Individual Psychotherapy in the Outpatient Treatment of Adults with Anorexia Nervosa_Chinese Journal of Evidence-Based Medicine

Authors：

Hay P , Bacaltchuk J

1. School of Medicine, James Cook University, 4811, Queensland, Australia2. Dept. of Psychiatry, Universidade Federal de Sao Paulo, Rua Casa do Ator 764 apto 102, Sao Paulo, Brazil3. University of Adelaide, Adelaide, 5001, South Australia, Australia4. Flinders University, Bedford Park 5042, South Australia, Australia;

Corresponding author：

Keywords：

Anorexia; Psychotherapy; Treatment; Eating disorders

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　Anorexia nervosa is a disorder of high morbidity and significant mortality. The aim of the present review was to evaluate the evidence from randomized controlled trials for the efficacy of outpatient psychotherapies used in the treatment of older adolescents ( aged ＞16 years) and adults with anorexia nervosa.
Methods 　The search strat egy comprised database searches of Medline, EXTRAMED, EMBASE, PSYCLIT, Current Contents, Cochrane Con trolled Trials Register and the Depression and Anxiety Neurosis Cochrane Group ( CCDAN), the search date was Novem ber 2002. A hand-search of The International Journal of Eating Disorders from its first issue up to March 2003, and the ref erence lists of all papers selected. Personal letters were sent to identified leading researchers published in the area, requesting information on trials that are unpublished. All randomized controlled trials of adult individual outpatient therapy for anorexia nervosa, as defined by the DSM-IV or similar international criterion, were included. Quality ratings were made according to the CCDAN criteria. A range of outcome variables were selected, including physical state, severity of eating disorder attitudes and behefs, interpersonal function, and general psychiatric symptom severity. Continuous outcome data comparisons were planned with the standardized mean difference statistic, and binary outcome comparisons planned with the relative risk statistic.
Results 　Six small trials only, two of which included children or adolescents, were identified from the search and aggregation of data was not possible. Bias was possible due to lack of blinding of outcome assessments. The results in two trials suggested that "treatment as usual" or similar may be less efficacious than a specific psychotherapy. No specific treatment was consistently superior to any other specific approach. Dietary advice as a control arm had a 100% non-completion rate in one trial.
Conclusions 　No specific approach can be recommended from this review. It is unclear why "treatment as usual" performed so poorly, or why dietary advice alone appeared so unacceptable. There is an urgent need for large well-designed trials in this area.

Citation： Hay P,Bacaltchuk J,Claudino A,Yong PY,BenTovim D. Individual Psychotherapy in the Outpatient Treatment of Adults with Anorexia Nervosa. Chinese Journal of Evidence-Based Medicine, 2004, 04(8): 515-522. doi: Copy

1.	［1］Gull WW. Anorexia nervosa ( apepsia hysterica, anorexia hysterica) [J]. Transactions of the Clinical Society of London,1874 ;7:22 - 28.
2.	［2］Lasegue C. De 1’ anorexie hysterique [ On hysterical anorexia [J] ]. Archives Generales de Medicine, 1873:385 -403.
3.	［3］American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) [ M ]. 4th edition. American Psychiatric Association, 1994.
4.	［4］Herzog W, Deter H-C, Fiehn W, Petzold E. Medical findings and predictors of long-term physical outcome in anorexia nervosa: a prospective, 12-year follow-up study [J ]. Psychol Med, 1997; 27(2) :269 -279.
5.	［5］Crisp AH, Callender JS, Halek C, Hsu LKG. Long-term mortality in anorexia nervosa. A 20-year follow-up of the St George’s and Aberdeen cohorts[J]. Br J Psychiatry, 1992;161:104- 107.
6.	［6］Verhulst FC, van der Ende J, Ferdinand RF, Kasius M. The prevalence of DSM-Ⅲ-R diagnoses in a national sample of Dutch adolescents [ J ]. Arch Gen Psychiatry, 1997; 54 ( 4 ):329 - 336.
7.	［7］Aalto-Setala T, Martunnen M, Tuulio-Henriksson A, Poilolainen K, Lonnqvist J. One-month prevalence of depression and other DSM-V disorders among young adults[J]. Psychol Med, 2001; 31 (5) :791 -801.
8.	［8］Pawluck DE, Gorey KM. Secular trends in the incidence of anorexia nervosa: Integrative review of population-based studies[J]. lnt J Eat Disord. 1998; 23(4) :347 -352.
9.	［9］Lucas AR, Beard CM, O’Fallon WM, Kurland LT. 50-year trends in the incidence of anorexia nervosa in Rochester, Minn.: A population based study[J]. Am J Psychiatry,1999;148(7) :917-922.
10.	［10］Garner DM Garfinkel PE. Handbook of treatment for eating disorders[ M]. 2nd edition. New York: The Guilford Press,1997.
11.	［11］Meads C, Gold L, Burls A, Jobanputra P. In-patient versus out-patient care for eating disorders. DPHE Report no 17 University of Birmingham 1999.
12.	［12］Garner DM, Needleman LD. Sequencing and integration of treatments. In: Garner DM, Garfinkel PE, editor(s). Handbook of treatment for eating disorders[M]. 2nd edition. New York: The Guilford Press, 1997:50-66.
13.	［13］Dare C, Crowther C. Psychodynamic models of eating disorders. In: Szmulker G, Dare C, Treasure J, editor(s). Handbook of Eating Disorders: Theory, treatment and research [M]. Chichester: John Wiley & Sons, 1995:125 - 139.
14.	［14］Brach H. Eating disorders: Obesity, anorexia nervosa and the person within[M]. New York: Basic Books, 1973.
15.	［15］Goodsitt A. Eating Disorders: A self-psychological perspective.In: Garner DM, Garfinkel PE, editor (s). Handbook of Treatments for Eating Disorders [M]. 2nd edition. New York: The Guilford Press, 1997:205 - 228.
16.	［16］Garner DM, Vitousek KM, Pike KM. Cognitive-behavioural therapy for anorexia nervosa. In: Garner DM, Garfinkel PE,editor (s). Handbook of Treatments for Eating Disorders [M]. 2nd edition. New York: The Guilford Press, 1997:67-93.
17.	［17］Fairbum CG, Shafran R, Cooper Z. A cognitive behavioural theory of anorexia nervosa[J]. Behav Res Ther. 1999; 37(1):1-13.
18.	［18］Treasure J, Todd G, Brolly M, Tiller J, Nehmed A, Denman F. A pilot study of a randomized trial of cognitive analytical therapy vs educational behavioural therapy for adult anorexia nervosa[J]. Behav Res Ther, 1995; 33(4):363-367.
19.	［19］Dare C, Eisler I, Russell G, TreaureJ, Dodge L. Psychological therapies for adults with anorexia nervosa[J]. Br J Psychiatry, 2000; 178:216 - 21.
20.	［20］Katzman MA, Lee S. Beyond body image: The integration of feminist and transcultural theories in the understanding of selfstarvaton[J]. Int J Eat Disord, 1997 ;22(4) :385 -394.
21.	［21］Striegel-Moore RH. A feminist perspective on the etiology of eating disorders. In: Brownell KD, Fairburn CG, editor(s).Eating Disorder and Obesity. A comprehensive handbook [M]. New York: The Guilford Press, 1995 :224 -229.
22.	［22］Wooley SC. Feminist influences on the treatment of eating disorders. In: Brownell KD, Fairburn CG, editor(s). Eating Disorders and Obesity A comprehensive haridbook. New York: The Guilford Press, 1995:294-298.
23.	［23］Dolan B. Gitzinger I. Why women? Gender issues and eating disorders[M]. London: The Athlone Press, 1994.
24.	［24］Fairburn CG, Jones R, Peveler RC, Carr SJ, Soloman RA, Burton J, Hope RA. Three psychological treatments for bulimia nervosa: A comparative trial [J ]. Arch Gen Psychiatry,1991; 48(5) :463 -469.
25.	［25］Vitousek KM, Watson S, Wilson GT. Enhancing motivation for change in treatment resistant eating disorders[J]. Clin Psychol Rev, 1998; 18(4):391-420.
26.	［26］WardA, TroopN, ToddG, TreasureJ. To change or not to change-‘ How’ is the question[J] ? Br J Med Psycho, 1996;69 ( Pt 2) :139 -146.
27.	［27］Prochaska, JO, DiClemente, CC, Norcross, JC. In search of how people change: Applications to addictive behaviors [J].Am Psychol, 1992; 47(9):1 102-1 114.
28.	［28］Windauer U, Lennerts W, Talbot P, Touyz SW. How well are "cured" anorexia nervosa patients? An investigation of 16weight-recovered anorexic patients[J]. Br J Psychiatry, 1993;163:195 -200.
29.	［29］World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders[ M ]. Geneva: World Health Organization, 1992.
30.	［30］Russell GF, Szmukler GI, Dare C, Eisler I. An evaluation of family therapy in anorexia nervosa and bulimia nervosa [J].Arch Gen Psychiatry,1987; 44(12) :1 047 - 1 056.
31.	［31］Morgan HG, Russell GFM. Value of family background and clinical features as predictors of long term outcome in anorexia nervosa: Four year follow-up study of 41 patients[J]. Psychol Med,1975; 5(4) :355 -371.
32.	［32］Morgan HG, Hayward AE. Clinical assessment of anorexia nervosa. The Morgan-Russell assessment schedule [J ]. Br J Psychiatry, 1988; 152:367-71.
33.	［33］Halmi K, Mitchell J, Crow S. Fluoxetine vs cognitive behavioral therapy in relapse prevention for anorexia nervosa [J].Eur. Neuropsychopharmaool, 1999 ;9 ( Supp 5 ) :373.
34.	［34］Joyce P. A comparison of three psychotherapies for anorexia nervosa[R]. AED 2002 Intemational Conference on Eating Disorders. 2002:14.
35.	［35］Channon S, de Silva P, Hemsley D, Perkins R. A contolled trial of cognitive-behavioural and behavioural treatment of anorexia nervosa, Behav Res Ther, 1989; 27 ( 5 ): 529 - 535.
36.	［36］Serfaty MA, Turkington D, Heap M, Ledsham L, Jolley E. Cognitive therapy versus dietary counselling in the outpatient treatment of anorexia nervosa: Effect of the treatment phase.Eur Eating Disoders Review, 1999 ;7:334 - 50.
37.	［37］Bachar E, Eytan B, Yael L, Shulamit K, Berry EM. Empirical comparison of two psychological therapies. Self Psychology and Cognitive Orientafon in the Treatment of Anorexia and Bulimia[J].J Psychother Pract Res,1999(2):115-128.
38.	［38］Bergh C,Brodin U,Lindberg G,Sodenten P Randomized controlledtrial of a treatment for anorexia and bulimia nervosa [J].Proc Nat Acad Sciences,2002;99(14):9 486-9 491(This paper ws first published in:The Cochrane Library,Issue 4.2003).

1. ［1］Gull WW. Anorexia nervosa ( apepsia hysterica, anorexia hysterica) [J]. Transactions of the Clinical Society of London,1874 ;7:22 - 28.
2. ［2］Lasegue C. De 1’ anorexie hysterique [ On hysterical anorexia [J] ]. Archives Generales de Medicine, 1873:385 -403.
3. ［3］American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) [ M ]. 4th edition. American Psychiatric Association, 1994.
4. ［4］Herzog W, Deter H-C, Fiehn W, Petzold E. Medical findings and predictors of long-term physical outcome in anorexia nervosa: a prospective, 12-year follow-up study [J ]. Psychol Med, 1997; 27(2) :269 -279.
5. ［5］Crisp AH, Callender JS, Halek C, Hsu LKG. Long-term mortality in anorexia nervosa. A 20-year follow-up of the St George’s and Aberdeen cohorts[J]. Br J Psychiatry, 1992;161:104- 107.
6. ［6］Verhulst FC, van der Ende J, Ferdinand RF, Kasius M. The prevalence of DSM-Ⅲ-R diagnoses in a national sample of Dutch adolescents [ J ]. Arch Gen Psychiatry, 1997; 54 ( 4 ):329 - 336.
7. ［7］Aalto-Setala T, Martunnen M, Tuulio-Henriksson A, Poilolainen K, Lonnqvist J. One-month prevalence of depression and other DSM-V disorders among young adults[J]. Psychol Med, 2001; 31 (5) :791 -801.
8. ［8］Pawluck DE, Gorey KM. Secular trends in the incidence of anorexia nervosa: Integrative review of population-based studies[J]. lnt J Eat Disord. 1998; 23(4) :347 -352.
9. ［9］Lucas AR, Beard CM, O’Fallon WM, Kurland LT. 50-year trends in the incidence of anorexia nervosa in Rochester, Minn.: A population based study[J]. Am J Psychiatry,1999;148(7) :917-922.
10. ［10］Garner DM Garfinkel PE. Handbook of treatment for eating disorders[ M]. 2nd edition. New York: The Guilford Press,1997.
11. ［11］Meads C, Gold L, Burls A, Jobanputra P. In-patient versus out-patient care for eating disorders. DPHE Report no 17 University of Birmingham 1999.
12. ［12］Garner DM, Needleman LD. Sequencing and integration of treatments. In: Garner DM, Garfinkel PE, editor(s). Handbook of treatment for eating disorders[M]. 2nd edition. New York: The Guilford Press, 1997:50-66.
13. ［13］Dare C, Crowther C. Psychodynamic models of eating disorders. In: Szmulker G, Dare C, Treasure J, editor(s). Handbook of Eating Disorders: Theory, treatment and research [M]. Chichester: John Wiley & Sons, 1995:125 - 139.
14. ［14］Brach H. Eating disorders: Obesity, anorexia nervosa and the person within[M]. New York: Basic Books, 1973.
15. ［15］Goodsitt A. Eating Disorders: A self-psychological perspective.In: Garner DM, Garfinkel PE, editor (s). Handbook of Treatments for Eating Disorders [M]. 2nd edition. New York: The Guilford Press, 1997:205 - 228.
16. ［16］Garner DM, Vitousek KM, Pike KM. Cognitive-behavioural therapy for anorexia nervosa. In: Garner DM, Garfinkel PE,editor (s). Handbook of Treatments for Eating Disorders [M]. 2nd edition. New York: The Guilford Press, 1997:67-93.
17. ［17］Fairbum CG, Shafran R, Cooper Z. A cognitive behavioural theory of anorexia nervosa[J]. Behav Res Ther. 1999; 37(1):1-13.
18. ［18］Treasure J, Todd G, Brolly M, Tiller J, Nehmed A, Denman F. A pilot study of a randomized trial of cognitive analytical therapy vs educational behavioural therapy for adult anorexia nervosa[J]. Behav Res Ther, 1995; 33(4):363-367.
19. ［19］Dare C, Eisler I, Russell G, TreaureJ, Dodge L. Psychological therapies for adults with anorexia nervosa[J]. Br J Psychiatry, 2000; 178:216 - 21.
20. ［20］Katzman MA, Lee S. Beyond body image: The integration of feminist and transcultural theories in the understanding of selfstarvaton[J]. Int J Eat Disord, 1997 ;22(4) :385 -394.
21. ［21］Striegel-Moore RH. A feminist perspective on the etiology of eating disorders. In: Brownell KD, Fairburn CG, editor(s).Eating Disorder and Obesity. A comprehensive handbook [M]. New York: The Guilford Press, 1995 :224 -229.
22. ［22］Wooley SC. Feminist influences on the treatment of eating disorders. In: Brownell KD, Fairburn CG, editor(s). Eating Disorders and Obesity A comprehensive haridbook. New York: The Guilford Press, 1995:294-298.
23. ［23］Dolan B. Gitzinger I. Why women? Gender issues and eating disorders[M]. London: The Athlone Press, 1994.
24. ［24］Fairburn CG, Jones R, Peveler RC, Carr SJ, Soloman RA, Burton J, Hope RA. Three psychological treatments for bulimia nervosa: A comparative trial [J ]. Arch Gen Psychiatry,1991; 48(5) :463 -469.
25. ［25］Vitousek KM, Watson S, Wilson GT. Enhancing motivation for change in treatment resistant eating disorders[J]. Clin Psychol Rev, 1998; 18(4):391-420.
26. ［26］WardA, TroopN, ToddG, TreasureJ. To change or not to change-‘ How’ is the question[J] ? Br J Med Psycho, 1996;69 ( Pt 2) :139 -146.
27. ［27］Prochaska, JO, DiClemente, CC, Norcross, JC. In search of how people change: Applications to addictive behaviors [J].Am Psychol, 1992; 47(9):1 102-1 114.
28. ［28］Windauer U, Lennerts W, Talbot P, Touyz SW. How well are "cured" anorexia nervosa patients? An investigation of 16weight-recovered anorexic patients[J]. Br J Psychiatry, 1993;163:195 -200.
29. ［29］World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders[ M ]. Geneva: World Health Organization, 1992.
30. ［30］Russell GF, Szmukler GI, Dare C, Eisler I. An evaluation of family therapy in anorexia nervosa and bulimia nervosa [J].Arch Gen Psychiatry,1987; 44(12) :1 047 - 1 056.
31. ［31］Morgan HG, Russell GFM. Value of family background and clinical features as predictors of long term outcome in anorexia nervosa: Four year follow-up study of 41 patients[J]. Psychol Med,1975; 5(4) :355 -371.
32. ［32］Morgan HG, Hayward AE. Clinical assessment of anorexia nervosa. The Morgan-Russell assessment schedule [J ]. Br J Psychiatry, 1988; 152:367-71.
33. ［33］Halmi K, Mitchell J, Crow S. Fluoxetine vs cognitive behavioral therapy in relapse prevention for anorexia nervosa [J].Eur. Neuropsychopharmaool, 1999 ;9 ( Supp 5 ) :373.
34. ［34］Joyce P. A comparison of three psychotherapies for anorexia nervosa[R]. AED 2002 Intemational Conference on Eating Disorders. 2002:14.
35. ［35］Channon S, de Silva P, Hemsley D, Perkins R. A contolled trial of cognitive-behavioural and behavioural treatment of anorexia nervosa, Behav Res Ther, 1989; 27 ( 5 ): 529 - 535.
36. ［36］Serfaty MA, Turkington D, Heap M, Ledsham L, Jolley E. Cognitive therapy versus dietary counselling in the outpatient treatment of anorexia nervosa: Effect of the treatment phase.Eur Eating Disoders Review, 1999 ;7:334 - 50.
37. ［37］Bachar E, Eytan B, Yael L, Shulamit K, Berry EM. Empirical comparison of two psychological therapies. Self Psychology and Cognitive Orientafon in the Treatment of Anorexia and Bulimia[J].J Psychother Pract Res,1999(2):115-128.
38. ［38］Bergh C,Brodin U,Lindberg G,Sodenten P Randomized controlledtrial of a treatment for anorexia and bulimia nervosa [J].Proc Nat Acad Sciences,2002;99(14):9 486-9 491(This paper ws first published in:The Cochrane Library,Issue 4.2003).

Chinese Journal of Evidence-Based Medicine

Individual Psychotherapy in the Outpatient Treatment of Adults with Anorexia Nervosa

Abstract Full text Figures/Tables Video References Cited by

Format

Content