Mentalization-based treatment for eating disorders: a systematic review and narrative synthesis

Abstract Background Mentalization-based treatment (MBT) targets difficulties in reflective functioning, emotion regulation and interpersonal relationships, which may contribute to the development and maintenance of eating disorders (EDs). This systematic review synthesised the available quantitative evidence on the outcomes of MBT or MBT-informed interventions for people with EDs. Methods A protocol was prospectively registered with PROSPERO (CRD42024421136) and the review was conducted in accordance with PRISMA guidelines. Bibliographic databases, trial registries, grey-literature sources and Google Scholar were searched from inception to 1 July 2026. Forward and backward citation chaining was conducted. Eligible studies included quantitative, longitudinal studies reporting outcomes of MBT or MBT-informed treatment in children, adolescents, or adults with a diagnosed ED. Two reviewers independently conducted each stage of study selection, data extraction, and risk of bias assessment. Findings were synthesised narratively because clinical and methodological heterogeneity precluded meta-analysis. Results Seven reports described 326 reported enrolments of participants with EDs; two reports may have included overlapping clinical samples. The evidence comprised three randomised controlled trials, two quasi-experimental studies, and two prospective observational studies. Samples were small and diagnostically heterogeneous, and interventions varied in format and duration. Although within-group improvements in ED symptoms and broader psychological functioning were frequently reported, comparative studies did not demonstrate consistent superiority of MBT over comparator interventions. All randomised studies raised some concerns about risk of bias, and all non-randomised studies were judged to have a critical risk of bias overall. Conclusions Evidence for MBT and MBT-informed interventions in EDs remains preliminary and is insufficient to establish comparative effectiveness or sustained benefit. Future research should use adequately powered, methodologically rigorous studies to clarify which people are most likely to benefit from MBT, in which clinical contexts, and through which mechanisms. PROSPERO registration CRD42024421136