Young women with AN who resume menstruation after recovery have better psychological and physiological health than those who do not, according to new research from the University of Florence, Italy. Dr. Giovanni Castellini and colleagues reported the results of their study of sexual function among anorexia nervosa (AN) patients at the 30th European College of Neuropsychopharmacology Congress in Paris in September. The researchers’ results challenge the usual idea of recovery from AN based on weight restoration or behavioral changes. In addition to these well-known markers of successful recovery, the authors recommend that factors such as concern over body image, as well as sexual function, poor overall quality of life, and patients’ subjective experiences be taken into account when measuring recovery from AN.
Dr. Castellini and his fellow researchers studied 39 patients with AN and 40 with BN to see how sexual functioning moderates recovery, and to identify factors associated with restoration of regular menstrual periods and healthy sexual function. All patients underwent individualized cognitive behavioral therapy (CBT) for one year and then were revaluated at the end of treatment and 2 years later (3-year follow-up). When CBT was completed, 56.4% (22) of AN patients and 57.5% (23) of BN patient were thought to have recovered from the disorder. At the 3-year follow-up evaluation, 48.7% of AN patients and 60.0% of BN patients were considered recovered.
The pattern of recovery at the end of CBT differed between those with and without amenorrhea. Those who had resumed menstruation had greater reductions in EDE-Q total score and in the restraint subscale score, and greater increases in body mass index, Female Sexual Functioning Index (FSFI) total score, and triglyceride levels at the end of CBT. These differences remained at the 3-year follow-up.
Dr. Castellini advised that that assessing patients’ sexual functioning could help determine the need and direction of ongoing treatment for AN. When patients remain amenorrheic after treatment, another cycle of psychotherapy may be warranted, or another psychotherapeutic evaluation may be necessary, particularly when there is no improvement after the first year of psychotherapy.