Children and young people with anorexia nervosa (AN) are often recommended family-based treatment as the first-line intervention (Gorrell et al., 2019). The child who has struggled to eat – limiting their intake, counting calories, adhering to rigid rules about food – is now re-fed by their parents and has the control over food taken away from them in efforts to restore their physical health. The parents who may have previously transitioned away from being responsible for their child’s intake, are now empowered by the treatment team to take back that responsibility to nourish the child.
This dynamic has good overall success in supporting young people to restore weight and regain health, though is not always effective (Stewart & Baumann, 2026). For children and young people who continue to struggle with independence in eating and restrictive behaviours as they age, there is an inevitable point at which family-based treatment is no longer the recommended intervention in their young adulthood.
This transition period, when an individual shifts from family-based treatment within Child and Adolescent Mental Health Services (CAMHS) to interventions aimed at treating adults within Adult Mental Health Services (AMHS), is a precarious time. Yet not much is known about how this period is experienced by service users or how we might improve it.
As such, Harboe and colleagues (2025) conducted a qualitative study to better understand how young people with anorexia experience the transition from CAMHS to adult services.
For young people with anorexia who continue to struggle into adulthood, the transition from CAMHS to AMHS can prove challenging and was the focus of a recent qualitative study.
Methods
The present study is a part of the VIBUS study (Bentz et al., 2021). Participants were patients who had been engaged in family-based treatment at a government-funded CAMHS in Denmark and had transitioned to a government-funded AMHS for treatment of AN by the age of 18.
Of the 22 eligible participants, only three agreed to the hour-long semi-structured interview focusing on the overall experience of treatment across the two services, the role of family during treatment, and motivational factors and ambivalence during treatment. These three participants were all 20 years old at the time of the interview, with two experiencing the onset of their eating disorder in late adolescence, and one experiencing onset in preadolescence. Once in AMHS, two participants had treatment focused on weight restoration (one inpatient), and one participant had outpatient treatment focused on readiness and motivation.
Interviews were transcribed then analysed using interpretative phenomenological analysis (IPA).
Results
Four overarching themes were identified, with differences in how the three participants experienced these changes.
Theme 1: Sudden shift of responsibility
While all three participants experienced a sudden shift in how they were treated between CAMHS and AMHS, two of the participants felt unprepared for and overwhelmed by this change. For many with eating disorders, taking responsibility for properly nourishing oneself can be a difficult transition after leaving a higher level of care where food is portioned and provided by others. However, for these individuals, the shift in responsibility to eat occurred during the transition from CAMHS to AMHS and added a layer of complexity and difficulty to this phase of their treatment.
In contrast, one participant experienced this shift in responsibility as relieving and motivating, as she felt like she was finally being taken seriously and had a choice. Such findings highlight individual differences in readiness for responsibility and the ways that can affect one’s emotional experience of treatment transition.
Theme 2: Relational needs unmet during transition
All three participants described challenges getting their relational needs met during the transition. For some, this challenge was experienced during their time receiving family-based treatment in CAMHS, when they felt their perspectives about treatment and difficulties experienced with weight restoration were not appreciated. In family-based treatment, the focus can be on arming parents with the confidence and knowledge necessary to refeed their children and this may shift some focus away from the designated patient. On the other hand, the experience of starting with new clinicians in AMHS was also perceived as isolating, and all three participants reported feeling uncertain and alone during the transition.
Theme 3: The changing role of the family
Two participants described family-based treatment as having significantly strained relationships with their families, so much so that they excluded them from treatment once they had transitioned to AMHS.
On the other hand, one participant experienced a gradual decline in her family’s involvement in treatment while still in CAMHS, which allowed for the change in the role of the family in treatment to be experienced as less abrupt and as a natural next step.
Theme 4: Transitioning to treatment with peers
For two participants, the experience of engaging in treatment with peers with anorexia initially led to unhealthy urges to compete with peers to have a worse eating disorder. These two participants also highlighted difficulties relating to adult peers that were older than them and had a longer duration of illness.
In contrast, the other participant found comparisons between herself and peers to increase her own motivation to further her recovery, highlighting the importance of illness severity when considering whether the effects of treatment with peers for AN is harmful or helpful. Two of the participants also found that, over time, relationships with peers grew and became more supportive.
Four themes emerged in qualitative analysis of the patients’ interviews, focusing on sudden shifts in responsibility, relational needs being unmet during service transition, the changing role of the family, and treatment with peers.
Conclusions
This qualitative study examined the experiences of three young people when transitioning from family-based treatment in CAMHS to adult treatment in AMHS for anorexia, all of which reveal the importance of individual factors, such as readiness for responsibility and illness severity, in how changes in treatment approaches are experienced and whether such factors are motivating or destabilising.
Individual differences in readiness for responsibility and illness severity are important to consider when anticipating what challenges may emerge during the transition from CAMHS to AMHS for anorexia.
Strengths and limitations
The authors’ aims, study design, and analytic strategy for interpreting qualitative interview data were rigorous and appropriate. Little is known about the shift from CAMHS to AMHS and this study was among the first to begin answering this question in the context of anorexia nervosa (AN), which will be useful for future research and practice.
However, a major limitation of this study was its sample size of only three participants. While a small, homogenous group of participants is appropriate for IPA as it focuses on depth rather than generalisability, it is noteworthy that for many of the themes, two of the participants reported similar experiences whereas the third participant differed. This brings into question how homogeneous the sample actually was, and whether efforts should have been made to increase the sample size and use a different analytic method, like reflexive thematic analysis, which is also focused on meaning-making but can handle more variety.
Relatedly, 19 eligible participants did not agree to be interviewed, increasing concerns for self-selection bias and the possibility that the results are reflective of the characteristics of those who were interested in participating. As such, there is limited representation of different perspectives in this study, making it difficult to transfer the findings to other, similar contexts. That said, the findings are still interesting and provide a starting point for further research on this topic.
Additionally, as noted by the authors, because only the perspective of the patient is included, the study is limited in contextual information from caregivers and providers involved in family-based treatment. Hearing about the experiences of other stakeholders involved in treatment could further improve our understanding of the transition process and ways in which it may be improved. Likewise, the authors noted that, due to lack of access to patient files, they could not fully characterise the sample or provide information about their treatment courses, further limiting interpretability of the findings.
Although the aim to understand the transition from CAMHS to AMHS in young people with anorexia is admirable, the small sample size and concerns about self-selection bias limit the generalisability of the findings.
Implications for practice
Prior research has shown that, in general, many young people tend to drop out of treatment after reaching the upper age limit of CAMHS (Appleton et al., 2019). For those who do continue with treatment in AMHS, the transition can present with many emotional and logistical barriers, including overcoming service gaps where certain populations are better served in CAMHS (Adanijo & Bird, 2025; Hill et al., 2019). The present study further examined how this transition is experienced by patients with anorexia nervosa (AN) whose transition also includes shifting from family-based treatment to treatments among adult peers.
Although much more research is needed before changes or improvements to services can be recommended, these initial findings suggest that the transition between CAMHS and AMHS for treating AN is a difficult period for an already vulnerable population. Maturity level, symptom severity, and readiness for increased autonomy and responsibility may affect how an individual weathers this transition period, empowering some while overwhelming others. It is important for clinicians to consider individual readiness when shifting from family-based treatment to an approach developed for adults, and to support patients during this transition period. Examples of potentially supportive approaches to take could be preparing an individual for an upcoming transition months in advance, gradually increasing autonomy in treatment and with eating, and providing transition sessions that help bridge the gap between treatment (Garland et al., 2019).
Likewise, parents may go from being heavily involved in treatment to being uninvolved or excluded from treatment based on patient preference. As is the patient’s right to choose who is involved in their treatment, the sudden shift in family involvement could impact both the recovery from an eating disorder and relationships between family members. Such changes in family dynamics may be useful to discuss in treatment with a patient to consider how these shifting roles are experienced by those involved.
Finally, this study also indicated that increased comparisons to peers are likely when a patient enters eating disorder treatment tailored to adults. Such comparisons may influence motivation positively or negatively depending on the individual, which is consistent with prior research suggesting both harmful and beneficial factors associated with peer influence on treatment in this population. Consequently, it may be helpful to discuss whether and how such comparisons are experienced by a given patient to mitigate harmful effects or enhance motivation.
While more research is needed to better understand this transition period, it seems important that this process is clearly discussed with patients while they are still in CAMHS, including consideration for changing family dynamics and heightened responsibility.
Statement of interests
Alexandra Allam reports financial support from NIMH (MH096679) but declares no conflicts of interest.
Edited by
Dr Nina Higson-Sweeney.
Links
Primary paper
Sofie Harboe, Emma Byskov, Mette Bentz, Anne Bryde, Stig Poulsen, & Signe Holm Pedersen (2026). Transitioning between treatment for eating disorders in adolescent and adult mental health services: The role of family and motivation. Journal of Family Therapy, 48(1), e70009. https://doi.org/10.1111/1467-6427.70009
Other references
Adanijo, A., & Bird, J. C. (2025). Young people’s experiences of transition from child and adolescent mental health services to adult mental health services: A qualitative study. Journal of Child & Adolescent Mental Health, 1-12. https://doi.org/10.2989/17280583.2025.2533162
Bentz, M., Pedersen, S. H., Moslet, U., Petersen, N., & Pagsberg, A. K. (2025). Predictors of response to family-based treatment for anorexia nervosa in youth: insights from the VIBUS project. European Child & Adolescent Psychiatry, 1-20. https://doi.org/10.1007/s00787-025-02766-x
Garland, B. H., Caldwell, K. L., Acosta, A. B., Wiemann, C. M., Gonzales, S. A., & Wolfe, R. S. (2019). Clinical considerations for emerging adults with eating disorders and transition to adult-based care. Evidence-Based Practice in Child and Adolescent Mental Health, 4(2), 187-201. https://doi.org/10.1080/23794925.2018.1504637
Gorrell, S., Loeb, K. L., & Le Grange, D. (2019). Family-based treatment of eating disorders: A narrative review. The Psychiatric Clinics of North America, 42(2), 193. https://doi.org/10.1016/j.psc.2019.01.004
Hill, A., Wilde, S., & Tickle, A. (2019). Transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS): a meta‐synthesis of parental and professional perspectives. Child and Adolescent Mental Health, 24(4), 295-306. https://doi.org/10.1111/camh.12339
Stewart, M. P., & Baumann, O. (2026). The effectiveness of adolescent-focused therapy and family-based therapy for anorexia nervosa. Psychological Reports, 129(1), 7-28. https://doi.org/10.1177/00332941241226687
