Challenge to anorexia nervosa therapies

Experts are calling for more work to find better targeted treatments for anorexia nervosa, a global problem underpinning the highest mortality of any psychological condition

A new paper in The Lancet Psychiatry shows a lack of strong evidence to support current guidance on psychological therapies for treating anorexia nervosa over expert treatment as usual.

The findings highlight a need for further research and support a call for individual trial data to be made available so the benefits of treatments in specific patient populations can be better understood.

Conducted by an international team of clinical experts and researchers, the analysis included 13 randomised controlled trials and a total of 1,049 patients.

The studies compared psychological therapies to treatment as usual in adults receiving outpatient treatment for anorexia. The trials measured eating disorder symptoms, body-mass index (BMI) and all-cause dropout rate up to 52 weeks of follow up.

The analysis found some therapies to have modest benefit to patients. However, the therapies, currently recommended by the UK’s National Institute for Clinical Excellence and in clinical guidelines internationally, were not shown to differ significantly from expert treatment as usual.

“Understanding the effectiveness of available treatments is particularly important for anorexia nervosa because it has one of the highest mortality rates of any psychiatric condition. This analysis highlights the gaps in existing evidence and the urgent need for more and better research into psychological therapies for treating anorexia,” says University of Oxford Professor Andrea Cipriani, the lead author on the project.

Professor Tracey Wade, a lead collaborator on a new research paper about standard treatments for anorexia nervosa just published by The Lancet Psychiatry.

Because of the relatively low quality and quantity of data available, this analysis should be understood as exploratory rather than confirmatory. However, it highlights the shortcomings of existing research and emphasises the need for more robust data.

Flinders University Distinguished Professor of Psychology Tracey Wade, a lead collaborator on the project, says: “We have made progress in understanding the effective non-specific factors that need to be included in any treatment for anorexia nervosa.

“Our future challenge is to develop treatment factors tailored to individual presentations that can be added to the non-specific factors to increase effectiveness of our treatments for the condition.”

  • The psychological interventions included in the analysis include Cognitive Behavioural Therapy (CBT), family-oriented treatments, psychodynamic treatments, and other treatments such as Maudsley anorexia nervosa treatment for adults (MANTRA) and specialist supportive clinical management (SSCM).
  • Treatment at usual varied between the trials included in the analysis and can involve several components delivered by many people. The poor description of treatment as usual was a limitation observed in most of the trials included in the analysis.

The UK-led research was funded by the NIHR Oxford Health Biomedical Research Centre, the University of Oxford and Flinders University, which supports the Flinders University Services for Eating Disorders. Professor Wade is also director of the Flinders Univesity Órama Institute for Mental Health and Wellbeing.

The paper, ‘Comparative efficacy and acceptability of psychological interventions for the treatment of adult outpatients with anorexia nervosa: a systematic review and network meta-analysis’ (2021) by M Solmi, TD Wade, S Byrne, C Del Giovane, CG Fairburn, EG Ostinelli, F De Crescenzo, C Johnson, U Schmidt, J Treasure, A Favaro, S Zipfel and A Cipriani can be viewed online in The Lancet Psychiatry DOI: 10.1016/S2215-0366(20)30566-6

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College of Education, Psychology and Social Work Orama Institute for Mental Health and Wellbeing Research

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