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CBT may benefit patients with lesser-known eating disorders

Findings published in European Psychiatry indicated that patients with different subtypes of other specified feeding or eating disorders — such as atypical anorexia nervosa, purging disorder and subthreshold bulimia nervosa — may benefit from the same cognitive-behavioral therapy.

“The update of the DSM-5 reconfigured and renamed [eating disorder not otherwise specified] as other specified feeding or eating disorder,” Nadine Riesco, PhD, from department of psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, and colleagues wrote. “However, because this nosology is relatively recent, most of the research in this field refers to [eating disorder not otherwise specified], while [other specified feeding or eating disorder] subtypes have barely been studied in the literature so far.”

Researchers evaluated the differential features among 176 female patients diagnosed with other specified feeding or eating disorder subtypes, the short-term CBT response, and identified clinical predictors of therapy outcome. The investigators also examined eating-related, psychopathological and personality measures. The study included 82 patients with atypical anorexia nervosa, 57 with purging disorder and 37 with subthreshold bulimia nervosa.

All patients received the same outpatient group therapy each week for 16 weeks, which taught problem-solving strategies, cognitive restructuring, emotion regulation, improving self-esteem and body image, and relapse prevention strategies.

Participants displayed very similar clinical and personality profiles regardless of their diagnostic subtype, according to the results. The researchers found that only patients with subthreshold bulimia nervosa showed more social impairment. Of the 99 patients with other specified feeding or eating disorders who completed treatment, 72 obtained good outcome, with 46.5% reaching partial remission and 26.3% reaching full remission.

There were no significant differences regarding treatment outcome between the three groups in remission rates, therapeutic adherence or dropout rates; however, Riesco and colleagues found that different eating disorder subtype predictors may be associated with full remission or dropout risk — specifically personality traits. The dropout rates ranged between 36.8% and 50%.

“The high dropout rates open the debate and highlight the need to add other therapeutic tools for improving the therapeutic adherence of these patients, for example, family, motivational or insight-based treatments,” Riesco and colleagues wrote.

“Future research should assess and compare key maintenance factors, such as denial of illness, lack of awareness, anosognosia or impaired insight, as well as their association with therapy outcome,” they continued. “This will benefit clinicians to obtain a better conceptual understanding of the processes involved in the treatment of these patients.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.