Priority 4 from the Eating Disorders (Netherlands) PSP

UNCERTAINTY: What is the most effective treatment (and order of treatment) for patients with an eating disorder and a co-morbid disorder? (JLA PSP Priority 4)
Overall ranking	4
JLA question ID	0039/4
Explanatory note	Most patients with an eating disorder also have co-morbid disorders (affective disorder, PTSD, OCD, etc.). What to treat first, the eating disorder or the co-morbid disorder, or to treat both integrally, has never been tested in a clinical trial.
Evidence	Huke V, Turk J, Saeidi S, Kent A, Morgan JF. Autism spectrum disorders in eating disorder populations: a systematic REVIEW. Eur Eat Disord Rev 2013; 21(5):345-351.
Health Research Classification System category	Mental Health

Extra information provided by this PSP
Original uncertainty examples	Why is there almost no treatment for patients with an eating disorder and comorbid disorder in the Netherlands? I see my eating disorder as a symptom, but for all specialized treatment (PTSD, Personality problems, etc.) require a minimal weight. This results in many years running in circles making it a hopeless and desperate mission. An eating disorder is a coping strategy due to a comorbid disorder. At least to me. I understand that severe underweight has priority, but the underlying problems are the cause. why isn’t it possible to treat both an eating disorder and comorbid disorder like trauma?
Submitted by	Clinician x 12, Patients x 19, Carers x 1

Extra information provided by this PSP

Original uncertainty examples

Why is there almost no treatment for patients with an eating disorder and comorbid disorder in the Netherlands? I see my eating disorder as a symptom, but for all specialized treatment (PTSD, Personality problems, etc.) require a minimal weight. This results in many years running in circles making it a hopeless and desperate mission. An eating disorder is a coping strategy due to a comorbid disorder. At least to me. I understand that severe underweight has priority, but the underlying problems are the cause. why isn’t it possible to treat both an eating disorder and comorbid disorder like trauma?

Submitted by

Clinician x 12, Patients x 19, Carers x 1

PSP information
PSP unique ID	0039
PSP name	Eating Disorders (Netherlands)
Total number of uncertainties identified by this PSP	77
Date of priority setting workshop	3 June 2016