Anorexia Nervosa Treatment - What Works and What Doesn't?
Anorexia nervosa has the highest mortality rate of any other psychiatric disorder according to a study published by the American Journal of Psychiatry. Other physical and emotional health consequences of anorexia nervosa include limb and joint pain, headache, gastrointestinal problems, menstrual problems, shortness of breath, chest pain, anxiety and depressive symptoms. Because of these co-morbid conditions, anorexia nervosa is often characterized as one of the most difficult psychiatric conditions to treat.
Numerous therapeutic techniques have been used to treat anorexia nervosa; however, many have met with little success according to a review study published in the Journal of Clinical Child and Adolescent Psychology. According to this study, there is “minimal support for the efficacy of CBT [cognitive behavioral therapy] for adults with AN [anorexia nervosa] or for children with any eating disorder.” However, “for adolescent patients with AN, a family-based intervention has demonstrated superiority.”
Emerging research supports the Maudsley Approach as an efficacious anorexia nervosa treatment for adolescents based on a study in the Archives of General Psychiatry.
Maudsley Approach: Philosophy
The Maudsley Approach is a family-based therapy gaining recognition as the only evidenced-based treatment for adolescents with anorexia nervosa. The goal of treatment focuses on rehabilitating the anorexic in an outpatient setting. The theoretical underpinning of the Maudsley Approach is that it incorporates the family as active members of treatment. The therapist uses the family as a resource to help the adolescent overcome anorexia nervosa. Rather than viewing the parents as the problem, the Maudsley Approach sees them as part of the solution. In treatment, the focus shifts from food and eating to positive interpersonal interactions.
Maudsley Approach: Treatment
The Maudsley Approach requires 15-20 hour-long family sessions over an approximate12-month period according to the National Eating Disorder Information Centre. The three phases of this approach are restoring weight, returning control over eating to the adolescent and establishing a healthy adolescent identity.
During the weight restoration phase, the therapist focuses on educating the adolescent and his or her family on the dangers of malnutrition, identifies familial-interaction patterns and assists during the re-feeding process. Often therapy will be conducted over a family meal, so the therapist can assess interactions and help during the re-feeding process. During the second phase of treatment, the adolescent gains more freedom over eating habits, and positive familial interactions are emphasized. The third phase of treatment involves identifying appropriate parental boundaries and supporting the adolescent’s autonomy.
Maudsley Approach: Limitations
The Maudsley Approach has a number of limitations. This anorexia treatment is only efficacious with individuals in adolescence or at the young-adult stage. At this time, there are no empirically-supported therapeutic treatments for older and middle-aged adults with anorexia nervosa. Additionally, the Maudsley Approach requires a family effort, a time commitment of at least one year and a mental health professional competent in delivering this method of treatment.
Pharmacological Treatment
Pharmacological anorexia nervosa treatments provide little benefit to these individuals. At best, pharmacological treatments can relieve specific co-morbid symptoms short-term. For example, antidepressants may help decrease depression and stabilize mood. Research suggests long-term benefits for co-morbid symptoms are discouraging. According to a study published in the International Journal of Eating Disorders, pharmacological treatments offer little value to an anorexic due to their high noncompliance rates and nutritional deficiencies interfering with medicinal benefits.
References
Crow, S.J., Mitchell, J.E., Roerig, J.D., et al. “What potential role is there for medication treatment in anorexia nervosa?” International Journal of Eating Disorders. John Wiley & Sons, Inc., 2009.
Johnson, J.G., Spitzer, R.L., & Williams, J.B. “Health problems, impairment and illnesses associated with bulimia nervosa and binge eating disorder among primary care and obstetric gynecology patients” Psychological Medicine. Cambridge University Press_,_2001.
Keel, P.K. & Haedt, A. “Evidenced-based psychosocial treatments for eating problems and eating disorders.” Journal of Clinical Child and Adolescent Psychology. Routledge, 2008.
Le Grange, D. & Lock, J. “Family-based treatment of adolescent anorexia nervosa: The Maudsley Approach”, https://www.nedic.ca/knowthefacts/documents/MaudsleyApproach.pdf
Lock, J., Le Grange, D., Agras, S.W., et al. “Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa” Archives of General Psychiatry. American Medical Association, 2010.
Sullivan, P. “Mortality in anorexia nervosa” American Journal of Psychiatry. American Psychiatric Association, 1995.
Wilson, G.T., Grilo, C.M., & Vitousek, K.M. “Psychological treatments of eating disorders” American Psychologist. American Psychological Association, 2007
