The latest American Psychologist (62:3) is a special issue all about eating disorders research. And most of it isn’t particularly encouraging. Here’s some of the concerns:
1. Our taxonomy (diagnostic categories) isn’t very helpful or specific. Anorexia (restricting type) is probably a completely different problem compared to Anorexia (with both restricting and binging). Also, the symptom of amenorrhea is an unreliable indicator of how bad the problem may be for a particular woman. Finally, most women fall in the category of “Not otherwise specified” so we have trouble understanding who will be best helped by what.
2. Medications such as SSRIs are apparently not particularly helpful (they may not be harmful either) in reducing symptoms or maintaining appropriate body weight. While medications do much for mood related problems, we do not yet have evidence that they help directly with the eating disorders.
3. Family therapy is the best treatment option for girls. But we have less evidence for those who are adults. One of the problems is that we have few controlled research trials to provide the evidence of what works best. CBT for eating disorders is the best researched method but the studies are hampered by high drop out rates. Yet, CBT drop out rates are lower than those for nutrition counseling alone. In fact, nutrition counseling alone without therapy is contraindicated. CBT is the treatment of choice at this point, and useful
4. Hospitalization is necessary at times but should be done only when necessary and the patient needs those strong connections to the natural environment (family and social settings). Weight gain will work best in the inpatient setting but may not lead to long-term gains.
Conclusions? We have much yet to learn about how best to care for those with eating disorders, in part because our treatments (weight gains) run contrary to the goals of the patient who obsessively thinks they are overweight and ties their feelings about themselves to their ability to restrict. I would have liked to see them address the OCD and addictions connections with the problem of anorexia. The intrusive thoughts and the habituations are very important to the maintenance of the problems.