A New Approach to Treating Severe, Chronic Anorexia Nervosa

Patients with severe, chronic forms of anorexia nervosa (AN) are notoriously hard to treat. Most develop AN in their teens, and many do not respond to treatment. By changing the focus of treatment, however, Dr. Stephen Touyz and a team of colleagues found that these patients will not only follow through with treatment but also can make significant improvement. As Dr. Touyz and his coauthors described at the May ICED meeting in Montreal, instead of using traditional treatment approaches that stress weight gain and weight recovery, these researchers took a different approach. They emphasized improving quality of life, and overall functioning, reduction of mood disorders, and enhanced social adjustment. In addition, the care team and patient collaborated on all treatment goals. By doing so, the team was able to engage even highly resistant individuals with severe AN in treatment. They also avoided the notoriously high dropout rates.

Their study of 63 female patients at the University of Sydney and St. George’s Hospital, London, was the first randomized clinical trial for chronic AN. Thirty-one patients were assigned to cognitive behavioral therapy and 32 to specialist-supported clinical management (SSCM). Both treatment approaches involved 30 outpatient sessions given over 8 months. The results from both treatment groups were comparable, with significant improvement on many follow-up measures. More than 85% of those who enrolled in the clinical trial completed treatment—this was nearly three times the usual retention rate. At the end of treatment patients in both groups reported improved quality of life, reduced symptoms of mood disorders, and enhanced social adjustment.