Insights from the 2022 ESCAP Research Academy Workshop
Imagine a room filled with some of the brightest young minds in child and adolescent psychiatry, gathered from across Europe and beyond, all united by a common goal: to advance our understanding of complex eating disorders.
From 12 different countries collaborating in Maastricht
Exclusive concentration on eating disorders research
Addressing misconceptions through rigorous research
Eating disorders represent some of the most severe mental illnesses characterized by dysfunctional eating behaviors and distorted body image 2 . They can sometimes be fatal, and are associated with distressing thoughts and emotions that severely affect physical, psychological, and social functioning 2 .
For children and adolescents, eating disorders pose particular challenges due to their early onset, developmental complexity, and frequent psychiatric comorbidities 8 . The clinical features of these disorders involve not only disordered eating behaviors but also a range of psychological and physical manifestations that impact overall health and well-being 8 .
| Disorder | Key Features | Prevalence in Young People | Physical Health Consequences |
|---|---|---|---|
| Anorexia Nervosa | Restrictive eating, intense fear of weight gain, distorted body image | 1-4% among young women 2 | Bone density loss, stunted growth, cardiovascular issues 8 |
| Bulimia Nervosa | Binge eating followed by compensatory behaviors | 1-2% 2 | Electrolyte imbalances, gastrointestinal issues, dental erosion 8 |
| Binge Eating Disorder | Binge eating without compensatory behaviors | 1-2% 2 | Increased risk of obesity, metabolic syndrome 8 |
Janet Treasure from London proposed "Compare and contrast rather than transdiagnostic as the new paradigm for aetiological models of eating disorders" 1 4 .
This approach suggests that instead of looking for common factors across all eating disorders (a transdiagnostic approach), researchers might gain more insight by directly comparing and contrasting different disorders to identify their unique underlying mechanisms.
Johannes Hebebrand from Duisburg-Essen presented on "Anorexia nervosa viewed as an aberrant adaptation to starvation: Implications for treatment" 1 4 .
This provocative perspective reframes AN not simply as a psychological disorder but as a maladaptive evolutionary adaptation to food scarcity. This model helps explain why treatment remains challenging - the brain may be interpreting starvation as a "successful" state rather than a pathological one.
Esther Via Virgili from Barcelona presented on "Neural correlates of eating disorders," highlighting how advances in neuroscience are revealing the brain mechanisms underlying these conditions 1 4 . Modern neuroimaging techniques have identified abnormal patterns in brain regions responsible for reward processing, impulse control, and body image perception 2 .
| Biological System | Research Findings | Potential Clinical Implications |
|---|---|---|
| Neuroendocrine | Suppression of hypothalamic-pituitary-gonadal axis 2 | Delayed puberty, reproductive issues |
| Immune Function | Altered inflammation markers, microglia activation 2 | New anti-inflammatory treatment approaches |
| Brain Structure | Reduced astrocyte density, altered neural correlates 2 | Neuromodulation therapies |
| Genetic Factors | Significant heritability, especially in AN 2 | Personalized treatment based on genetic profile |
Perhaps one of the most promising discussions revolved around the gut microbiota-brain axis disturbance as a core pathology of eating disorders 2 .
The hypothesis suggests that alterations in the gut microbiota caused by malnutrition could be an early step in the pathogenesis of AN, opening up potential avenues for intervention through microbiome restoration 2 .
The final part of the workshop was structured around group work by the Fellows, supervised by mentors, focusing on the finalisation of the FAiCAP (First Assessment in Child and Adolescent Psychiatry) study 1 . The launch of this ambitious project had been interrupted by the COVID-19 pandemic, making the Maastricht session particularly important for revitalizing the initiative.
The FAiCAP study aims to achieve two primary objectives:
The international composition of the research team - with Fellows from 12 different countries including Albania, Austria, Belgium, France, Germany, Hungary, Lebanon, Netherlands, Serbia, Spain, Sweden, and Turkey - ensures that the findings will have broad applicability across different cultural contexts 1 .
The FAiCAP study represents a crucial step forward in standardizing and improving the initial assessment of eating disorders across Europe. By understanding current practices and their effectiveness, the research team hopes to establish best practices that can reduce the time between symptom onset and effective intervention.
| Study Dimension | Current Status Across Europe | Desired Outcome |
|---|---|---|
| Assessment Duration | Variable across countries and centers | Standardized optimal timeframe |
| Diagnostic Tools | Diverse instruments with varying validation | Consensus on core assessment battery |
| Family Involvement | Inconsistent inclusion of family perspectives | Guidelines for family-centered assessment |
| Cultural Adaptation | Limited systematic adaptation | Culturally sensitive assessment framework |
| Comorbidity Evaluation | Varying attention to co-occurring conditions | Integrated approach to complex diagnoses |
Modern eating disorder research employs a diverse array of methodological approaches and tools to unravel the complexity of these conditions. The 2022 ESCAP Research Academy highlighted several key methods that are advancing our understanding and treatment of eating disorders.
Genetic studies have revealed that AN shows significant heritability, with family studies demonstrating a substantial prevalence of AN in first-degree relatives of a proband, who are about 11 times more likely to develop AN than controls 2 .
Genome-wide association studies have further shown that metabolic factors play a key role in AN, challenging purely psychological explanations of the disorder 2 .
Neuroimaging techniques allow researchers to examine the neural correlates of eating disorders, identifying abnormalities in brain structure and function that underlie symptoms 1 2 .
These methods have revealed alterations in brain regions responsible for reward processing, body image perception, and impulse control.
Animal models, particularly the activity-based anorexia (ABA) model in rodents, have provided important insights into the neurobiology of anorexia 2 .
These models have demonstrated that ABA reduces cortical astrocyte density, suggesting that astrocyte loss and subsequent neuroinflammation may be involved in the neurobiology of anorexia 2 .
Standardized assessment tools have been developed specifically for pediatric populations, improving early detection and diagnosis 8 .
These psychometric instruments are essential for identifying eating disorders in young people who may have difficulty articulating their distress or body image concerns.
The research presented at the workshop also highlighted several novel treatment approaches currently under investigation. These include interventions targeting glial cells, which have been suggested as potential therapeutic targets for AN based on evidence from mouse models 2 . Other approaches focus on neurotransmitters such as dopamine and serotonin, which play important roles in regulating appetite and food intake 2 .
The 2022 ESCAP Research Academy Workshop in Maastricht served as a powerful reminder of the importance of collaborative science in addressing complex health challenges like eating disorders. By bringing together promising young Fellows with established experts in the field, the workshop created a dynamic environment where new ideas could flourish and innovative research projects could take shape 1 .
As Professor Hebebrand concluded the meeting, he proposed that the Fellows reflect on a future European collaborative project on eating disorders 1 . This forward-looking perspective ensures that the momentum generated in Maastricht will continue to drive progress in the field long after the workshop's conclusion.
For the millions of young people worldwide affected by eating disorders, the work of the ESCAP Research Academy offers genuine hope. Through continued research, international collaboration, and the development of evidence-based assessment and treatment protocols, we move closer to a future where eating disorders are identified early, treated effectively, and perhaps even prevented altogether.
| Area of Focus | Traditional View | New Perspective |
|---|---|---|
| Etiology of AN | Purely psychological disorder | Aberrant adaptation to starvation 1 |
| Research Approach | Transdiagnostic models | Compare and contrast framework 1 |
| Assessment | Variable practices across Europe | Standardized protocols (FAiCAP) 1 |
| Treatment Targets | Primarily psychological | Neurobiological systems (glia, neurotransmitters) 2 |
| Scope | Individual research projects | Large-scale European collaboration 1 |
The terraces of Maastricht, which facilitated so many meaningful conversations between Fellows and mentors, symbolize the open exchange of ideas that is essential for scientific progress 1 . As these young clinician-scientists return to their home countries, they carry with them new perspectives, new collaborations, and a renewed commitment to addressing one of the most challenging mental health conditions affecting young people today.