|
Eating Disorders - A 20 Year Review
The current issue of Lancet (Lancet 2003; 361: 407-16 ) has a section called “seminar” and this month they review eating disorders compiled by C G Fairburn and P J Harrison from the Oxford University, Department of Psychiatry. The authors review the usual demographics and clinical features and examine research into risk factors with “two most prominent being low self esteem and perfectionism, the latter being a particularly common antecedent of anorexia nervosa” They touch upon the medical complications and management and the clinical research possibilities.
In their survey of the literature over the last 20 years, their conclusions were quite interesting. They discovered that with the treatment of bulimia nervosa has attracted considerable research attention, and evidence-based management is now possible. There have been unfortunately very few randomized controlled studies into the treatment of anorexia nervosa. The same is true for the atypical eating disorders. The authors make a few noteworthy suggestions for the management of eating disorders.
In Bulimia, “although almost all the trials have been efficacy rather than effectiveness studies, there are good reasons to think that their findings are relevant to management in most psychiatric settings.” The review of research has made several important points.
Bulimia
1. The most effective treatment is a specific type of cognitive behaviour therapy that focuses on modifying the specific behaviours and ways of thinking that maintain these patients' eating disorder.Typical there were 20 individual treatment sessions over 5 months which resulted in substantial improvement with (on intent-to-treat analyses) a third to a half of the patients making a complete and lasting recovery
2. Antidepressant drugs have an antibulimic effect. There is a resultin rapid decline in the frequency of binge eating and purging, and an improvement in mood. A promising finding although not as significant as with cognitive behavior therapy and often not as sustained.
3. There have unfortunately been no consistent predictors of outcome.
Anorexia
In anorexia, the authors clarify that there is a paucity of research on the treatment of anorexia nervosa and that their comments summarize current management considerations.
1. It is important for clinicians to help patients understand the need to remain in treatment and maintain a motivation to get better.
2. It is crucial to reverse the malnutrition and move toward weight restoration. Evaluation and treatment of medical complications is also important. For many this can be accomplished in a variety of clinical settings
3. Management of patients' overevaluation of shape and weight, their eating habits, and their general psychosocial functioning. This can perhaps be accomplished through family treatment and cognitive behavioral therapy.
4. The use of compulsory treatment is only relevant to a few cases and pharmacological management needs more in depth study.
Atypical
Atypical eating disorders have received almost no research attention. The authors suggest that the only advice that can be given is for clinicians to follow the guidelines for treatment of bulimia nervosa in instances in which there is binge eating, and those for the treatment of anorexia nervosa in instances in which weight is low.
Conclusions The authors conclude that the current diagnostic structure for eating disorder “is unsatisfactory and anomalous.” They found that approximately half the cases seen in clinical practice are relegated to an atypical or not otherwise specified group. More twin and genetic studies are needed to clarify the pathogenesis of eating disorders. Also, there is a pressing need for more treatment research to developing more effective treatments and focus on the full range of eating disorders. Finally they point out that “the gulf between research evidence and service provision needs to be investigated and bridged; too few patients receive evidence-based treatment and too many receive suboptimal or inappropriate therapy.”
10:11:26 PM 
|
