Anorexia Nervosa: Taking a Multidisciplinary Approach

Because of the complex nature of anorexia nervosa, severely ill patients have a much better prognosis when they are treated by an experienced multidisciplinary team, according to Dr. Stephan Zipfel of the University of Heidelberg, Germany (Lancet 2000; 355:721).

Dr. Zipfel and a team of researchers recently attempted to contact 84 women at least 21 years after their first inpatient treatment for anorexia nervosa. Follow-up revealed that 14 of the 84 patients (17%) had died. Twelve deaths were due to anorexia-related symptoms, including bronchial pneumonia, sepsis, dehydration, and suicide.

Sixty-three of the 70 survivors underwent a psychiatric interview and physical assessment and also completed standardized psychological questionnaires. Of the survivors, the researchers classified 50.6% as fully recovered, 20.8% as having an intermediate outcome, and 26% as having a poor outcome.

Who had the poorest outcome?

Women with a poor outcome were more likely to have had the disease for a long time before they were first hospitalized, did not gain adequate weight during hospitalization, and had a low body mass index. In addition, women who did poorly had severe psychological or social problems at the time the diagnosis was first made.

Dr. Zipfel noted that such patients would greatly benefit from being treated by a team of psychiatrists/psychotherapists, physicians, dietitians, family therapists, and additional therapists experienced in treating patients with body image disturbances. He added that clinicians treating patients with severe anorexia nervosa should focus on social and psychological symptoms as well as adequate weight gain during treatment.