Anorexia Nervosa: Opportunities and Challenges in Treatment

Physiology & Behavior, 2008

Anorexia nervosa is a behavioral disorder characterized by ego-syntonic self-starvation, denial of illness and ambivalence towards treatment. Treatment refusal and drop-out rates are high and relapse is common. Treatment is best viewed as comprised of two phases, weight restoration and normalization of eating behavior followed by relapse prevention. Most patients verbalize a desire to change, however they seek treatment on their own terms, ideally with minimal or no weight gain. Successful treatment must therefore convince patients to overcome their drive to diet. Evidence-based data on treatment interventions for anorexia nervosa are scarce and methodological problems afflict the few published, controlled trials. Taken together, clinical expertise and data from correlational and controlled trials suggest that chronicity and adult status are associated with a worse prognosis. Outpatient family therapy is effective in weight-restoring the majority of adolescent patients whereas older patients, or those with severe medical or psychiatric comorbidity, often require intensive treatment on an inpatient eating disorders behavioral specialty unit. Correlational data suggest that weight-restored patients are less likely to relapse. Despite limitations of the current knowledge-base, several new areas of research hold promise in elucidating risk factors, in identifying the pathophysiology that sustains anorectic behavior, and in developing more targeted and effective treatments.

Nutrients, 2023

Anorexia nervosa is a psychiatric disorder with an unknown etiology that is characterized by an individual’s preoccupation with their weight and body structure while denying the severity of their low body weight. Due to the fact that anorexia nervosa is multifaceted and may indicate the coexistence of genetic, social, hormonal, and psychiatric disorders, a description of non-pharmacological interventions can be used to ameliorate or reduce the symptoms of this condition. Consequently, the purpose of the present narrative review is to describe the profile’s context in the anorexic person as well as the support they would require from their family and environment. In addition, it is aimed at examining preventative and non-pharmacological interventions, such as nutritional interventions, physical activity interventions, psychological interventions, psychosocial interventions, and physical therapy interventions. To reach the narrative review aims, a critical review was conducted utilizing both primary sources, such as scientific publications, and secondary sources, such as bibliographic indexes, web pages, and databases. Nutritional interventions include nutritional education and an individualized treatment for each patient, physical activity interventions include allowing patients to perform controlled physical activity, psychological interventions include family therapy and evaluation of the existence of other psychological disorders, psychosocial interventions include management of the relationship between the patient and social media and physical therapy interventions include relaxation massages and exercises to relieve pain. All these non-pharmacological interventions need to be individualized based on each patient’s needs.

Harvard Review of Psychiatry, 1994

Inpatient treatment of anorexia nervosa, difficult and at times complex, has been shown to promote enduring change. An integrated treatment approach that includes medical, psychological, nursing, and social interventions can restore patients to a healthy weight, improve abnormal eating behaviors, and ameliorate many of the central psychopathological attitudes and illness-driven behaviors characteristic of the disorder. Thi s article reviews inpatient treatment of anorexia nervosa, evaluating empirical studies and providing a critique of their methodology and potential applicability, combining available published studies with clinical experience to suggest a comprehensive pragmatic treatment approach, and noting research needs for the future. More controlled double-blind studies are urgently needed to assess virtually every aspect of inpatient care, especially methods for promoting safe and rapid weight restoration. Comparative studies on the efficacy of behavioral, psychotherapeutic, and pharmacological approaches and determination of the optimum step-wise preparation for discharge into a weight-preoccupied society are also needed. (HARVARD REV PSYCHLATRY 1994;2:193-203.) Anorexia nervosa was first described by Morton' in 1694. It has been recognized as a syndrome in the medical literature for more than 100 years (see, for example, Gull'). As a syndrome, anorexia nervosa is characterized by a phobic fear of fatness and/or a relentless pursuit of thinness; self-starvation; and reproductive hormone abnormalities. The central psychopathology of anorexia nervosa is better explained by the concept of an "overvalued idea"3 than by delusions or compulsions. The pursuit of thinness and the phobic fear of fatness are not ego-alien, as with true

Progress in Health Sciences, 2020

Introduction: Anorexia nervosa is a food intake disorder characterized by acute weight loss that it could cause severe psychosomatic problems. Purpose: To present the data and information as well as the treatment related to Anorexia nervosa. Materials and methods: The study material consisted of reviewed articles on the topic found in Greek and globally accepted electronic databases, Pubmed, Scopus, Medline, Google Scholar, regarding the effects of Anorexia nervosa on health and its treatment. Results: Initial symptoms of Anorexia nervosa and Bulimia Nervosa may be characterised by bodyrelated negative interpretation bias, distorted body image and pronounced body dissatisfaction. Anorexic patients refuse to eat with their family or in public places. They lose weight by drastically reducing their total food intake, with a disproportionate reduction in the amount of meals containing carbohydrates and fats. The term Anorexia is unfortunate, because a decrease in appetite does not occur...

Current Opinion in Psychiatry, 2020

Purpose of review Our aim is to give an overview of the recent literature on psychological treatment for young adults and adults with anorexia nervosa and to discuss the implications of the findings for clinical practice. Recent findings Three systematic reviews and meta-analyses have recently been published on psychological treatments for anorexia nervosa. Treatment outcomes are still modest and mainly focus on weight outcome, although outcomes for eating disorder disease and quality of life have also been reported. Adhering to a treatment protocol might lead to faster and better results. Summary For children and adolescents with anorexia nervosa, the major guidelines recommend a family-based treatment. The treatments of choice for young adults and adults with anorexia nervosa are the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), Cognitive Behaviour Therapy-Enhanced (CBT-E) and Specialist Supportive Clinical Management (SSCM), but none of these treatments seem to be superior. In search of other ways to improve outcome, shared decision making may be a way to help patients become more involved in their treatment, enhance their motivation and consequently improve the outcome.

Protocols, 1996

Anorexia Nervosa has been a long-standing, much researched problem in modern medicine and psychology, with researchers, medical experts, psychology experts and media specialists trying to find a suitable answer for questions such as, why does anorexia develop, what is its main demographic, how does society affect the potential for anorexia development etc. While research has been done not only on popular discourse of anorexia nervosa, as well as the medical and clinical aspects and manifestations of the disease, the varying symptomatology of this disorder as well as the abundance of backgrounds it stems from in different patients, have made it hard to pin anorexia down. As of today, an official description and diagnostic assessment exist, yet instances of so-called "atypical" anorexia are becoming more frequent with the societal phenomena that spur on the development of the illness.

Journal, 2013

For the mainstream Psychology/Psychiatry, anorexia nervosa is considered an eating disorder characterized by the low body weight and by the restrictive eating pattern. The traditional psychiatric treatment consists in the establishment of a meal plan that must be scrupulously followed and, most frequently, in pharmacological treatment. We propose an alternative conceptualization of anorexia nervosa that envisages this disorder as pertaining to the control domain. In this sense, we formulate psychiatric intervention as a " pact with anorexia " , once it follows the very same logic, prohibitions and self-impositions of the disorder. Specifically, we envisage the meal plan as a way of maintaining anorexia, instead of suppressing it. As we could observe in our four year research project, in which we've followed several anorectic female patients, those who were more committed to their psychiatric treatment were precisely those who had more difficulty in recovering from anorexia – i.e., from renouncing the control from which the disorder lives. Finally, we suggest some fundamental underpinnings to an effective therapeutic approach, based in our conceptualization and understanding of the disorder. 1. The Usual Way of Conceiving Anorexia Nervosa For the mainstream Psychology/Psychiatry, anorexia nervosa is considered an eating disorder characterized, firstly, by the low body weight and by the disordered, restrictive eating pattern. Although conceptions and ideas about anorexia nervosa have clearly suffered many alterations over time, in mainstream clinical research and practice very little has changed. The notion of anorexia as an illness remains basically untouched and unchallenged. Symptoms are categorized into syndromes that are operationally defined and objectively analysed. Since anorexia nervosa was conceptualized as a psychiatric disorder and included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) (critically recognizing this classification as the expression of the trends of reification and naturalization of Psychology/Psychiatry, ideological mechanisms that, according to Horkheimer and Adorno (1947; published in English 1972), both in collective/societal level and in individual/ psychological level have functions of protection and legitimation of political interests), the diagnostic criteria for anorexia nervosa are focused on the physical body and in perception distortions and biomedical factors that can be observed and measured in an objective manner. The DSM criteria (DSM-IV-TR) for anorexia nervosa include: a refusal to maintain body weight at or above a minimally normal weight for age and height; an intense fear of gaining weight; a disturbance in the way in which one's body weight or shape is experienced, undue influence of body shape on self-evaluation, or denial of the seriousness of the current low body weight; and amenorrhea in postmenarcheal females (APA, 2000). Anorectics are considered psychologically disordered and are analyzed, in terms of comorbidity, in several psychological dimensions that promote or are caused by anorexia, such as depression, anxiety, alexithymia, obsessive-compulsive behavior or borderline personality disorder. Anorexia nervosa is associated with a distorted self-image which may be maintained by various cognitive biases that alter how the affected individual evaluates and thinks about her or his body, food and eating.

BJSTR, 2017

To provide deeper & novel perspective about Anorexia Nervosa, as an Eating Disorder. Other than focusing on book-based explanations on symptoms & treatments, to be able to get the picture of the mental disorder from the sufferers’ eyes….A disorder most often seen in adolescent females characterized by a refusal to maintain minimally normal body weight, intense fear of gaining weight, disturbance in body image, development of amenorrhea in postmenarcheal females Body weight is maintained at least 15% below that expected (either lost or never achieved), or Body Mass Index (BMI) is 17.5 or lessThe weight loss is self-induced by avoidance of ‘fattening foods’ and one or more of the following: self-induced vomiting; selfinduced purging; excessive exercise; use of appetite suppressants and/or diuretics. There is body-image distortion 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.

Transactional Analysis Journal, 1985

The existing outcome research on the efficacy of treatment of anorexia nervosa yields minimal insight regarding the nature of the recovery process and the quality of life pursuant to recovery. A primary problem is the omission of direct inquiry of recovered patients. This study, utilizing intensive interviewing of 25 recovered anorexics, finds that few who received formal treatment believe it was essential to their recovery. Many experience the therapeutic experience as duplicating the dynamics and problems leading to the illness. Citing insufficient attention to eating behavior, body image, and family dynamics, the interviews alsoreveal that factors essential to a therapeutic relationship are more often found in relationships outside of treatment. Recovery occurs over time as the anorexic accepts and adapts to the problems in the systems around her and in turn accepts herself. Findings validate the need for an existential, systems-oriented approach in the treatment of anorexic patients. Recovery from anorexia nervosa, a complex biopsychosocial disorder characterized by lifethreatening deficits in interoceptive awareness, necessitates dramatic changes in selfawareness, cognition, and perception. Because this disorder may lead to death or to severe physical sequelae, treatment is often multimodal, with many interventions (medical, psychotherapeutic, nutritional, behavioral), initiated at the same time. Smith, Glass, and Miller (1980) point out that delaying treatment or utilizing controlled comparative studies of treatment effects is inconceivable and unethical. Thus, assessment of the value of various treatment effects is difficult as combinations of factors inside and outside of treatment may be 48