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Evidence summaries

Individual Psychological Therapy in the Outpatient Treatment of Adults with Anorexia Nervosa

Focal psychoanalytic therapy may be more efficacious than no treatment or treatment as usual in anorexia nervosa. Most therapies may be as acceptable as any other approach. Level of evidence: "C"

A Cochrane review [Abstract]1 included 10 trials with a total of 599 anorexia nervosa participants. Two of the 10 trials included children, 86-98% of patients were females. Five trials evaluated a form of cognitive and/or behaviour therapy, 4 trials evaluated an integrative therapy and 3 trials evaluated a form of psychodynamic therapy. The results suggest that treatment as usual (TAU) when delivered by a non-eating-disorder specialist or similar may be less efficacious than focal psychodynamic therapy. This was suggested for a primary outcome of recovery by achievement of a good or intermediate outcome on the Morgan and Russell Scale (RR 0.70, 95% CI 0.51 to 0.97; 1 RCT, n=40). However there were no differences between cognitive analytic therapy and TAU for this outcome (RR 0.78, 95% CI 0.61 to 1.00; 2 RCTs, n=71), nor for body mass index (BMI). There were no differences in overall dropout rates between individual psychological therapies and TAU.Two trials (n=197) found a non-specific specialist therapy (Specialist Supportive Clinical Management) or an Optimised TAU delivered by therapists with eating disorder expertise was similar in outcomes to cognitive behaviour therapy (BMI MD -0.00, 95% CI -0.91 to 0.91). When comparing individual psychological therapies with each other, no specific treatment was consistently superior to any other specific approach. Dietary advice as a control arm had a 100% non-completion rate in one trial (n=35). None of the trials identified any adverse effects.

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in patients and treatments) and imprecise results (few studies and few patients in each comparison).

    References

    • Hay PJ, Claudino AM, Touyz S et al. Individual psychological therapy in the outpatient treatment of adults with anorexia nervosa. Cochrane Database Syst Rev 2015;7():CD003909. [PubMed]

Primary/Secondary Keywords