Digital tools may make eating-disorder care easier to reach—but therapists do not see them as a replacement for treatment. Their strongest support is for carefully targeted tools added to an existing therapeutic relationship. Digital mental health interventions, or DMHIs, are becoming increasingly important for mental health care, but in eating disorders they are still in early stages.

Few studies so far investigated the views of mental health professionals for eating disorders on integrating DMHIs into routine care. The evidence regarding DMHIs for eating disorders remains limited. One review identified twelve randomized controlled trials, with interventions both with and without therapist support.

Another review covered thirty-six randomized controlled trials, but only eight targeted treatment; both reviews reported low study quality, high drop-out rates, and inconsistent intervention acceptability. The app market was also growing: one review selected twenty-eight apps, while another study found sixty-five apps in twenty twenty-one, and only seven percent had been scientifically evaluated.

Little is known about clinical experts’ views on applying DMHIs to eating disorders, and only one study had focused on German stakeholders’ perspectives on online interventions. In that study, only fourteen point six percent of professionals had personal experience with DMHIs for eating disorders, less than half had looked into an application, and nearly thirty percent had never heard of them.

In-depth insights into risks, implementation barriers, expectations, and potential advantages were still missing or scarce. The study aimed to understand mental health professionals’ experiences, perspectives, and expectations regarding DMHIs for eating disorders.

It asked how much professionals already used DMHIs, which advantages they saw, what disadvantages and risks they perceived, and what requirements might support integration into routine care. Clinical experts for eating disorders throughout Germany, from inpatient clinics, outpatient clinics, and private practices, took part in thirty- to sixty-minute semi-structured telephone interviews.

Participants were identified both conveniently through author contacts and purposively through an internet search, and informed consent was given electronically and confirmed by telephone. The interview guide covered previous digital-service experience, advantages, disadvantages, framework conditions, prerequisites, and expectations for an ideal DMHI.

The interviews also explained the broad meaning of DMHI and gave examples including email or chat counseling, video conferencing, mobile apps, fitness bracelets, online programs, and virtual reality. Table one summarizes the twenty-four mental health professionals in the study and their demographic and clinical backgrounds.

Most participants were female, with twenty-two, and psychology was the most common professional background, with fourteen; the table also reports institution type, professional status, clinical orientation, and patient group. Because multiple clinical orientations were possible, those percentages are not intended to sum to one hundred, providing important context for interpreting the interview findings.

The analysis used deductive-inductive content analysis, combining best practices from two coding techniques. The majority of codes were generated from the material, while aspects such as advantages or risks were assigned according to the interview guide.

The codes were organized into main codes and subcodes, and two trained psychologists compared results, refined the coding structure, and agreed on joint definitions through several iterations. The decision on thematic saturation was made when all codes and subcodes covered the meaning of the data.

Table two lays out the authors’ coding system for analyzing interviews about digital mental health interventions, or DMHIs. It organizes statements into nine main codes, spanning initial situations and attitudes, societal conditions, experiences, advantages, disadvantages, desired functions, target groups, and general requirements, with detailed subcodes under each.

This matters because the study used deductive–inductive content analysis, allowing codes to come both from the interview material and from questions such as advantages or risks; statements could also receive multiple codes. Advantages of DMHIs were categorized for patients and healthcare provision, with a few advantages also mentioned for relatives.

Many participants viewed DMHIs as an easily accessible, low-threshold first contact with mental healthcare for patients from remote areas or without medical treatment. Because many patients feel shame or fear stigma, a DMHI might be a first step toward support or eating-disorder-related healthcare, and digital psychoeducation was seen as beneficial.

All participants were aware of risks and limitations of DMHIs for eating disorders, grouped as disadvantages for patients and healthcare provision. Patient disadvantages included data-security issues, lacking personalization, and the possibility that DMHIs might not be adequate or sufficient help.

Some participants even perceived a danger that the disorder itself might worsen. When asked for an ideal DMHI for their patients, all participants expressed ideas and wishes, grouped around the design of the DMHI and its respective medium.

A prevalent view was that there would never be a one-size-fits-all digital solution for individuals affected by eating disorders. Functionalities that might support all kinds of eating disorders included meal records, meal planning, skills training, and planning of activities.

The appropriate assignment of eating-disorder-specific tools should depend on age, motivation to change, exact diagnosis, and comorbidities. Activity planning might suggest sports and motion for patients with bulimia nervosa and binge eating disorder, while patients with anorexia nervosa should rather be encouraged to reduce excessive exercise and workouts.

One main requirement was an appropriate setting for DMHIs, and nearly all participants expressed concerns about unguided self-management. As an adjunct to ongoing inpatient or outpatient treatment, however, professionals saw many benefits, including meal records or daily mood tracking during inpatient psychotherapy.

Outpatient services could benefit from homework, journal keeping, protocols, and psychoeducation modules. Single in-person sessions could be replaced by online sessions as long as a good therapeutic alliance had been established beforehand. Mental health professionals saw the greatest potential in digitally enhanced outpatient care, with DMHIs used as an adjunct to conventional psychotherapy.

DMHIs were assumed to be useful as soon as a positive therapeutic alliance had been established, and clinicians viewed that alliance as a facilitator for integrating DMHIs into routine care. The Dutch program Look at your eating, or Etendebaas, found that therapeutic alliance was predictive for pathology and treatment completion.

Outpatient clinicians were reported to promote adherence more effectively than hospital clinicians because of their long-lasting relationships with patients. The main prerequisite for integrating DMHIs into conventional healthcare was defining the most suitable care settings: outpatient treatment, daycare, and aftercare.

A blended care concept combines face-to-face psychotherapy with internet-based support from a DMHI, while stepped care can integrate DMHIs early or follow conventional treatment with a DMHI to stabilize treatment success. Randomized controlled designs on aftercare showed improvements, but these remained statistically not significant for the main outcome of eating-disorder symptomatology at follow-up.

Patients with eating disorders appreciated using a DMHI after discharge and showed high adherence, while stepped care supported by DMHIs reached a high level of acceptability among mental health professionals. Legal, financial, and technical barriers also had to be considered, including accountability, data protection, reimbursement, spatial resources, and devices for therapists.

The study was limited to the healthcare system in Germany, so international comparisons remained limited. DMHIs were defined broadly to include mobile apps, virtual reality interventions, and online programs, and the qualitative approach could not systematically examine specific facilitators and barriers for every intervention and eating-disorder type.

As a consequence, factors such as barriers to mobile apps for bulimia nervosa or virtual reality for anorexia nervosa may have been overlooked. Because technology is rapidly developing and becoming more specific, future research should focus on single technologies, their specific barriers and facilitators, and the whole diagnostic spectrum of eating disorders.

The professionals were positive about digital mental health interventions, especially alongside outpatient care and aftercare, but stressed that therapeutic alliance, clinical risk, personalization, and implementation barriers determine whether they can work in routine care.