With the highest mortality rate of any mental illness and one of the lowest recovery rates, anorexia nervosa presents substantial challenges to the clinician. That is one reason treatment of the disease requires an interdisciplinary team of providers, including a medical doctor, a mental health specialist, and a dietitian, all with experience in treating eating disorders. This team must deliver integrated, coordinated care to patients, explained Kathryn Pieper, PhD, a child psychologist and director of the Eating Disorders Center at Children’s Mercy and the University of Missouri-Kansas City School of Medicine in Kansas City.
Pieper said there has also been a movement away from blaming families and toward empowering them to help adolescents with anorexia.
“It used to be that clinicians believed a lot of anorexia nervosa arose from control battles with over-controlling parents and that the individual had to develop insight and motivation to recover,” Dr Pieper said. “Now we recognize that having family intervention that empowers the family, including parenting in terms of how to feed the child, has been a key factor in the success of that child.”
Research has continued to change rapidly in the field of eating disorder treatments, as seen in a new review of recent evidence into existing and emerging treatments for anorexia nervosa, published in the journal Psychological Medicine by Timo Brockmeyer and Hans-Christoph Friederich, of the Heinrich-Heine-University Düsseldorf in Germany, and Ulrike Schmidt of King’s College London in the United Kingdom.
“I thought the review was really worthwhile and discussed a lot of the emerging treatments well,” Dr Pieper said. “You can’t say a lot about the emerging treatments because there is not a lot of research into them yet, but those are exciting and helpful for the clinician to read about.”
Established Treatments for Teens and Adults
The authors summarized the findings from 8 studies with 833 teen patients and 11 studies with 1257 adult patients, all published since the previous review 5 years ago. They also reviewed 6 unpublished trials on adolescents, 8 unpublished trials on adults, and any ongoing studies.
“Available trials paint a nuanced picture of the relative merits of different types of family-based interventions for adolescents with anorexia nervosa,” the authors wrote. “They also support the use of a range of individual psychotherapies for adults, with little information on what works best for whom.”
Neither multifamily group therapy nor separate (parents only) family therapy was superior to the other, nor did eating disorder-focused family therapy and systemic family therapy show any significant differences in outcomes. Among adults, cognitive behavioral therapy (CBT), focal psychodynamic psychotherapy (FPT), the Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) or Specialist Supportive Clinical Management (SSCM) all showed similar improvements in primary and secondary outcomes.
“Some advantages over optimized treatment as usual or SSCM have been reported for enhanced CBT, FPT, and MANTRA in terms of the speed of weight gain, long-term global outcomes, and weight gain in patients with a more severe form of the illness, respectively,” the authors wrote. “However, the overall picture remains that there is no single psychotherapy that is substantially superior to another.”
A clinician may need to try different approaches before determining which one works best for a particular patient’s needs, Dr Pieper told Psychiatry Advisor.
“There are a number of therapy approaches that are effective, but we don’t have a lot of research to say which one is best for each person,” Dr Pieper said. “What’s important is that the person doing the treatment needs to have expertise in treating eating disorders. They need to understand how to work with a multidisciplinary team and how to make sure their patient is safe physically by seeing a doctor who is experienced in tracking eating disorders.”
The research review also looked at comparisons of long-term inpatient care vs day care following a shorter inpatient stay for adolescents. Recent evidence suggests the latter “is a safe and less costly alternative to longer inpatient treatment for adolescent patients with non-chronic anorexia nervosa.” No similar studies involving adults were published, however.