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Recent advances in therapies for the eating disorders

Recent advances in therapies for the eating disorders In the first part of this decade, many reviews of the impact of treatments for the eating disorders were conducted, with broadly similar conclusions. This review provides an update on progress (or otherwise) in the field over the past three years. Introduction and context 4. Antidepressants (particularly fluoxetine) are effective The eating disorders have proven a challenge for in reducing the level of bulimic symptoms in bulimia clinicians since they were first identified. Such patients nervosa and binge eating disorder, though the duration often have physical safety needs as a priority, and then of the effect may be short-term. require effective therapy for the eating disorder itself. This review focuses on recent developments in the latter 5. Self-help approaches have a relatively low level of part of that process – treatment for the eating pathology. impact on the eating disorders, producing little impact Many authoritative treatment reviews have been pub- on abstinence from behaviours [8]. lished in recent years [1-7], based on synthesis of both the empirical evidence and expert clinical experience. 6. Apart from binge eating disorder, there is little evidence They include recommendations for both physical safety of the impact of treatment for atypical cases (which and therapies, and have been relatively consistent in their probably represent the largest number of sufferers [5]). conclusions. Their key empirical findings regarding therapies for the eating disorders are as follows. For younger sufferers 1. There is no clear evidence regarding what works for For adult sufferers children. 1. Psychological treatments have relatively low levels of impact on anorexia nervosa, and there is no clear 2. Adolescents with anorexia nervosa benefit more from difference in outcome between such treatments. family-orientated therapies than individual therapies, though there is little evidence for such a difference in 2. Physical treatments for anorexia nervosa (for example, bulimic or atypical cases. nutrition or medication) are needed to ensure safety (for example, biological safety or psychiatric risk), but there is Of course, these conclusions should be read alongside no consistent evidence that those treatments have an the expert clinical opinions that the guidelines use to impact on the anorexia nervosa itself. supplement the evidence base (particularly where there is no real empirical base to rely on). 3. Psychological treatments for bulimia nervosa and binge eating disorder are relatively effective, with strong Recent advances evidence for the impact of cognitive behavioural therapy The past 3 years have yielded significant advances in our (CBT) and interpersonal psychotherapy (the former knowledge base that are not reflected in these reviews. being faster to take effect than the latter). Some of those advances are in the form of consolidation Page 1 of 4 (page number not for citation purposes) F1000 Medicine Reports 2009, 1:38 http://F1000.com/Reports/Medicine/content/1/38 of the existing positive evidence, some are new conclu- There is no clear evidence for medication in the sions, and some are disappointingly negative findings. treatment of the core symptoms of anorexia nervosa, One key finding is that relatively few patients who are regardless of age [21,24]. There have been some referred to specialist services either make it through to suggestions that olanzapine might be a useful adjunct treatment or complete that treatment [9]. This finding to other treatments for anorexia nervosa (particularly needs to be taken into account when considering the given its tendency to promote weight gain). However, it following advances. is too early to support this contention, given the differing outcomes of recent studies, their methodological weak- Types of therapy nesses, and the lack of clarity about the mechanisms that Motivational enhancement might be involved [25-27]. A number of motivational approaches have been trialled as adjuncts to other therapeutic methods. The recent Specific subgroups of eating disordered patients evidence from this work is mixed, with motivational Atypical cases enhancement therapy proving relatively ineffective for As already identified, atypical cases constitute a very inpatients with eating disorders (leading to little reliable large proportion of the eating disordered population change in motivation or in eating pathology itself) [10]. [5], but there has been almost no evidence on their There is some evidence of increased motivational benefit treatment (beyond the subgroup of binge eating among binge eaters, though there is less consistency disorder patients). This gap has been addressed recently regarding change in their eating pathology [11,12]. in adults and adolescents. Such cases can be successfully treated using similar methods to those employed with Cognitive behavioural therapy bulimic disorders, with broadly comparable outcomes Among bulimic cases, CBT has extended its evidence [17,18,28]. base considerably [13]. That development parallels improvements in this form of therapy [14,15], although Younger cases whether CBT is actually applied in broad clinical practice Family-oriented therapies still have a pre-eminent is questionable [16]. It has been shown that CBT can be position with adolescents with anorexia nervosa [29]. individualised and applied to patients in non-research However, there is now good evidence that both family settings [17]. The most important finding is an improved and CBT approaches are effective for bulimia nervosa in outcome with bulimic cases (and comparable outcomes adolescents [30]. with atypical cases – see below) [18]. There is pre- liminary evidence that relatively complex cases benefit Methods of delivery most from a more complex form of CBT [18] and that Self-help some in-patients can benefit from a CBT-based pro- Recent findings in this domain have been uninspiring. gramme [19]. However, CBT remains unproven with A recent review has concluded that self-help for bulimia relatively low-weight anorexic patients, where physical nervosa and binge eating disorder is beneficial, but only needs and starvation effects predominate. relative to a waiting list control condition. There is little evidence that this approach is more helpful than any Dialectical behaviour therapy active control condition [31]. Dialectical behaviour therapy (DBT) has previously been proposed for use with bulimia and binge eating disorder. Electronic delivery This stance has been supported by recent work using a Various researchers have tested electronic methods (for version of DBT that is only minimally adapted from the example, via internet, text messages, and CD-ROM) of original [20]. delivering treatments that are effective when delivered individually. Unfortunately, the results are relatively Medication weak and uptake is poor, leading to the conclusion that There has been some advance in the field of psycho- this is not yet a method of conducting therapy that can pharmacology for bulimic eating disorders over the past be widely recommended [32,33]. few years, though these findings need replication and extension. First, there is some evidence that fluoxetine is Implications for clinical practice useful for bulimic adolescents [21]. Second, sibutramine In brief, recent findings reiterate and extend the role may be effective in the treatment of binge eating disorder of CBT as the first line treatment for most adult cases of [22]. Finally, topirimate seems to be effective in the short eating disorders (provided the CBT is delivered appro- term for bulimic disorders where there is comorbid priately), extending its utility to younger cases and to obesity [23]. atypical cases, and showing its effectiveness in Page 2 of 4 (page number not for citation purposes) F1000 Medicine Reports 2009, 1:38 http://F1000.com/Reports/Medicine/content/1/38 non-research settings. However, existing self-help meth- Acknowledgements ods and the use of electronic media for delivery of CBT The author would like to thank Victoria Mountford for are not supported at present. The role of family therapy her helpful comments on this review. for younger cases is also more widely supported. There are more positive findings regarding the use of DBT and References medication for bulimic disorders, but medication is not 1. Berkman ND, Lohr KN, Bulik CM: Outcomes of eating disorders: a systematic review of the literature. Int J Eat Disord 2007, indicated for the core pathology of anorexia nervosa. 40:293-309. 2. Beumont P, Hay P, Beumont D, Birmingham L, Derham H, Jordan A, Future directions in clinical research in therapies for Kohn M, McDermott B, Marks P, Mitchell J, Paxton S, Surgenor L, Thornton C, Wakefield A, Weigall S; Royal Australian and New the eating disorders Zealand College of Psychiatrists Clinical Practice Guidelines Team for Over the next few years, it will be important to monitor Anorexia Nervosa: Australian and New Zealand clinical practice guidelines for the treatment of anorexia nervosa. the following aspects of the treatment literature in the Aust N Z J Psychiatry 2004, 38:659-70. eating disorders: 3. Brownley KA, Berkman ND, Sedway JA, Lohr KN, Bulik CM: Binge eating disorder treatment: A systematic review of rando- 1. Continued developments of psychological therapies for mised controlled trials. Int J Eat Disord 2007, 40:337-48. bulimic disorders and atypical eating disorders (for 4. Bulik CM, Berkman ND, Brownley KA, Sedway JA, Lohr KN: Anorexia nervosa treatment: A systematic review of rando- example, CBT, DBT), to enhance existing outcomes and mised controlled trials. Int J Eat Disord 2007, 40:310-20. to carry these effects further into everyday clinical practice. 5. Fairburn CG, Harrison PJ: Eating disorders. Lancet 2003, 361:407-16. 2. Treatment outcomes for anorexia nervosa, including 6. National Institute for Clinical Excellence: Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, psychological and psychopharmacological approaches Bulimia Nervosa and Related Eating Disorders (Clinical Guideline 9). (findings are anticipated from a number of current London, UK: National Collaborating Centre for Mental Health; 2004. trials). 7. Shapiro JR, Berkman ND, Brownley KA, Sedway JA, Lohr KN, Bulik CM: Bulimia nervosa treatment: a systematic review of randomised controlled trials. Int J Eat Disord 2007, 40:321-36. 3. The development of psychopharmacological 8. Perkins SJ, Murphy R, Schmidt U, Williams C: Self-help and guided approaches that relate to the psychobiology of the eating self-help for eating disorders. Cochrane Database Syst Rev 2006, 3: disorders (including anxiety structures) [34] that have CD004191. more extensive periods of follow-up. 9. Waller G, Schmidt U, Treasure J, Murray K, Aleyna J, Emanuelli F, Crockett J, Yeomans M: Problems across care pathways in specialist adult eating disorder services. Psychiatric Bulletin 2009, 4. Psychological therapies that have been proposed to be 33:26-9. valuable but where the evidence base is minimal should 10. Dean HY, Touyz SW, Rieger E, Thornton CE: Group motivational enhancement therapy as an adjunct to inpatient treatment be tested more fully in order to demonstrate whether or for eating disorders: a preliminary study. Eur Eat Disord Rev not they meet the criteria for evidence-based practice. 2008, 16:256-7. 11. Dunn EC, Neighbors C, Larimer ME: Motivational enhancement 5. The matching of psychological therapies to indivi- therapy and self-help treatment for binge eaters. Psychol Addict Behav 2006, 20:44-52. duals, to ensure that individuals are offered the most 12. Cassin SE, von Ranson KM, Heng K, Brar J, Wojtowicz AE: Adapted effective treatment for their individual problem [18]. motivational interviewing for women with binge eating disorder: a randomized controlled trial. Psychol Addict Behav 2008, 22:417-25. 6. Working via carers, addressing both their own stress 13. Mitchell JE, Agras S, Wonderlich S: Treatment of bulimia nervosa: and making them more able to work as members of the where are we and where are we going? Int J Eat Disord 2007, broader team treating the sufferer [35]. 40:95-101. 14. Fairburn CG: Cognitive Behavior Therapy and Eating Disorders. New York, NY: Guilford; 2008. 7. The determination of whether treatment effects 15. Waller G, Corstorphine E, Cordery H, Hinrichsen H, Lawson R, generalise across settings (for example, do therapies for Mountford V, Russell K: Cognitive-behavioral Therapy for the Eating restrictive problems tested in outpatient settings work as Disorders: a Comprehensive Treatment Guide. Cambridge, UK: Cam- well in day- and in-patient settings?). bridge University Press; 2007. 16. Tobin DL, Banker JD, Weisberg L, Bowers W: I know what you did last summer (and it was not CBT): a factor analytic model of international psychotherapeutic practice in the eating dis- Abbreviations orders. Int J Eat Disord 2007, 40:754-7. CBT, cognitive behavioural therapy; DBT, dialectical 17. Ghaderi A: Does individualization matter? A randomized trial of standardized (focused) versus individualized (broad) behaviour therapy. cognitive behavior therapy for bulimia nervosa. Beh Res Ther 2006, 44:273-88. Competing interests 18. Fairburn CG, Cooper Z, Doll HA, O’Connor ME, Bohn K, The author declares that he has no competing interests. Hawker DM, Wales JA, Palmer RL: Transdiagnostic cognitive- Page 3 of 4 (page number not for citation purposes) F1000 Medicine Reports 2009, 1:38 http://F1000.com/Reports/Medicine/content/1/38 behavioral therapy for patients with eating disorders: a two- Olanzapine therapy in anorexia nervosa: psychobiological site trial with 60-week follow-up. Am J Psychiatry 2009, 166:311-9. effects. Int Clin Psychopharmacol 2007, 22:197-204. Changes Clinical Practice F1000 Factor 3.0 Recommended F1000 Factor 4.8 Recommended Evaluated by Beate Herpertz-Dahlmann 07 Jan 2008 Evaluated by Glenn Waller 23 Dec 2008, Nicole Barbarich-Marsteller 27. Halmi KA: The perplexities of conducting randomized, double- 18 Feb 2009 blind, placebo-controlled treatment trials in anorexia ner- vosa patients. Am J Psychiatry 2008, 165:1227-8. 19. Bowers WA, Ansher LS: The effectiveness of cognitive beha- vioural therapy on changing eating disorder symptoms and 28. Schmidt U, Lee S, Perkins S, Eisler I, Treasure J, Beecham J, psychopathology of 32 anorexia nervosa patients at hospital Berelowitz M, Dodge L, Frost S, Jenkins M, Johnson-Sabine E, discharge and one year follow-up. Ann Clin Psychiatry 2008, Keville S, Murphy R, Robinson P, Winn S, Yi I: Do adolescents with 20:79-86. eating disorder not otherwise specified or full-syndrome bulimia nervosa differ in clinical severity, comorbidity, risk F1000 Factor 3.0 Recommended factors, treatment outcome or cost? Int J Eat Disord 2008, Evaluated by Glenn Waller 09 Apr 2009 41:498-504. 20. Chen EY, Matthews L, Allen C, Kuo JR, Linehan MM: Dialectical F1000 Factor 6.0 Must Read behavior therapy for clients with binge-eating disorder or Evaluated by Daniel le Grange 26 Aug 2008 bulimia nervosa and borderline personality disorder. Int J Eat Disord 2008, 41:505-12. 29. Keel PK, Haedt A: Evidence-based psychosocial treatments for eating problems and eating disorders. J Clin Child Adolesc Psychol F1000 Factor 6.0 Must Read 2008, 37:39-61. Evaluated by Glenn Waller 11 Sep 2008 30. Schmidt U, Lee S, Beecham J, Perkins S, Treasure J, Yi I, Winn S, Robinson P, Murphy R, Keville S, Johnson-Sabine E, Jenkins M, Frost S, 21. Couturier J, Lock J: A review of medication use for children and Dodge L, Berelowitz M, Eisler I: A randomized controlled trial of adolescents with eating disorders. J Can Acad Child Adolesc family therapy and cognitive behavior therapy guided self- Psychiatry 2007, 16:173-6. care for adolescents with bulimia nervosa and related 22. Wilfley DE, Crow SJ, Hudson JI, Mitchell JE, Berkowitz RI, Blakesley V, disorders. Am J Psychiatry 2007, 164:591-8. Walsh BT; Sibutramine Binge Eating Disorder Research Group: Efficacy of sibutramine for the treatment of binge eating F1000 Factor 6.4 Must Read disorder: a randomized multicenter placebo-controlled Evaluated by Howard Steiger 02 May 2007 double-blind study. Am J Psychiatry 2008, 165:51-8. 31. Sysko R, Walsh BT: A critical evaluation of the efficacy of self- F1000 Factor 3.0 Recommended help interventions for the treatment of bulimia nervosa and Evaluated by Guido Frank 10 Jul 2008 binge-eating disorder. Int J Eat Disord 2008, 41:97-112. 32. Robinson S, Perkins S, Bauer S, Hammond N, Treasure J, Schmidt U: 23. Arbaizar B, Gómez-Acebo I, Llorca J: Efficacy of topiramate in Aftercare intervention through text messaging in the treat- bulimia nervosa and binge-eating disorder: a systematic ment of bulimia nervosa - feasibility pilot. Int J Eat Disord 2006, review. Gen Hosp Psychiatry 2008, 30:471-5. 39:633-8. 24. Crow SJ, Mitchell JE, Roerig JD, Steffen K: What potential role is 33. Schmidt U, Andiappan M, Grover M, Robinson S, Perkins S, there for medication treatment in anorexia nervosa? Int J Eat Dugmore O, Treasure J, Landau S, Eisler I, Williams C: Randomised Disord 2009, 42:1-8. controlled trial of CD-ROM-based cognitive-behavioural self- care for bulimia nervosa. Br J Psychiatry 2008, 193:493-500. F1000 Factor 6.4 Must Read Evaluated by Glenn Waller 24 Oct 2008, Daniel le Grange 10 Feb F1000 Factor 6.0 Must Read Evaluated by Glenn Waller 27 Mar 2008 25. Bissada H, Tasca GA, Barber AM, Bradwejn J: Olanzapine in the 34. Strober M, Freeman R, Lampert C, Diamond J: The association of treatment of low body weight and obsessive thinking in anxiety disorders and obsessive compulsive personality women with anorexia nervosa: a randomized, double-blind, disorder with anorexia nervosa: evidence from a family placebo-controlled trial. Am J Psychiatry 2008, 165:1281-8. study with discussion of nosological and neurological evi- dence. Int J Eat Disord 2007, 40:S46-S51. F1000 Factor 4.9 Must Read Evaluated by Nicole Barbarich-Marsteller 15 Jul 2008, Guido Frank F1000 Factor 6.0 Must Read 18 Aug 2008, Beate Herpertz-Dahlmann 23 Jan 2009 Evaluated by Glenn Waller 27 Mar 2008 26. Brambilla F, Garcia CS, Fassino S, Daga GA, Favaro A, Santonastaso P, 35. Treasure J, Smith G, Crane A: Skills-based Learning for Caring for a Loved Ramaciotti C, Bondi E, Mellado C, Borriello R, Monteleone P: One with an Eating Disorder. London, UK: Routledge; 2007. 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Recent advances in therapies for the eating disorders

F1000 Medicine Reports , Volume 1 – May 8, 2009

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Pubmed Central
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© 2009 Medicine Reports Ltd
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1757-5931
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Abstract

In the first part of this decade, many reviews of the impact of treatments for the eating disorders were conducted, with broadly similar conclusions. This review provides an update on progress (or otherwise) in the field over the past three years. Introduction and context 4. Antidepressants (particularly fluoxetine) are effective The eating disorders have proven a challenge for in reducing the level of bulimic symptoms in bulimia clinicians since they were first identified. Such patients nervosa and binge eating disorder, though the duration often have physical safety needs as a priority, and then of the effect may be short-term. require effective therapy for the eating disorder itself. This review focuses on recent developments in the latter 5. Self-help approaches have a relatively low level of part of that process – treatment for the eating pathology. impact on the eating disorders, producing little impact Many authoritative treatment reviews have been pub- on abstinence from behaviours [8]. lished in recent years [1-7], based on synthesis of both the empirical evidence and expert clinical experience. 6. Apart from binge eating disorder, there is little evidence They include recommendations for both physical safety of the impact of treatment for atypical cases (which and therapies, and have been relatively consistent in their probably represent the largest number of sufferers [5]). conclusions. Their key empirical findings regarding therapies for the eating disorders are as follows. For younger sufferers 1. There is no clear evidence regarding what works for For adult sufferers children. 1. Psychological treatments have relatively low levels of impact on anorexia nervosa, and there is no clear 2. Adolescents with anorexia nervosa benefit more from difference in outcome between such treatments. family-orientated therapies than individual therapies, though there is little evidence for such a difference in 2. Physical treatments for anorexia nervosa (for example, bulimic or atypical cases. nutrition or medication) are needed to ensure safety (for example, biological safety or psychiatric risk), but there is Of course, these conclusions should be read alongside no consistent evidence that those treatments have an the expert clinical opinions that the guidelines use to impact on the anorexia nervosa itself. supplement the evidence base (particularly where there is no real empirical base to rely on). 3. Psychological treatments for bulimia nervosa and binge eating disorder are relatively effective, with strong Recent advances evidence for the impact of cognitive behavioural therapy The past 3 years have yielded significant advances in our (CBT) and interpersonal psychotherapy (the former knowledge base that are not reflected in these reviews. being faster to take effect than the latter). Some of those advances are in the form of consolidation Page 1 of 4 (page number not for citation purposes) F1000 Medicine Reports 2009, 1:38 http://F1000.com/Reports/Medicine/content/1/38 of the existing positive evidence, some are new conclu- There is no clear evidence for medication in the sions, and some are disappointingly negative findings. treatment of the core symptoms of anorexia nervosa, One key finding is that relatively few patients who are regardless of age [21,24]. There have been some referred to specialist services either make it through to suggestions that olanzapine might be a useful adjunct treatment or complete that treatment [9]. This finding to other treatments for anorexia nervosa (particularly needs to be taken into account when considering the given its tendency to promote weight gain). However, it following advances. is too early to support this contention, given the differing outcomes of recent studies, their methodological weak- Types of therapy nesses, and the lack of clarity about the mechanisms that Motivational enhancement might be involved [25-27]. A number of motivational approaches have been trialled as adjuncts to other therapeutic methods. The recent Specific subgroups of eating disordered patients evidence from this work is mixed, with motivational Atypical cases enhancement therapy proving relatively ineffective for As already identified, atypical cases constitute a very inpatients with eating disorders (leading to little reliable large proportion of the eating disordered population change in motivation or in eating pathology itself) [10]. [5], but there has been almost no evidence on their There is some evidence of increased motivational benefit treatment (beyond the subgroup of binge eating among binge eaters, though there is less consistency disorder patients). This gap has been addressed recently regarding change in their eating pathology [11,12]. in adults and adolescents. Such cases can be successfully treated using similar methods to those employed with Cognitive behavioural therapy bulimic disorders, with broadly comparable outcomes Among bulimic cases, CBT has extended its evidence [17,18,28]. base considerably [13]. That development parallels improvements in this form of therapy [14,15], although Younger cases whether CBT is actually applied in broad clinical practice Family-oriented therapies still have a pre-eminent is questionable [16]. It has been shown that CBT can be position with adolescents with anorexia nervosa [29]. individualised and applied to patients in non-research However, there is now good evidence that both family settings [17]. The most important finding is an improved and CBT approaches are effective for bulimia nervosa in outcome with bulimic cases (and comparable outcomes adolescents [30]. with atypical cases – see below) [18]. There is pre- liminary evidence that relatively complex cases benefit Methods of delivery most from a more complex form of CBT [18] and that Self-help some in-patients can benefit from a CBT-based pro- Recent findings in this domain have been uninspiring. gramme [19]. However, CBT remains unproven with A recent review has concluded that self-help for bulimia relatively low-weight anorexic patients, where physical nervosa and binge eating disorder is beneficial, but only needs and starvation effects predominate. relative to a waiting list control condition. There is little evidence that this approach is more helpful than any Dialectical behaviour therapy active control condition [31]. Dialectical behaviour therapy (DBT) has previously been proposed for use with bulimia and binge eating disorder. Electronic delivery This stance has been supported by recent work using a Various researchers have tested electronic methods (for version of DBT that is only minimally adapted from the example, via internet, text messages, and CD-ROM) of original [20]. delivering treatments that are effective when delivered individually. Unfortunately, the results are relatively Medication weak and uptake is poor, leading to the conclusion that There has been some advance in the field of psycho- this is not yet a method of conducting therapy that can pharmacology for bulimic eating disorders over the past be widely recommended [32,33]. few years, though these findings need replication and extension. First, there is some evidence that fluoxetine is Implications for clinical practice useful for bulimic adolescents [21]. Second, sibutramine In brief, recent findings reiterate and extend the role may be effective in the treatment of binge eating disorder of CBT as the first line treatment for most adult cases of [22]. Finally, topirimate seems to be effective in the short eating disorders (provided the CBT is delivered appro- term for bulimic disorders where there is comorbid priately), extending its utility to younger cases and to obesity [23]. atypical cases, and showing its effectiveness in Page 2 of 4 (page number not for citation purposes) F1000 Medicine Reports 2009, 1:38 http://F1000.com/Reports/Medicine/content/1/38 non-research settings. However, existing self-help meth- Acknowledgements ods and the use of electronic media for delivery of CBT The author would like to thank Victoria Mountford for are not supported at present. The role of family therapy her helpful comments on this review. for younger cases is also more widely supported. There are more positive findings regarding the use of DBT and References medication for bulimic disorders, but medication is not 1. Berkman ND, Lohr KN, Bulik CM: Outcomes of eating disorders: a systematic review of the literature. Int J Eat Disord 2007, indicated for the core pathology of anorexia nervosa. 40:293-309. 2. Beumont P, Hay P, Beumont D, Birmingham L, Derham H, Jordan A, Future directions in clinical research in therapies for Kohn M, McDermott B, Marks P, Mitchell J, Paxton S, Surgenor L, Thornton C, Wakefield A, Weigall S; Royal Australian and New the eating disorders Zealand College of Psychiatrists Clinical Practice Guidelines Team for Over the next few years, it will be important to monitor Anorexia Nervosa: Australian and New Zealand clinical practice guidelines for the treatment of anorexia nervosa. the following aspects of the treatment literature in the Aust N Z J Psychiatry 2004, 38:659-70. eating disorders: 3. Brownley KA, Berkman ND, Sedway JA, Lohr KN, Bulik CM: Binge eating disorder treatment: A systematic review of rando- 1. Continued developments of psychological therapies for mised controlled trials. Int J Eat Disord 2007, 40:337-48. bulimic disorders and atypical eating disorders (for 4. Bulik CM, Berkman ND, Brownley KA, Sedway JA, Lohr KN: Anorexia nervosa treatment: A systematic review of rando- example, CBT, DBT), to enhance existing outcomes and mised controlled trials. Int J Eat Disord 2007, 40:310-20. to carry these effects further into everyday clinical practice. 5. Fairburn CG, Harrison PJ: Eating disorders. Lancet 2003, 361:407-16. 2. Treatment outcomes for anorexia nervosa, including 6. National Institute for Clinical Excellence: Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, psychological and psychopharmacological approaches Bulimia Nervosa and Related Eating Disorders (Clinical Guideline 9). (findings are anticipated from a number of current London, UK: National Collaborating Centre for Mental Health; 2004. trials). 7. Shapiro JR, Berkman ND, Brownley KA, Sedway JA, Lohr KN, Bulik CM: Bulimia nervosa treatment: a systematic review of randomised controlled trials. Int J Eat Disord 2007, 40:321-36. 3. The development of psychopharmacological 8. Perkins SJ, Murphy R, Schmidt U, Williams C: Self-help and guided approaches that relate to the psychobiology of the eating self-help for eating disorders. Cochrane Database Syst Rev 2006, 3: disorders (including anxiety structures) [34] that have CD004191. more extensive periods of follow-up. 9. Waller G, Schmidt U, Treasure J, Murray K, Aleyna J, Emanuelli F, Crockett J, Yeomans M: Problems across care pathways in specialist adult eating disorder services. Psychiatric Bulletin 2009, 4. Psychological therapies that have been proposed to be 33:26-9. valuable but where the evidence base is minimal should 10. Dean HY, Touyz SW, Rieger E, Thornton CE: Group motivational enhancement therapy as an adjunct to inpatient treatment be tested more fully in order to demonstrate whether or for eating disorders: a preliminary study. Eur Eat Disord Rev not they meet the criteria for evidence-based practice. 2008, 16:256-7. 11. Dunn EC, Neighbors C, Larimer ME: Motivational enhancement 5. The matching of psychological therapies to indivi- therapy and self-help treatment for binge eaters. Psychol Addict Behav 2006, 20:44-52. duals, to ensure that individuals are offered the most 12. Cassin SE, von Ranson KM, Heng K, Brar J, Wojtowicz AE: Adapted effective treatment for their individual problem [18]. motivational interviewing for women with binge eating disorder: a randomized controlled trial. Psychol Addict Behav 2008, 22:417-25. 6. Working via carers, addressing both their own stress 13. Mitchell JE, Agras S, Wonderlich S: Treatment of bulimia nervosa: and making them more able to work as members of the where are we and where are we going? Int J Eat Disord 2007, broader team treating the sufferer [35]. 40:95-101. 14. Fairburn CG: Cognitive Behavior Therapy and Eating Disorders. New York, NY: Guilford; 2008. 7. The determination of whether treatment effects 15. Waller G, Corstorphine E, Cordery H, Hinrichsen H, Lawson R, generalise across settings (for example, do therapies for Mountford V, Russell K: Cognitive-behavioral Therapy for the Eating restrictive problems tested in outpatient settings work as Disorders: a Comprehensive Treatment Guide. Cambridge, UK: Cam- well in day- and in-patient settings?). bridge University Press; 2007. 16. Tobin DL, Banker JD, Weisberg L, Bowers W: I know what you did last summer (and it was not CBT): a factor analytic model of international psychotherapeutic practice in the eating dis- Abbreviations orders. Int J Eat Disord 2007, 40:754-7. CBT, cognitive behavioural therapy; DBT, dialectical 17. Ghaderi A: Does individualization matter? A randomized trial of standardized (focused) versus individualized (broad) behaviour therapy. cognitive behavior therapy for bulimia nervosa. Beh Res Ther 2006, 44:273-88. Competing interests 18. Fairburn CG, Cooper Z, Doll HA, O’Connor ME, Bohn K, The author declares that he has no competing interests. Hawker DM, Wales JA, Palmer RL: Transdiagnostic cognitive- Page 3 of 4 (page number not for citation purposes) F1000 Medicine Reports 2009, 1:38 http://F1000.com/Reports/Medicine/content/1/38 behavioral therapy for patients with eating disorders: a two- Olanzapine therapy in anorexia nervosa: psychobiological site trial with 60-week follow-up. Am J Psychiatry 2009, 166:311-9. effects. Int Clin Psychopharmacol 2007, 22:197-204. Changes Clinical Practice F1000 Factor 3.0 Recommended F1000 Factor 4.8 Recommended Evaluated by Beate Herpertz-Dahlmann 07 Jan 2008 Evaluated by Glenn Waller 23 Dec 2008, Nicole Barbarich-Marsteller 27. Halmi KA: The perplexities of conducting randomized, double- 18 Feb 2009 blind, placebo-controlled treatment trials in anorexia ner- vosa patients. Am J Psychiatry 2008, 165:1227-8. 19. Bowers WA, Ansher LS: The effectiveness of cognitive beha- vioural therapy on changing eating disorder symptoms and 28. Schmidt U, Lee S, Perkins S, Eisler I, Treasure J, Beecham J, psychopathology of 32 anorexia nervosa patients at hospital Berelowitz M, Dodge L, Frost S, Jenkins M, Johnson-Sabine E, discharge and one year follow-up. Ann Clin Psychiatry 2008, Keville S, Murphy R, Robinson P, Winn S, Yi I: Do adolescents with 20:79-86. eating disorder not otherwise specified or full-syndrome bulimia nervosa differ in clinical severity, comorbidity, risk F1000 Factor 3.0 Recommended factors, treatment outcome or cost? Int J Eat Disord 2008, Evaluated by Glenn Waller 09 Apr 2009 41:498-504. 20. Chen EY, Matthews L, Allen C, Kuo JR, Linehan MM: Dialectical F1000 Factor 6.0 Must Read behavior therapy for clients with binge-eating disorder or Evaluated by Daniel le Grange 26 Aug 2008 bulimia nervosa and borderline personality disorder. Int J Eat Disord 2008, 41:505-12. 29. Keel PK, Haedt A: Evidence-based psychosocial treatments for eating problems and eating disorders. J Clin Child Adolesc Psychol F1000 Factor 6.0 Must Read 2008, 37:39-61. Evaluated by Glenn Waller 11 Sep 2008 30. Schmidt U, Lee S, Beecham J, Perkins S, Treasure J, Yi I, Winn S, Robinson P, Murphy R, Keville S, Johnson-Sabine E, Jenkins M, Frost S, 21. 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Robinson S, Perkins S, Bauer S, Hammond N, Treasure J, Schmidt U: 23. Arbaizar B, Gómez-Acebo I, Llorca J: Efficacy of topiramate in Aftercare intervention through text messaging in the treat- bulimia nervosa and binge-eating disorder: a systematic ment of bulimia nervosa - feasibility pilot. Int J Eat Disord 2006, review. Gen Hosp Psychiatry 2008, 30:471-5. 39:633-8. 24. Crow SJ, Mitchell JE, Roerig JD, Steffen K: What potential role is 33. Schmidt U, Andiappan M, Grover M, Robinson S, Perkins S, there for medication treatment in anorexia nervosa? Int J Eat Dugmore O, Treasure J, Landau S, Eisler I, Williams C: Randomised Disord 2009, 42:1-8. controlled trial of CD-ROM-based cognitive-behavioural self- care for bulimia nervosa. Br J Psychiatry 2008, 193:493-500. F1000 Factor 6.4 Must Read Evaluated by Glenn Waller 24 Oct 2008, Daniel le Grange 10 Feb F1000 Factor 6.0 Must Read Evaluated by Glenn Waller 27 Mar 2008 25. Bissada H, Tasca GA, Barber AM, Bradwejn J: Olanzapine in the 34. Strober M, Freeman R, Lampert C, Diamond J: The association of treatment of low body weight and obsessive thinking in anxiety disorders and obsessive compulsive personality women with anorexia nervosa: a randomized, double-blind, disorder with anorexia nervosa: evidence from a family placebo-controlled trial. Am J Psychiatry 2008, 165:1281-8. study with discussion of nosological and neurological evi- dence. Int J Eat Disord 2007, 40:S46-S51. F1000 Factor 4.9 Must Read Evaluated by Nicole Barbarich-Marsteller 15 Jul 2008, Guido Frank F1000 Factor 6.0 Must Read 18 Aug 2008, Beate Herpertz-Dahlmann 23 Jan 2009 Evaluated by Glenn Waller 27 Mar 2008 26. Brambilla F, Garcia CS, Fassino S, Daga GA, Favaro A, Santonastaso P, 35. Treasure J, Smith G, Crane A: Skills-based Learning for Caring for a Loved Ramaciotti C, Bondi E, Mellado C, Borriello R, Monteleone P: One with an Eating Disorder. London, UK: Routledge; 2007. Page 4 of 4 (page number not for citation purposes)

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F1000 Medicine ReportsPubmed Central

Published: May 8, 2009

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