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Despite recent advances, anorexia nervosa requires further research

Despite recent treatment studies on anorexia nervosa, challenges remain to improve management of the illness and new interventions are needed to improve outcomes, according to a recent review.

“In high-income countries, the lifetime prevalence of anorexia nervosa in the general population is reported to be around 1% in women and less than 0.5% in men. Accurate point prevalence has been more difficult to calculate, with studies often failing to identify any cases of DSM-IV-defined anorexia nervosa,” Stephan Zipfel, PhD, of the University of Tübingen, Germany, and colleagues wrote.

When applying broader DSM-5 criteria (ie, low weight in the presence of overvaluation of weight or shape), the point prevalence of anorexia nervosa is approximately 0.3% to 0.5%, according to researchers.

Anorexia nervosa occurs more commonly among females, with a 1:8 sex ratio. Sex distribution is less skewed among children.

Further, adolescents with anorexia nervosa have higher rates of full recovery and lower mortality (2% vs. 5%) compared with adults.

Approximately half of individuals with anorexia nervosa do not access treatment even though 40% of those who receive treatment achieve full recovery, according to results from a Finnish study.

The overall evidence base for treatment of anorexia nervosa is increasing, according to Zipfel and colleagues. Novel and effective psychological treatments for anorexia nervosa include specialist supportive clinical management, Maudsley model of anorexia treatment for adults, enhanced cognitive behavioral therapy (CBT) and focal psychodynamic psychotherapy.

Twelve randomized trials have evaluated psychological treatments for anorexia nervosa among 1,157 adults in outpatient settings.

The largest of these trials compared focal psychodynamic psychotherapy, enhanced CBT and an optimized treatment as usual among 242 individuals with anorexia nervosa.

Analysis showed similar weight gain among all three treatment groups.

Focal psychodynamic psychotherapy appeared more advantageous for recovery at 12-month follow-up, whereas enhanced CBT yielded quicker of weight gain and improved eating disorder psychopathology compared with other treatments.

In addition to psychotherapy treatments, Zipfel and colleagues discussed pharmacological treatments, nutritional treatments, osteoporosis prevention and treatment and experimental treatments for anorexia nervosa.

“The past 5 years have seen substantial advances in the knowledge of anorexia nervosa. Recent treatment studies suggest that patients with anorexia nervosa have a realistic chance of recovery, especially if treated early, or at least, to achieve substantial improvement. However, there is widespread agreement that several challenges remain in the management of anorexia nervosa and new interventions are needed to improve outcomes, especially in adults with the disorder,” Zipfel and colleagues wrote. “A clearer understanding of how anorexia nervosa behavior is encoded in neural circuits would provide a key for developing more effective treatments.” – by Amanda Oldt

Disclosure: Zipfel reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.