Introduction

  • Caution is suggested in the interpretation of the following results as the majority of individuals included in the treatment studies are females. As a result, treatments and interventions have been developed based on data collected from females. It is unclear whether or not these interventions are effective in treating males with eating disorders.1
  • It is important to pay attention to each of the studies’ target age groups as the findings are not necessarily generalizable to other age groups.1
  • It is also necessary to note that research findings are not necessarily transferrable from one eating disorder to other eating disorders..1
  • A further limitation to much of the research done to date is the lack of inclusion of racial and ethnic diversity amongst the populations studied.1
1Keel, P.K & Haedt, A. (2008). Evidence-based psychosocial treatments for eating problems and eating disorders. Journal of Clinical Child & Adolescent Psychology, 37(1), 39-61. DOI: 10.1080/15374410701817832
 

Anorexia Nervosa

Psychotherapy

  • A systematic review completed by Hay (2013) aimed to update a review published in 2007. Hay found progress has been made in the discovery of evidence for Family Based Treatment (FBT) in adolescents with anorexia nervosa.1
  • Evidence from five trials indicated FBT led to clinically relevant weight gain in adolescents compared to their baseline and noted improvements in psychological functioning. This review was unable to determine differences between the family therapy interventions.2
  • An RCT comparing FBT with Adolescent-Focused Individual Therapy for Adolescents (AFT) was performed with 121 participants, aged 12 to 18 years who were diagnosed with Anorexia Nervosa. The study authors found both treatments led to considerable improvement in weight and eating related issues. FBT and AFT were similarly effective in producing full remission at the end of treatment; however, FBT was more effective in facilitating full remission at both six month and 12 month follow up. The authors suggest given the situation where the parents are unable to be involved in FBT, AFT would be the preferred treatment choice.3
  • Follow up on an earlier RCT conducted by Eisler, et al (2000) adds to the empirical support for family therapy as an effective treatment for anorexia nervosa in adolescents. The initial RCT compared two forms of outpatient family intervention, conjoint family therapy (CFT) and separated family therapy (SFT). The findings demonstrated considerable improvement in nutritional and psychological state for both groups at end of treatment. However, SFT was superior to CFT for those individuals whose families expressed high levels of maternal criticism. CFT was superior to SFT for individual psychological outcomes, namely depression, self-esteem, and obsessive behaviours.4 The five year follow-up study on 38 of the 40 initial participants showed there was little difference between the results at five years. More than 75% of subjects were found to have no eating disorder symptoms and only 8% reported any sort of relapse. Three participants developed symptoms of bulimia, one of which warranted a diagnosis.5
  • A synthesis review of interventions for eating disorders in adolescents suggests family therapy is a well-established intervention for the treatment of anorexia nervosa in adolescents.6,7,8
  • CBT is showing promising results as treatment for anorexia nervosa in those 17 years and older.8
  • Anorexia nervosa should be managed as an outpatient unless the individual is medically unstable, lacks a positive social and familial environment, or for psychiatric reasons.8

Pharmacological Treatment

Atypical antipsychotics and SSRIs have seen the most evaluation thus far. Pharmacological treatment of anorexia nervosa has not yet had the positive results necessary to make broad recommendations.8

1Hay, P. (2013). A systematic review of evidence for psychological treatments in eating disorders: 2005-2012. International Journal of Eating Disorders, 46, 462-469.
2Berkman, N.D., Bulik, C.M., Brownley, K.A., Lohr, K.N., Sedway, J.A., et al. (2006). Management of eating disorders. Rockville, MD, USA: Agency for Healthcare Research and Quality. Evidence Report/Technology Assessment; 135. Retrieved from http://www.ahrq.gov/clinic/tp/eatdistp.htm
3Lock, J., LeGrange, D., Agras, W.S., Moye, A., Bryson, S.W., et al. (2010). Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Archives of General Psychiatry, 67(10), 1025-1032.
4Eisler, I., Dare, C., Hodes, M., Russell, G., Dodge, E., et al. (2000). Family therapy for adolescent anorexia nervosa: The results of a controlled comparison of two family interventions. Journal of Child Psychology and Psychiatry, 41, 727-736.
5Eisler, I., Simic, M., Russell, G. & Dare, C. (2007). A randomized controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: A five year follow-up. Journal of Child Psychology and Psychiatry, 48(6), 552-560. DOI: 10.111/j.1469-7610.2007.01726.x
6Keel, P.K & Haedt, A. (2008). Evidence-based psychosocial treatments for eating problems and eating disorders. Journal of Clinical Child & Adolescent Psychology, 37(1), 39-61. DOI: 10.1080/15374410701817832
7Couturier, J., Kimber, M. & Szatmari, P. (2013). Efficacy of family-based treatment for adolescents with eating disorders: A systematic review and meta-analysis. International Journal of Eating Disorders, 46(1), 3-11.
8Watson, H.J. & Bulik, C.M. (2013). Update on the treatment of anorexia nervosa: Review of clinical trials, practice guidelines, and emerging interventions. Psychological Medicine, 43(12), 2477-2500. DOI: 10.1017/S0033291712002620

 

Bulimia Nervosa

Psychotherapy

  • A systematic review completed by Hay (2013) aimed to update a review published in 2007. Caution is suggested in the interpretation of these results as the review included both adult and adolescent populations. Hay found therapist led Cognitive Behavioural Therapy (CBT) remains the first line of treatment therapy for Bulimia Nervosa.1,4
  • CBT is the treatment of choice for older adolescents ages 18-21.2
  • Family Based Treatment (FBT) was found to be superior to supportive psychotherapy for treatment of BN in teenagers aged 12-19 years. Those who received FBT were more likely to recover or experience symptom improvement at the end of the study and at the six month follow-up.3
  • An RCT comparing Family Therapy (adapted from the Maudsley model) and CBT guided self-care for adolescents with BN found CBT guided self-care is valuable as an early intervention that can be delivered in nonspecialist settings. It may also have an edge over Family Therapy; however, more research is needed.5
  • A systematic review and meta-analysis concluded FBT (based on the Maudsley Approach) focusing on symptom interruption of eating disordered behaviours is superior to individual therapy for adolescents with AN or BN. FBT should be recommended as the first line of treatment for adolescents with eating disorders.6

Pharmacological Treatment

Several RCTs demonstrated that Fluoxetine administered for six to 18 weeks reduced binge eating and purging compared with placebo. Fluoxetine administration was also found to reduce relapse at the one year follow up. Caution must be taken in interpretation of these results as trials in the review included those aged 10 and over.4

1Hay, P. (2013). A systematic review of evidence for psychological treatments in eating disorders: 2005-2012. International Journal of Eating Disorders, 46, 462-469.
2Keel, P.K. & Haedt, A. (2008). Evidence-based psychosocial treatments for eating problems and eating disorders. Journal of Clinical Child & Adolescent Psychology, 37(1), 39-61. DOI: 10.1080/15374410701817832
3LeGrange, D., Crosby, R.D., Rathouz, P.J. & Levanthal, B.L. (2007). A randomized controlled comparison of Family-Based Treatment and Supportive Psychotherapy for adolescent Bulimia Nervosa. Archives of General Psychiatry, 64(9), 1049-1056.
4Berkman, N.D., Bulik, C.M., Brownley, K.A., Lohr, K.N., Sedway, J.A., et al. (2006). Management of eating disorders. Rockville, MD, USA: Agency for Healthcare Research and Quality. Evidence Report/Technology Assessment; 135. Retrieved from http://www.ahrq.gov/clinic/tp/eatdistp.htm
5Schmidt, U., Lee, S., Beecham, J., Perkins, S., Treasure, J., et al. (2007). A randomized controlled trial of family therapy and cognitive behavior therapy guided self-care for adolescents with bulimia nervosa and related disorders. American Journal of Psychiatry, 164(4), 591-598. Doi: 10.1176/appi.ajp.164.4.591
6Couturier, J., Kimber, M. & Szatmari, P. (2013). Efficacy of family-based treatment for adolescents with eating disorders: A systematic review and meta-analysis. International Journal of Eating Disorders, 46(1), 3-11.