Update on the treatment of anorexia nervosa: review of clinical trials, practice guidelines and emerging interventions

• Published in: Psychological medicine Vol. 43; no. 12; pp. 2477 - 2500
• Main Authors: Watson, H. J., Bulik, C. M.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.12.2013
• Subjects: Adult and adolescent clinical studies; Age; Anorexia; Anorexia nervosa; Anorexia Nervosa - therapy; Behavior therapy. Cognitive therapy; Biological and medical sciences; Clinical decision making; Clinical guidelines; Clinical trials; Eating behavior disorders; Evidence-based medicine; Evidence-Based Practice; Humans; Interventions; Invited Review; Medical sciences; Medical treatment; Medicin och hälsovetenskap; Neuropharmacology; Pharmacology. Drug treatments; Practice Guidelines as Topic; Psychiatry; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psycholeptics: tranquillizer, neuroleptic; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Psychotherapy; Puberty; Treatments; cognitive behavioral therapy; family therapy; treatment; reviews; antipsychotics; antidepressants; clinical trials; family-based treatment; Anorexia nervosa; eating disorders; systematic reviews; Cognitive therapy; Neuroleptic; Psychotropic; Pharmacotherapy; Review; Eating disorder; Recommendation; Treatment; Family psychotherapy; Antidepressant agent; Antipsychotic; Clinical trial; Behavior therapy
• ISSN: 0033-2917; 1469-8978; 1469-8978
• DOI: 10.1017/S0033291712002620

Anorexia nervosa is a potentially deadly psychiatric illness that develops predominantly in females around puberty but is increasingly being recognized as also affecting boys and men and women across the lifespan. The aim of this environmental scan is to provide an overview of best practices in anorexia nervosa treatment across the age spectrum. A triangulation approach was used. First, a detailed review of randomized controlled trials (RCTs) for anorexia nervosa published between 1980 and 2011 was conducted; second, clinical practice guidelines were consulted and reviewed; third, information about RCTs currently underway was sourced. This approach facilitated a comprehensive overview, which addressed the extant evidence base, recent advances in evidence and improvements in treatment, and future directions. The evidence base for the treatment of anorexia nervosa is advancing, albeit unevenly. Evidence points to the benefit of family-based treatment for youth. For adults no specific approach has shown superiority and, presently, a combination of renourishment and psychotherapy such as specialist supportive clinical management, cognitive behavioral therapy, or interpersonal psychotherapy is recommended. RCTs have neither sufficiently addressed the more complex treatment approaches seen in routine practice settings, such as multidisciplinary treatment or level of care, nor specifically investigated treatment in ethnically diverse populations. Methodological challenges that hinder progress in controlled research for anorexia nervosa are explained. The review highlights evidence-based and promising treatment modalities for anorexia nervosa and presents a triangulated analysis including controlled research, practice guidelines, and emerging treatments to inform and support clinical decision making.