disorders Center, the Mass General Weight Center, and the Mass General Pediatric Gastrointestinal Unit. The DSM-5 Feeding and Eating Disorders Work Group has used our findings, among others, to support modification of current criteria and the addition of newly discovered syndromes to the diagnostic nomenclature, including purging disorder, avoidant/restrictive food intake disorder and night eating syndrome.

Mass General Longitudinal Study
This study mapped the course and outcome of eating disorders, addressing a central question posed by many patients and their families: “What will I be like in 5, 10, or 25 years?” We followed 246 women with anorexia nervosa and bulimia nervosa from 1987 to gather interview data about eating attitudes and behaviors, mood disorders, substance use, health, work and relationships. To date, the work has generated over 40 published articles about eating disorders, on topics such as recovery and relapse, longitudinal diagnostic crossover, alcohol and substance use, depression, pregnancy and medical complications. This study gives us the opportunity to investigate the long-term course and outcome of these illnesses, to understand mechanisms of recovery and the predictors of both wellness and poor outcome and to better describe the definition of full recovery.

 


Teen Mentor Program

This program offers adolescent girls the opportunity to learn to promote positive self-image. Participants participate in mentoring workshops and an educational curriculum that covers topics from culture and media to self-esteem which supports the prevention of eating disorders and fosters positive self-image. We accept nominations of high school students who demonstrate leadership and have an interest in promoting wellness and positive body image awareness each fall.


Eating Disorder Resources

Professional Training & Education

The Eating Disorders Clinical and Research Program is committed to providing educational resources for individuals, families and the wider community with the tools they need to recognize, understand, and help others struggling with disordered eating. We help trainees cultivate expertise in empirically supported treatments and clinical research techniques. We also provide clinical consultation and off-site workshops to practitioners outside of Mass General.

Clinical Training

Mass General Internship in Clinical Psychology
Our clinical faculty provides supervision for several psychology interns per year in cognitive-behavioral therapy for eating disorders. Interns may arrange for 6-month or 12-month clinical electives and can receive training in both individual and group psychotherapy. Mentorship, supervision and case mix will be selected to create a foundation in evidence-based treatment for diagnostically diverse and complex patients.

Mass General/McLean Adult Psychiatry Residency
The PGY III Psychopharmacology of Eating Disorders module provides didactic training and supervision on pharmacologic management of eating disorders. PGY IV residents may also arrange for 6-month or 12-month clinical electives at the EDCRP. Mentorship, supervision and case mix will be selected to create a foundation in psychotherapeutic and pharmacologic management of diagnostically diverse and complex patients.

Multidisciplinary Eating Disorders Case Conference
A one-hour team clinician-to-clinician consultation is available as a pro bono service to clinicians managing challenging cases within the metro-Boston community. Clinicians are asked to present their cases at a clinical case conference and are provided with team feedback. These one-time consultations focus on topics such as optimizing communication within multidisciplinary teams, selecting the optimal level of care for a specific patient and engaging a patient who is ambivalent about relinquishing valued symptoms.

Off-Site Evidence-Based Treatment Workshops
The EDCRP is dedicated to the dissemination of empirically supported treatments to interested real-world practitioners. Our faculty members have led interactive workshops on the use of cognitive-behavioral therapy and family-based treatment for eating disorders locally, regionally and nationally.

To inquire about faculty availability and fee structure, please call 617-726-8470.

Research Training

Please note: Per hospital-wide policy, we cannot offer unpaid research assistantships. With the exception of the Summer Research Fellowships, students who wish to work with us must first arrange to earn course credit from their undergraduate or graduate institution.

Mass General/McLean Adult Psychiatry Residency and Mass General Internship in Clinical Psychology
Residents and interns who wish to undertake clinical research in eating disorders are invited to contact program faculty to discuss their interests and possible mentorship opportunities. A 6- to 12-month commitment is required.

Summer Research Fellowships

Each summer, the EDCRP mentors emerging scientists and students, giving them the resources and guidance they need to undertake an eight-week independent research project.  

Pioneering Psychiatry Research

The integration of patient care and clinical research has been a hallmark of the Department of Psychiatry for more than 30 years. Today, the department has the largest clinical research program in the hospital, with studies at the forefront of neuroscience, molecular biology and genetics.