anorexia nervosa research paper pdf

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Treatment of Anorexia Nervosa-New Evidence-Based Guidelines

Affiliations.

1 Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Baden-Wuerttemberg, Germany. [email protected].
2 Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University Bochum, Alexandrinenstr. 1-3, Nordrhein-Westfalen, 55791 Bochum, Germany. [email protected].
3 Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Neuenhofer Weg 21, Nordrhein-Westfalen, 52074 Aachen, Germany. [email protected].
4 Department of Psychosomatic Medicine and Psychotherapy, University Hospital Freiburg, Hauptstr. 8, Baden-Wuerttemberg, 79104 Freiburg, Germany. [email protected].
PMID: 30700054
PMCID: PMC6406277
DOI: 10.3390/jcm8020153

Anorexia nervosa is the most severe eating disorder; it has a protracted course of illness and the highest mortality rate among all psychiatric illnesses. It is characterised by a restriction of energy intake followed by substantial weight loss, which can culminate in cachexia and related medical consequences. Anorexia nervosa is associated with high personal and economic costs for sufferers, their relatives and society. Evidence-based practice guidelines aim to support all groups involved in the care of patients with anorexia nervosa by providing them with scientifically sound recommendations regarding diagnosis and treatment. The German S3-guideline for eating disorders has been recently revised. In this paper, the new guideline is presented and changes, in comparison with the original guideline published in 2011, are discussed. Further, the German guideline is compared to current international evidence-based guidelines for eating disorders. Many of the treatment recommendations made in the revised German guideline are consistent with existing international treatment guidelines. Although the available evidence has significantly improved in quality and amount since the original German guideline publication in 2011, further research investigating eating disorders in general, and specifically anorexia nervosa, is still needed.

Keywords: anorexia nervosa; evidenced-based; guidelines; treatment.

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The authors declare no conflict of interest.

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DOI: 10.1038/nrdp.2015.74
Corpus ID: 21580134

Anorexia nervosa

J. Treasure , Stephan Zipfel , +7 authors Elisabet Wentz
Published in Nature Reviews Disease… 2015
Medicine, Psychology

153 Citations

Anorexia nervosa: outpatient treatment and medical management, sudden gains in the outpatient treatment of anorexia nervosa: a process‐outcome study, anorexia nervosa in adolescents., treatment of anorexia nervosa—new evidence-based guidelines, body shape in inpatients with severe anorexia nervosa, emerging therapeutic targets for anorexia nervosa, when anorexia nervosa symptoms mask kallmann syndrome.

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Anorexia nervosa: 30-year outcome

Trauma experiences are common in anorexia nervosa and related to eating disorder pathology but do not influence weight-gain during the start of treatment, pseudo bartter syndrome in anorexia nervosa, 227 references, antidepressants for anorexia nervosa., inpatient treatment for anorexia nervosa: a systematic review of randomized controlled trials, long-term follow-up of adolescent onset anorexia nervosa in northern sweden, epidemiology and course of anorexia nervosa in the community., anorexia nervosa in young men: a cohort study., compulsivity in anorexia nervosa: a transdiagnostic concept, should amenorrhea be a diagnostic criterion for anorexia nervosa, temperament-based treatment for anorexia nervosa., anorexia nervosa: outcome and prognostic factors after 20 years, adolescent-onset anorexia nervosa: 18-year outcome., related papers.

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MINI REVIEW article

Bulimia nervosa and treatment-related disparities: a review.

College of Health Sciences, Utah Tech University, St. George, UT, United States

Introduction: Bulimia nervosa (BN) is a type of eating disorder disease usually manifesting between adolescence and early adulthood with 12 as median age of onset. BN is characterized by individuals’ episodes of excessive eating of food followed by engaging in unusual compensatory behaviors to control weight gain in BN. Approximately 94% of those with BN never seek or delay treatment. While there are available treatments, some populations do not have access. Left untreated, BN can become severe and lead to other serious comorbidities. This study is a review of randomized controlled trials to explore available treatments and related treatment disparities. The objective of this review was to identify differences among treatment modalities of BN and aide in the further treatment and research of bulimia nervosa.

Methods: This study followed narrative overview guidelines to review BN treatment studies published between 2010 and 2021. The authors used PubMed and PsychInfo databases to search for articles meeting the inclusion criteria. Search terms included phrases such as, BN treatment, BN and clinical trials, and BN and randomized clinical trials.

Results: Most of the reviewed studies had their sample sizes between 80 and 100% female with age range between 18 and 60 years old. Sample sizes were mostly between 80 and 100% white. Treatment practices included both pharmacological and psychosocial interventions, such as cognitive behavioral therapy (CBT) and limited motivational interviewing (MI). Most studies were in outpatient settings.

Conclusion: Reviewed research shows that certain populations face disparities in BN treatment. Generally, individuals older than 60, males and racial minorities are excluded from research. Researchers and practitioners need to include these vulnerable groups to improve BN treatment-related disparities.

Bulimia nervosa (BN) is a serious eating disorder (ED) that usually manifests between adolescence and early adulthood ( Hail and Le Grange, 2018 ). BN is characterized by episodes of recurrent binge eating ( Martins et al., 2020 ). BN involves engaging in compensatory behaviors such as self-induced vomiting, misuse of laxatives, diuretics, or enemas ( Mond, 2013 ; American Psychiatric Association, 2022 ). Other compensatory behaviors may include activities such as fasting or excessive exercise ( Mond, 2013 ; American Psychiatric Association, 2022 ). The episodes can be mixed and are classified as recurrent episodes of binge eating in any 2-h period that is larger than most people would during a similar period ( Mond, 2013 ; American Psychiatric Association, 2022 ). Individuals might go as far as to arrange their schedules to accommodate episodes of bingeing ( Harrington et al., 2015 ).

The median age of onset is 12.4 ( Hail and Le Grange, 2018 ), however onset could be as high as 18–44 years old with a lifetime prevalence of 1.5% among females, and 0.5% among males ( Udo and Grilo, 2018 ). Other research has shown the range of lifetime prevalence among females to be 0.3–4.6% and 0.1–1.3% among males ( van Eeden et al., 2021 ). Research also shows that 85–94% of those with BN never seek professional help, or delay treatment by 4–5 years ( Mathisen et al., 2017 ). Left untreated, BN can become severe and lead to other comorbidities or bad health outcomes, including death in some cases ( Hail and Le Grange, 2018 ). This study is a review of randomized controlled trials to explore available treatments and related treatment disparities. While different authors may define health disparities in different ways, our definition is one generally accepted which is that health disparities are differences or gaps in health outcomes, or even healthcare access, and treatment among populations ( Riley, 2012 ; Arcaya et al., 2015 ). These differences are unjust and preventable and can occur between racial groups, social economic status, or gender ( Riley, 2012 ; Arcaya et al., 2015 ). These differences or gaps would not normally occur if the distribution of resources were fair ( Riley, 2012 ; Arcaya et al., 2015 ). Our objective was to identify these differences in the treatment and research of bulimia nervosa among populations. An identification of these differences is key in the successful treatment and research of bulimia nervosa.

The primary diagnostic criterion of BN is stated in the Diagnostic and Statistical Manual of Mental Disorders Fourth edition, DSM-IV and Fifth edition, DSM-V ( MacDonald et al., 2014 ; Harrington et al., 2015 ; American Psychiatric Association, 2022 ). Individuals with BN are usually of normal height and weight ( Frank, 2012 ), but can also be overweight which makes the diagnosis of BN challenging ( Harrington et al., 2015 ). Also, according to the DSM criteria, BN is characterized by an episode of binge eating by (a) eating in a discrete period, an amount of food that is larger than most individuals would eat in a similar period and under similar circumstances, and lacking control of eating during this episode. (b) recurrent compensatory behaviors that prevent weight gain, (c) at least once per week for 3 months, (d) self-evaluation of body shape and weight is unduly influenced, and (e) this behavior is not that of anorexia nervosa ( Mond, 2013 ; Harrington et al., 2015 ; American Psychiatric Association, 2022 ). The individual is in partial remission if some, but not all criteria have been met for a sustained period of time and will be considered full remission if none of the criteria is met for a sustained period of time ( Harrington et al., 2015 ; American Psychiatric Association, 2022 ). The average frequency of binge eating and purging has decreased from twice per week, per the DSM-IV, to once per week ( Mond, 2013 ; Harrington et al., 2015 ; American Psychiatric Association, 2022 ), which was the increasing prevalence for BN ranging from 4 to 6.7% ( Nitsch et al., 2021 ).

The severity of BN is based upon the frequency of compensatory behaviors and may reflect other symptoms and functional disability and are categorized based upon average episodes of compensatory behaviors per week. These categories include Mild 1–3, Moderate 4–7, Severe 8–13 and Extreme 14+ ( Harrington et al., 2015 ; Nitsch et al., 2021 ; American Psychiatric Association, 2022 ).

Untreated or undertreated BN

Untreated or undertreated BN is associated with several comorbidities. These comorbidities may include psychiatric disorders, hopelessness, shame and impulsivity, which can contribute to non-suicidal self-harm, suicidal ideation and death by suicide ( Nitsch et al., 2021 ). The suicide rates among individuals with BN are high where compared to the general population, they are 8 times more likely to die by suicide ( Preti et al., 2011 ; Cucchi et al., 2016 ; Nitsch et al., 2021 ). The standardized mortality rates among those with BN are elevated at 1.5 to 2.5% ( Arcelus et al., 2011 ; Nitsch et al., 2021 ). This higher mortality rate in BN is due to the medical complications of purging ( Nitsch et al., 2021 ). These purging behaviors and laxative use can cause electrolyte imbalances leading to increased risk of cardiovascular disease, including ischemic heart disease and in some cases resulting in death in females ( Nitsch et al., 2021 ).

Other problems associated with purging include dental erosion and hypertrophy of salivary glands ( Harrington et al., 2015 ; Nitsch et al., 2021 ), trauma to the pharynx, increased risk of aspiration pneumonia, irregular menses due to endocrine system disruption and gastrointestinal problems ( Nitsch et al., 2021 ). The binge eating aspect of BN can also cause gastrointestinal problems such as bloating, dysphagia and acid reflux ( Nitsch et al., 2021 ). Prognosis and recovery are variable and there is an increased risk of relapse with psychological dysfunction and body image disturbance. There is evidence to support changes in neuronal activity and suggest a link in BN with body image distortion ( Wang et al., 2019 ). Poor outcomes can be attributed to fewer follow-up years, increased drive for thinness and beginning treatment at an older age ( Nitsch et al., 2021 ). It is however estimated that with proper treatment 80% of individuals with BN achieve remission ( Harrington et al., 2015 ).

This study followed narrative overview guidelines to review randomized controlled trial ( Wonderlich et al., 2014 ; Jacobi et al., 2017 ; Mannan et al., 2021 ) studies published between 2010 and 2021. The authors searched PubMed and PsychInfo databases to search for articles meeting the inclusion criteria. Search terms included phrases such as bulimia nervosa treatment, bulimia nervosa and clinical trials, bulimia nervosa and randomized clinical trials, or bulimia nervosa diagnosis and treatment. Any studies that did not involve randomized controlled trials and treatment of bulimia nervosa were excluded. Review studies such as systematic reviews or meta-analysis were also excluded from review for this study. This paper was not a review of review studies and because such review works had already been completed by other investigators, they were left out of this current review study. Of the 685 studies resulting from the search terms used, 17 studies met the inclusion our inclusion criteria and were reviewed for this study. The variables examined included, sample size, sex, mean age, race/ethnicity, study setting (inpatient/outpatient), intervention/treatment type, and response to interventions ( Figure 1 ).

Figure 1 . Flow chart of studies reviewed.

Table 1 (Summary of Bulimia Nervosa Randomized Clinical Trials) is a summary of journal articles published between 2010 and 2021 which were reviewed for this study. Following the inclusion criteria, 17 studies were included in this review. Most of the reviewed studies had their sample sizes between 80 and 100% female with age range between 18 and 60 years old. Sample sizes were mostly between 80 and 100% white. Treatment practices included both pharmacological, and behavioral, or psychosocial interventions, such as cognitive behavior therapy (CBT) and limited motivational interviewing (MI), using at-home questionnaires. Most psychosocial interventions used were CBT and incorporated other strategies such as dialectical behavioral therapy (DBT), family-based therapy (FBT), limited MI, guided self-help (GSH), integrative cognitive-affective therapy (ICAT), virtual reality (VR), mindfulness and acceptance-based therapy (MABT), psychodynamic therapy (PDT), identity intervention program (IIP) and supportive psychotherapy (SPT). Other studies included those utilizing physical exercises and dietary therapy (PED-t), transcranial magnetic stimulation (rTMS), direct current stimulation (DCS), and pharmacological treatments using phentermine/topiramate (PHEN/TPM-ER). Most of the studies were done in outpatient settings.

Table 1 . Summary of bulimia nervosa randomized controlled trial intervention studies (2010–2021).

Our findings show that several behavioral interventions are used for the treatment of BN, with CBT as the preferred choice ( Mathisen et al., 2017 ; Burmester et al., 2021 ). Other behavioral interventions included VR, DBT and FBT. Most individuals with BN do not seek treatment and instead present for weight loss issues, making CBT the first line of defense for treating eating disorders (ED) ( Donnelly et al., 2018 ). Other tools such as the Stroop Test guide clinicians in the understanding of the effects of visual stimuli as it translates into emotional, psychological and neural responses in those with ED and therefore aides in forming clinical treatment programs using CBT and visual imagery ( Burmester et al., 2021 ). The vicious cycle of compensatory strategies that affect perceptions of weight and shape can render CBT effective in treating BN.

The focus of CBT-BN can restructure the cognitive distortions of body shape and weight, perfectionism, low self-esteem, interpersonal stress, and mood tolerance. While self-reporting can be a source of shame, it is important in the problem-solving process during CBT-BN treatment ( Hagan and Walsh, 2021 ). However, FBT is shown to be more effective in adolescents than in adults ( Gorrell et al., 2019 ). Physical exercise can also be used to treat BN symptoms, however, it is not typically used in clinics due to the propensity for those with ED to overexercise and the clinicians’ fear that such exercise prescription would increase the compensatory behaviors ( Bratland-Sanda et al., 2009 ; Quesnel et al., 2018 ; Mathisen et al., 2020 ). A combination of Dietary Therapy and Physical Exercise (PED-t) was studied as a trial, as a new method of treatment and was hypothesized to re-establish healthy patterns by focusing on the functionality of the body rather than appearance. This also aimed to provide knowledge to those suffering with ED, specifically BN and binge eating disorder to change thought patterns. The concern for this treatment approach was the overall long-term effectiveness yet is still an approach that is being considered as part of their evidenced-based practice ( Mathisen et al., 2020 ).

CBT and other behavioral interventions compared

Individuals receiving CBT treatment have reported a decreased desire for thinness and demonstrated fewer purging episodes ( Ferrer-García et al., 2017 ). Studies also compared CBT with other methods such as Physical Exercise/Dietary Therapy (PED-t). A comparison of CBT and PED-t found that in addition to reduced depression symptoms, PED-t performed just as good as CBT in reducing the symptoms of BN and binge eating disorder and improving other psychosocial impairment ( Mathisen et al., 2020 ). There were also increased abstinence rates with VR ( Ferrer-García et al., 2017 ), and mindfulness and acceptance-based treatment (MABT) performed just as equal to CBT in increased retention rates and reductions in BN symptoms ( Juarascio et al., 2021 ). Participants receiving Guided Self-Help (GSH) had fewer objective binge eating days (OBD), vomiting, psychopathology and improved abstinence rates ( Chen et al., 2017 ) and greater meal/snack adherence with GSH and CBT combined ( Hildebrandt et al., 2017 ). These results suggest that while CBT is the preferred method, approaches such as PED-t and MABT can be just as good and even good alternatives when use of CBT is not possible ( Mathisen et al., 2020 ; Juarascio et al., 2021 ). Abstinence rates among adolescents aged 12–18 were greater with FBT ( Le Grange et al., 2015 ), and with improved cognitive symptoms, self-esteem and depressive symptoms as compared to CBT and SPT ( Ciao et al., 2015 ). Further research is needed to determine effective treatment outcomes for adolescents.

In addition to CBT, other innovative methods were found in the review. Identity Intervention Program (IIP) was used to identify self-schemas and promote new cognitive structures. Supportive Psychotherapy Intervention (SPI) was used as the control group for this study. Participants used descriptive cards to identify how they think about themselves, along with the Beck Depression Inventory (BDI), Psychological Well-Being scales and a Health Survey during this study. At end of treatment, the IIP group had higher mean increases in positive self-schemas, with no significance in the SPT group, taken from baseline measurements ( Stein et al., 2013 ). Repetitive transcranial magnetic stimulation (rTMS) and sham rTMS were used to determine the efficacy of reducing food cravings in bulimic patients by stimulating the left dorsolateral prefrontal cortex. This resulted in no significant differences between groups for binge/purge days ( Gay et al., 2016 ). Use of at home questionnaires were used to determine food cravings, binge-eating, negative mood, and meal skipping using general inhibitory control and food specific inhibitory control methods.

Results showed that although negative mood and binge eating co-occurred, there were no significant differences in binge eating days and negative mood between patient groups. Food cravings were also higher on binge days and did not differ between groups ( Chami et al., 2021 ). Other methods to consider are transcranial Direct Current Stimulation (tDCS) which has shown comparable effects of wanting and liking food and bulimic behaviors after receiving tDCS treatment vs. sham tDCS. This method utilized two varieties of anode/cathode placement to determine effects on mood, ED cognitions and bulimic behaviors, exhibiting reduced ED cognitions and mood improvement with anode right/cathode left (AR/CL) versus reduced bulimic behaviors with anode left/cathode right (AL/CR) placement ( Kekic et al., 2017 ).

Pharmacological treatment

In cases of comorbidities, pharmacological interventions are used. Over half of those diagnosed with BN meet criteria for having a major depressive episode, and others may also suffer from obsessive compulsive disorder, social phobia, anxiety, or substance use disorders. Other psychological traits could be perfectionism, social withdrawal, emotional dysregulation, and poor distress tolerance ( Harrington et al., 2015 ). Due to the possibility of underlying depression or other comorbidities, use of selective serotonin reuptake inhibitors (SSRIs) may be prescribed for BN to decrease binge and purge frequency especially among those who have not responded initially to psychotherapy ( Harrington et al., 2015 ). Use of Bupropion has been contraindicated due to an increased risk of seizure and has a boxed warning ( Nitsch et al., 2021 ). Use of stimulant medications are often discontinued until individuals have been abstinent of purging behaviors for a period of time ( Nitsch et al., 2021 ). Research shows that among adolescents with BN, 88% meet the criteria for one or more comorbidities for mood and anxiety disorders, and low self-esteem, with depressive disorder being the most common.

Although both CBT and FBT have shown to improve depression and self-esteem for adolescents 12–18, based on the Beck Depression Inventory and Rosenberg Self-Esteem Scale (RSES), neither treatment is adequate and a supplemental pharmacological intervention is helpful especially among individuals with BN ( Valenzuela et al., 2018 ).

This study identified some treatment-related disparities of individuals with BN. Most of the studies reviewed enrolled participants between age 18 and 60 and therefore creating a gap of limited research on those aged under 12 and over 60 ( Safer et al., 2019 ; Stedal et al., 2023 ). Out of the 17 studies we reviewed, only 3 included participants between ages 12 and 18 ( Le Grange et al., 2015 ; Stefini et al., 2017 ; Valenzuela et al., 2018 ). While the majority onset age is between 18–20 and 30–44, there is evidence that individuals under 18 and over 44 also suffer from BN ( Kotler et al., 2003 ; Silén and Keski-Rahkonen, 2022 ; Cadwallader et al., 2023 ). Along with these age groups, males are often excluded from the research and interventions, yet it is known that males also suffer from BN ( Ferrer-García et al., 2017 ; Hildebrandt et al., 2017 ) and females’ responses to interventions could be different from that of males. Also unknown, and mostly excluded in the literature is how BN affects other marginalized populations such as LGBTQ individuals ( Simone et al., 2020 ). Moreover, many studies also exclude individuals that are not identified as White/Caucasian ( Stein et al., 2013 ; Chami et al., 2021 ; Juarascio et al., 2021 ) and further research is needed for non-English speaking individuals and/or less acculturated minoritized groups. Individuals with serious mental illness and severe substance use are generally excluded from studies. Most of the studies in this review were done in outpatient settings ( Gay et al., 2016 ; Chen et al., 2017 ) leaving few opportunities or none for individuals in inpatient settings to participate in research and newer treatment opportunities. Interventions presented in this review are largely behavioral and research is needed to determine the impact of psychotropics and holistic medicine alone, or in conjunction with behavioral therapies.

Research shows that all in the general population face risks of developing BN and that treatments are available. However, in research reviewed in this study, certain populations such as those of male sex, age group, or racial minority groups are excluded from research and treatment options and therefore creating bulimia nervosa treatment-related disparities. To improve and eliminate the bulimia nervosa treatment disparities, researchers and practitioners need to include marginalized populations such as the LGBTQ or other vulnerable groups such as racial minorities, and all those populations generally left out of research and treatment.

Author contributions

KW: Conceptualization, Investigation, Methodology, Writing – original draft, Writing – review & editing. RK: Supervision, Writing – review & editing.

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

Acknowledgments

Thank you to RK for providing education in research methodology, which inspired me to continue in my research. Also, thank you for your mentorship during this process. I also want to thank Utah Tech University and the University of Utah for providing me with the opportunity to present my poster on bulimia nervosa research.

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: bulimia nervosa treatment, bulimia nervosa research, bulimia nervosa treatment-related disparities, bulimia nervosa diagnosis and treatment, bulimia nervosa and clinical trials

Citation: Wilson K and Kagabo R (2024) Bulimia nervosa and treatment-related disparities: a review. Front. Psychol . 15:1386347. doi: 10.3389/fpsyg.2024.1386347

Received: 15 February 2024; Accepted: 25 July 2024; Published: 14 August 2024.

Reviewed by:

Copyright © 2024 Wilson and Kagabo. 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: Kim Wilson, [email protected]

† ORCID: Kim Wilson, orcid.org/0009-0004-4796-2562 Robert Kagabo, orcid.org/0000-0002-9510-7200

Disclaimer: 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.

Sociodemographic and clinical characteristics of treated and untreated adults with bulimia nervosa or binge-eating disorder recruited for a large-scale research study

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Affiliation: College of Arts and Sciences, Department of Psychology and Neuroscience
Other Affiliation: Department of Biotechnology, Dr D. Y. Patil Biotechnology and Bioinformatics Institute, Pune, India
Other Affiliation: Department of Psychology, State University of New York at Albany, Albany, NY, USA
Other Affiliation: Recovery Record, Inc, Palo Alto, CA, USA
Affiliation: School of Medicine, Department of Psychiatry
Background Eating disorders affect millions of people worldwide, but most never receive treatment. The majority of clinical research on eating disorders has focused on individuals recruited from treatment settings, which may not represent the broader population of people with eating disorders. This study aimed to identify potential differences in the characteristics of individuals with eating disorders based on whether they self-reported accessing treatment or not, in order to contribute to a better understanding of their diverse needs and experiences. Methods The study population included 762 community-recruited individuals (85% female, M±SD age=30±7 years) with bulimia nervosa or binge-eating disorder (BN/BED) enrolled in the Binge Eating Genetics Initiative (BEGIN) United States study arm. Participants completed self-report surveys on demographics, treatment history, past and current eating disorder symptoms, weight history, and their current mental health and gastrointestinal symptoms. Untreated participants (n=291, 38%) were compared with treated participants (n=471, 62%) who self-reported accessing BN/BED treatment at some point in their lives. Results Untreated participants disproportionately self-identified as male and as a racial or ethnic minority compared with treated participants. Treated participants reported a more severe illness history, specifically, an earlier age at onset, more longstanding and frequent eating disorder symptoms over their lifetime, and greater body dissatisfaction and comorbid mental health symptoms (i.e., depression, anxiety, ADHD) at the time of the study. A history of anorexia nervosa was positively associated with treatment engagement. Individuals self-reporting a history of inpatient or residential treatment exhibited the most severe illness history, those with outpatient treatment had a less severe illness history, and untreated individuals had the mildest illness history. Conclusions Historically overlooked and marginalized populations self-reported lower treatment access rates, while those who accessed treatment reported more severe eating disorder and comorbid mental health symptoms, which may have motivated them to seek treatment. Clinic-based recruitment samples may not represent individuals with milder symptoms or racial and ethnic diversity, and males. Community-based recruitment is crucial for improving the ability to apply research findings to broader populations and reducing disparities in medical research.Trial Registration ClinicalTrials.gov NCT04162574 ( https://clinicaltrials.gov/ct2/show/NCT04162574 ).
https://doi.org/10.17615/ah70-je12
https://doi.org/10.1186/s40337-023-00846-4
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Journal of Eating Disorders
National Institute of Mental Health
Brain & Behavior Research Foundation
Karolinska Institutet
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Springer Nature

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v.334(7599); 2007 Apr 28

Anorexia nervosa

Jane morris.

Royal Edinburgh Hospital, Edinburgh EH10 5HF

Sara Twaddle

Anorexia nervosa has the highest mortality of any psychiatric disorder. 1 It has a prevalence of about 0.3% in young women. It is more than twice as common in teenage girls, with an average age of onset of 15 years; 80-90% of patients with anorexia are female. Anorexia is the most common cause of weight loss in young women and of admission to child and adolescent hospital services. Most primary care practitioners encounter few cases of severe anorexia nervosa, but these cause immense distress and frustration in carers and professionals. We describe the clinical features of anorexia nervosa and review the current evidence on treatment and management management .

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Object name is morj385203.f1.jpg

Nineteenth century drawing of young woman with anorexia nervosa

How good is the evidence for managing anorexia nervosa?

Ironically, this most lethal of psychiatric disorders is the Cinderella of research. It is hard to engage patients with anorexia for treatment, let alone research. Furthermore, the complexity of coordinated approaches used in most specialist centres may overwhelm conventional research methods.

High quality evidence on the effects of starvation on the body is available to guide physical aspects of care. 2 Genetic studies, including twin and family studies, 3 and more recently gene analysis, have shed some light on causes, but few randomised controlled trials of treatment exist. In contrast, many randomised controlled trials are found on the management of normal weight bulimia nervosa. 4 Unfortunately, these interventions have a poor response in anorexia nervosa.

This review is based on searches in PubMed, Medline, and PsycLIT for treatment of anorexia nervosa and related eating disorders, and the National Institute for Health and Clinical Excellence (NICE) clinical guideline. 5 We found no category A evidence (at least one randomised controlled trial as part of a high quality and consistent body of literature (evidence level 1)), and only family interventions met category B criteria (well conducted clinical studies but no randomised controlled trials (evidence levels 2 and 3) or extrapolated from level I evidence). NICE uses category C recommendations (expert committee reports or clinical experience of respected authorities (evidence level 4) or extrapolation from level 2 or 3) to provide guidance where high quality formal evidence is absent.

Two Cochrane reviews cover antidepressant treatment for anorexia nervosa 6 and individual psychotherapy for adults with the disorder. 7 The reviews are based on only seven and six small studies, respectively, all of which had major methodological limitations. A further electronic and hand search of papers published more recently is supplemented by work in press, conference presentations, and some personal communications with the relatively small group of international experts in the field.

What are the hallmarks of anorexia nervosa?

The core psychological feature of anorexia nervosa is the extreme overvaluation of shape and weight. People with anorexia also have the physical capacity to tolerate extreme self imposed weight loss. Food restriction is only one aspect of the practices used to lose weight. Many people with anorexia use overexercise and overactivity to burn calories. They often choose to stand rather than sit; generate opportunities to be physically active; and are drawn to sport, athletics, and dance. Purging practices include self induced vomiting, together with misuse of laxatives, diuretics, and “slimming medicines.” Patients may also practise “body checking,” which involves repeated weighing, measuring, mirror gazing, and other obsessive behaviour to reassure themselves that they are still thin (box 1).

Box 1 ICD-10 (international classification of diseases, 10th revision) criteria for anorexia nervosa 8

All five criteria must be met for a definite diagnosis to be made
Body weight is maintained at least 15% below that expected (either lost or never achieved) or body-mass index is 17.5 or less. Prepubertal patients may fail to gain the expected amount of weight during the prepubertal growth spurt
Weight loss is self induced by avoiding “fattening foods” together with self induced vomiting, purging, excessive exercising, or using appetite suppressants or diuretics (or both)
Body image is distorted in the form of a specific psychopathology whereby a dread of fatness persists as an intrusive, overvalued idea and the patient imposes a low weight threshold on himself or herself
A widespread endocrine disorder involving the hypothalamic-pituitary-gonadal axis is manifest in women as amenorrhoea and in men as a loss of sexual interest and potency (except for the persistence of vaginal bleeds in women who are taking replacement hormonal therapy, usually the contraceptive pill). Concentrations of growth hormone and cortisol may be raised, and changes in the peripheral metabolism of thyroid hormone and abnormalities of insulin secretion may also be seen
If onset is before puberty, the sequence of pubertal events will be delayed or even arrested (growth will cease; in girls the breasts will not develop and primary amenorrhoea will be present; in boys the genitals will remain juvenile). After recovery, puberty will often complete normally, but the menarche will be late

What causes anorexia nervosa?

Anorexia has no single cause. it seems that a genetic predisposition is necessary but not sufficient for development of the disorder. Twin and family studies, 3 brain scans of affected and unaffected family members, and a current multicentre gene analysis support observations that anorexia is found in families with obsessive, perfectionist, and competitive traits, and possibly also autistic spectrum traits.

Anorexia nervosa is precipitated as a coping mechanism against, for instance, developmental challenges, transitions, family conflicts, and academic pressures. Sexual abuse may precipitate anorexia but not more commonly than it would trigger other psychiatric disorders. The onset of puberty and adolescence are particularly common precipitants, but anorexia is also found without apparent precipitants in otherwise well functioning families.

How is anorexia nervosa diagnosed and assessed?

The diagnosis is usually suspected by family, friends, and in younger patients school before a doctor becomes involved. When weight loss is well concealed, presenting features may include depression, obsessive behaviour, infertility, or amenorrhoea. Alternatively, weight loss may be thought to be secondary to allergies or other physical conditions.

A positive diagnosis of psychologically driven weight loss can be made in most patients, without the need for a battery of complex investigations to reach a diagnosis of exclusion. Basic medical investigations, blood tests, electrocardiography, weighing, and measuring the patient provide an opportunity for the patient to return (to discuss the results) and can uncover psychological problems.

If the patient refuses to be weighed it is worth persisting gently and exploring their fears. Doctors should not collude with the illness, but should advise against harmful behaviours such as running marathons, skiing, or undergoing in vitro fertilisation when at low weight.

It falls to primary care to recognise and manage relapses as well as first episodes of the illness, and to support patients and families in appropriate use of services. General practitioners may need support from a specialist in eating disorders, and early referral for more detailed assessment and advice gives patients the message that their illness is of genuine concern.

Summary points

Anorexia nervosa has the highest rate of mortality of any psychiatric disorder
It is best to make a positive diagnosis of psychologically driven weight loss, rather than reach a diagnosis by exclusion
Short term structured treatments—such as cognitive behaviour therapy—are not effective, and longer term therapies that incorporate motivational enhancement techniques are recommended
Focused family work is effective in adolescents and young adults; counselling can involve the family as a whole or the patient and their family can be treated separately
To date, no effective drugs are available to treat anorexia

How is serious physical risk managed?

The level of physical risk should be assessed at diagnosis. No safe cut off weight or body mass index exists. Survival analyses show that death is unusual where low weight is maintained purely by starvation. 9 Death is more likely if the patient's weight fluctuates rapidly than if it is stable, even if the body mass index is below 12. Risk is also increased if the patient frequently purges or misuses substances.

Compulsory treatment for anorexia nervosa is clearly indicated by mental health legislation in acute emergencies where the patient is unable to accept treatment. 10 In most countries this means detention in hospital. Legal responsibility becomes less clear once the immediate danger of death or irreversible deterioration has passed. Many centres invoke longer detention orders to continue compulsory refeeding to a healthier weight. Without this, the risk of repeated cycles of detention and relapse exists. In practice, patients in extremis can often be treated with their consent. Voluntary treatment is more likely when the clinician is experienced at managing anorexia and can confidently assess and tolerate fairly high levels of risk in the interests of collaborative therapeutic relationships, rather than coerce patients. Even legal measures of compulsion may be used in a helpful therapeutic way, though, and should not be avoided at all costs.

The best place to admit patients with life threatening anorexia is not always obvious. An acute medical ward—especially one that specialises in endocrinology, gastroenterology, or diabetes—is usually better than a general psychiatric ward. Some non-specialist medical wards have nurse specialists, who are experienced in managing patients with eating disorders. These nurses can help translate recommendations into practice and “troubleshoot” for the furtive compulsions of anorexia.

What is the currently accepted best management?

Anorexia takes an average of five or six years from diagnosis to recovery. Up to 30% of patients do not recover. 11 12 This makes meaningful follow-up of interventions crucial but difficult. Coercive approaches may result in impressive short term weight gain but make patients more likely to identify with and cling on to the behaviour associated with anorexia.

Overall prognosis for patients with eating disorders is independent of whether treatment is received or not. 13 Discredited behavioural regimens for anorexia involved incarceration in hospital, with removal of all “privileges” (visitors, television, independent use of bathroom), which were given back as a reward for weight gain.

Hospital admission is still strongly correlated with poor outcome. 14 Long term prognosis is worse for patients compulsorily detained in an inpatient facility than for those treated voluntarily in the same unit, with more deaths in the first group. 10 The use of brief hospital admissions to acute medical wards at times of life threatening crisis or after overdose may be associated with lower mortality. 9 12

How is weight gain achieved?

In countries where all treatment is given in hospital, refeeding is an early intervention. Subsequent treatment helps patients tolerate, maintain, or regain normal weight. This may also be the preferred approach for children and young adolescents, where long periods at low weight are detrimental to growth and development. Hospital refeeding needs physiological fine tuning and may expose the patient to iatrogenic complications such as infections, the sequelae of passing tubes, and the effects of being exposed to a “proanorexia” culture (by mixing with other patients who have anorexia).

A second approach temporarily accepts low weight, if weight is stable and regularly monitored, while patients or their families take responsibility for refeeding. It is helpful to provide dietetic expertise separately from psychotherapy. One study found that unsupported dietetic advice without parallel interventions had a 100% dropout rate. 15 Weight gain is slower with this second approach, but it is more likely to be maintained. This approach avoids many iatrogenic risks. However, clinicians still need access to medical wards for physical emergencies.

What is the role of psychotherapy?

Short term structured treatments such as cognitive behaviour therapy and interpersonal psychotherapy, which are effective in other eating disorders, have not helped so far in patients with anorexia. One report found no difference in outcome between behaviour therapy and cognitive therapy. 16 The preliminary results of a New Zealand study of cognitive behaviour therapy and interpersonal psychotherapy compared with usual treatment were disappointing. 17 A cognitive behaviour therapy based “transdiagnostic” treatment for all eating disorders, including cases of anorexia where body mass index is above 15, has shown promise however. 18

Expert consensus favours long term, wide ranging, complex treatments using psychodynamic understanding, systemic principles, and techniques borrowed from motivational enhancement therapy and dialectical behavioural therapy (box 2). These treatments should be delivered in various settings that cater for the level of intensity and degree of medical monitoring and care needed. The coordinated working of a wide range of medical and psychiatric services that do not usually work together will be needed. Because of the age group affected, and the time span involved, patients' care often undergoes many transitions. These are peak times for relapse and decompensation.

Box 2 Psychotherapies available for managing anorexia nervosa

Individual therapy.

Structured individual treatments are usually offered as a weekly one hour session with a therapist trained in the management of eating disorders and in the therapy model used

Cognitive analytic therapy

This psychotherapy uses letters and diagrams to examine habitual patterns of behaviour around other people and to experiment with more flexible responses

Cognitive behaviour therapy

This psychotherapy explores feelings, educates patients about body chemistry, and challenges the automatic thoughts and assumptions behind behaviour in anorexia

Interpersonal psychotherapy

This psychotherapy maps out a person's network of relationships, selects a focus—such as role conflict, transition, or loss—and works to generate new ways to deal with distress

Motivational enhancement therapy

This psychotherapy uses interviewing techniques derived from work with substance misuse to reframe “resistance” to change as “ambivalence” about change, and to nurture and amplify healthy impulses

Dynamically informed therapies

These therapies may also result in weight gain and recovery provided the patient is aware of the risk of irreversible physical damage or death and acknowledges that certain boundaries (for example, that they must be weighed weekly, examined monthly by a doctor, and admitted to hospital if weight continues on a downward trend) are observed. The therapies involve talking, art, music, and movement

Group therapy

There is little evidence that therapy for patients with anorexia benefits from being delivered in group sessions rather than individual sessions; in fact, group therapy may even worsen the problem. However, dialectical behaviour therapy offers structured groups in parallel with individual sessions. This therapy teaches skills that help patients to tolerate distress, soothe their feelings, and manage interpersonal relationships

Family work

The term “family work” covers any intervention that harnesses the strengths of the family in tackling the patient's disorder or that tries to deal with the family's stress in the face of it. It includes family therapies, support groups, and psychoeducational input

Conjoint therapy

Evidence points to the effectiveness of the Maudsley model of family therapy and similar interventions focused on eating disorders. Whole families—or at least the parents and the patient—attend counselling sessions together, which can cause intolerable emotional stress

Separated family therapy

The patient and the parents attend separate meetings, sometimes with two different therapists. This form of therapy seems to be as effective as conjoint therapy, particularly for older patients, and involves lower levels of expressed emotion

Multifamily groups

Such groups provide a novel way of empowering parents by means of peer support and help from a therapist. Several families, including the patients, meet together for intensive sessions that often last the whole day and include eating together

Relatives' and carers' support groups

These groups range from self help meetings to highly structured sessions led by a therapist that aim to teach psychosocial and practical skills to help patients with anorexia to recover while avoiding unnecessary conflict. Most encompass at least some educational input about the nature of anorexia

Early on, especially in younger patients, motivation for treatment lies with parents, schoolteachers, or medical professionals. The guiding principle of motivational enhancement is to acknowledge and explore rather than fight the patient's ambivalence about recovery. Treatment is more effective when the therapist and the patient work together against the anorexia. Such a relationship may allow the patient to be treated without having to invoke the Mental Health Act. Motivation is not an all or nothing battle to be won before treatment can start—it must be actively engendered throughout the treatment.

TIPS FOR NON-SPECIALISTS

Recovery takes years rather than weeks or months, and patients must accept that they should attain a normal weight—refeeding alone may lead to relapse
Trends should be monitored by weighing, which needs to be managed skilfully so it does not become a battleground
No cut off weight or body mass index exists because many other factors influence risk
Substance misuse—including alcohol, deliberate overdoses, or misuse of prescribed insulin—greatly increases risk
Weight fluctuations and binge-purge methods (rather than pure restriction) increase risk
Depression, anxiety, and family arguments are probably secondary to the disorder, not underlying causes, so the anorexia should be treated first
Medication has little benefit in anorexia and the risk of dangerous side effects is high in malnourished patients
Try to involve the family—encourage calm firmness and assertive care

Family work is the only well researched intervention that has a beneficial impact. 19 Family work teaches the family and patient to be aware of the perpetuating features of the disorder. Fury, anger, and fighting lead to entrenched symptoms but too much permissiveness encourages the illness by allowing it to become an accepted response to stress, or—if the family will do anything to encourage the patient to eat—a route to providing “secondary gain” from the illness. Support of carers is essential to maintain the firm but sympathetic boundaries conducive to recovery

Early studies on teenagers with relatively recent onset anorexia showed that therapy involving the whole family was superior to treating just the patient. Further studies showed that, if tolerated, sessions involving the family and patient together gave the best results in terms of the family's psychological adjustment, but that weight gain was greater when families were seen separately from the patient. 19 Both types of family intervention were more effective than individual work. More recently, “multi-family groups” have been piloted. 20

The Maudsley group compared individual focused dynamic therapy, dynamically informed family therapy, individual cognitive analytic therapy, and “treatment as usual” over the course of a year. 21 The dynamically informed therapies—both family and individual—produced the best results. The study showed that severely ill adults with anorexia could be managed as outpatients, and it highlighted the benefits of continuity of care by one therapist and of the expertise provided. However, nothing can be concluded about the specific model of therapy provided.

What is it like to experience anorexia nervosa?

At first I believed my thoughts were normal when I looked in the mirror—you don't expect your eyes to lie. I felt such self loathing that I drastically reduced my food intake and did a lot of exercise. I felt better about myself and decided that once I'd lost a pound or two I would eat normally again. When it came to it I was too scared. It felt good to lose a couple of pounds but it became addictive. If I did a certain amount of exercise one day, the next day I had to do at least the same amount. I ended up feeling physically rubbish, but my mind said I'm a horrible person who deserves pain.

Paranoia sets in. You're convinced people think you are fat even when they say you are not. Your mind tells you they are lying, until you find you can't trust anyone. Living with anorexia is a constant battle between two evils. On one hand eating feels like an evil thing, but other people see that very belief as the evil. When I feel I really must starve or exercise I get angry with the nurses. Other times it's a relief though, because at least they take the responsibility away from me.

Is drug treatment effective?

The evidence base for the use of drugs in anorexia nervosa is poor. Antidepressants are often used to treat depressive symptoms but have limited success. The well documented benefits of antidepressants in bulimia nervosa 4 do not extend to anorexia, and the benefit from selective serotonin reuptake inhibitors in preventing relapse after weight gain is unclear. Case reports describe the benefit of antipsychotic drugs such as olanzapine to promote weight gain. This success may be attributable to symptomatic relief of anxiety and increased appetite, rather than any effect on core pathology. Harmful effects of drugs, particularly the appearance of a long QT interval, with the risk of dangerous cardiac dysrhythmias, are more likely in patients who are malnourished and have electrolyte abnormalities.

What affects recovery and what is the prognosis?

A premature mortality rate of 20% was seen in an inpatient cohort, and a large proportion of cases took six to 12 years to resolve. 11 Bingeing and vomiting at low weight greatly increase mortality compared with purely restrictive starvation. Comorbidity is associated with bleaker prognosis. More recently, full recovery has been demonstrated even after 21 years of chronic severe anorexia nervosa. 12

Criteria are available for assessing recovery from anorexia nervosa. 11 The capacity to undertake normal levels of exercise and activity are also important. If the patient is given renutrition and care to protect against irreversible damage during the acute illness, cardiovascular function, immune function, fertility, and bone density can all return to healthy levels. Bone recovery takes years rather than months, so patients should protect the spine and pelvis in particular against gymnastic activity too early after weight gain. Even when a person has developed the crucial motivation to tolerate weight gain and explored the possibility of living with values other than those imposed by the cult of thinness, psychological recovery is difficult as the challenges of a rekindled adolescence must be faced.

ADDITIONAL EDUCATIONAL RESOURCES

Resources for healthcare professionals.

National Institute for Health and Clinical Excellence ( www.nice.org.uk )—Several guidelines are available that cover anorexia nervosa, bulimia nervosa, and atypical eating disorders
American Psychiatric Association ( www.psych.org/psych_pract/treatg/pg/EatingDisorders3ePG_04-28-06.pdf )—A recently published guideline on the treatment of patients with eating disorders
The Edinburgh Anorexia Nervosa Intensive Treatment Team ( www.anitt.org.uk )—This site contains a detailed clinical pathway for anorexia nervosa
Institute of Psychiatry/Maudsley Hospital ( www.iop.kcl.ac.uk/ )—This site has good information and downloadable PDFs on medical complications of eating disorders and is kept up to date with research development
Treasure J. Anorexia nervosa: a survival guide for families, friends and sufferers. Hove: Psychology Press, 1997

Resources for patients and carers

Beating Eating Disorders ( www.edauk.com )—The Eating Disorders Association site has good information about the eating disorders network in the United Kingdom, resource lists, and details of local self help and support groups
National Institute for Health and Clinical Excellence ( www.nice.org.uk )—This site also contains a patient and carer version of the NICE guidelines
Bloomfield S. Eating disorders: helping your child recover . Norwich: Eating Disorders Association, 2006
Bryant-Waugh R, Lask B. Eating disorders: a parents' guide. Revised ed. Hove: Brunner-Routledge, 2004

Competing interests: None declared.

IMAGES

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(PDF) Applying neurobiology to the treatment of adults with anorexia
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(PDF) Anorexia nervosa: A cognitive-behavioral approach to AN
(PDF) A Case Study of Anorexia Nervosa and Obsessive Personality
(PDF) The Integrative Research Approach of Anorexia Nervosa

COMMENTS

Anorexia nervosa: A literature review
Anorexia nervosa is a food intake disorder. characterized by a cute weight loss that it could cause. severe psychosomatic problems [1]. Diagnostic criteria for Anorexia nervosa. include an intense ...
(PDF) Anorexia Nervosa: Etiology, Impact, and Treatment
This is a general overview of Anorexia Nervosa by reviewing around 20 research and studies from the past and present, compromising with its etiology, psychosocial impacts, treatment, and ...
(PDF) Anorexia Nervosa: Pathophysiology, Treatment, and Genetic
PDF | On Dec 1, 2018, Sarah Cooper and others published Anorexia Nervosa: Pathophysiology, Treatment, and Genetic Considerations | Find, read and cite all the research you need on ResearchGate
Incidence, prevalence and mortality of anorexia nervosa and bulimia
For eating disorders, there are some methodological problems regarding epidemiological research. Eating disorders are relatively rare in the community and help seeking is often avoided or delayed, for example for reasons of denial (particularly in anorexia nervosa) or stigma and shame (particularly in bulimia nervosa).
Recent advances in understanding anorexia nervosa
Anorexia nervosa is a complex psychiatric illness associated with food restriction and high mortality. Recent brain research in adolescents and adults with anorexia nervosa has used larger sample sizes compared with earlier studies and tasks that test specific brain circuits. Those studies have produced more robust results and advanced our ...
PDF Anorexia nervosa: aetiology, assessment, and treatment
Anorexia nervosa is an important cause of physical and psychosocial morbidity. Recent years have brought advances in understanding of the underlying psychobiology that contributes to illness onset and maintenance. Genetic factors infl uence risk, psychosocial and interpersonal factors can trigger onset, and changes in neural networks can sustain the illness. Substantial advances in treatment ...
Treatment of Anorexia Nervosa—New Evidence-Based Guidelines
Anorexia nervosa is associated with high personal and economic costs for sufferers, their relatives and society. Evidence-based practice guidelines aim to support all groups involved in the care of patients with anorexia nervosa by providing them with scientifically sound recommendations regarding diagnosis and treatment.
Anorexia Nervosa
Anorexia nervosa is associated with a high incidence of coexisting psychiatric conditions, marked treatment resistance, frequent medical complications, and a substantial risk of death. Several psyc...
Anorexia Nervosa
Anorexia nervosa is a serious mental illness characterized by the maintenance of an inappropriately low body weight, a relentless pursuit of thinness, and distorted cognitions about body shape and weight. Anorexia nervosa commonly begins during middle to late adolescence, although onsets in both prepubertal children and older adults have been ...
Anorexia Nervosa
Anorexia nervosa is a severe psychiatric disorder characterized by starvation and malnutrition, a high prevalence of coexisting psychiatric conditions, marked treatment resistance or no response ...
PDF Initial Evaluation, Diagnosis, and Treatment of Anorexia Nervosa and
The use of psychotropic medications is limited for anorexia nervosa, whereas treatment studies have shown a benefit of antidepressant medi-cations for patients with bulimia nervosa.
PDF Applying neurobiology to the treatment of adults with anorexia nervosa
This paper introduces a new, five-day treatment for adults with anorexia nervosa and their supports that in-tegrates neurobiological research with experiential treat-ment tools. A new neurobiological model is introduced that sets the stage for the possible genetic and brain basis of this deadly illness.
Treatment of Anorexia Nervosa-New Evidence-Based Guidelines
Anorexia nervosa is associated with high personal and economic costs for sufferers, their relatives and society. Evidence-based practice guidelines aim to support all groups involved in the care of patients with anorexia nervosa by providing them with scientifically sound recommendations regarding diagnosis and treatment.
[PDF] Anorexia nervosa
The epidemiology, diagnosis, screening and prevention, aetiology, treatment and quality of life of patients with Anorexia nervosa are described. Anorexia nervosa (AN) is a psychiatric condition characterized by severe weight loss and secondary problems associated with malnutrition. AN predominantly develops in adolescence in the peripubertal period. Without early effective treatment, the ...
The evolving profile of eating disorders and their treatment in a
It has been more than 70 years since the first eating disorder, anorexia nervosa, was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Since then, recognition of a spectrum of disorders with eating difficulties has grown.1 We draw on academic, clinical, and lived experience expertise to identify two inter-related challenges in the understanding and treatment of ...
(PDF) Looking for the origins of anorexia nervosa in adolescence
We give a clinical confirmation of the diverse origins of anorexia nervosa and of the impact of sexual abuse. This paper proposes a new therapeutic approach to patients with anorexia nervosa, in ...
Current approach to eating disorders: a clinical update
Advances and the current status of evidence‐based treatment and outcomes for the main eating disorders, anorexia nervosa, bulimia nervosa and BED are discussed with focus on first‐line psychological therapies. Deficits in knowledge and directions for further research are highlighted, particularly with regard to treatments for BED and ARFID ...
The American Psychiatric Association Practice Guideline for the
for anorexia nervosa, 0.28% for bulimia nervosa, and 0.85% for binge-eating disorder, although estimates can vary depending on the study location, sample demographic characteristics, case fnding, and diagnostic approaches.
PDF Volume 1
An interpretative phenomenological analysis. Introduction: Eating disorders, but particularly anorexia nervosa, have been considered 'ego-syntonic' in that people often believe that their behaviours fit with their sense of who they are. This can make anorexia nervosa difficult to treat, as individuals are reluctant to
Binge-eating disorder with and without lifetime anorexia nervosa: A
Binge-eating disorder with and without lifetime anorexia nervosa: A comparison of sociodemographic and clinical features ... Download PDF. Citations Request ... Deposit scholarly works such as posters, presentations, research protocols, conference papers or white papers. If you would like to deposit a peer-reviewed article or book chapter, use ...
Acyl-CoA binding protein for the experimental treatment of anorexia
Despite its seriousness, anorexia nervosa has limited treatment options. Chen et al. report that acyl CoA binding protein (ACBP), a conserved peptide known to induce hunger, is particularly low in hospitalized anorexic patients with poor prognosis.Administration of ACBP by chemogenetic, daily intravenous, or subcutaneous osmotic pump approaches in mouse models of stress- or chemotherapy ...
Anorexia Nervosa
Anorexia nervosa is an eating disorder defined by restriction of energy intake relative to requirements, leading to a significantly low body weight. Patients will have an intense fear of gaining weight and distorted body image with the inability to recognize the seriousness of their significantly low body weight.[1][2][3]
Bulimia nervosa and treatment-related disparities: a review
However, in research reviewed in this study, certain populations such as those of male sex, age group, or racial minority groups are excluded from research and treatment options and therefore creating bulimia nervosa treatment-related disparities.
(PDF) Anorexia Nervosa
PDF | On Apr 1, 2020, Fatima Elif Ergüney Okumuş published Anorexia Nervosa | Find, read and cite all the research you need on ResearchGate
A Comprehensive Review of Complications and New Findings Associated
Anorexia nervosa is a complex and deadly psychiatric disorder. It is characterized by a significant degree of both co-occurring psychiatric diseases and widespread physiological changes which affect nearly every organ system. It is important for clinicians ...
Scholarly Article or Book Chapter
Sociodemographic and clinical characteristics of treated and untreated adults with bulimia nervosa or binge-eating disorder recruited for a large-scale research study
Anorexia nervosa
Anorexia is the most common cause of weight loss in young women and of admission to child and adolescent hospital services. Most primary care practitioners encounter few cases of severe anorexia nervosa, but these cause immense distress and frustration in carers and professionals.

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Anorexia nervosa

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How good is the evidence for managing anorexia nervosa?

What are the hallmarks of anorexia nervosa?

Box 1 ICD-10 (international classification of diseases, 10th revision) criteria for anorexia nervosa 8

What causes anorexia nervosa?

How is anorexia nervosa diagnosed and assessed?

Summary points

How is serious physical risk managed?

What is the currently accepted best management?

How is weight gain achieved?

What is the role of psychotherapy?

Box 2 Psychotherapies available for managing anorexia nervosa

Cognitive analytic therapy

Cognitive behaviour therapy

Interpersonal psychotherapy

Motivational enhancement therapy

Dynamically informed therapies

Group therapy

Family work

Conjoint therapy

Separated family therapy

Multifamily groups

Relatives' and carers' support groups

TIPS FOR NON-SPECIALISTS

What is it like to experience anorexia nervosa?

Is drug treatment effective?

What affects recovery and what is the prognosis?

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