a critical review of a research paper

How to Write Critical Reviews

When you are asked to write a critical review of a book or article, you will need to identify, summarize, and evaluate the ideas and information the author has presented. In other words, you will be examining another person’s thoughts on a topic from your point of view.

Your stand must go beyond your “gut reaction” to the work and be based on your knowledge (readings, lecture, experience) of the topic as well as on factors such as criteria stated in your assignment or discussed by you and your instructor.

Make your stand clear at the beginning of your review, in your evaluations of specific parts, and in your concluding commentary.

Remember that your goal should be to make a few key points about the book or article, not to discuss everything the author writes.

Understanding the Assignment

To write a good critical review, you will have to engage in the mental processes of analyzing (taking apart) the work–deciding what its major components are and determining how these parts (i.e., paragraphs, sections, or chapters) contribute to the work as a whole.

Analyzing the work will help you focus on how and why the author makes certain points and prevent you from merely summarizing what the author says. Assuming the role of an analytical reader will also help you to determine whether or not the author fulfills the stated purpose of the book or article and enhances your understanding or knowledge of a particular topic.

Be sure to read your assignment thoroughly before you read the article or book. Your instructor may have included specific guidelines for you to follow. Keeping these guidelines in mind as you read the article or book can really help you write your paper!

Also, note where the work connects with what you’ve studied in the course. You can make the most efficient use of your reading and notetaking time if you are an active reader; that is, keep relevant questions in mind and jot down page numbers as well as your responses to ideas that appear to be significant as you read.

Please note: The length of your introduction and overview, the number of points you choose to review, and the length of your conclusion should be proportionate to the page limit stated in your assignment and should reflect the complexity of the material being reviewed as well as the expectations of your reader.

Write the introduction

Below are a few guidelines to help you write the introduction to your critical review.

Introduce your review appropriately

Begin your review with an introduction appropriate to your assignment.

If your assignment asks you to review only one book and not to use outside sources, your introduction will focus on identifying the author, the title, the main topic or issue presented in the book, and the author’s purpose in writing the book.

If your assignment asks you to review the book as it relates to issues or themes discussed in the course, or to review two or more books on the same topic, your introduction must also encompass those expectations.

Explain relationships

For example, before you can review two books on a topic, you must explain to your reader in your introduction how they are related to one another.

Within this shared context (or under this “umbrella”) you can then review comparable aspects of both books, pointing out where the authors agree and differ.

In other words, the more complicated your assignment is, the more your introduction must accomplish.

Finally, the introduction to a book review is always the place for you to establish your position as the reviewer (your thesis about the author’s thesis).

As you write, consider the following questions:

• Is the book a memoir, a treatise, a collection of facts, an extended argument, etc.? Is the article a documentary, a write-up of primary research, a position paper, etc.?
• Who is the author? What does the preface or foreword tell you about the author’s purpose, background, and credentials? What is the author’s approach to the topic (as a journalist? a historian? a researcher?)?
• What is the main topic or problem addressed? How does the work relate to a discipline, to a profession, to a particular audience, or to other works on the topic?
• What is your critical evaluation of the work (your thesis)? Why have you taken that position? What criteria are you basing your position on?

Provide an overview

In your introduction, you will also want to provide an overview. An overview supplies your reader with certain general information not appropriate for including in the introduction but necessary to understanding the body of the review.

Generally, an overview describes your book’s division into chapters, sections, or points of discussion. An overview may also include background information about the topic, about your stand, or about the criteria you will use for evaluation.

The overview and the introduction work together to provide a comprehensive beginning for (a “springboard” into) your review.

• What are the author’s basic premises? What issues are raised, or what themes emerge? What situation (i.e., racism on college campuses) provides a basis for the author’s assertions?
• How informed is my reader? What background information is relevant to the entire book and should be placed here rather than in a body paragraph?

Write the body

The body is the center of your paper, where you draw out your main arguments. Below are some guidelines to help you write it.

Organize using a logical plan

Organize the body of your review according to a logical plan. Here are two options:

• First, summarize, in a series of paragraphs, those major points from the book that you plan to discuss; incorporating each major point into a topic sentence for a paragraph is an effective organizational strategy. Second, discuss and evaluate these points in a following group of paragraphs. (There are two dangers lurking in this pattern–you may allot too many paragraphs to summary and too few to evaluation, or you may re-summarize too many points from the book in your evaluation section.)
• Alternatively, you can summarize and evaluate the major points you have chosen from the book in a point-by-point schema. That means you will discuss and evaluate point one within the same paragraph (or in several if the point is significant and warrants extended discussion) before you summarize and evaluate point two, point three, etc., moving in a logical sequence from point to point to point. Here again, it is effective to use the topic sentence of each paragraph to identify the point from the book that you plan to summarize or evaluate.

Questions to keep in mind as you write

With either organizational pattern, consider the following questions:

• What are the author’s most important points? How do these relate to one another? (Make relationships clear by using transitions: “In contrast,” an equally strong argument,” “moreover,” “a final conclusion,” etc.).
• What types of evidence or information does the author present to support his or her points? Is this evidence convincing, controversial, factual, one-sided, etc.? (Consider the use of primary historical material, case studies, narratives, recent scientific findings, statistics.)
• Where does the author do a good job of conveying factual material as well as personal perspective? Where does the author fail to do so? If solutions to a problem are offered, are they believable, misguided, or promising?
• Which parts of the work (particular arguments, descriptions, chapters, etc.) are most effective and which parts are least effective? Why?
• Where (if at all) does the author convey personal prejudice, support illogical relationships, or present evidence out of its appropriate context?

Keep your opinions distinct and cite your sources

Remember, as you discuss the author’s major points, be sure to distinguish consistently between the author’s opinions and your own.

Keep the summary portions of your discussion concise, remembering that your task as a reviewer is to re-see the author’s work, not to re-tell it.

And, importantly, if you refer to ideas from other books and articles or from lecture and course materials, always document your sources, or else you might wander into the realm of plagiarism.

Include only that material which has relevance for your review and use direct quotations sparingly. The Writing Center has other handouts to help you paraphrase text and introduce quotations.

Write the conclusion

You will want to use the conclusion to state your overall critical evaluation.

You have already discussed the major points the author makes, examined how the author supports arguments, and evaluated the quality or effectiveness of specific aspects of the book or article.

Now you must make an evaluation of the work as a whole, determining such things as whether or not the author achieves the stated or implied purpose and if the work makes a significant contribution to an existing body of knowledge.

Consider the following questions:

• Is the work appropriately subjective or objective according to the author’s purpose?
• How well does the work maintain its stated or implied focus? Does the author present extraneous material? Does the author exclude or ignore relevant information?
• How well has the author achieved the overall purpose of the book or article? What contribution does the work make to an existing body of knowledge or to a specific group of readers? Can you justify the use of this work in a particular course?
• What is the most important final comment you wish to make about the book or article? Do you have any suggestions for the direction of future research in the area? What has reading this work done for you or demonstrated to you?

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Writing Critical Reviews

What is a Critical Review of a Journal Article?

A critical review of a journal article evaluates the strengths and weaknesses of an article's ideas and content. It provides description, analysis and interpretation that allow readers to assess the article's value.

Before You Read the Article

• What does the title lead you to expect about the article?
• Study any sub-headings to understand how the author organized the content.
• Read the abstract for a summary of the author's arguments.
• Study the list of references to determine what research contributed to the author's arguments. Are the references recent? Do they represent important work in the field?
• If possible, read about the author to learn what authority he or she has to write about the subject.
• Consult Web of Science to see if other writers have cited the author's work. (Please see 'How to use E-Indexes'.) Has the author made an important contribution to the field of study?

Reading the Article: Points to Consider

Read the article carefully. Record your impressions and note sections suitable for quoting.

• Who is the intended audience?
• What is the author's purpose? To survey and summarize research on a topic? To present an argument that builds on past research? To refute another writer's argument?
• Does the author define important terms?
• Is the information in the article fact or opinion? (Facts can be verified, while opinions arise from interpretations of facts.) Does the information seem well-researched or is it unsupported?
• What are the author's central arguments or conclusions? Are they clearly stated? Are they supported by evidence and analysis?
• If the article reports on an experiment or study, does the author clearly outline methodology and the expected result?
• Is the article lacking information or argumentation that you expected to find?
• Is the article organized logically and easy to follow?
• Does the writer's style suit the intended audience? Is the style stilted or unnecessarily complicated?
• Is the author's language objective or charged with emotion and bias?
• If illustrations or charts are used, are they effective in presenting information?

Prepare an Outline

Read over your notes. Choose a statement that expresses the central purpose or thesis of your review. When thinking of a thesis, consider the author's intentions and whether or not you think those intentions were successfully realized. Eliminate all notes that do not relate to your thesis. Organize your remaining points into separate groups such as points about structure, style, or argument. Devise a logical sequence for presenting these ideas. Remember that all of your ideas must support your central thesis.

Write the First Draft

The review should begin with a complete citation of the article. For example:

Platt, Kevin M.F. "History and Despotism, or: Hayden White vs. Ivan the Terrible  and Peter the Great." Rethinking History 3:3 (1999) : 247-269.

NOTE: Use the same bibliographic citation format as you would for any bibliography, works cited or reference list. It will follow a standard documentation style such as MLA or APA.

Be sure to ask your instructor which citation style to use. For frequently used style guides consult Queen's University Library's Citing Sources guide.

The first paragraph may contain:

• a statement of your thesis
• the author's purpose in writing the article
• comments on how the article relates to other work on the same subject
• information about the author's reputation or authority in the field

The body of the review should:

• state your arguments in support of your thesis
• follow the logical development of ideas that you mapped out in your outline
• include quotations from the article which illustrate your main ideas

The concluding paragraph may:

• summarize your review
• restate your thesis

Revise the First Draft

Ideally, you should leave your first draft for a day or two before revising. This allows you to gain a more objective perspective on your ideas. Check for the following when revising:

• grammar and punctuation errors
• organization, logical development and solid support of your thesis
• errors in quotations or in references

You may make major revisions in the organization or content of your review during the revision process. Revising can even lead to a radical change in your central thesis.

NOTE: Prepared by University of Toronto Mississauga Library, Hazel McCallion Academic Learning Centre.

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Additional Resources

Writing a Critical Review (Allyson Skene, The Writing Centre, U of Toronto at Scarborough)

The Book Review or Article Critique (Margaret Procter, Writing Support, University of Toronto)

Critical Reviews of Journal Articles (Herbert Coutts, University of Alberta)

Writing a Critical Review (The Writing Centre, Queen's University)

• Last Updated: Aug 29, 2023 12:23 PM
• Subjects: Multidisciplinary

IOE Writing Centre

• Writing a Critical Review

Writing a Critique

A critique (or critical review) is not to be mistaken for a literature review. A 'critical review', or 'critique', is a complete type of text (or genre), discussing one particular article or book in detail.  In some instances, you may be asked to write a critique of two or three articles (e.g. a comparative critical review). In contrast, a 'literature review', which also needs to be 'critical', is a part of a larger type of text, such as a chapter of your dissertation.

Most importantly: Read your article / book as many times as possible, as this will make the critical review much easier.

1. Read and take notes 2. Organising your writing 3. Summary 4. Evaluation 5. Linguistic features of a critical review 6. Summary language 7. Evaluation language 8. Conclusion language 9. Example extracts from a critical review 10. Further resources

Read and Take Notes

To improve your reading confidence and efficiency, visit our pages on reading.

Further reading: Read Confidently

After you are familiar with the text, make notes on some of the following questions. Choose the questions which seem suitable:

• What kind of article is it (for example does it present data or does it present purely theoretical arguments)?
• What is the main area under discussion?
• What are the main findings?
• What are the stated limitations?
• Where does the author's data and evidence come from? Are they appropriate / sufficient?
• What are the main issues raised by the author?
• What questions are raised?
• How well are these questions addressed?
• What are the major points/interpretations made by the author in terms of the issues raised?
• Is the text balanced? Is it fair / biased?
• Does the author contradict herself?
• How does all this relate to other literature on this topic?
• How does all this relate to your own experience, ideas and views?
• What else has this author written? Do these build / complement this text?
• (Optional) Has anyone else reviewed this article? What did they say? Do I agree with them?

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Organising your writing

You first need to summarise the text that you have read. One reason to summarise the text is that the reader may not have read the text. In your summary, you will

• focus on points within the article that you think are interesting
• summarise the author(s) main ideas or argument
• explain how these ideas / argument have been constructed. (For example, is the author basing her arguments on data that they have collected? Are the main ideas / argument purely theoretical?)

In your summary you might answer the following questions:     Why is this topic important?     Where can this text be located? For example, does it address policy studies?     What other prominent authors also write about this?

Evaluation is the most important part in a critical review.

Use the literature to support your views. You may also use your knowledge of conducting research, and your own experience. Evaluation can be explicit or implicit.

Explicit evaluation

Explicit evaluation involves stating directly (explicitly) how you intend to evaluate the text. e.g. "I will review this article by focusing on the following questions. First, I will examine the extent to which the authors contribute to current thought on Second Language Acquisition (SLA) pedagogy. After that, I will analyse whether the authors' propositions are feasible within overseas SLA classrooms."

Implicit evaluation

Implicit evaluation is less direct. The following section on Linguistic Features of Writing a Critical Review contains language that evaluates the text. A difficult part of evaluation of a published text (and a professional author) is how to do this as a student. There is nothing wrong with making your position as a student explicit and incorporating it into your evaluation. Examples of how you might do this can be found in the section on Linguistic Features of Writing a Critical Review. You need to remember to locate and analyse the author's argument when you are writing your critical review. For example, you need to locate the authors' view of classroom pedagogy as presented in the book / article and not present a critique of views of classroom pedagogy in general.

Linguistic features of a critical review

The following examples come from published critical reviews. Some of them have been adapted for student use.

Summary language

•     This article / book is divided into two / three parts. First...
•     While the title might suggest...
•     The tone appears to be...
•     Title is the first / second volume in the series Title, edited by...The books / articles in this series address...
•     The second / third claim is based on...
•     The author challenges the notion that...
•     The author tries to find a more middle ground / make more modest claims...
•     The article / book begins with a short historical overview of...
•     Numerous authors have recently suggested that...(see Author, Year; Author, Year). Author would also be once such author. With his / her argument that...
•     To refer to title as a...is not to say that it is...
•     This book / article is aimed at... This intended readership...
•     The author's book / article examines the...To do this, the author first...
•     The author develops / suggests a theoretical / pedagogical model to…
•     This book / article positions itself firmly within the field of...
•     The author in a series of subtle arguments, indicates that he / she...
•     The argument is therefore...
•     The author asks "..."
•     With a purely critical / postmodern take on...
•     Topic, as the author points out, can be viewed as...
•     In this recent contribution to the field of...this British author...
•     As a leading author in the field of...
•     This book / article nicely contributes to the field of...and complements other work by this author...
•     The second / third part of...provides / questions / asks the reader...
•     Title is intended to encourage students / researchers to...
•     The approach taken by the author provides the opportunity to examine...in a qualitative / quantitative research framework that nicely complements...
•     The author notes / claims that state support / a focus on pedagogy / the adoption of...remains vital if...
•     According to Author (Year) teaching towards examinations is not as effective as it is in other areas of the curriculum. This is because, as Author (Year) claims that examinations have undue status within the curriculum.
•     According to Author (Year)…is not as effective in some areas of the curriculum / syllabus as others. Therefore the author believes that this is a reason for some school's…

Evaluation language

•     This argument is not entirely convincing, as...furthermore it commodifies / rationalises the...
•     Over the last five / ten years the view of...has increasingly been viewed as 'complicated' (see Author, Year; Author, Year).
•     However, through trying to integrate...with...the author...
•     There are difficulties with such a position.
•     Inevitably, several crucial questions are left unanswered / glossed over by this insightful / timely / interesting / stimulating book / article. Why should...
•     It might have been more relevant for the author to have written this book / article as...
•     This article / book is not without disappointment from those who would view...as...
•     This chosen framework enlightens / clouds...
•     This analysis intends to be...but falls a little short as...
•     The authors rightly conclude that if...
•     A detailed, well-written and rigorous account of...
•     As a Korean student I feel that this article / book very clearly illustrates...
•     The beginning of...provides an informative overview into...
•     The tables / figures do little to help / greatly help the reader...
•     The reaction by scholars who take a...approach might not be so favourable (e.g. Author, Year).
•     This explanation has a few weaknesses that other researchers have pointed out (see Author, Year; Author, Year). The first is...
•     On the other hand, the author wisely suggests / proposes that...By combining these two dimensions...
•     The author's brief introduction to...may leave the intended reader confused as it fails to properly...
•     Despite my inability to...I was greatly interested in...
•     Even where this reader / I disagree(s), the author's effort to...
•     The author thus combines...with...to argue...which seems quite improbable for a number of reasons. First...
•     Perhaps this aversion to...would explain the author's reluctance to...
•     As a second language student from ...I find it slightly ironic that such an anglo-centric view is...
•     The reader is rewarded with...
•     Less convincing is the broad-sweeping generalisation that...
•     There is no denying the author's subject knowledge nor his / her...
•     The author's prose is dense and littered with unnecessary jargon...
•     The author's critique of...might seem harsh but is well supported within the literature (see Author, Year; Author, Year; Author, Year). Aligning herself with the author, Author (Year) states that...
•     As it stands, the central focus of Title is well / poorly supported by its empirical findings...
•     Given the hesitation to generalise to...the limitation of...does not seem problematic...
•     For instance, the term...is never properly defined and the reader left to guess as to whether...
•     Furthermore, to label...as...inadvertently misguides...
•     In addition, this research proves to be timely / especially significant to... as recent government policy / proposals has / have been enacted to...
•     On this well researched / documented basis the author emphasises / proposes that...
•     Nonetheless, other research / scholarship / data tend to counter / contradict this possible trend / assumption...(see Author, Year; Author, Year).
•     Without entering into detail of the..., it should be stated that Title should be read by...others will see little value in...
•     As experimental conditions were not used in the study the word 'significant' misleads the reader.
•     The article / book becomes repetitious in its assertion that...
•     The thread of the author's argument becomes lost in an overuse of empirical data...
•     Almost every argument presented in the final section is largely derivative, providing little to say about...
•     She / he does not seem to take into consideration; however, that there are fundamental differences in the conditions of…
•     As Author (Year) points out, however, it seems to be necessary to look at…
•     This suggest that having low…does not necessarily indicate that…is ineffective.
•     Therefore, the suggestion made by Author (Year)…is difficult to support.
•     When considering all the data presented…it is not clear that the low scores of some students, indeed, reflects…

Conclusion language

•     Overall this article / book is an analytical look at...which within the field of...is often overlooked.
•     Despite its problems, Title offers valuable theoretical insights / interesting examples / a contribution to pedagogy and a starting point for students / researchers of...with an interest in...
•     This detailed and rigorously argued...
•     This first / second volume / book / article by...with an interest in...is highly informative...

Example extracts from a critical review

Writing critically.

If you have been told your writing is not critical enough, it probably means that your writing treats the knowledge claims as if they are true, well supported, and applicable in the context you are writing about. This may not always be the case.

In these two examples, the extracts refer to the same section of text. In each example, the section that refers to a source has been highlighted in bold. The note below the example then explains how the writer has used the source material.    

There is a strong positive effect on students, both educationally and emotionally, when the instructors try to learn to say students' names without making pronunciation errors (Kiang, 2004).

Use of source material in example a: 

This is a simple paraphrase with no critical comment. It looks like the writer agrees with Kiang. (This is not a good example for critical writing, as the writer has not made any critical comment).        

Kiang (2004) gives various examples to support his claim that "the positive emotional and educational impact on students is clear" (p.210) when instructors try to pronounce students' names in the correct way. He quotes one student, Nguyet, as saying that he "felt surprised and happy" (p.211) when the tutor said his name clearly . The emotional effect claimed by Kiang is illustrated in quotes such as these, although the educational impact is supported more indirectly through the chapter. Overall, he provides more examples of students being negatively affected by incorrect pronunciation, and it is difficult to find examples within the text of a positive educational impact as such.

Use of source material in example b: 

The writer describes Kiang's (2004) claim and the examples which he uses to try to support it. The writer then comments that the examples do not seem balanced and may not be enough to support the claims fully. This is a better example of writing which expresses criticality.

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Further resources

You may also be interested in our page on criticality, which covers criticality in general, and includes more critical reading questions.

Further reading: Read and Write Critically

We recommend that you do not search for other university guidelines on critical reviews. This is because the expectations may be different at other institutions. Ask your tutor for more guidance or examples if you have further questions.

IOE Writing Centre Online

Self-access resources from the Academic Writing Centre at the UCL Institute of Education.

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How to read a paper, critical review

Reading a scientific article is a complex task. The worst way to approach this task is to treat it like the reading of a textbook—reading from title to literature cited, digesting every word along the way without any reflection or criticism.

A critical review (sometimes called a critique, critical commentary, critical appraisal, critical analysis) is a detailed commentary on and critical evaluation of a text. You might carry out a critical review as a stand-alone exercise, or as part of your research and preparation for writing a literature review. The following guidelines are designed to help you critically evaluate a research article.

How to Read a Scientific Article

You should begin by skimming the article to identify its structure and features. As you read, look for the author’s main points.

• Generate questions before, during, and after reading.
• Draw inferences based on your own experiences and knowledge.
• To really improve understanding and recall, take notes as you read.

What is meant by critical and evaluation?

• To be critical does not mean to criticise in an exclusively negative manner.   To be critical of a text means you question the information and opinions in the text, in an attempt to evaluate or judge its worth overall.
• An evaluation is an assessment of the strengths and weaknesses of a text.   This should relate to specific criteria, in the case of a research article.   You have to understand the purpose of each section, and be aware of the type of information and evidence that are needed to make it convincing, before you can judge its overall value to the research article as a whole.

Useful Downloads

• How to read a scientific paper
• How to conduct a critical review

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• Can Med Educ J
• v.12(3); 2021 Jun

Writing, reading, and critiquing reviews

Écrire, lire et revue critique, douglas archibald.

1 University of Ottawa, Ontario, Canada;

Maria Athina Martimianakis

2 University of Toronto, Ontario, Canada

Why reviews matter

What do all authors of the CMEJ have in common? For that matter what do all health professions education scholars have in common? We all engage with literature. When you have an idea or question the first thing you do is find out what has been published on the topic of interest. Literature reviews are foundational to any study. They describe what is known about given topic and lead us to identify a knowledge gap to study. All reviews require authors to be able accurately summarize, synthesize, interpret and even critique the research literature. 1 , 2 In fact, for this editorial we have had to review the literature on reviews . Knowledge and evidence are expanding in our field of health professions education at an ever increasing rate and so to help keep pace, well written reviews are essential. Though reviews may be difficult to write, they will always be read. In this editorial we survey the various forms review articles can take. As well we want to provide authors and reviewers at CMEJ with some guidance and resources to be able write and/or review a review article.

What are the types of reviews conducted in Health Professions Education?

Health professions education attracts scholars from across disciplines and professions. For this reason, there are numerous ways to conduct reviews and it is important to familiarize oneself with these different forms to be able to effectively situate your work and write a compelling rationale for choosing your review methodology. 1 , 2 To do this, authors must contend with an ever-increasing lexicon of review type articles. In 2009 Grant and colleagues conducted a typology of reviews to aid readers makes sense of the different review types, listing fourteen different ways of conducting reviews, not all of which are mutually exclusive. 3 Interestingly, in their typology they did not include narrative reviews which are often used by authors in health professions education. In Table 1 , we offer a short description of three common types of review articles submitted to CMEJ.

Three common types of review articles submitted to CMEJ

More recently, authors such as Greenhalgh 4 have drawn attention to the perceived hierarchy of systematic reviews over scoping and narrative reviews. Like Greenhalgh, 4 we argue that systematic reviews are not to be seen as the gold standard of all reviews. Instead, it is important to align the method of review to what the authors hope to achieve, and pursue the review rigorously, according to the tenets of the chosen review type. Sometimes it is helpful to read part of the literature on your topic before deciding on a methodology for organizing and assessing its usefulness. Importantly, whether you are conducting a review or reading reviews, appreciating the differences between different types of reviews can also help you weigh the author’s interpretation of their findings.

In the next section we summarize some general tips for conducting successful reviews.

How to write and review a review article

In 2016 David Cook wrote an editorial for Medical Education on tips for a great review article. 13 These tips are excellent suggestions for all types of articles you are considering to submit to the CMEJ. First, start with a clear question: focused or more general depending on the type of review you are conducting. Systematic reviews tend to address very focused questions often summarizing the evidence of your topic. Other types of reviews tend to have broader questions and are more exploratory in nature.

Following your question, choose an approach and plan your methods to match your question…just like you would for a research study. Fortunately, there are guidelines for many types of reviews. As Cook points out the most important consideration is to be sure that the methods you follow lead to a defensible answer to your review question. To help you prepare for a defensible answer there are many guides available. For systematic reviews consult PRISMA guidelines ; 13 for scoping reviews PRISMA-ScR ; 14 and SANRA 15 for narrative reviews. It is also important to explain to readers why you have chosen to conduct a review. You may be introducing a new way for addressing an old problem, drawing links across literatures, filling in gaps in our knowledge about a phenomenon or educational practice. Cook refers to this as setting the stage. Linking back to the literature is important. In systematic reviews for example, you must be clear in explaining how your review builds on existing literature and previous reviews. This is your opportunity to be critical. What are the gaps and limitations of previous reviews? So, how will your systematic review resolve the shortcomings of previous work? In other types of reviews, such as narrative reviews, its less about filling a specific knowledge gap, and more about generating new research topic areas, exposing blind spots in our thinking, or making creative new links across issues. Whatever, type of review paper you are working on, the next steps are ones that can be applied to any scholarly writing. Be clear and offer insight. What is your main message? A review is more than just listing studies or referencing literature on your topic. Lead your readers to a convincing message. Provide commentary and interpretation for the studies in your review that will help you to inform your conclusions. For systematic reviews, Cook’s final tip is most likely the most important– report completely. You need to explain all your methods and report enough detail that readers can verify the main findings of each study you review. The most common reasons CMEJ reviewers recommend to decline a review article is because authors do not follow these last tips. In these instances authors do not provide the readers with enough detail to substantiate their interpretations or the message is not clear. Our recommendation for writing a great review is to ensure you have followed the previous tips and to have colleagues read over your paper to ensure you have provided a clear, detailed description and interpretation.

Finally, we leave you with some resources to guide your review writing. 3 , 7 , 8 , 10 , 11 , 16 , 17 We look forward to seeing your future work. One thing is certain, a better appreciation of what different reviews provide to the field will contribute to more purposeful exploration of the literature and better manuscript writing in general.

In this issue we present many interesting and worthwhile papers, two of which are, in fact, reviews.

Major Contributions

A chance for reform: the environmental impact of travel for general surgery residency interviews by Fung et al. 18 estimated the CO 2 emissions associated with traveling for residency position interviews. Due to the high emissions levels (mean 1.82 tonnes per applicant), they called for the consideration of alternative options such as videoconference interviews.

Understanding community family medicine preceptors’ involvement in educational scholarship: perceptions, influencing factors and promising areas for action by Ward and team 19 identified barriers, enablers, and opportunities to grow educational scholarship at community-based teaching sites. They discovered a growing interest in educational scholarship among community-based family medicine preceptors and hope the identification of successful processes will be beneficial for other community-based Family Medicine preceptors.

Exploring the global impact of the COVID-19 pandemic on medical education: an international cross-sectional study of medical learners by Allison Brown and team 20 studied the impact of COVID-19 on medical learners around the world. There were different concerns depending on the levels of training, such as residents’ concerns with career timeline compared to trainees’ concerns with the quality of learning. Overall, the learners negatively perceived the disruption at all levels and geographic regions.

The impact of local health professions education grants: is it worth the investment? by Susan Humphrey-Murto and co-authors 21 considered factors that lead to the publication of studies supported by local medical education grants. They identified several factors associated with publication success, including previous oral or poster presentations. They hope their results will be valuable for Canadian centres with local grant programs.

Exploring the impact of the COVID-19 pandemic on medical learner wellness: a needs assessment for the development of learner wellness interventions by Stephana Cherak and team 22 studied learner-wellness in various training environments disrupted by the pandemic. They reported a negative impact on learner wellness at all stages of training. Their results can benefit the development of future wellness interventions.

Program directors’ reflections on national policy change in medical education: insights on decision-making, accreditation, and the CanMEDS framework by Dore, Bogie, et al. 23 invited program directors to reflect on the introduction of the CanMEDS framework into Canadian postgraduate medical education programs. Their survey revealed that while program directors (PDs) recognized the necessity of the accreditation process, they did not feel they had a voice when the change occurred. The authors concluded that collaborations with PDs would lead to more successful outcomes.

Experiential learning, collaboration and reflection: key ingredients in longitudinal faculty development by Laura Farrell and team 24 stressed several elements for effective longitudinal faculty development (LFD) initiatives. They found that participants benefited from a supportive and collaborative environment while trying to learn a new skill or concept.

Brief Reports

The effect of COVID-19 on medical students’ education and wellbeing: a cross-sectional survey by Stephanie Thibaudeau and team 25 assessed the impact of COVID-19 on medical students. They reported an overall perceived negative impact, including increased depressive symptoms, increased anxiety, and reduced quality of education.

In Do PGY-1 residents in Emergency Medicine have enough experiences in resuscitations and other clinical procedures to meet the requirements of a Competence by Design curriculum? Meshkat and co-authors 26 recorded the number of adult medical resuscitations and clinical procedures completed by PGY1 Fellow of the Royal College of Physicians in Emergency Medicine residents to compare them to the Competence by Design requirements. Their study underscored the importance of monitoring collection against pre-set targets. They concluded that residency program curricula should be regularly reviewed to allow for adequate clinical experiences.

Rehearsal simulation for antenatal consults by Anita Cheng and team 27 studied whether rehearsal simulation for antenatal consults helped residents prepare for difficult conversations with parents expecting complications with their baby before birth. They found that while rehearsal simulation improved residents’ confidence and communication techniques, it did not prepare them for unexpected parent responses.

Review Papers and Meta-Analyses

Peer support programs in the fields of medicine and nursing: a systematic search and narrative review by Haykal and co-authors 28 described and evaluated peer support programs in the medical field published in the literature. They found numerous diverse programs and concluded that including a variety of delivery methods to meet the needs of all participants is a key aspect for future peer-support initiatives.

Towards competency-based medical education in addictions psychiatry: a systematic review by Bahji et al. 6 identified addiction interventions to build competency for psychiatry residents and fellows. They found that current psychiatry entrustable professional activities need to be better identified and evaluated to ensure sustained competence in addictions.

Six ways to get a grip on leveraging the expertise of Instructional Design and Technology professionals by Chen and Kleinheksel 29 provided ways to improve technology implementation by clarifying the role that Instructional Design and Technology professionals can play in technology initiatives and technology-enhanced learning. They concluded that a strong collaboration is to the benefit of both the learners and their future patients.

In his article, Seven ways to get a grip on running a successful promotions process, 30 Simon Field provided guidelines for maximizing opportunities for successful promotion experiences. His seven tips included creating a rubric for both self-assessment of likeliness of success and adjudication by the committee.

Six ways to get a grip on your first health education leadership role by Stasiuk and Scott 31 provided tips for considering a health education leadership position. They advised readers to be intentional and methodical in accepting or rejecting positions.

Re-examining the value proposition for Competency-Based Medical Education by Dagnone and team 32 described the excitement and controversy surrounding the implementation of competency-based medical education (CBME) by Canadian postgraduate training programs. They proposed observing which elements of CBME had a positive impact on various outcomes.

You Should Try This

In their work, Interprofessional culinary education workshops at the University of Saskatchewan, Lieffers et al. 33 described the implementation of interprofessional culinary education workshops that were designed to provide health professions students with an experiential and cooperative learning experience while learning about important topics in nutrition. They reported an enthusiastic response and cooperation among students from different health professional programs.

In their article, Physiotherapist-led musculoskeletal education: an innovative approach to teach medical students musculoskeletal assessment techniques, Boulila and team 34 described the implementation of physiotherapist-led workshops, whether the workshops increased medical students’ musculoskeletal knowledge, and if they increased confidence in assessment techniques.

Instagram as a virtual art display for medical students by Karly Pippitt and team 35 used social media as a platform for showcasing artwork done by first-year medical students. They described this shift to online learning due to COVID-19. Using Instagram was cost-saving and widely accessible. They intend to continue with both online and in-person displays in the future.

Adapting clinical skills volunteer patient recruitment and retention during COVID-19 by Nazerali-Maitland et al. 36 proposed a SLIM-COVID framework as a solution to the problem of dwindling volunteer patients due to COVID-19. Their framework is intended to provide actionable solutions to recruit and engage volunteers in a challenging environment.

In Quick Response codes for virtual learner evaluation of teaching and attendance monitoring, Roxana Mo and co-authors 37 used Quick Response (QR) codes to monitor attendance and obtain evaluations for virtual teaching sessions. They found QR codes valuable for quick and simple feedback that could be used for many educational applications.

In Creation and implementation of the Ottawa Handbook of Emergency Medicine Kaitlin Endres and team 38 described the creation of a handbook they made as an academic resource for medical students as they shift to clerkship. It includes relevant content encountered in Emergency Medicine. While they intended it for medical students, they also see its value for nurses, paramedics, and other medical professionals.

Commentary and Opinions

The alarming situation of medical student mental health by D’Eon and team 39 appealed to medical education leaders to respond to the high numbers of mental health concerns among medical students. They urged leaders to address the underlying problems, such as the excessive demands of the curriculum.

In the shadows: medical student clinical observerships and career exploration in the face of COVID-19 by Law and co-authors 40 offered potential solutions to replace in-person shadowing that has been disrupted due to the COVID-19 pandemic. They hope the alternatives such as virtual shadowing will close the gap in learning caused by the pandemic.

Letters to the Editor

Canadian Federation of Medical Students' response to “ The alarming situation of medical student mental health” King et al. 41 on behalf of the Canadian Federation of Medical Students (CFMS) responded to the commentary by D’Eon and team 39 on medical students' mental health. King called upon the medical education community to join the CFMS in its commitment to improving medical student wellbeing.

Re: “Development of a medical education podcast in obstetrics and gynecology” 42 was written by Kirubarajan in response to the article by Development of a medical education podcast in obstetrics and gynecology by Black and team. 43 Kirubarajan applauded the development of the podcast to meet a need in medical education, and suggested potential future topics such as interventions to prevent learner burnout.

Response to “First year medical student experiences with a clinical skills seminar emphasizing sexual and gender minority population complexity” by Kumar and Hassan 44 acknowledged the previously published article by Biro et al. 45 that explored limitations in medical training for the LGBTQ2S community. However, Kumar and Hassen advocated for further progress and reform for medical training to address the health requirements for sexual and gender minorities.

In her letter, Journey to the unknown: road closed!, 46 Rosemary Pawliuk responded to the article, Journey into the unknown: considering the international medical graduate perspective on the road to Canadian residency during the COVID-19 pandemic, by Gutman et al. 47 Pawliuk agreed that international medical students (IMGs) do not have adequate formal representation when it comes to residency training decisions. Therefore, Pawliuk challenged health organizations to make changes to give a voice in decision-making to the organizations representing IMGs.

In Connections, 48 Sara Guzman created a digital painting to portray her approach to learning. Her image of a hand touching a neuron showed her desire to physically see and touch an active neuron in order to further understand the brain and its connections.

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Structure of a Critical Review

Critical reviews, both short (one page) and long (four pages), usually have a similar structure. Check your assignment instructions for formatting and structural specifications. Headings are usually optional for longer reviews and can be helpful for the reader.

Introduction

The length of an introduction is usually one paragraph for a journal article review and two or three paragraphs for a longer book review. Include a few opening sentences that announce the author(s) and the title, and briefly explain the topic of the text. Present the aim of the text and summarise the main finding or key argument. Conclude the introduction with a brief statement of your evaluation of the text. This can be a positive or negative evaluation or, as is usually the case, a mixed response.

Present a summary of the key points along with a limited number of examples. You can also briefly explain the author’s purpose/intentions throughout the text and you may briefly describe how the text is organised. The summary should only make up about a third of the critical review.

The critique should be a balanced discussion and evaluation of the strengths, weakness and notable features of the text. Remember to base your discussion on specific criteria. Good reviews also include other sources to support your evaluation (remember to reference).

You can choose how to sequence your critique. Here are some examples to get you started:

• Most important to least important conclusions you make about the text.
• If your critique is more positive than negative, then present the negative points first and the positive last.
• If your critique is more negative than positive, then present the positive points first and the negative last.
• If there are both strengths and weakness for each criterion you use, you need to decide overall what your judgement is. For example, you may want to comment on a key idea in the text and have both positive and negative comments. You could begin by stating what is good about the idea and then concede and explain how it is limited in some way. While this example shows a mixed evaluation, overall you are probably being more negative than positive.
• In long reviews, you can address each criterion you choose in a paragraph, including both negative and positive points. For very short critical reviews (one page or less), where your comments will be briefer, include a paragraph of positive aspects  and another of negative.
• You can also include recommendations for how the text can be improved in terms of ideas, research approach; theories or frameworks used can also be included in the critique section.

Conclusion & References

This is usually a very short paragraph.

• Restate your overall opinion of the text.
• Briefly present recommendations.
• If necessary, some further qualification or explanation of your judgement can be included. This can help your critique sound fair and reasonable.

If you have used other sources in you review you should also include a list of references at the end of the review.

Summarising and paraphrasing for the critical review

The best way to summarise

• Scan the text. Look for information that can be deduced from the introduction, conclusion, title, and headings. What do these tell you about the main points of the article?
• Locate the topic sentences and highlight the main points as you read.
• Reread the text and make separate notes of the main points. Examples and evidence do not need to be included at this stage. Usually they are used selectively in your critique.

Paraphrasing means putting it into your own words. Paraphrasing offers an alternative to using direct quotations in your summary (and the critique) and can be an efficient way to integrate your summary notes.

The best way to paraphrase

• Review your summary notes
• Rewrite them in your own words and in complete sentences
• Use reporting verbs and phrases, e.g. 'The author describes…', 'Smith argues that …'.
• Use quotation marks if If you include unique or specialist phrases from the text.

  Next: Some general criteria for evaluating texts

Essay and assignment writing guide.

• Essay writing basics
• Essay and assignment planning
• Answering assignment questions
• Editing checklist
• Structure of a critical review
• General criteria for evaluating
• Sample extracts
• Annotated bibliography
• Reflective writing
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Write a Critical Review

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• To introduce the source, its main ideas, key details, and its place within the field
• To present your assessment of the quality of the source

In general, the introduction of your critical review should include

• Author(s) name
• Title of the source 
• What is the author's central purpose?
• What methods or theoretical frameworks were used to accomplish this purpose?
• What topic areas, chapters, sections, or key points did the author use to structure the source?
• What were the results or findings of the study?
• How were the results or findings interpreted? How were they related to the original problem (author's view of evidence rather than objective findings)?
• Who conducted the research? What were/are their interests?
• Why did they do this research?
• Was this research pertinent only within the author’s field, or did it have broader (even global) relevance?
• On what prior research was this source-based? What gap is the author attempting to address?
• How important was the research question posed by the researcher?
• Your overall opinion of the quality of the source. Think of this like a thesis or main argument.
• Present your evaluation of the source, providing evidence from the text (or other sources) to support your assessment.

In general, the body of your critical review should include

• Is the material organized logically and with appropriate headings?
• Are there stylistic problems in logical, clarity or language?
• Were the author(s) able to answer the question (test the hypothesis) raised
• What was the objective of the study?
• Does all the information lead coherently to the purpose of the study?
• Are the methods valid for studying the problem or gap?
• Could the study be duplicated from the information provided?
• Is the experimental design logical and reliable?
• How are the data organized? Is it logical and interpretable?
• Do the results reveal what the researcher intended?
• Do the authors present a logical interpretation of the results?
• Have the limitations of the research been addressed?
• Does the study consider other key studies in the field or other research possibilities or directions?
• How was the significance of the work described?
• Follow the structure of the journal article (e.g. Introduction, Methods, Results, Discussion) - highlighting the strengths and weaknesses in each section
• Present the weaknesses of the article, and then the strengths of the article (or vice versa).
• Group your ideas according to different research themes presented in the source
• Group the strengths and weaknesses of the article into the following areas: originality, reliability, validity, relevance, and presentation

Purpose: 

• To summarize the strengths and weaknesses of the article as a whole
• To assert the article’s practical and theoretical significance

In general, the conclusion of your critical review should include

• A restatement of your overall opinion
• A summary of the key strengths and weaknesses of the research that support your overall opinion of the source
• Did the research reported in this source result in the formation of new questions, theories or hypotheses by the authors or other researchers?
• Have other researchers subsequently supported or refuted the observations or interpretations of these authors?
• Did the research provide new factual information, a new understanding of a phenomenon in the field, a new research technique?
• Did the research produce any practical applications? 
• What are the social, political, technological, or medical implications of this research?
• How do you evaluate the significance of the research? 
• Find out what style guide you are required to follow (e.g., APA, MLA, Chicago) and follow the guidelines to create a reference list (may be called a bibliography or works cited).
• Be sure to include citations in the text when you refer to the source itself or external sources. 
• Check out our Cite Your Sources Guide for more information. 
• Read assignment instructions carefully and refer to them throughout the writing process.
• Make an outline of your main sections before you write.
• If your professor does not assign a topic or source, you must choose one yourself. Select a source that interests you and is written clearly so you can understand it.
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PSY290 - Research Methods

• Identifying & Locating Empirical Research Articles
• Survey & Test Instruments

Writing a Critical Review

Sample summaries, verbs to help you write the summary, how to read a scholarly article.

• APA Citation Style Help

A critical review is an academic appraisal of an article that offers both a summary and critical comment. They are useful in evaluating the relevance of a source to your academic needs. They demonstrate that you have understood the text and that you can analyze the main arguments or findings. It is not just a summary; it is an evaluation of what the author has said on a topic. It’s critical in that you thoughtfully consider the validity and accuracy of the author’s claims and that you identify other valid points of view.

An effective critical review has three parts:

• APA citation of article
• Clearly summarizes the purpose for the article and identifies the strengths and weaknesses of the research. (In your own words – no quotations.)
• Evaluates the contribution of the article to the discipline or broad subject area and how it relates to your own research.

Steps to Write a Critical Review:

• Create and APA style citation for the article you are reviewing.
• Skim the text: Read the title, abstract, introduction, and conclusion.
• Read the entire article in order to identify its main ideas and purpose.

Q. What were the authors investigating? What is their thesis? Q. What did the authors hope to discover?

        D. Pay close attention to the methods used by the authors to collection information.

Q. What are the characteristics of the participants? (e.g.) Age/gender/ethnicity

Q. What was the procedure or experimental method/surveys used?

Q. Are their any flaws in the design of their study?

  E. Review the main findings in the “Discussion” or “Conclusion” section. This will help you to evaluate the validity of their evidence, and the credibility of the authors.             Q.   Are their conclusions convincing?            Q.   Were their results significant? If so, describe how they were significant.  F. Evaluate the usefulness of the text to YOU in the context of your own research.

Q. How does this article assist you in your research?

Q. How does it enhance your understanding of this issue?

Q. What gaps in your research does it fill?

Good Summary:

Hock, S., & Rochford, R. A. (2010). A letter-writing campaign: linking academic success and civic engagement. Journal  of Community Engagement and Scholarship, 3 (2), 76-82.

Hock & Rochford (2010) describe how two classes of developmental writing students were engaged in a service-learning project to support the preservation of an on-campus historical site. The goal of the assignment was to help students to see how they have influence in their community by acting as engaged citizens, and to improve their scores on the ACT Writing Sample Assessment (WSA) exam. The authors report that students in developmental classes often feel disempowered, especially when English is not their first language. This assignment not only assisted them in elevating their written communication skills, but it also gave real-life significance to the assignment, and by extension made them feel like empowered members of the community. The advancement in student scores serves as evidence to support my research that when students are given assignments which permit local advocacy and active participation, their academic performance also improves.

Bad Summary:

Two ELL classes complete a service-learning project and improve their writing scores. This article was good because it provided me with lots of information I can use. The students learned a lot in their service-learning project and they passed the ACT exam.  

Remember you're describing what someone else has said. Use verbal cues to make this clear to your reader.  Here are some suggested verbs to use: 

* Adapted from: http://www.laspositascollege.edu/raw/summaries.php

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• Knowledge Base

Methodology

• How to Write a Literature Review | Guide, Examples, & Templates

How to Write a Literature Review | Guide, Examples, & Templates

Published on January 2, 2023 by Shona McCombes . Revised on September 11, 2023.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research that you can later apply to your paper, thesis, or dissertation topic .

There are five key steps to writing a literature review:

• Search for relevant literature
• Evaluate sources
• Identify themes, debates, and gaps
• Outline the structure
• Write your literature review

A good literature review doesn’t just summarize sources—it analyzes, synthesizes , and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

What is the purpose of a literature review, examples of literature reviews, step 1 – search for relevant literature, step 2 – evaluate and select sources, step 3 – identify themes, debates, and gaps, step 4 – outline your literature review’s structure, step 5 – write your literature review, free lecture slides, other interesting articles, frequently asked questions, introduction.

• Quick Run-through
• Step 1 & 2

When you write a thesis , dissertation , or research paper , you will likely have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and its scholarly context
• Develop a theoretical framework and methodology for your research
• Position your work in relation to other researchers and theorists
• Show how your research addresses a gap or contributes to a debate
• Evaluate the current state of research and demonstrate your knowledge of the scholarly debates around your topic.

Writing literature reviews is a particularly important skill if you want to apply for graduate school or pursue a career in research. We’ve written a step-by-step guide that you can follow below.

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Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

• Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
• Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
• Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
• Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research problem and questions .

Make a list of keywords

Start by creating a list of keywords related to your research question. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list as you discover new keywords in the process of your literature search.

• Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
• Body image, self-perception, self-esteem, mental health
• Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some useful databases to search for journals and articles include:

• Your university’s library catalogue
• Google Scholar
• Project Muse (humanities and social sciences)
• Medline (life sciences and biomedicine)
• EconLit (economics)
• Inspec (physics, engineering and computer science)

You can also use boolean operators to help narrow down your search.

Make sure to read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

You likely won’t be able to read absolutely everything that has been written on your topic, so it will be necessary to evaluate which sources are most relevant to your research question.

For each publication, ask yourself:

• What question or problem is the author addressing?
• What are the key concepts and how are they defined?
• What are the key theories, models, and methods?
• Does the research use established frameworks or take an innovative approach?
• What are the results and conclusions of the study?
• How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
• What are the strengths and weaknesses of the research?

Make sure the sources you use are credible , and make sure you read any landmark studies and major theories in your field of research.

You can use our template to summarize and evaluate sources you’re thinking about using. Click on either button below to download.

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It is important to keep track of your sources with citations to avoid plagiarism . It can be helpful to make an annotated bibliography , where you compile full citation information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

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To begin organizing your literature review’s argument and structure, be sure you understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly visual platforms like Instagram and Snapchat—this is a gap that you could address in your own research.

There are various approaches to organizing the body of a literature review. Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarizing sources in order.

Try to analyze patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organize your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text , your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, you can follow these tips:

• Summarize and synthesize: give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: don’t just paraphrase other researchers — add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically evaluate: mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: use transition words and topic sentences to draw connections, comparisons and contrasts

In the conclusion, you should summarize the key findings you have taken from the literature and emphasize their significance.

When you’ve finished writing and revising your literature review, don’t forget to proofread thoroughly before submitting. Not a language expert? Check out Scribbr’s professional proofreading services !

This article has been adapted into lecture slides that you can use to teach your students about writing a literature review.

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If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

• Sampling methods
• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarize yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your thesis or dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

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A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and plays). When we say “literature review” or refer to “the literature,” we are talking about the research ( scholarship ) in a given field. You will often see the terms “the research,” “the scholarship,” and “the literature” used mostly interchangeably.

Where, when, and why would I write a lit review?

There are a number of different situations where you might write a literature review, each with slightly different expectations; different disciplines, too, have field-specific expectations for what a literature review is and does. For instance, in the humanities, authors might include more overt argumentation and interpretation of source material in their literature reviews, whereas in the sciences, authors are more likely to report study designs and results in their literature reviews; these differences reflect these disciplines’ purposes and conventions in scholarship. You should always look at examples from your own discipline and talk to professors or mentors in your field to be sure you understand your discipline’s conventions, for literature reviews as well as for any other genre.

A literature review can be a part of a research paper or scholarly article, usually falling after the introduction and before the research methods sections. In these cases, the lit review just needs to cover scholarship that is important to the issue you are writing about; sometimes it will also cover key sources that informed your research methodology.

Lit reviews can also be standalone pieces, either as assignments in a class or as publications. In a class, a lit review may be assigned to help students familiarize themselves with a topic and with scholarship in their field, get an idea of the other researchers working on the topic they’re interested in, find gaps in existing research in order to propose new projects, and/or develop a theoretical framework and methodology for later research. As a publication, a lit review usually is meant to help make other scholars’ lives easier by collecting and summarizing, synthesizing, and analyzing existing research on a topic. This can be especially helpful for students or scholars getting into a new research area, or for directing an entire community of scholars toward questions that have not yet been answered.

What are the parts of a lit review?

Most lit reviews use a basic introduction-body-conclusion structure; if your lit review is part of a larger paper, the introduction and conclusion pieces may be just a few sentences while you focus most of your attention on the body. If your lit review is a standalone piece, the introduction and conclusion take up more space and give you a place to discuss your goals, research methods, and conclusions separately from where you discuss the literature itself.

Introduction:

• An introductory paragraph that explains what your working topic and thesis is
• A forecast of key topics or texts that will appear in the review
• Potentially, a description of how you found sources and how you analyzed them for inclusion and discussion in the review (more often found in published, standalone literature reviews than in lit review sections in an article or research paper)
• Summarize and synthesize: Give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: Don’t just paraphrase other researchers – add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically Evaluate: Mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: Use transition words and topic sentence to draw connections, comparisons, and contrasts.

Conclusion:

• Summarize the key findings you have taken from the literature and emphasize their significance
• Connect it back to your primary research question

How should I organize my lit review?

Lit reviews can take many different organizational patterns depending on what you are trying to accomplish with the review. Here are some examples:

• Chronological : The simplest approach is to trace the development of the topic over time, which helps familiarize the audience with the topic (for instance if you are introducing something that is not commonly known in your field). If you choose this strategy, be careful to avoid simply listing and summarizing sources in order. Try to analyze the patterns, turning points, and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred (as mentioned previously, this may not be appropriate in your discipline — check with a teacher or mentor if you’re unsure).
• Thematic : If you have found some recurring central themes that you will continue working with throughout your piece, you can organize your literature review into subsections that address different aspects of the topic. For example, if you are reviewing literature about women and religion, key themes can include the role of women in churches and the religious attitude towards women.
• Qualitative versus quantitative research
• Empirical versus theoretical scholarship
• Divide the research by sociological, historical, or cultural sources
• Theoretical : In many humanities articles, the literature review is the foundation for the theoretical framework. You can use it to discuss various theories, models, and definitions of key concepts. You can argue for the relevance of a specific theoretical approach or combine various theorical concepts to create a framework for your research.

What are some strategies or tips I can use while writing my lit review?

Any lit review is only as good as the research it discusses; make sure your sources are well-chosen and your research is thorough. Don’t be afraid to do more research if you discover a new thread as you’re writing. More info on the research process is available in our "Conducting Research" resources .

As you’re doing your research, create an annotated bibliography ( see our page on the this type of document ). Much of the information used in an annotated bibliography can be used also in a literature review, so you’ll be not only partially drafting your lit review as you research, but also developing your sense of the larger conversation going on among scholars, professionals, and any other stakeholders in your topic.

Usually you will need to synthesize research rather than just summarizing it. This means drawing connections between sources to create a picture of the scholarly conversation on a topic over time. Many student writers struggle to synthesize because they feel they don’t have anything to add to the scholars they are citing; here are some strategies to help you:

• It often helps to remember that the point of these kinds of syntheses is to show your readers how you understand your research, to help them read the rest of your paper.
• Writing teachers often say synthesis is like hosting a dinner party: imagine all your sources are together in a room, discussing your topic. What are they saying to each other?
• Look at the in-text citations in each paragraph. Are you citing just one source for each paragraph? This usually indicates summary only. When you have multiple sources cited in a paragraph, you are more likely to be synthesizing them (not always, but often
• Read more about synthesis here.

The most interesting literature reviews are often written as arguments (again, as mentioned at the beginning of the page, this is discipline-specific and doesn’t work for all situations). Often, the literature review is where you can establish your research as filling a particular gap or as relevant in a particular way. You have some chance to do this in your introduction in an article, but the literature review section gives a more extended opportunity to establish the conversation in the way you would like your readers to see it. You can choose the intellectual lineage you would like to be part of and whose definitions matter most to your thinking (mostly humanities-specific, but this goes for sciences as well). In addressing these points, you argue for your place in the conversation, which tends to make the lit review more compelling than a simple reporting of other sources.

Training videos   |   Faqs

Critical Literature Review : How to Critique a Research Article?

A literature review critically examines the methodologies used in the studies, discussing their strengths and weaknesses. Your review should be critical and analytical, not just descriptive. In this blog, we will look at how to use constructive language when critiquing other’s work in your research paper.

1. Should a Literature Review be Critical?

Absolutely! A literature review should indeed be critical. It’s like being a judge in a talent show. Rather than simply describing each performance, you critically evaluate them, highlighting strengths, noting weaknesses, and considering how each act contributes to the show’s overall theme. In the context of a literature review:

Assess the Methodology

Critically analyze the research methods used in the studies you review. Are there limitations or biases in how the research was conducted?

Compare and Contrast

Examine how different studies relate to each other. Do they present conflicting evidence? Do they build upon each other’s work?

Identify Gaps

A critical review identifies what hasn’t been explored or fully understood in your area of study. Highlighting these gaps is crucial for setting the direction for future research.

Theoretical Analysis

Engage with the theoretical frameworks underpinning the research. Are there alternative theories or perspectives that could be applied?

Remember, a critical literature review doesn’t mean being negative about the studies. It’s about providing a thoughtful, in-depth analysis that offers a balanced view of the research landscape. This critical approach adds depth to your review, demonstrating your understanding and engagement with the field.

2. How to Critique a Research Article?

Keep your review academic and objective. Avoid personal bias and ensure your research backs your arguments. Your critique should be evidence-based. Here are some academic phrases from Ref-n-write’s academic phrasebank that you can use to critique research articles.

• Drawbacks of previous studies
• Debates/Controvesies
• Research gap

3. Using Constructive and Diplomatic Language

Try to use constructive and diplomatic language in your literature review. Pay specific attention to your language when you are criticizing other researchers in your field. Let’s look at some examples.

3.1. Example 1

Here, we are pointing out the drawback of previous studies.

None of the previous works [1-4] offer a good solution. The problem is still unsolved. Bad: Too blunt

Despite the success of previous works [1-4] in certain aspects, the problem is still unsolved. Good: Some credit given to previous research

Look at the first statement, it is quite blunt and we are very critical of previous works. Now look at the second statement, we are giving some credit to the previous authors and appreciating their efforts. And then we are making our claim that there is no solution to the problem.

3.2. Example 2

Here is another example. Here we are establishing the research gap.

There are no studies in the literature that deals with this problem. Bad: Too confident

To the best of our knowledge, there are no studies in the literature that deals with this problem. Good: Modest language

Look at the first statement, we are coming across as too confident. We are saying that we are 100% sure that there are no studies in the literature that deals with this issue. Now, look at the second statement. We managed to tone it down a bit by using the phrase ‘To the best of our knowledge’. Now the statement sounds a bit more modest and constructive.

Bear these things in your mind while writing your literature review.

4. Can I use ChatGPT for Critical Literature Review?

Using ChatGPT or similar AI language models to assist in a literature review is intriguing, blending traditional research methods with cutting-edge technology. ChatGPT can quickly provide summaries or explanations of concepts, saving time in the initial stages of research. However, it’s essential to understand the disadvantages:

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• Volume 24, Issue 2
• Five tips for developing useful literature summary tables for writing review articles
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• http://orcid.org/0000-0003-0157-5319 Ahtisham Younas 1 , 2 ,
• http://orcid.org/0000-0002-7839-8130 Parveen Ali 3 , 4
• 1 Memorial University of Newfoundland , St John's , Newfoundland , Canada
• 2 Swat College of Nursing , Pakistan
• 3 School of Nursing and Midwifery , University of Sheffield , Sheffield , South Yorkshire , UK
• 4 Sheffield University Interpersonal Violence Research Group , Sheffield University , Sheffield , UK
• Correspondence to Ahtisham Younas, Memorial University of Newfoundland, St John's, NL A1C 5C4, Canada; ay6133{at}mun.ca

https://doi.org/10.1136/ebnurs-2021-103417

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Introduction

Literature reviews offer a critical synthesis of empirical and theoretical literature to assess the strength of evidence, develop guidelines for practice and policymaking, and identify areas for future research. 1 It is often essential and usually the first task in any research endeavour, particularly in masters or doctoral level education. For effective data extraction and rigorous synthesis in reviews, the use of literature summary tables is of utmost importance. A literature summary table provides a synopsis of an included article. It succinctly presents its purpose, methods, findings and other relevant information pertinent to the review. The aim of developing these literature summary tables is to provide the reader with the information at one glance. Since there are multiple types of reviews (eg, systematic, integrative, scoping, critical and mixed methods) with distinct purposes and techniques, 2 there could be various approaches for developing literature summary tables making it a complex task specialty for the novice researchers or reviewers. Here, we offer five tips for authors of the review articles, relevant to all types of reviews, for creating useful and relevant literature summary tables. We also provide examples from our published reviews to illustrate how useful literature summary tables can be developed and what sort of information should be provided.

Tip 1: provide detailed information about frameworks and methods

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Tabular literature summaries from a scoping review. Source: Rasheed et al . 3

The provision of information about conceptual and theoretical frameworks and methods is useful for several reasons. First, in quantitative (reviews synthesising the results of quantitative studies) and mixed reviews (reviews synthesising the results of both qualitative and quantitative studies to address a mixed review question), it allows the readers to assess the congruence of the core findings and methods with the adapted framework and tested assumptions. In qualitative reviews (reviews synthesising results of qualitative studies), this information is beneficial for readers to recognise the underlying philosophical and paradigmatic stance of the authors of the included articles. For example, imagine the authors of an article, included in a review, used phenomenological inquiry for their research. In that case, the review authors and the readers of the review need to know what kind of (transcendental or hermeneutic) philosophical stance guided the inquiry. Review authors should, therefore, include the philosophical stance in their literature summary for the particular article. Second, information about frameworks and methods enables review authors and readers to judge the quality of the research, which allows for discerning the strengths and limitations of the article. For example, if authors of an included article intended to develop a new scale and test its psychometric properties. To achieve this aim, they used a convenience sample of 150 participants and performed exploratory (EFA) and confirmatory factor analysis (CFA) on the same sample. Such an approach would indicate a flawed methodology because EFA and CFA should not be conducted on the same sample. The review authors must include this information in their summary table. Omitting this information from a summary could lead to the inclusion of a flawed article in the review, thereby jeopardising the review’s rigour.

Tip 2: include strengths and limitations for each article

Critical appraisal of individual articles included in a review is crucial for increasing the rigour of the review. Despite using various templates for critical appraisal, authors often do not provide detailed information about each reviewed article’s strengths and limitations. Merely noting the quality score based on standardised critical appraisal templates is not adequate because the readers should be able to identify the reasons for assigning a weak or moderate rating. Many recent critical appraisal checklists (eg, Mixed Methods Appraisal Tool) discourage review authors from assigning a quality score and recommend noting the main strengths and limitations of included studies. It is also vital that methodological and conceptual limitations and strengths of the articles included in the review are provided because not all review articles include empirical research papers. Rather some review synthesises the theoretical aspects of articles. Providing information about conceptual limitations is also important for readers to judge the quality of foundations of the research. For example, if you included a mixed-methods study in the review, reporting the methodological and conceptual limitations about ‘integration’ is critical for evaluating the study’s strength. Suppose the authors only collected qualitative and quantitative data and did not state the intent and timing of integration. In that case, the strength of the study is weak. Integration only occurred at the levels of data collection. However, integration may not have occurred at the analysis, interpretation and reporting levels.

Tip 3: write conceptual contribution of each reviewed article

While reading and evaluating review papers, we have observed that many review authors only provide core results of the article included in a review and do not explain the conceptual contribution offered by the included article. We refer to conceptual contribution as a description of how the article’s key results contribute towards the development of potential codes, themes or subthemes, or emerging patterns that are reported as the review findings. For example, the authors of a review article noted that one of the research articles included in their review demonstrated the usefulness of case studies and reflective logs as strategies for fostering compassion in nursing students. The conceptual contribution of this research article could be that experiential learning is one way to teach compassion to nursing students, as supported by case studies and reflective logs. This conceptual contribution of the article should be mentioned in the literature summary table. Delineating each reviewed article’s conceptual contribution is particularly beneficial in qualitative reviews, mixed-methods reviews, and critical reviews that often focus on developing models and describing or explaining various phenomena. Figure 2 offers an example of a literature summary table. 4

Tabular literature summaries from a critical review. Source: Younas and Maddigan. 4

Tip 4: compose potential themes from each article during summary writing

While developing literature summary tables, many authors use themes or subthemes reported in the given articles as the key results of their own review. Such an approach prevents the review authors from understanding the article’s conceptual contribution, developing rigorous synthesis and drawing reasonable interpretations of results from an individual article. Ultimately, it affects the generation of novel review findings. For example, one of the articles about women’s healthcare-seeking behaviours in developing countries reported a theme ‘social-cultural determinants of health as precursors of delays’. Instead of using this theme as one of the review findings, the reviewers should read and interpret beyond the given description in an article, compare and contrast themes, findings from one article with findings and themes from another article to find similarities and differences and to understand and explain bigger picture for their readers. Therefore, while developing literature summary tables, think twice before using the predeveloped themes. Including your themes in the summary tables (see figure 1 ) demonstrates to the readers that a robust method of data extraction and synthesis has been followed.

Tip 5: create your personalised template for literature summaries

Often templates are available for data extraction and development of literature summary tables. The available templates may be in the form of a table, chart or a structured framework that extracts some essential information about every article. The commonly used information may include authors, purpose, methods, key results and quality scores. While extracting all relevant information is important, such templates should be tailored to meet the needs of the individuals’ review. For example, for a review about the effectiveness of healthcare interventions, a literature summary table must include information about the intervention, its type, content timing, duration, setting, effectiveness, negative consequences, and receivers and implementers’ experiences of its usage. Similarly, literature summary tables for articles included in a meta-synthesis must include information about the participants’ characteristics, research context and conceptual contribution of each reviewed article so as to help the reader make an informed decision about the usefulness or lack of usefulness of the individual article in the review and the whole review.

In conclusion, narrative or systematic reviews are almost always conducted as a part of any educational project (thesis or dissertation) or academic or clinical research. Literature reviews are the foundation of research on a given topic. Robust and high-quality reviews play an instrumental role in guiding research, practice and policymaking. However, the quality of reviews is also contingent on rigorous data extraction and synthesis, which require developing literature summaries. We have outlined five tips that could enhance the quality of the data extraction and synthesis process by developing useful literature summaries.

• Aromataris E ,
• Rasheed SP ,

Twitter @Ahtisham04, @parveenazamali

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; externally peer reviewed.

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• Open access
• Published: 05 September 2022

Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature

• Ashlea Hambleton 1 ,
• Genevieve Pepin 2 ,
• Anvi Le 3 ,
• Danielle Maloney 1 , 4 ,
• National Eating Disorder Research Consortium ,
• Stephen Touyz 1 , 4 &
• Sarah Maguire 1 , 4  

Journal of Eating Disorders volume  10 , Article number:  132 ( 2022 ) Cite this article

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Eating disorders (EDs) are potentially severe, complex, and life-threatening illnesses. The mortality rate of EDs is significantly elevated compared to other psychiatric conditions, primarily due to medical complications and suicide. The current rapid review aimed to summarise the literature and identify gaps in knowledge relating to any psychiatric and medical comorbidities of eating disorders.

This paper forms part of a rapid review) series scoping the evidence base for the field of EDs, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021–2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for English-language studies focused on the psychiatric and medical comorbidities of EDs, published between 2009 and 2021. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised.

A total of 202 studies were included in this review, with 58% pertaining to psychiatric comorbidities and 42% to medical comorbidities. For EDs in general, the most prevalent psychiatric comorbidities were anxiety (up to 62%), mood (up to 54%) and substance use and post-traumatic stress disorders (similar comorbidity rates up to 27%). The review also noted associations between specific EDs and non-suicidal self-injury, personality disorders, and neurodevelopmental disorders. EDs were complicated by medical comorbidities across the neuroendocrine, skeletal, nutritional, gastrointestinal, dental, and reproductive systems. Medical comorbidities can precede, occur alongside or emerge as a complication of the ED.

Conclusions

This review provides a thorough overview of the comorbid psychiatric and medical conditions co-occurring with EDs. High psychiatric and medical comorbidity rates were observed in people with EDs, with comorbidities contributing to increased ED symptom severity, maintenance of some ED behaviours, and poorer functioning as well as treatment outcomes. Early identification and management of psychiatric and medical comorbidities in people with an ED may improve response to treatment and overall outcomes.

Plain English Summary

The mortality rate of eating disorders is significantly elevated compared to other psychiatric conditions, primarily due to medical complications and suicide. Further, individuals with eating disorders often meet the diagnostic criteria of at least one comorbid psychiatric or medical disorder, that is, the individual simultaneously experiences both an ED and at least one other condition. This has significant consequences for researchers and health care providers – medical and psychiatric comorbidities impact ED symptoms and treatment effectiveness. The current review is part of a larger Rapid Review series conducted to inform the development of Australia’s National Eating Disorders Research and Translation Strategy 2021–2031. A Rapid Review is designed to comprehensively summarise a body of literature in a short timeframe, often to guide policymaking and address urgent health concerns. The Rapid Review synthesises the current evidence base and identifies gaps in eating disorder research and care. This paper gives a critical overview of the scientific literature relating to the psychiatric and medical comorbidities of eating disorders. It covers recent literature regarding psychiatric comorbidities including anxiety disorders, mood disorders, substance use disorders, trauma and personality disorders and neurodevelopmental disorders. Further, the review discusses the impact and associations between EDs and medical comorbidities, some of which precede the eating disorder, occur alongside, or as a consequence of the eating disorder.

Introduction

Eating Disorders (EDs) are often severe, complex, life-threatening illnesses with significant physiological and psychiatric impacts. EDs impact individuals across the entire lifespan, affecting all age groups (although most often they emerge in childhood and adolescence), genders, socioeconomic groups and cultures [ 1 ]. EDs have some of the highest mortality rates of all psychiatric illnesses and carry a significant personal, interpersonal, social and economic burdens [ 2 , 3 ].

Adding to the innate complexity of EDs, it is not uncommon for people living with an ED to experience associated problems such as psychological, social, and functional limitations [ 2 ] in addition to psychiatric and medical comorbidities [ 4 , 5 , 6 ]. Comorbidity is defined as conditions or illnesses that occur concurrently to the ED. Evidence suggests that between 55 and 95% of people diagnosed with an ED will also experience a comorbid psychiatric disorder in their lifetime [ 4 , 6 ]. Identifying psychiatric comorbidities is essential because of their potential impact on the severity of ED symptomatology, the individual’s distress and treatment effectiveness [ 7 , 8 ].

The mortality rate of EDs is significantly higher than the general population, with the highest occurring in Anorexia Nervosa (AN) due to impacts on the cardiovascular system [ 9 ] and suicide. [ 10 ] Mortality rates are also heightened in Bulimia Nervosa (BN) and Other Specified Feeding and Eating Disorder (OSFED) [ 11 ]. Suicide rates are elevated across the ED spectrum, and higher rates are observed in patients with a comorbid psychiatric disorder [ 10 , 12 ]. Of concern, the proportion of people with an ED not accessing treatment is estimated to be as high as 75% [ 13 ], potentially a consequence of comorbidities which impact on motivation, the ability to schedule appointments or require clinical prioritisation (i.e., self-harm or suicidal behaviours) [ 14 ]. Further, for many of those diagnosed with an ED who access treatment, recovery is a lengthy process. A longitudinal study found approximately two-thirds of participants with AN or BN had recovered by 22 years follow-up [ 15 ]. Although recovery occurred earlier for those with BN, illness duration was lengthy for both groups with quality of life and physical health impacts [ 15 ]. Further, less is known regarding the illness trajectory for those who do not receive treatment.

Medical comorbidities associated with EDs can range from mild to severe and life-threatening, with complications observed across all body systems, including the cardiac, metabolic and gastrointestinal, and reproductive systems [ 5 ]. These comorbidities and complications can place people at increased risk of medical instability and death [ 5 ]. Therefore, understanding how co-occurring medical comorbidities and complications impact EDs is critical to treatment and recovery.

In addition to ED-associated medical comorbidities, EDs often present alongside other psychiatric conditions. Psychiatric comorbidities in people with EDs are associated with higher health system costs, emergency department presentations and admissions [ 16 ]. Comorbidities may precede the onset of the ED, be co-occurring, or result from symptoms and behaviours associated with the ED [ 17 , 18 ]. Individuals with an ED, their carers and care providers often face a complex and important dilemma; the individual with an ED requires treatment for their ED but also for their psychiatric comorbidities, and it can be difficult for treatment providers to determine which is the clinical priority [ 19 ]. This is further complicated by the fact that EDs and comorbidities may have a reciprocal relationship, whereby the presence of one impact the pathology, treatment and outcomes of the other.

The current Rapid Review (RR) forms part of a series of reviews commissioned by the Australian Federal Government to inform the Australian National Eating Disorders Research and Translation Strategy 2021–2031 [ 20 ]. In response to the impact of psychiatric and medical comorbidities on outcomes, this rapid review summarises the recent literature on the nature and implications of psychiatric and medical comorbidities associated with EDs.

The Australian Government Commonwealth Department of Health funded the InsideOut Institute for Eating Disorders (IOI) to develop the Australian Eating Disorders Research and Translation Strategy 2021–2031 [ 20 ] under the Psych Services for Hard to Reach Groups initiative (ID 4-8MSSLE). The strategy was developed in partnership with state and national stakeholders including clinicians, service providers, researchers, and experts by lived experience (both consumers and families/carers). Developed through a two-year national consultation and collaboration process, the strategy provides the roadmap to establishing EDs as a national research priority and is the first disorder-specific strategy to be developed in consultation with the National Mental Health Commission. To inform the strategy, IOI commissioned Healthcare Management Advisors (HMA) to conduct a series of RRs to assess all available peer-reviewed literature on all DSM-5 listed EDs.

A RR Protocol [ 21 ] was utilised to allow swift synthesis of the evidence in order to guide public policy and decision-making [ 22 ]. This approach has been adopted by several leading health organisations including the World Health Organisation [ 17 ] and the Canadian Agency for Drugs and Technologies in Health Rapid Response Service [ 18 ], to build a strong evidence base in a timely and accelerated manner, without compromising quality. A RR is not designed to be as comprehensive as a systematic review—it is purposive rather than exhaustive and provides actionable evidence to guide health policy [ 23 ].

The RR is a narrative synthesis adhering to the PRISMA guidelines [ 24 ]. It is divided by topic area and presented as a series of papers. Three research databases were searched: ScienceDirect, PubMed and Ovid/Medline. To establish a broad understanding of the progress made in the field of EDs, and to capture the largest evidence base from the past 12 years (originally 2009–2019, but expanded to include the preceding two years), the eligibility criteria for included studies were kept broad. Therefore, included studies were published between 2009 and 2021, written in English, and conducted within Western healthcare systems or health systems comparable to Australia in terms of structure and resourcing. The initial search and review process was conducted by three reviewers between 5 December 2019 and 16 January 2020. The re-run for the years 2020–2021 was conducted by two reviewers at the end of May 2021.

The RR had a translational research focus with the objective of identifying evidence relevant to developing optimal care pathways. Searches therefore used a Population, Intervention, Comparison, Outcome (PICO) approach to identify literature relating to population impact, prevention and early intervention, treatment, and long-term outcomes. Purposive sampling focused on high-level evidence studies encompassing meta-analyses; systematic reviews; moderately sized randomised controlled studies (RCTs) (n > 50); moderately sized controlled-cohort studies (n > 50); and population studies (n > 500). However, the diagnoses ARFID and UFED necessitated less stringent eligibility criteria due to a paucity of published articles. As these diagnoses are newly captured in the DSM-5 (released in 2013, within the allocated search timeframe), the evidence base is still emerging, and few studies have been conducted. Thus, smaller studies (n =  ≤ 20) and narrative reviews were also considered and included. Grey literature, such as clinical or practice guidelines, protocol papers (without results) and Masters’ theses or dissertations, were excluded. Other sources (which may not be replicable when applying the current methodology) included the personal libraries of authors, yielding two additional studies (see Additional file 1 ). This extra step was conducted in line with the PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews [ 25 ].

Full methodological details including eligibility criteria, search strategy and terms and data analysis are published in a separate protocol paper, which included a total of 1320 studies [ 26 ] (see Additional file 1 : Fig. S1 for PRISMA flow diagram). Data from included studies relating to psychiatric and medical comorbidities of EDs were synthesised and are presented in the current review. No further analyses were conducted.

The search included articles published in the period January 2009 to May 2021. The RR identified 202 studies for inclusion. Of these, 58% related to psychiatric comorbidities (n = 117) and 42% to medical comorbidities (n = 85). A full list of the studies included in this review and information about population, aims and results can be found in Additional file 2 : Tables S3, S4. Results are subdivided into two categories: (1) psychiatric comorbidities and (2) medical complications. Tables 1 and 2 provide high-level summaries of the results.

Psychiatric comorbidities

The study of psychiatric comorbidities can assist with developing models of ED aetiology, conceptualising psychopathology and has relevance for treatment development and outcomes. Given that common psychological factors are observed across psychiatric disorders [ 87 ], it is not surprising that there are high prevalence rates of co-occurring psychiatric conditions with EDs. Comorbidity rates of EDs and other psychiatric conditions are elevated further in ethnic/racial minority groups [ 88 ]. When looking at the evidence from studies conducted with children and young people, one study of children with ARFID found that 53% of the population had a lifetime comorbid psychiatric disorder [ 89 ]. It emerged from the RR that research regarding psychiatric comorbidities generally focussed on the prevalence rates of comorbidities among certain ED subgroups, with some also exploring implications for treatment and ED psychopathology.

Anxiety disorders

Research indicates that EDs and anxiety disorders frequently co-occur [ 8 , 27 ]. The high prevalence rates of anxiety disorders in the general population are also observed in people with EDs; with a large population study finding anxiety disorders were the most frequently comorbid conditions reported [ 8 ]. In a study of women presenting for ED treatment, 65% also met the criteria for at least one comorbid anxiety disorder [ 28 ]. Of note, 69% of those endorsing the comorbidity also reported that the anxiety disorder preceded the onset of the ED [ 28 ]. Another study explored anxiety across individuals with an ED categorised by three weight ranges (individuals whose weight is in the ‘healthy weight’ range, individuals in the ‘overweight’ range and individuals in the ‘obese’ range). While anxiety was elevated across all groups, the authors did note that individuals in the overweight group reported significantly higher rates of anxiety than individuals within the healthy weight group [ 90 ]. One study that explored temperamental factors provided some insight into factors that may mediate this association; anxiety sensitivity (a predictor of anxiety disorders) was associated with greater ED severity among individuals in a residential ED treatment facility [ 29 ]. Further, this association was mediated by a tendency to engage in experiential avoidance—the authors noting that individuals with greater ED symptoms were more likely to avoid distressing experiences [ 29 ].

Generalised anxiety disorder (GAD)

Studies have noted the potential genetic links between EDs and GAD, noting that the presence of one significantly increases the likelihood of the other [ 8 , 30 ]. Further, there appears to be a relationship between the severity of ED behaviours and the co-occurrence of GAD, with comorbidity more likely when fasting and excessive exercise are present, as well as a lower BMI [ 30 ]. The authors noted the particularly pernicious comorbidity of EDs (specifically AN) and GAD may be amplified by the jointly anxiolytic and weight loss effects of food restriction and excessive exercise [ 30 ].

Social anxiety

A meta-analysis of 12 studies found higher rates of social anxiety across all ED diagnoses, with patients with BN demonstrating the highest rate of comorbidity at 84.5%, followed by both BED and AN-BP both at 75% [ 31 ]. High levels of social anxiety were also associated with more severe ED psychopathology [ 31 ] and higher body weight [ 91 ]. This particular comorbidity may also impact on access to treatment for the ED; a large follow-up study of adolescents found that self-reported social phobia predicted not seeking treatment for BN symptoms [ 32 ]. Interestingly, two studies noted that anxiety symptoms improved following psychological treatments that targeted ED symptoms, possibly due to a shared symptom profile [ 29 , 31 ].

Obsessive–compulsive disorder

Similarities between the symptoms of Obsessive–Compulsive Disorder (OCD) and EDs, such as cognitive rigidity, obsessiveness, detail focus, perfectionism and compulsive routines have long been reported in the literature [ 34 ]. Given the symptom overlap, a meta-analysis sought to clarify the lifetime and current (that is, a current diagnosis at the time of data collection) comorbidity rates of OCD and EDs, noting the lifetime comorbidity rate was 18% and current comorbidity rate was 15% [ 33 ]. However, the authors noted that this prevalence may double over longer periods of observation, with some follow-up data demonstrating comorbidity rates of 33% [ 33 ]. Prevalence rates of OCD seemed to be highest among people with AN (lifetime = 19% and current = 14%) compared to other ED subtypes. In addition to the symptom crossover, this RR found evidence of a complex relationship between OCD and EDs, including a potential association between OCD and greater ED severity [ 34 ].

Network analysis found that doubts about simple everyday things and repeating things over and over bridged between ED and OCD symptoms. Further, a pathway was observed between restricting and checking compulsions and food rigidity as well as binge eating and hoarding. However, as the data was cross-sectional, directional inferences could not be made [ 36 ]. An earlier study explored how changes in OCD symptoms impact ED symptoms among an inpatient sample [ 35 ]. As was hypothesised, decreases in OCD symptoms accounted for significant variance in decreases in ED symptoms, and this effect was strongest among ED patients with comorbid OCD. The study also found that irrespective of whether patients had comorbid OCD or not, when ED symptoms improved, so did symptoms of OCD [ 35 ]. The authors concluded that perhaps there is a reciprocal relationship between OCD and ED symptoms, whereby symptoms of both conditions interact in a synergistic, bidirectional manner, meaning that improvement in one domain can lead to improvement in another [ 35 ]. These findings were somewhat supported in a study by Simpson and colleagues (2013), which found exposure and response prevention (a specialised OCD treatment) resulted in a significant reduction in OCD severity, as was expected, and an improvement in ED symptoms. In their study, individuals with BN showed more improvement than those with AN–nevertheless, BMI still increased among those underweight [ 92 ].

Mood disorders

Depression and major depressive disorder (mdd).

This RR also found high levels of comorbidity between major depression and EDs. A longitudinal study of disordered eating behaviours among adolescents found that disordered eating behaviours and depressive symptoms developed concurrently [ 37 ]. Among the sample, over half the adolescent sample had a depressive disorder. Prevalence rates were similar for AN (51.5%) and BN (54%) [ 37 ]. The study also explored the neurological predictors of comorbid depression in individuals with EDs, noting that lower grey matter volumes in the medial orbitofrontal, dorsomedial, and dorsolateral prefrontal cortices predicted the concurrent development of purging and depressive symptoms [ 37 ]. The results suggested that alterations in frontal brain circuits were part of a neural aetiology common to EDs and depression [ 37 ].

This RR found much support for a strong relationship between depression and ED symptomatology. In a study of patients with AN, comorbid MDD was associated with a greater AN symptom severity [ 93 ], and this relationship between the symptoms of MDD and AN was bidirectional in a study of adolescents undergoing treatment for AN, whereby dietary restraint predicted increased guilt and hostility (symptoms of low mood) and fear predicted further food restriction [ 94 ]. Further studies noted the association between BN, BED and NES, with a higher prevalence of depression and more significant depression symptoms [ 95 , 96 , 97 ]. However, other studies have failed to find support for this association–for example, a Swedish twin study found no association between NES and other mental health disorders [ 98 ].

The impact of the relationship between depression and EDs on treatment outcomes was variable across the studies identified by the RR. One study noted the impact of depression on attrition; patients with BN and comorbid depression attending a university clinic had the highest rates of treatment drop-out [ 99 ]. However, in a sample of patients with AN, the comorbidity of depression (or lack of) did not impact treatment outcome and the severity of depression was not associated with changes in ED symptoms [ 100 ]. This finding was supported in another study of inpatients with AN; pre-treatment depression level did not predict treatment outcome or BMI [ 101 ].

Bipolar disorders

Notable comorbidity rates between bipolar disorders (BD) and EDs were reported in the literature reviewed, however evidence about the frequency of this association was mixed. Studies noted comorbidity rates of BD and EDs ranging between 1.9% to as high as 35.8% [ 38 , 39 , 40 ]. In order to better understand the nature of comorbidity, a recent systematic review and meta-analysis found BD (including bipolar 1 disorder and bipolar 2 disorder) and ED comorbidity varied across different ED diagnostic groups (BED—12.5%, BN—7.4%, AN—3.8%) [ 102 ]. However, the authors noted the scant longitudinal studies available, particularly in paediatric samples. An analysis of comorbidity within a sample of patients with BD identified that 27% of participants also met criteria for an ED; 15% had BN, 12% had BED, and 0.2% had AN [ 103 ]. Two other studies noted considerable comorbidity rates of BD; 18.6% for binge eating [ 104 ] and 8.8% for NES [ 105 ]. Some studies suggested the co-occurrence of BD and EDs were seen most in people with AN-BP, BN and BED—all of which share a binge and/or purge symptom profile [ 38 , 106 ]. Specifically, BED and BN were the most common co-occurring EDs with BD [ 40 ], however, these EDs are also the most prevalent in the population. Therefore, it is unclear if this finding is reflective of the increased prevalence of BN and BED, or if it reflects a shared underlying psychopathology between BD and these EDs [ 40 ].

Comorbid ED-BD patients appear to experience increased ED symptom severity, poorer daily and neuropsychological functioning than patients with only a ED or BD diagnosis [ 107 ]. In an effort to understand which shared features in ED-BD relate to quality of life, one study assessed an adult sample with BD [ 108 ]. Binge eating, restriction, overevaluation of weight and shape, purging and driven exercise were associated with poorer clinical outcomes, quality of life and mood regulation [ 108 ]. Additionally, a study of patients undergoing treatment for BD noted patients with a comorbid ED had significantly poorer clinical outcomes and higher scores of depression [ 109 ]. Further, quality of life was significantly lower among patients with comorbid ED-BD [ 109 ]. The comorbidity of ED and BD has implications for intervention and clinical management, as at least one study observed higher rates of alcohol abuse and suicidality among patients with comorbid ED and BD compared to those with BD only [ 40 ].

Personality disorders

This RR identified limited research regarding the comorbidity between personality disorders (PD) and EDs. A meta-analysis sought to summarise the proportion of comorbid PDs among patients with AN and BN [ 41 ]. There was a heightened association between any type of ED and PDs, and this was significantly different to the general population. For specific PDs, the proportions of paranoid, borderline, avoidant, dependant and obsessive–compulsive PD were significantly higher in EDs than in the general population. For both AN and BN, Cluster C PDs (avoidant, dependant and obsessive–compulsive) were most frequent. The authors noted that the specific comorbidity between specific EDs and PDs appears to be associated with common traits—constriction/perfectionism and rigidity is present in both AN and obsessive–compulsive PD (which had a heightened association), as was the case with impulsivity, a characteristic of both BN and borderline PD [ 41 ]. This symptom association was also observed in a study of adolescents admitted to an ED inpatient unit whereby a significant interaction between binge-purge EDs (AN-BP and BN), childhood emotional abuse (a risk factor for PD) and borderline personality style was found [ 110 ].

This comorbidity may be associated with greater patient distress and have implications for patient outcomes [ 41 , 42 ]. Data from a nine-year observational study of individuals with BN reported that comorbidity with a PD was strongly associated with elevated mortality risk [ 111 ]. In terms of treatment outcomes, an RCT compared the one- and three-year treatment outcomes of four subgroups of women with BN, defined by PD complexity; no comorbid PD (health control), personality difficulties, simple PD and complex PD [ 112 ]. At pre-treatment, the complex PD group had greater ED psychopathology than the other three groups. Despite this initial difference, there were no differences in outcomes between groups at one-year and three-year follow up [ 112 ]. The authors suggested this result could be due to the targeting of the shared symptoms of BN and PD by the intervention delivered in this study, and that as ED symptoms improve, so do PD symptoms [ 112 ]. Suggesting that beyond symptom overlap, perhaps some symptoms attributed to the PD are better explained by the ED. This was consistent with Brietzke and colleagues’ (2011) recommendation that for individuals with ED and a comorbid PD, treatment approaches should target both conditions where possible [ 113 ].

Substance use disorders

Comorbid substance use disorders (SUDs) are also often noted in the literature as an issue that complicates treatment and outcomes of EDs [ 114 ]. A meta-analysis reported the lifetime prevalence of EDs and comorbid SUD was 27.9%, [ 43 ] with a lifetime prevalence of comorbid illicit drug use of 17.2% for AN and 18.6% for BN [ 115 ]. Alcohol, caffeine and tobacco were the most frequently reported comorbidities [ 43 ]. Further analysis of SUDs by substance type in a population-based twin sample indicated that the lifetime prevalence of an alcohol use disorder among individuals with AN was 22.4% [ 115 ]. For BN, the prevalence rate was slightly higher at 24.0% [ 115 ].

The comorbidity of SUD is considered far more common among individuals with binge/purge type EDs, evidenced by a meta-analysis finding higher rates of comorbid SUD among patients with AN-BP and BN than AN-R [ 44 ]. This trend was also observed in population data [ 116 ]. Further, a multi-site study found that patients with BN had higher rates of comorbid SUD than patients with AN, BED and Eating Disorder Not Otherwise Specific (EDNOS) (utilised DSM-IV criteria) [ 117 ]. Behaviourally, there was an association between higher frequencies of binge/purge behaviours with high rates of substance use [ 117 ]. The higher risk of substance abuse among patients with binge/purge symptomology was also associated with younger age of binge eating onset [ 118 ]. A study explored whether BN and ED subtypes with binge/purge symptoms predicted adverse outcomes and found that adolescent girls with purging disorder were significantly more likely to use drugs or frequently binge drink [ 119 ]. This association was again observed in a network analysis of college students, whereby there was an association between binge drinking and increased ED cognitions [ 120 ].

Psychosis and schizophrenia

The RR identified a small body of literature with mixed results regarding the comorbidity of ED and psychosis-spectrum symptoms. A study of patients with schizophrenia found that 12% of participants met full diagnostic criteria for NES, with a further 10% meeting partial criteria [ 45 ]. Miotto and colleagues’ (2010) study noted higher rates of paranoid ideation and psychotic symptoms in ED patients than those observed in healthy controls [ 121 ]. However, the authors concluded that these symptoms were better explained by the participant's ED diagnosis than a psychotic disorder [ 121 ]. At a large population level, an English national survey noted associations between psychotic-like experiences and uncontrolled eating, food dominance and potential EDs [ 122 ]. In particular, these associations were stronger in males [ 122 ]. However, the true comorbidity between psychotic disorders and ED remains unclear and further research is needed.

Body dysmorphic disorder

While body image disturbances common to AN, BN and BED are primarily related to weight and shape concerns, individuals with body dysmorphic disorder (BDD) have additional concerns regarding other aspects of their appearance, such as facial features and skin blemishes [ 46 , 123 ]. AN and BDD share similar psychopathology and both have a peak onset period in adolescence, although BDD development typically precedes AN [ 46 ]. The prevalence rates of BDD among individuals with AN are variable. In one clinical sample of female AN patients, 26% met BDD diagnostic criteria [ 124 ]. However, much higher rates were observed in another clinical sample of adults with AN, where 62% of patients reported clinically significant 'dysmorphic concern' [ 125 ].

As the RR has found with other mental health comorbidities, BDD contributes to greater symptom severity in individuals with AN, making the disorder more difficult to treat. However, some research suggested that improved long-term outcomes from treatments for AN are associated with the integration of strategies that address dysmorphic concerns [ 124 , 126 ]. However, there remains little research on the similarities, differences and co-occurrence of BDD and AN, and with even less research on the cooccurrence of BDD and other EDs.

Neurodevelopmental disorders

Attention deficit hyperactivity disorder

Several studies noted the comorbidity between Attention Deficit Hyperactivity Disorder (ADHD) and EDs. A systematic review found moderate evidence for a positive association between ADHD and disordered eating, particularly between overeating and ADHD [ 47 ]. The impulsivity symptoms of ADHD were particularly associated with BN for all genders, and weaker evidence was found for the association between hyperactivity and restrictive EDs (AN and ARFID) for males, but not females [ 47 ]. Another meta-analysis reported a two-fold increased risk of ADHD in individuals with an ED [ 48 ] and studies have noted particularly strong associations between ADHD and BN [ 49 , 50 ]. In a cohort of adults with a diagnosis of an ED, 31.3% had a 'possible' ADHD [ 127 ]. Another study considered sex differences; women with ADHD had a significantly higher lifetime prevalence of both AN and BN than women without ADHD [ 128 ]. Further, the comorbidity rates for BED were considerably higher among individuals with ADHD for both genders [ 128 ].

Further evidence for a significant association between ADHD and EDs was reported in a population study of children [ 51 ]. Results revealed that children with ADHD were more like to experience an ED or binge, purge, or restrictive behaviours above clinical threshold [ 51 ]. Another study of children with ADHD considered gender differences; boys with ADHD had a greater risk of binge eating than girls [ 129 ]. However, the study found no significant difference in AN's prevalence between ADHD and non-ADHD groups. Further, among patients attending an ED specialist clinic, those with comorbid ADHD symptoms had poorer outcomes at one-year follow-up [ 130 ].

Autism spectrum disorder

There is evidence of heightened prevalence rates of autism spectrum disorder (ASD) among individuals with EDs. A systematic review found an average prevalence of ASD with EDs of 22.9% compared with 2% observed in the general population [ 52 ]. With regards to AN, several studies have found symptoms of ASD to be frequently exhibited by patients with AN [ 53 , 54 ]. An assessment of common phenomena between ARFID and ASD in children found a shared symptom profile of eating difficulties, behavioural problems and sensory hypersensitivity beyond what is observed in typically developing children (the control group) [ 55 ]. While research in this area is developing, the findings indicated these comorbidities would likely have implications for the treatment and management of both conditions [ 55 ].

Post traumatic stress disorder

Many individuals with EDs report historical traumatic experiences, and for a proportion of the population, symptoms of post traumatic stress disorder (PTSD). A broad range of prevalence rates between PTSD and EDs have been reported; between 16.1–22.7% for AN, 32.4–66.2% for BN and 24.02–31.6% for BED [ 56 ]. A review noted self-criticism, low self-worth, guilt, shame, depression, anxiety, emotion dysregulation, anger and impulsivity were linked to the association between EDs and trauma [ 57 ]. It was suggested that for individuals with trauma/PTSD, EDs might have a functional role to manage PTSD symptoms and reduce negative affect [ 57 ]. Further, some ED behaviours such as restriction, binge eating, and purging may be used to avoid hyperarousal, in turn maintaining the association between EDs and PTSD [ 57 ].

Few studies have explored the impact of comorbid PTSD on ED treatment outcomes. A study of inpatients admitted to a residential ED treatment service investigated whether PTSD diagnosis at admission was associated with symptom changes [ 56 ]. Cognitive and behavioural symptoms related to the ED had decreased at discharge, however, they increased again at six-month follow up. In contrast, while PTSD diagnosis was associated with higher baseline ED symptoms, it was not related to symptom change throughout treatment or treatment dropout [ 56 ]. Given previous research identified that PTSD and EDs tend to relate to more complex courses of illness, greater rates of drop out and poorer outcomes, a study by Brewerton and colleagues [ 131 ], explored the presence of EDs in patients with PTSD admitted to a residential setting. Results showed that patients with PTSD had significantly higher scores of ED psychopathology, as well as depression, anxiety and quality of life. [ 131 ]. Further, those with PTSD had a greater tendency for binge-type EDs.

Suicidality

Suicide is one of the leading causes of death for individuals with EDs [ 58 ]. In a longitudinal study of adolescents, almost one quarter had attempted suicide, and 65% reported suicidal ideation within the past 6 months [ 37 ]. EDs are a significant risk factor for suicide, with some evidence suggesting a genetic association between suicide risk and EDs [ 59 , 60 ]. This association was supported in the analysis of Swedish population registry data, which found that individuals with a sibling with an ED had an increased risk of suicide attempts with an odds ratio of 1.4 (relative cohort n  = 1,680,658) [ 61 ]. For suicide attempts, this study found an even higher odds ratio of 5.28 (relative cohort n  = 2,268,786) for individuals with an ED and 5.39 (relative cohort n  = 1,919,114) for death by suicide [ 61 ]. A comparison of individuals with AN and BN indicated that risk for suicide attempts was higher for those with BN compared to AN [ 61 ]. However, the opposite was true for death by suicide; which was higher in AN compared to BN [ 61 ]. This result is consistent with the findings of a meta-analysis—the incidence of suicide was higher among patients with AN compared to those with BN or BED [ 62 ].

The higher incidence of suicide in adults with AN [ 132 ] is potentially explained by the findings from Guillaume and colleagues (2011), which suggested that comparative to BN, AN patients are more likely to have more serious suicide attempts resulting in a higher risk of death [ 133 ]. However, death by suicide remains a significant risk for both diagnoses. As an example, Udo and colleagues (2019) study reported that suicide attempts were more common in those with an AN-BP subtype (44.1%) than AN-R (15.7%), or BN (31.4%) [ 134 ]. Further, in a large cohort of transgender college students with EDs, rates of past-year suicidal ideation (a significant risk factor for suicide attempts) was 75.2%, and suicide attempts were 74.8%, significantly higher than cisgender students with EDs and transgender students without EDs [ 135 ]. The RR found that the risk of suicidal ideation and behaviour was associated with ED diagnosis and the presence of other comorbidities. Among a community-based sample of female college students diagnosed with an ED, 25.6% reported suicidal ideation, and this was positively correlated with depression, anxiety and purging [ 136 ]. In support of this evidence, Sagiv and Gvion (2020) proposed a dual pathway model of risk of suicide attempt in individuals with ED, which implicates trait impulsivity and comorbid depression [ 137 ]. In two large transdiagnostic ED patient samples, suicidal ideation was associated with different aspects of self-image between ED diagnoses. For example, suicidal ideation was associated with higher levels of self-blame among individuals with BED, while among patients with AN and OSFED, increased suicidal ideation was associated with a lack of self-love [ 138 , 139 ].

Anorexia nervosa

Amongst adults with AN, higher rates of suicide have been reported amongst those with a binge-purge subtype (25%) than restrictive subtype (8.65%) [ 58 , 140 ]. Further, comorbid depression and prolonged starvation were strongly associated with elevated suicide attempts for both subtypes [ 58 , 140 ]. In another study, the risk of attempted suicide was associated with depression, but it was moderated by hospital treatment [ 93 ]. Further, suicidal ideation was related to depression. A significant 'acquired' suicide risk in individuals with AN has been identified by Selby et al. (2010) through an increased tolerance for pain and discomfort resultant from repeated exposure to painful restricting and purging behaviours [ 141 ].

Bulimia nervosa

Further research among individuals diagnosed with BN found an increased level of suicide risk [ 142 ]. Results from an extensive study of women with BN indicated that the lifetime prevalence of suicide attempts in this cohort was 26.9% [ 143 ]. In one study of individuals diagnosed with severe BN, 60% of deaths were attributed to suicide [ 144 ]. The mean age at the time of death was 29.6 years, and predictive factors included previous suicide attempts and low BMI. Further, in a sample of children and adolescents aged 7 to 18 years, higher rates of suicidal ideation were associated with BN, self-induced vomiting and a history of trauma [ 12 ].

A large population-based study of adolescents and adults explored the frequency and correlates of suicidal ideation and attempts in those who met the criteria for BN [ 145 ]. Suicidal ideation was highest in adolescents with BN (53%), followed by BED (34.4%), other non-ED psychopathology (21.3%) or no psychopathology (3.8%). A similar trend was observed for suicide plans and attempts [ 145 ]. However, for adults, suicidality was more prevalent in the BN group compared to no psychopathology, but not statistically different to the AN, BED or other psychopathology groups [ 145 ].

Consistent with Crow and colleagues’ (2014) results, in a sample of women with BN, depression had the strongest association with lifetime suicide attempts [ 146 ]. There were also associations between identity problems, cognitive dysregulation, anxiousness, insecure attachment and lifetime suicide attempts among the sample. Depression was the most pertinent association, suggesting that potential comorbid depression should be a focus of assessment and treatment among individuals with BN due to the elevated suicide risk for this group [ 146 ]. Insecure attachment is associated with childhood trauma, and a systematic review found that suicide attempts in women with BN were significantly associated with childhood abuse and familial history of EDs [ 58 ].

Binge eating disorder

The RR found mixed evidence for the association between suicidal behaviour and BED. A meta-analysis found no suicides for patients with BED [ 62 ]. However, evidence from two separate large national surveys found that a significant proportion of individuals who had a suicide attempt also had a diagnosis of BED [ 134 , 147 ].

Non-suicidal self injury

Non-suicidal self-injury (NSSI), broadly defined, is the intentional harm inflicted to one’s body without intent to die [ 148 ]. Recognising NSSI is often a precursor for suicidal ideation and behaviour [ 149 ], together with the already heightened mortality rate for EDs, several studies have examined the association between EDs and NSSI. Up to one-third of patients with EDs report NSSI at some stage in their lifetime, with over one quarter having engaged in NSSI within the previous year [ 63 ]. Similarly, a cohort study [ 148 ] found elevated rates of historical NSSI amongst patients with DSM-IV EDs; specifically EDNOS (49%), BN (41%) and AN (26%). In a Spanish sample of ED patients, the most prevalent form of NSSI was banging (64.6%) and cutting (56.9%) [ 63 ].

Further research has explored the individual factors associated with heightened rates of NSSI. Higher levels of impulsivity among patients with EDs have been associated with concomitant NSSI [ 64 ]. This was demonstrated in a longitudinal study of female students, whereby NSSI preceded purging, marking it a potential risk factor for ED onset [ 65 ]. In a study of a large clinical sample of patients with EDs and co-occurring NSSI, significantly higher levels of emotional reactivity were observed [ 150 ]. The highest levels of emotional reactivity were reported by individuals with a diagnosis of BN, who were also more likely to engage in NSSI than those with AN [ 150 ]. In Olatunji and colleagues’ (2015) cohort study, NSSI was used to regulate difficult emotions, much like other ED behaviours. NSSI functioning as a means to manage negative affect associated with EDs was further supported by Muehlenkamp and colleagues’ [ 66 ] study exploring the risk factors in inpatients admitted for an ED. The authors found significant differences in the prevalence of NSSI across ED diagnoses, although patients with binge/purge subtype EDs were more likely to engage in poly-NSSI (multiple types of NSSI). Consistent with these findings, a study of patients admitted to an ED inpatient unit found that 45% of patients displayed at least one type of NSSI [ 151 ]. The function of NSSI among ED patients was explored in two studies, one noting that avoiding or suppressing negative feelings was the most frequently reported reason for NSSI [ 151 ]. The other analysed a series of interviews and self-report questionnaires and found patients with ED and comorbid Borderline Personality Disorder (BPD) engaged in NSSI as a means of emotion regulation [ 152 ].

Medical comorbidities

The impact of EDs on physical health and the consequential medical comorbidities has been a focus of research. Many studies reported medical comorbidities resulting from prolonged malnutrition, as well as excessive exercise, binging and purging behaviours.

Cardiovascular complications

As discussed above, although suicide is a significant contributor to the mortality rate of EDs, physical and medical complications remain the primary cause of death, particularly in AN, with a high proportion of deaths thought to result from cardiovascular complications [ 153 ]. AN has attracted the most research focus given its increased risk of cardiac failure due to severe malnutrition, dehydration and electrolyte imbalances [ 67 ].

Cardiovascular complications in AN can be divided by conduction, structural and ischemic diseases. A review found that up to 87% of patients experience cardiovascular compromise shortly following onset of AN [ 153 ]. Within conduction disease, bradycardia and QT prolongation occur at a high frequency, largely due to low body weight and resultant decreased venous return to the heart. Whereas, atrioventricular block and ventricular arrhythmia are more rare [ 153 ]. Various structural cardiomyopathies are observed in AN, such as low left ventricular mass index (occurs frequently), mitral prolapse and percardial effusion (occurs moderately). Ischemic diseases such as dyslipidemia or acute myocardial infarction are more rare.

Another review identified cardiopulmonary abnormalities that are frequently observed in AN; mitral valve prolapse occurred in 25% of patients, sinus bradycardia was the most common arrhythmia, and pericardial effusion prevalence rates ranged from 15 to 30%. [ 68 ] Sudden cardiac death is thought to occur due to increased QT interval dispersion and heart rate variability. [ 68 ] A review of an inpatient database in a large retrospective cohort study found that coronary artery disease (CAD) was lower in AN patients than the general population (4.4% and 18.4%, respectively). Consistent with trends in the general population, the risk of cardiac arrest, arrhythmias and heart failure was higher in males with AN than females with AN [ 69 ].

Given that individuals with AN have compromised biology, may avoid medical care, and have higher rates of substance use, research has examined cancer incidence and prognosis among individuals with AN. A retrospective study noted higher mortality from melanoma, cancers of genital organs and cancers of unspecified sites among individuals with AN, however, there was no statistically significant difference compared to the general population [ 70 ]. No further studies of cancer in EDs were identified.

Gastrointestinal disorders

The gastrointestinal (GI) system plays a pivotal role in the development, maintenance, and treatment outcomes for EDs, with changes and implications present throughout the GI tract. More than 90% of AN patients report fullness, early satiety, abdominal distention, pain and nausea [ 68 ]. Although it is well understood that GI system complaints are complicated and exacerbated by malnutrition, purging and binge eating [ 154 , 155 ], the actual cause of the increased prevalence of GI disorders and their contribution to ED maintenance remain poorly understood.

To this end, a review aimed to determine the GI symptoms reported in two restrictive disorders (AN and ARFID), as well as the physiologic changes as a result of malnutrition and function of low body weight and the contribution of GI diseases to the disordered eating observed in AN and ARFID [ 156 ]. The review found mixed evidence regarding whether GI issues were increased in patients with AN and ARFID. This was partly due to the relatively limited amount of research in this area and mixed results across the literature. The review noted that patients with AN and ARFID reported a higher frequency of symptoms of gastroparesis. Further, there was evidence for a bidirectional relationship between AN and functional gastrointestinal disorders (FGIDs) contributing to ongoing disordered eating. The review found that GI symptoms observed in EDs develop due to (1) poorly treated medical conditions with GI-predominant symptoms, (2) the physiological and anatomical changes that develop due to malnutrition or (3) FGIDs.

There was a high rate of comorbidity (93%) between ED and FGIDs, including oesophageal, bowel and anorectal disorders, in a patient sample with AN, BN and EDNOS [ 157 ]. A retrospective study investigating increased rates of oesophageal cancer in individuals with a history of EDs could not conclude that risk was associated with purging over other confounding factors such as alcohol abuse and smoking [ 158 ].

Given that gut peptides like ghrelin, cholecystokinin (CCK), peptide tyrosine (PYY) and glucagon-like peptide 1 (GLP-1) are known to influence food intake, attention has focussed on the dysregulation of gut peptide signalling in EDs [ 159 ]. A review aimed to discuss how these peptides or the signals triggered by their release are dysregulated in EDs and whether they are normalised following weight restoration or weight loss (in the case of people with higher body weight) [ 159 ]. The results were inconsistent, with significant variability in peptide dysregulation observed across EDs [ 159 ]. A systematic review and meta-analysis explored whether ghrelin is increased in restrictive AN. The review found that all forms of ghrelin were raised in AN’s acute state during fasting [ 160 ]. In addition, the data did not support differences in ghrelin levels between AN subtypes [ 160 ]. Another study examined levels of orexigenic ghrelin and anorexigenic peptide YY (PYY) in young females with ARFID, AN and healthy controls (HC) [ 161 ]. Results demonstrated that fasting and postprandial ghrelin were lower in ARFID than AN, but there was no difference between ARFID and AN for fasting and postprandial PYY [ 161 ].

Oesophageal and gastrointestinal dysfunction have been observed in patients with AN and complicate nutritional and refeeding interventions [ 155 ]. Findings from a systematic review indicated that structural changes that occurred in the GI tract of patients with AN impacted their ability to swallow and absorb nutrients [ 162 ]. Interestingly, no differences in the severity of gastrointestinal symptoms were observed between AN-R and AN-BP subtypes [ 155 ].

A systematic review of thirteen studies aimed to identify the most effective treatment approaches for GI disorders and AN [ 163 ]. An improvement in at least one or more GI symptoms was reported in 11 of the 13 studies, with all studies including nutritional rehabilitation, and half also included concurrent psychological treatment [ 163 ]. Emerging evidence on ED comorbidity with chronic GI disorders suggested that EDs are often misdiagnosed in children and adolescents due to the crossover of symptoms. Therefore, clinicians treating children and adolescents for GI dysfunction should be aware of potential EDs and conduct appropriate screening [ 164 ]. There has been an emerging focus on the role of the gut microbiome in the regulation of core ED symptoms and psychophysiology. Increased attention is being paid to how the macronutrient composition of nutritional rehabilitation should be considered to maximise treatment outcomes. A review found that high fibre consumption in addition to prebiotic and probiotic supplementation helped balance the gut microbiome and maintained the results of refeeding [ 165 ].

Bone health

The RR found evidence for bone loss/poor bone mineral density (BMD) and EDs, particularly in AN. The high rates of bone resorption observed in patients with AN is a consequence of chronic malnutrition leading to osteoporosis (weak and brittle bones), increased fracture risk and scoliosis [ 166 ]. The negative impacts of bone loss are more pronounced in individuals with early-onset AN when the skeleton is still developing [ 67 ] and among those who have very low BMI [ 71 ], with comorbidity rates as high as 46.9% [ 71 ]. However, lowered BMD was also observed among patients with BN [ 72 ].

A review [ 167 ] explored the prevalence and differences in pathophysiology of osteoporosis and fractures in patients with AN-R and AN-BP. AN-R patients had a higher prevalence of osteoporosis, and AN-BP patients had a higher prevalence of osteopenia (loss of BMD) [ 167 ]. Further, the authors noted the significant increase in fracture risk that starts at disease onset and lasts throughout AN, with some evidence that risk remains increased beyond remission and recovery [ 167 ]. Findings from a longitudinal study of female patients with a history of adolescent AN found long-term bone thinning at five and ten-year follow-up despite these patients achieving weight restoration [ 168 ].

Given this, treatment to increase BMD in individuals with AN has been the objective of many pharmacotherapy trials, mainly investigating the efficacy of hormone replacement [ 169 , 170 ]. Treatments include oestrogen and oral contraceptives [ 169 , 170 , 171 , 172 ]; bisphosphonates [ 169 , 173 ]; other hormonal treatment [ 174 , 175 , 176 , 177 ] and vitamin D [ 178 ]. However, the outcomes of these studies were mixed.

Refeeding syndrome

Nutritional rehabilitation of severely malnourished individuals is central to routine care and medical stabilisation of patients with EDs [ 179 ]. Within inpatient treatment settings, reversing severe malnutrition is achieved using oral, or nasogastric tube feeding. However, following a period of starvation, initiating/commencing feeding has been associated with ‘refeeding syndrome’ (RFS), a potentially fatal electrolyte imbalance caused by the body's response to introducing nutritional restoration [ 180 , 181 ]. The studies identified in the RR focused predominantly on restrictive EDs/on this population group—results regarding RFS risk were mixed [ 73 ].

A retrospective cohort study of inpatients diagnosed with AN with a very low BMI implemented a nasogastric feeding routine with vitamin, potassium and phosphate supplementation [ 182 ]. All patients achieved a significant increase in body weight. None developed RFS [ 182 ], suggesting that even with extreme undernutrition, cautious feeding within a specialised unit can be done safely without RFS. For adults with AN, aminotransferases are often high upon admission, however are normalised following four weeks of enteral feeding [ 183 , 184 ]. Further, the RR identified several studies demonstrating the provision of a higher caloric diet at intake to adolescents with AN led to faster recoveries and fewer days in the hospital with no observed increased risk for RFS [ 75 , 76 , 77 ]. These findings were also noted in a study of adults with AN [ 179 ].

However, the prevalence of RFS among inpatients is highly variable, with one systematic review noting rates ranging from 0 to 62% [ 74 ]. This variability was largely a reflection of the different definitions of RFS used across the literature [ 74 ]. A retrospective review of medical records of patients with AN admitted to Intensive Care Units (ICUs) aimed to evaluate complications, particularly RFS, that occurred during the ICU stay and the impact of these complications on treatment outcomes [ 185 ]. Of the 68 patients (62 female), seven developed RFS (10.3%) [ 185 ].

Although easily detectable and treatable, hypophosphatemia (a low serum phosphate concentration) may lead to RFS which is the term used to describe severe fluid and electrolyte shifts that can occur when nutrition support is introduced after a period of starvation. Untreated hypophosphatemia may lead to characteristic signs of the RFS such as respiratory failure, heart failure, and seizures [ 76 , 179 , 186 , 187 , 188 ]. A retrospective case–control study of inpatients with severe AN identified [ 189 ]. A retrospective study of AN and atypical AN patients undergoing refeeding found that the risk of hypophosphatemia was associated with a higher level of total weight loss and recent weight loss rather than the patient’s weight at admission [ 190 ]. The safe and effective use of prophylactic phosphate supplementation during refeeding was supported by the results from Agostino and colleagues’ chart review study [ 191 ], where 90% of inpatients received supplementation during admission.

Higher calorie refeeding approaches are considered safe in most cases, however the steps necessitated to monitor health status are costly to health services [ 192 ]. The most cost-effective approach would likely involve prophylactic electrolyte supplementation in addition to high calorie refeeding, which would decrease the need for daily laboratory monitoring as well as shortening hospital stays [ 75 , 191 , 192 ]. A systematic review noted that much of the research regarding refeeding, particularly in children and young people, has been limited by small sample sizes, single-site studies and heterogeneous designs [ 181 ]. Further, the differing definitions of RFS, recovery, remission and outcomes leading to variable results. While RFS appears safe for many people requiring feeding, the risk and benefits of it are unclear [ 193 ] due to the limited research on this topic. Following current clinical practice guidelines on the safe introduction of nutrition is recommended.

Metabolic syndrome

Metabolic syndrome refers to a group of factors that increase risks for heart disease, diabetes, stroke and other related conditions [ 194 ]. Metabolic syndrome is conceptualised as five key criteria; (1) elevated waist circumference, (2) elevated triglyceride levels, (3) reduced HDL-C, (4) elevated blood pressure and (5) elevated fasting glucose. The binge eating behaviours exhibited in BN, BED and NES have been linked to the higher rates of metabolic syndrome observed in these ED patients [ 78 , 195 ].

An analysis of population data of medical comorbidities with BED noted the strongest associations were with diabetes and circulatory systems, likely indexing components of metabolic syndrome [ 196 ]. While type 1 diabetes is considered a risk factor for ED development, both BN and BED have increased risk for type 2 diabetes [ 78 ]. A 16-year observation study found that the risk of type 2 diabetes was significantly increased in male patients with BED compared to the community controls [ 78 ]. By the end of the observation period, 33% of patients with BED had developed type 2 diabetes compared to 1.7% of the control group. The prevalence of type 2 diabetes among patients with BN was also slightly elevated at 4.4% [ 78 ]. Importantly, the authors were not able to control for BMI in this study. In another study, BED was the most prevalent ED in a cohort of type 2 diabetes patients [ 197 ]. Conversely, the prevalence of AN among patients with type 2 diabetes is significantly lower, with a review of national data reporting comorbidity rates to be 0.06% [ 198 ].

Metabolic dysfunction was observed in a relatively large sample of individuals with NES, including metabolic syndrome and type 2 diabetes, with women reporting slightly higher rates (13%) than men (11%) [ 199 ]. In another group of adults with type 2 diabetes, 7% met the diagnostic criteria for NES [ 200 ]. These findings suggested a need for increased monitoring and treatment of type 2 diabetes in individuals with EDs, particularly BED and NES. Another study found BED had a significant impact on metabolic abnormalities, including elevated cholesterol and poor glycaemic control [ 201 ].

The RR identified one intervention study, which examined an intervention to address medical comorbidities associated with BN and BED [ 195 ]. The study compared cognitive behaviour therapy (CBT) to an exercise and nutrition intervention to increase physical fitness, decrease body fat percentage and reduce the risk for metabolic syndrome. While the exercise intervention improved participants' physical fitness and body composition, neither group reduced cardiovascular risk at one-year follow-up [ 195 ].

Oral health

Purging behaviour, particularly self-induced vomiting, has been associated with several oral health and gastrointestinal dysfunctions in patients with EDs. A case–control study of ED patients with binge/purge symptomology found that despite ED patients reporting an increased concern for dental issues and engaging in more frequent brushing, their oral health was poorer than controls. [ 79 ] Further, a systematic review and meta-analysis aimed to explore whether EDs increase the risk of tooth erosion [ 80 ]. The analysis found that patients with EDs had more risk of dental erosion, especially among those who self-induced vomiting [ 80 ]. These findings were also found in a large cohort study, where the increased risk for BN was associated with higher rates of dental erosion but not dental cavities [ 81 ].

However, a systematic review of 10 studies suggested that poor oral health may be common among ED patients irrespective of whether self-induced vomiting forms part of their psychopathology [ 202 ]. One study reported that AN-R patients had poorer oral health outcomes and tooth decay than BN patients [ 203 ]. Two studies identified associations between NES and poor oral health, including higher rates of missing teeth, periodontal disease [ 204 , 205 ]. Another study of a group of patients with AN, BN and EDNOS, demonstrated the impact of ED behaviours on dental soft tissue, whereby 94% of patients had oral mucosal lesions, and 3% were found to have dental erosion [ 206 ].

Vitamin deficiencies

The prolonged periods of starvation, food restriction (of caloric intake and/or food groups), purging and excessive exercise observed across the ED spectrum have detrimental impacts on micronutrient balances [ 207 ]. The impact of prolonged vitamin deficiencies in early-onset EDs can also impair brain development, substantially reducing neurocognitive function in some younger patients even after weight restoration [ 82 ]. Common micronutrient deficiencies include calcium, fat soluble vitamins, essential fatty acids selenium, zinc and B vitamins [ 183 ]. One included study looked at prevalence rates of cerebral atrophy and neurological conditions, specifically Wernicke's encephalopathy in EDs and found that these neurological conditions were very rare in people with EDs [ 208 ].

Cognitive functioning

The literature included in RR regarding the cognitive changes in ED patients with AN following weight gain was sparse. It appears that some cognitive functions affected by EDs recover following nutritional restoration, whereas others persist. Cognitive functions, such as flexibility, central coherence, decision making, attention, processing speed and memory, are hypothesised to be impacted by, and influence the maintenance of EDs. A systematic review explored whether cognitive functions improved in AN following weight gain [ 83 ]. Weight gain appeared to be associated with improved processing speed in children and adolescents. However, no improvement was observed in cognitive flexibility following weight gain. Further, the results for adults were inconclusive [ 83 ].

Reproductive health

Infertility and higher rates of poor reproductive health are strongly associated with EDs, including miscarriages, induced abortions, obstetric complications, and poorer birth outcomes [ 84 , 85 ]. Although amenorrhea is a known consequence of AN, oligomenorrhea (irregular periods) was common among individuals with BN and BED [ 86 ]. A twin study found women diagnosed with BN and BED were also more likely to have poly cystic ovarian syndrome (PCOS), leading to menstrual irregularities [ 209 ]. The prevalence of lifetime amenorrhea in this sample was 10.4%, and lifetime oligomenorrhea was 33.7%. An epidemiological study explored the association of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) in women with BN and BED and found prevalence rates as high as 42.4% for PMS and 4.2% for PMDD [ 210 ].

Given the increased rates of menstrual irregularities and issues, questions have been raised regarding whether this complication is reversed or improves with recovery. A review of five studies monitoring reproductive functions during recovery over a 6- to 18-year follow up period [ 211 ] noted no significant difference between the pooled odds of childbirth rates between the AN and general population—demonstrating that if patients undergo treatment for AN, achieve weight restoration, and continue to maintain wellness, reproductive functions can renormalise [ 211 ].

An observational study of women with AN, BN or EDNOS found higher rates of low birth rate, pre-term deliveries, caesarean deliveries, and intrauterine growth restrictions [ 84 ]. Increased caesarean delivery was also observed in a large cohort of women diagnosed with BED [ 212 ]. However, these women had higher birth weight babies [ 212 ]. Further, women with comorbid ED and epilepsy were found to have an increased risk of pregnancy-related comorbidities, including preeclampsia (gestational hypertension and signs of damage to the liver and kidneys ) , gestational diabetes and perinatal depression [ 213 ].

The results from this review identified that the symptomology and outcomes of EDs are impacted by both psychiatric and medical factors. Further, EDs have a mortality rate substantially higher than the general population, with a significant proportion of those who die from an ED dying by suicide or as a result of severe medical complications.

This RR noted high rates of psychiatric and medical comorbidities in people with EDs, with comorbidities contributing to increased ED symptom severity, maintenance of some ED behaviours, compromised functioning, and adverse treatment outcomes. Evidence suggested that early identification and management of psychiatric and medical comorbidities in people with an ED may improve response to treatment and outcomes [ 29 , 35 , 83 ].

EDs and other psychiatric conditions often shared symptoms and high levels of psychopathology crossover were noted. The most prevalent psychiatric comorbidities were anxiety disorders, mood disorders and substance use disorders [ 8 , 100 , 119 ]. perhaps unsurprising given the prevalence of these illnesses in the general population. Of concern is the elevated suicide rate noted across the ED spectrum, the highest observed in AN [ 58 , 140 , 149 ]. For people with AN, suicide attempts were mostly associated with comorbid mood and anxiety disorders [ 136 ]. The review noted elevated rates of NSSI were particularly associated with binge/purge subtype EDs [ 150 ], impulsivity and emotional dysregulation (again, an example of psychopathological overlap).

With regards to PDs, studies were limited to EDs with binge-purge symptomology. Of those included, the presence of a comorbid personality disorder and ED was associated with childhood trauma [ 110 ] and elevated mortality risk [ 111 ]. There appeared to be a link between the clinical characteristics of the ED (e.g., impulsivity, rigidity) and the comorbid PD (cluster B PDs were more associated with BN/BED and cluster C PDs were more associated with AN). There was mixed (albeit limited) evidence regarding the comorbidity between EDs and psychosis and schizophrenia, with some studies noting an association between EDs and psychotic experiences [ 45 ]. Specifically, there was an association between psychotic experiences and uncontrolled eating and food dominance, which were stronger in males [ 122 ]. In addition, the review noted the association between EDs and neurodevelopmental disorders-specifically ADHD—was associated with features of BN and ASD was more prevalent among individuals with AN [ 53 , 54 ] and ARFID [ 55 ].

EDs are complicated by medical comorbidities across the neuroendocrine, skeletal, nutritional, gastrointestinal, dental, and reproductive systems that can occur alongside, or result from the ED. The RR noted mixed evidence regarding the effectiveness and safety of enteral feeding [ 180 , 181 ], with some studies noting that RFS could be safely managed with supplementation [ 191 ]. Research also described the impacts of restrictive EDs on BMD and binge eating behaviour on metabolic disorders [ 78 , 195 ]. Purging behaviours, particularly self-induced vomiting [ 79 ], were found to increase the risk of tooth erosion [ 81 ] and damage to soft tissue within the gastrointestinal tract [ 206 ]. Further, EDs were associated with a range of reproductive health issues in women, including infertility and birth complications [ 84 ].

Whilst the RR achieved its aim of synthesising a broad scope of literature, the absence of particular ED diagnoses and other key research gaps are worth noting. A large portion of the studies identified focused on AN, for both psychiatric and medical comorbidities. This reflects the stark lack of research exploring the comorbidities for ARFID, NES, and OSFED compared to that seen with AN, BN and BED. There were no studies identified exploring the psychiatric and medical comorbidities of Pica. These gaps could in part be due to the timeline utilised in the RR search strategy, which included the transition from DSM-IV to DSM-5. The update in the DSM had significant implications for psychiatric diagnosis, with the addition of new disorders (such as Autism Spectrum Disorder and various Depressive Disorders), reorganisation (for example, moving OCD and PTSD out of anxiety disorders and into newly defined chapters) and changes in diagnostic criteria (including for AN and BN, and establishing BED as a discrete disorder). Although current understanding suggests EDs are more prevalent in females, research is increasingly demonstrating that males are not immune to ED symptoms, and the RR highlighted the disproportionate lack of male subjects included in recent ED research, particularly in the domain of psychiatric and medical comorbidities.

As the RR was broad in scope and policy-driven in intent, limitations as a result of this methodology ought to be considered. The RR only considered ‘Western’ studies, leading to the potential of important pieces of work not being included in the synthesis. In the interest of achieving a rapid synthesis, grey literature, qualitative and theoretical works, case studies or implementation research were not included, risking a loss of nuance in developing fields, such as the association and prevalence of complex/developmental trauma with EDs (most research on this comorbidity focuses on PTSD, not complex or developmental trauma) or body image dissatisfaction among different gender groups. No studies regarding the association between dissociative disorders and EDs were included in the review. However, dissociation can co-occur with EDs, particularly AN-BP and among those with a trauma history [ 214 ]. Future studies would benefit from exploring this association further, particularly as trauma becomes more recognised as a risk factor for ED development.

The review was not designed to be an exhaustive summary of all medical comorbidities. Thus, some areas of medical comorbidity may not be included, or there may be variability in the level of detail included (such as, limited studies regarding the association between cancer and EDs). Studies that explored the association between other autoimmune disorders (such as Type 1 Diabetes, Crohn’s disease, Addison’s disease, ulcerative colitis, and coeliac disease) and EDs [ 215 , 216 ] were not included. Future reviews and research should examine the associations between autoimmune disorders and the subsequent increased risk of EDs, and likewise, the association between EDs and the subsequent risk of autoimmune disorders.

An important challenge for future research is to explore the impact of comorbidity on ED identification, development and treatment processes and outcomes. Insights could be gained from exploring shared psychiatric symptomology (i.e., ARFID and ASD, BN/BED and personality disorders, and food addiction). Particularly in disorders where the psychiatric comorbidity appears to precede the ED diagnosis (as may be the case in anxiety disorders [ 28 ]) and the unique physiological complications of these EDs (e.g., the impact of ARFID on childhood development and growth). Further, treatment outcomes would benefit from future research exploring the nature of the proposed reciprocal nature between EDs and comorbidities, particularly in those instances where there is significant shared psychopathology, or the presence of ED symptoms appears to exacerbate the symptoms of the other condition—and vice versa.

The majority of research regarding the newly introduced EDs has focused on understanding their aetiology, psychopathology, and what treatments demonstrate efficacy. Further, some areas included in the review had limited included studies, for example cancer and EDs. Thus, in addition to the already discussed need for further review regarding the association between EDs and autoimmune disorders, future research should explore the nature and prevalence of comorbidity between cancers and EDs. There was variability regarding the balance of child/adolescent and adult studies across the various comorbidities. Some comorbidities are heavily researched in child and adolescent populations (such as refeeding syndrome) and others there is stark child and adolescent inclusion, with included studies only looking at adult samples. Future studies should also address specific comorbidities as they apply to groups underrepresented in current research. This includes but is not limited to gender, sexual and racial minorities, whereby prevalence rates of psychiatric comorbidities are elevated. [ 88 ] In addition, future research would benefit from considering the nature of psychiatric and medical comorbidity for subthreshold and subclinical EDs, particularly as it pertains to an opportunity to identify EDs early within certain comorbidities where ED risk is heightened.

This review has identified the psychiatric and medical comorbidities of EDs, for which there is a substantial level of literature, as well as other areas requiring further investigation. EDs are associated with a myriad of psychiatric and medical comorbidities which have significant impacts on the symptomology and outcomes of an already difficult to treat, and burdensome illness.

Availability of data and materials

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Abbreviations

Anorexia nervosa—restricting type

Anorexia nervosa—binge-purge type

Avoidant restrictive food intake disorder

Body mass index

Borderline personality disorder

Diagnostic and statistical manual of mental disorders, 5th edition

Eating disorder

Generalised anxiety disorder

International classification of diseases, 11th edition

Major depressive disorder

Night eating syndrome

Other specified feeding or eating disorder

Post-traumatic stress disorder

Rapid review

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Acknowledgements

The authors would like to thank and acknowledge the hard work of Healthcare Management Advisors (HMA) who were commissioned to undertake the Rapid Review. Additionally, the authors would like to thank all members of the consortium and consultation committees for their advice, input, and considerations during the development process. Further, a special thank you to the carers, consumers and lived experience consultants that provided input to the development of the Rapid Review and wider national Eating Disorders Research & Translation Strategy. Finally, thank you to the Australian Government—Department of Health for their support of the current project.

National Eating Disorder Research Consortium: Phillip Aouad, Sarah Barakat, Robert Boakes, Leah Brennan, Emma Bryant, Susan Byrne, Belinda Caldwell, Shannon Calvert, Bronny Carroll, David Castle, Ian Caterson, Belinda Chelius, Lyn Chiem, Simon Clarke, Janet Conti, Lexi Crouch, Genevieve Dammery, Natasha Dzajkovski, Jasmine Fardouly, Carmen Felicia, John Feneley, Amber-Marie Firriolo, Nasim Foroughi, Mathew Fuller-Tyszkiewicz, Anthea Fursland, Veronica Gonzalez-Arce, Bethanie Gouldthorp, Kelly Griffin, Scott Griffiths, Ashlea Hambleton, Amy Hannigan, Mel Hart, Susan Hart, Phillipa Hay, Ian Hickie, Francis Kay-Lambkin, Ross King, Michael Kohn, Eyza Koreshe, Isabel Krug, Anvi Le, Jake Linardon, Randall Long, Amanda Long, Sloane Madden, Sarah Maguire, Danielle Maloney, Peta Marks, Sian McLean, Thy Meddick, Jane Miskovic-Wheatley, Deborah Mitchison, Richard O’Kearney, Shu Hwa Ong, Roger Paterson, Susan Paxton, Melissa Pehlivan, Genevieve Pepin, Andrea Phillipou, Judith Piccone, Rebecca Pinkus, Bronwyn Raykos, Paul Rhodes, Elizabeth Rieger, Sarah Rodan, Karen Rockett, Janice Russell, Haley Russell, Fiona Salter, Susan Sawyer, Beth Shelton, Urvashnee Singh, Sophie Smith, Evelyn Smith, Karen Spielman, Sarah Squire, Juliette Thomson, Marika Tiggemann, Stephen Touyz, Ranjani Utpala, Lenny Vartanian, Andrew Wallis, Warren Ward, Sarah Wells, Eleanor Wertheim, Simon Wilksch & Michelle Williams

The RR was in-part funded by the Australian Government Department of Health in partnership with other national and jurisdictional stakeholders. As the organisation responsible for overseeing the National Eating Disorder Research & Translation Strategy, InsideOut Institute commissioned Healthcare Management Advisors to undertake the RR as part of a larger, ongoing, project. Role of Funder: The funder was not directly involved in informing the development of the current review.

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DM, PM, ST and SM oversaw the Rapid Review process; AL carried out and wrote the initial review; AH and GP wrote the first manuscript; all authors edited and approved the final manuscript.

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ST receives royalties from Hogrefe and Huber, McGraw Hill and Taylor and Francis for published books/book chapters. He has received honoraria from the Takeda Group of Companies for consultative work, public speaking engagements and commissioned reports. He has chaired their Clinical Advisory Committee for Binge Eating Disorder. He is the Editor in Chief of the Journal of Eating Disorders. ST is a committee member of the National Eating Disorders Collaboration as well as the Technical Advisory Group for Eating Disorders. AL undertook work on this RR while employed by HMA. A/Prof Sarah Maguire is a guest editor of the special issue “Improving the future by understanding the present: evidence reviews for the field of eating disorders.”

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PRISMA diagram.

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Studies included in the Rapid Review.

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Hambleton, A., Pepin, G., Le, A. et al. Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature. J Eat Disord 10 , 132 (2022). https://doi.org/10.1186/s40337-022-00654-2

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Original research article, analyzing the relationship between consumers’ and entrepreneurs’ food waste and sustainable development using a bibliometric approach.

• 1 Department of Economics and Sustainable Development, School of Environment, Geography and Applied Economics, Harokopio University of Athens, Kallithea, Greece
• 2 Department of Public and Community Health, University of West Attica, Athens, Greece

The present study investigates the relationship between food waste and sustainable development, aiming to reveal contextual insights and present novel findings regarding the pivotal importance of waste and environmental strategies toward a circular economy. This research represents an effort to delineate methodological and thematic contributions, thoroughly analyze key themes, examine co-citation patterns, assess collaboration among countries, and identify current knowledge gaps in the literature. As waste management takes precedence within the framework of sustainable development goals, policymakers, and academia will better understand how effective food waste management can contribute to environmental sustainability. Methodologically, we employ systematic review, employing the PRISMA approach, analyzing 761 final papers, and investigating the relationship between food waste and sustainable development. We delve deeper to reveal contextual insights and present empirical findings that underscore the critical role of food waste in the economy and environment. Furthermore, guided by the identified knowledge gaps, we illuminate potential future research avenues that hold immense promise for advancing our understanding of food waste and its impact on sustainable development.

1 Introduction

Sustainable Development Goals centered on food security, environmental preservation, and optimizing material and energy usage are significant motivators for effectively managing the overuse of food waste ( Kaur et al., 2021 ). Food waste is a pressing global issue that squanders valuable resources and exacerbates challenges related to food security, environmental sustainability, and economic efficiency. Food waste, as defined by the Waste and Resources Action Programme, 1 “ is any food and inedible parts sent to a specified list of food waste destinations, where “food” is defined as any substance that was at some point intended for human consumption.”

A critical issue facing our global food system is the enormous amounts of food wasted yearly, leaving millions hungry. In order to resolve this contradiction, it is essential to comprehend the complex relationship between food waste and consumption patterns. This comprehensive investigation explores the different ways that consuming habits, from meal preparation and disposal to planning and purchasing, contribute to the creation of food waste. By looking at these relationships, we hope to pinpoint important intervention areas and create plans to encourage ethical and sustainable food consumption habits, ultimately reducing waste and guaranteeing everyone fair access to wholesome food. Approximately one-third of the food produced for human consumption goes to waste ( Schanes et al., 2018 ). This phenomenon leads to several environmental issues, such as soil erosion, deforestation, water and air pollution, and the release of greenhouse gases during various stages of food production ( Mourad, 2016 ). Thus, most developed countries have witnessed growing awareness and concern regarding the magnitude of food waste within their borders in recent years. Understanding food waste’s intricate parameters and dynamics becomes paramount as we strive to become more environmentally conscious and sustainable.

The current study broadly examines the available literature and discusses the interdisciplinary nature of food waste and its role in sustainable development ( Buczacki et al., 2021 ). Our investigation seeks to unravel the main findings of the current research on sustainable development and SDGs. In doing so, we aim to shed light on the extent of the problem, the societal, economic, and environmental repercussions, and the potential strategies and interventions that can be adopted to mitigate food waste. The world, characterized by its cultural diversity, varying consumption patterns, and dynamic economies, presents a unique and complex landscape for studying food waste. Our investigation extends academic discussion on the association between food waste and sustainability.

More specifically, this study highlights the countries, the authors, and the sources that decidedly investigate the relationship between food waste and sustainable development. By analyzing the successes and challenges faced in the region, we aim to provide valuable insights that can underline possible scientific gaps, inform policy development, and encourage cross-border collaboration in the fight against food waste. In conclusion, this research contributes to the growing knowledge surrounding food waste. By examining the shape of food waste dynamics, we hope to provide food of thought for a foundation for evidence-based policies and practices to minimize food waste’s detrimental impact on society, the environment, and the economy. Pursuing a more sustainable and food-secure future for Europe necessitates a deeper understanding of food waste, making this study an essential step toward that goal.

In sum, the main contribution of this systematic literature review is twofold. Firstly, it serves as a tool for pinpointing areas where scholarly evidence remains insufficient, highlighting the need for further research to expand our understanding of food waste behavior. Secondly, it establishes a knowledge repository that can offer valuable insights for evidence-based decision-making and policy formulation. This, in turn, can enhance the quality and efficacy of policy measures and technological innovations to reduce food waste. However, several objectives and research questions should be addressed and responded to achieve these goals. The main objectives are as follows:

• To investigate the relationship between food waste and sustainable development through a bibliometric analysis.

• To identify key themes, trends, and knowledge gaps in the existing research on food waste and its connection to sustainability within the framework of a circular economy and

• To provide valuable insights for policymakers, academics, and stakeholders working toward reducing food waste and achieving sustainable development goals.

After that, the research questions that are necessary to be addressed and be able to achieve the objectives of the current research are as follows:

• RQ1: What are the dominant themes and research trends in the literature on food waste and sustainable development within a circular economy framework, as revealed by a bibliometric analysis?

• RQ2: What key methodological approaches are employed in the existing research on food waste and sustainable development?

• RQ3: What are the prominent countries, institutions, and authors contributing to the field, and how do they collaborate on research related to food waste and sustainable development?

• RQ4: What are the critical knowledge gaps and potential future research avenues identified in the current body of literature on food waste and sustainable development?

By addressing these research questions, this study aims to offer a comprehensive and data-driven understanding of the current knowledge surrounding food waste and its connection to achieving sustainable development within a circular economy. This understanding can inform future research efforts and guide the development of effective strategies to address this pressing global challenge.

The remaining components are organized as follows: Section 2 summarizes the research methodology and data selection. Section 3 delves into the empirical findings, exploring their connections to the article’s conceptual, intellectual, and social framework. Section 4 presents the conclusion and implications for policy.

2 Scheme of the research and empirical methodology

2.1 bibliometric data.

The bibliometrics approach assesses information trends to emphasize the contributions of both individuals and research groups. We also utilize review processes to synthesize content and generate innovative policy recommendations concerning the relationship between food waste and sustainable development. For the subsequent procedures, we exclusively rely on the Scopus database, which is recognized as one of the most reliable and comprehensive sources. We used “ food waste ” and “ sustainable development ” to pinpoint publications. After that, we eliminated non-relevant publications to exclude irrelevant studies ( Shahbaz et al., 2021 ) following the PRISMA methodology ( Page et al., 2021 ).

In particular, a comprehensive search string in Scopus combined relevant keywords related to food waste and sustainable development. The exclusion criteria were as follows: duplicates were removed, non-English language articles were excluded, and conference materials, editorials, and letters to maintain focus on in-depth research were also removed. Following data extraction using a standardized form, we employed a multifaceted approach. Bibliometric software like VOSviewer and bibliometrix facilitated co-citation analysis, keyword clustering, and citation network visualization are also employed. Additionally, text analysis techniques complemented our understanding of key themes and emerging trends within the selected publications. This process narrows our selection to a final set of 761 studies from 214 sources for further examination.

A compilation of 1,480 research publications published between 2003 and 2023 is the outcome of our first search. We chose this time frame with significant consideration for the reasons listed below. First, we want to highlight some recent developments. There has been much advancement in food waste and its relationship to sustainable development in recent years. With an emphasis on studies released after 2003, we sought to encompass the most recent findings and patterns in this quickly developing subject. Second, it is critical to comprehend the most recent research findings and their implications for current policy and practice as the urgency of tackling food waste and reaching sustainable development goals increases.

2.2 Bibliometric analysis

Researchers can use quantitative and qualitative methodologies to identify gaps in the scientific literature by using the bibliometrics methodology to track trends in academic research ( Siddiqui et al., 2023 ). We have used bibliometric tools like VOSviewer, the R-package, and Biblioshiny to analyze publications about food waste ( Aria and Cuccurullo, 2017 ). The VOSviewer is a tool that uses a two-dimensional map to show the relationships between co-citation data, geographic locations, research journals, and keywords. Their proximity shows the degree of link or similarity between nodes in this visualization. More specifically, this software is excellent at producing two-dimensional maps showing the connections between various items in a dataset. The most popular keywords and how they gathered together are shown in the visualization, which sheds light on the recurring themes in food waste. In addition, VOSviewer assists us in recognizing significant research and schools of thinking that have shaped our current comprehension of food waste and its relationship to sustainability.

On the other hand, R-package and Biblioshiny utilize a diverse set of bibliometric tools that serve as visualization functions for conducting information analysis and generating scientific maps related to the intersection of food waste and sustainability ( da Silva Duarte et al., 2021 ; Srinivas, 2022 ). The package facilitates efficient data processing and transformation, ensuring the accuracy and consistency of the analysis. Biblioshiny provides advanced functions for constructing and analyzing bibliographic networks, allowing us to explore the intricate relationships between different entities within the food waste literature.

3 Empirical results

3.1 publication output and citation growth.

Figure 1 presents a per annum publication and citation growth trend since 2003, with an average of 75.6 citations per document. Notably, interdisciplinary research on food waste has received significant attention recently ( Dhir et al., 2020 ). There has been an exponential increase in publications in recent years, with 2023 having the highest number of publications (146 articles).

Figure 1 . Publication output.

Document-citation analysis was also performed using the “document” unit from the downloaded publications to create a table based on citation data by selecting the first ten documents as a threshold. For each of the ten documents, the number of citations and doi number are presented in the following Table 1 . For brevity, most citations reported by Papargyropoulou et al. (2014) (910 citations) have investigated the factors that increase food waste through several channels of the food supply chain and propose a framework for appropriately managing food waste. Guo et al. (2010) (636 citations) focused their interest on agricultural production and the degradation of the natural environment due to the energy crisis. Authors propose hydrogen as one of the most promising substitutes for fossil fuels. After that, a group of authors with around 300 citations consists of Notarnicola et al. (2017) , who has a total of 383 citations; Williams et al. (2012) , with 360 citations, and Xue et al. (2017) , who has 359 citations. Next, Alexander et al. (2017) , Mourad, Garrone et al. (2014) , Sharma P. et al. (2020) , and Sharma S. et al. (2020) papers have more than 200 citations, but less than 300 completed the first ten high-cited documents.

Table 1 . Top 10 most cited documents.

3.2 Countries’ collaboration networks

Next, Figures 2 , 3 visually represent global research collaboration among countries, displaying the collaboration network and the volume of publications contributed by each country.

Figure 2 . Country scientific production.

Figure 3 . Countries’ collaboration network.

In Figure 2 , the research output is presented with varying shades of color, wherein the darker colors represent the regions with the highest frequency of publications. Notably, China is the global leader in research publications, with an impressive count of 481, showcasing its substantial contribution to the academic landscape. Following closely behind are other key players in the research arena, with Italy contributing 442 publications, the United Kingdom with 246, India with 215, and the United States with 208, all demonstrating their significant presence in the global research community. Additionally, several other highly productive economies, such as Spain, Sweden, Germany, Malaysia, and Australia, are notable contributors, further enriching the global research output landscape.

Moving on to Figure 3 , it describes the collaborative aspect of research on a global scale, shedding light on the interconnections and partnerships between various countries in the pursuit of knowledge and academic advancement.

A compelling pattern emerges when examining collaborations between authors and countries in food waste. Notably, China, Italy, and the United Kingdom substantially collaborate. This outcome highlights their proactive stance in fostering international partnerships to tackle food waste and sustainability nexus. Following closely behind are the United States and Spain, both of which also participate actively in collaborative initiatives. These findings underscore the global significance of addressing food waste and the willingness of these nations to join forces in addressing this critical challenge.

3.3 Keywords, authors, and key countries framework

The upcoming section aims to reveal how researchers have documented various research streams across different countries. To achieve this, we employ the CAK framework to introduce innovative visualizations that portray the amalgamation of authors, research themes, and countries.

It is evident from Figure 4 that Italy, China, and the UK are the most prominent geographical locations. Likewise, the most dominant research themes are food waste, sustainable development, waste management, and waste disposal. It is worth noting that the smaller size of countries with limited contributions suggests that the current state of research is in its early stages. Additional research, mainly from European economies with substantial food demands, should shed light on recent research developments and explore new avenues of inquiry.

Figure 4 . CAK framework. Authors, keywords, countries.

Figure 5 , depicted as a tree diagram, visually represents the keywords extensively employed in the array of previously studied records. A closer examination of the results illuminates the prominent themes authors have chosen to emphasize in their works.

Figure 5 . Keywords tree-map.

Notably, “food waste” takes the lead, featuring in approximately 36% of the articles. This underscores the paramount significance of addressing food waste within the scope of the research, signifying its pervasive relevance in current academic discourse. Sustainability is another crucial focus in 18% of the articles, highlighting the shared commitment to promoting sustainable practices and environmental responsibility within food waste management. Furthermore, the concept of a “circular economy” garners notable attention, being employed as a keyword in 10% of the publications, reflecting the growing interest in developing circular and resource-efficient systems to combat food waste. The utilization of “life cycle assessment” as a keyword in 8% of the articles underscores the methodological approach many authors took, emphasizing the importance of assessing environmental impacts across the entire life cycle of food products. Finally, the notion of “sustainable development” is reflected in 7% of the works, signifying the broader context in which food waste mitigation is situated, emphasizing the pursuit of development that satisfies current requirements without jeopardizing those of coming generations. This breakdown of prevalent keywords offers valuable insights into the thematic and methodological orientations of the scholarly discourse surrounding food waste. It underscores the critical areas of focus within this research domain.

3.4 Co-citation analysis of authors – intellectual structure

Afterward, we utilize co-citation analysis to understand better how literature has evolved in recent decades. The extent to which studies reference one another indicates the interrelatedness within the scientific literature. Co-citation analysis is a constantly changing metric that aids in recognizing emerging paradigms within a selected body of academic literature ( Buczacki et al., 2021 ). In our present study, we refer to Figure 6 (co-citation analysis), where the number of citations is represented, and the relatedness of topics is indicated by the distance between these nodes, shedding light on academic discourse. The visualization in Figure 6 reveals two distinct clusters.

Figure 6 . Co-citations analysis of authors.

The first group of publications delves into the importance of food waste as a critical element in developing a sustainable food system ( Quested et al., 2011 ). They also attempt to identify the losses occurring along the entire food chain and identify the causes of food losses and possible ways of preventing them ( Quested et al., 2011 ; Falasconi et al., 2015 ; Eriksson et al., 2020 ). Conversely, a second cluster examines food issues in a more global scale analysis linked to sustainable development goals ( Liu et al., 2022 ) introducing, for instance, the effects of international food trade on the food system ( Wang et al., 2022 ). Smaller groups use a more quantitative analysis highlighting possible environmental and socio-economic impacts of food waste ( Albizzati et al., 2021 ) and policies at a micro level ( Lassen et al., 2019 ).

3.5 Conceptual structure of the publications

Recently, keyword co-occurrence networks have become increasingly popular in systematic review-based studies, offering a means to harness knowledge mapping and uncover associations among research themes in research management ( Bashir et al., 2021 ). This approach empowers researchers to comprehensively understand a specific field within the amassed knowledge, harnessing the associations between keywords to reveal insights in economic literature. In our current research, we utilize a keyword co-occurrence network approach, setting a threshold of at least five occurrences for a word to be included. Consequently, out of a total of 1,136 keywords, 113 satisfied this requirement (see Figures 7 , 8 ).

Figure 7 . Keywords co-occurrence network.

Figure 8 . Keywords co-occurrence network.

Notably, keywords like “food waste,” “sustainability,” “waste management,” “environmental impact,” and “waste disposable” are the most frequently occurring. Furthermore, as depicted in Figure 7 , three separate groups of keywords are evident (green, red, and blue). Looking at the blue cluster, the keywords “sustainability,” “food supply,” “food security,” “nutrition” and “supply chain” exhibit close associations. As far as the red cluster is concerned, the keywords “article,” “waste disposal,” “fertilizer,” “biogas,” and “nitrogen” indicate a group of research that investigates the concept of food waste from a different perspective. An interesting observation is that keywords (green cluster) such as “life cycle assessment,” “gas emissions,” “anaerobic digestion,” “municipal waste,” and “climate change” have small node sizes but remain interconnected in terms of links.

After that, we expanded the keywords’ co-occurrence network by exploring its time evolution. The connection between food waste and sustainability is relatively recent, with most publications emerging after 2019. Even more recently, authors have also incorporated into their analysis the “circular economy,” “sustainable development goals,” “waste management,” and “food supply.” These keywords provide more information on the trend already in process around the relationship between food waste management and sustainability in the future. A notable trend is observed, with most publications centered around food waste, sustainability, environmental impact assessment, food supply, and climate change.

We further employ Figure 9 to explore thematic mapping from the perspective of four distinct subdivisions, which aids in comprehending the diversity and significance of sub-components within the scientific literature ( Buczacki et al., 2021 ). We have established the maximum number of keywords at 119 and the minimum cluster frequency at 3.

Figure 9 . Thematic map.

The upper right section encompasses “motor themes,” representing research topics with the highest density and centrality, such as “food waste,” “sustainability,” “circular economy,” “life cycle assessment,” and “waste management.” In the lower-right quadrant, we find “food security” characterized by low density, discussing topics like “recycling,” “climate change,” “food waste management,” and “food supply chain.” These transversal themes hold significant importance in the research, contributing to discussions on various research directions. Lastly, “declining or emerging themes” and “niche themes” encompass research topics related to “household food waste” and “co-digestion.” In summary, Figure 9 serves as a valuable tool for understanding the current academic discourse and the potential role of food waste in future waste management policies.

4 Discussion

The present work aims to offer researchers and policymakers a toolbox of organized ideas to tackle food waste. Simultaneously, to achieve the objectives outlined in the Sustainable Development Goals, the target of reducing food waste and adopting a comprehensive strategy incorporating various measures is domineering. These efforts rectify informational gaps already highlighted by previous systematic literature review works ( Schanes et al., 2018 ).

Besides, similar to previous studies ( Principato et al., 2021 ) our research sheds light on the complex sides of the food waste phenomenon, highlighting the trend of research on this topic ( Zhang et al., 2018 ; Vásquez Neyra et al., 2022 ; D'Adamo et al., 2023 ). More specifically, our study provides an essential segment of information presenting the issues around food waste that are denoted as the motor themes with a critical role of food waste in future food waste management and policies, such as the concept of circular economy ( de Oliveira et al., 2021 ; Nikolaou and Tsagarakis, 2021 ; Santagata et al., 2021 ). In this direction, the European Food Safety Authority (2020) highlights that circular economy initiatives are increasing attention to food waste as a food and feed source.

Furthermore, our review, concentrating on strategies to reduce food waste and promote sustainability, dovetails with the Green Deal’s priorities, such as resource efficiency, waste reduction, and sustainable consumption. By positioning the study within the broader context of global sustainability challenges, it becomes evident that addressing food waste is integral to achieving the Green Deal’s ambitious targets. In this direction, according to FAO (2021) one of the ways toward more sustainable agriculture and food production is to manage food production systems sustainably through significant reductions in food loss and waste.

5 Concluding remarks and policy implications

The central objective of our research is to investigate the relationship between food waste and sustainability through a review of academic literature. Our study thoroughly examines all pertinent publications on the nexus between food waste and sustainable development. Given the pivotal role of food waste in the context of Sustainable Development Goals (SDGs), it becomes crucial for policymaking institutions to evaluate socio-economic and policy variables.

This evaluation is essential for harmonizing food consumption and environmental sustainability via several policy implications. For instance, policymakers should prioritize integrating food waste reduction strategies into the broader framework of SDGs. This approach ensures a more holistic and sustainable approach to addressing food waste while advancing the global sustainability agenda. Also, at a microeconomic level, governments must focus on socio-economic and policy factors that directly influence food waste. By designing policies that incentivize food waste reduction at the individual, household, and industrial levels, they can contribute to achieving both economic and environmental goals. On a more global-scale and macroeconomic level, collaboration among countries, mainly focusing on emerging economies, is essential to address the multifaceted challenges posed by food waste. Policymakers should explore international partnerships to facilitate knowledge sharing, best practices, and innovative strategies in mitigating food waste.

In a more specific and focused aspect, our analysis identifies key themes and research areas related to food waste and sustainability. European and national policy measures should emphasize the need to integrate specific food waste reduction strategies into national SDG goals such as Goal 2 (zero hunger) and Goal 12 (responsible consumption and production). Moreover, governments and policymakers can identify specific socio-economic and policy factors that significantly influence food waste at individual, household, and industrial levels. These policy interventions could include consumer awareness campaigns, incentivizing food waste reduction within entrepreneurs, exploring policies like tax breaks for businesses implementing waste reduction strategies, or introducing waste disposal fees based on waste generation. Financially, the public sector could also encourage policies that facilitate the redistribution of surplus food to those in need, reducing waste and promoting social welfare. That can be done by promoting the establishment of international funding mechanisms to support emerging economies in implementing effective food waste reduction strategies.

However, it is noteworthy that conducting country-specific analyses can offer valuable insights and potentially address limitations associated with quantitative data and analysis. Understanding the specific dynamics of food waste in different nations is crucial for tailoring effective policies and interventions. In addition, we urge future research to delve into the role of addressing food waste issues, particularly in emerging economies. Such research endeavors have the potential to yield diverse policy insights. By examining the unique challenges and opportunities food waste presents in these regions, policymakers can better understand the evolving issues in developing and developed nations. This knowledge is invaluable for shaping effective strategies to reduce food waste and promote sustainable practices worldwide.

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Author contributions

IK: Conceptualization, Investigation, Software, Visualization, Supervision, Visualization, Writing – original draft, Writing – review & editing. SP: Investigation, Software, Visualization, Writing – original draft, Writing – review & editing. GM: Investigation, Methodology, Software, Visualization, Writing – original draft, Writing – review & editing.

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: food waste, sustainability, behavior, bibliometric analysis, VOSviewer, bibliometrix

Citation: Kostakis I, Papadaki S and Malindretos G (2024) Analyzing the relationship between consumers’ and entrepreneurs’ food waste and sustainable development using a bibliometric approach. Front. Sustain . 5:1373802. doi: 10.3389/frsus.2024.1373802

Received: 20 January 2024; Accepted: 15 March 2024; Published: 04 April 2024.

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Copyright © 2024 Kostakis, Papadaki and Malindretos. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Ioannis Kostakis, [email protected]

This article is part of the Research Topic

Innovation in Sustainable Food