Treating Anorexia Nervosa through Pharmacotherapy and Psychotherapy
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Abstract
Anorexia nervosa is a disorder recognized by the Diagnostic and Statistical Manual of Mental Disorder, the Fourth Edition, Text Revision (DSM-IV-TR). It affects more women than men and is characterized by body weight less than 85% of what is considered normal. Anorexics limit their food intake, are constantly on diet, are never satisfied with their appearance, have a disordered body image believing to be overweight, engage in excessive exercising, suffer from long-term depression, and the female anorexics experience amenorrhea (Barlow & Durand, 2005; Kring, Davison, Neale, & Johnson, 2007). Pharmacotherapy and psychotherapy show promising result in treating anorexia nervosa even though the research outcome is not always consistent. This article gives an overview of pharmacotherapy and psychotherapy as primary treatments for anorexia nervosa.
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References
Agras, W. S. 2001 The consequence and costs of eating disorders, Psychiatric Clinics of North America, 24, 371-379.
Agras, W. S., et al. 2004 Report of the National Institutes of Health Workshop on Overcoming Barriers to Treatment Research in Anorexia Nervosa, International Journal of Eating Disorders, 35, 509– 521.
Attia, E., Haiman, C., Walsh, B.T. and Flater, S.R. 1998 Does Fluoxetine augment the inpatient treatment of anorexia nervosa? American Journal of Psychiatry, 155, 548–551.
Attia, E., Mayer, L., and Killory, E. 2001 Medication response in the treatment of patients with anorexia nervosa, Journal of Psychiatric Practice, 7,157-162.
Bachar, E., Latzer, Y., Kreitler, S., and Berry, E.M. 1999 Empirical comparison of two psychological therapies, Journal of Psychotherapy Practice and Research, 8, 115–128.
Baranowska, B., Rozbicka, G., Jeske, W., and Abdel-Fattah, M. H. 1984 The role of endogenous opiates in the mechanism of inhibited luteinizing hormone (LH) secretion in women with anorexia nervosa: The effect of endorphin secretion, Journal of Clinical Endocrinology Metabolosm, 59, 412–6.
Baran, S. A., Weltzin, T. E., and Kaye, W. H. 1995 Low discharge weight and outcome in anorexia nervosa, American Journal of Psychiatry, 152, 1070-1072.
Barlow, D. H. and Durand, V. M. 2005 Abnormal psychology an integrative approach, 4th edition. United States of America: Thomson Wadsworth, Inc.
Ben-Tovim, D. 1997) What works in the treatment of AN? Paper presented at the Max Planck Research Workshop, Palm Cove, Australia.
Biederman, J., et al. 1985 Amitriptyline in the treatment of anorexia nervosa: A double-blind, placebo-controlled study. Journal of Clinical Psychopharmacology, 5, 10–16.
Carney, J. M. 2009 A demographic and symptom descriptive study of callers to the National Association of Anorexia Nervosa and associated disorders: linking research and advocacy. Eating Disorder, 17, 293-301.
Channon S., de Silva P., Hemsley D., Perkins, R. 1989 A controlled trial of cognitive-behavioural and behavioural treatment of anorexia nervosa, Behavioural Research and Therapy, 27, 529-535.
Crisp, A. H., Lacey, J. H., Crutchfield, M. 1987 Clomipramine and “drive” in people with anorexia nervosa, British Journal of Psychiatry, 150, 355–8.
Crisp, A. H., et al 1991 A controlled study of the effect of therapies aimed at adolescent and family psychopathology in anorexia nervosa, British Journal of Psychiatry, 59, 325–333.
Dare, C., Eisler, I., Russell, G., Treasure, J., and Dodge, L. 2001 Psychological therapies for adults with anorexia nervosa: Randomised controlled trial of out-patient treatments, British Journal of Psychiatry, 178, 216–221. De Zwann, M., Roerig, J. L., and Mitchell, J. E. 2004 Pharmacological treatment of anorexia nervosa, bulimia nervosa and binge eating disorder. In J. K. Thompson (Ed.) Handbook of eating disorders and obesity (pp.186-217). New York: J ohn Wiley.
DSM-IV. American Psychiatric Association. 1994 Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC.
Eisler, I., Dare, C., Hodes, M., Russell, G., Dodge, E., and Le Grange, D. 2000 Family therapy for adolescent anorexia nervosa: The results of a controlled comparison of two family interventions, Journal of Child Psychology & Psychiatry & Allied Disciplines, 41, 727–736.
Foltin, R. W., Fischman, M. W., and Byrne, M. F. 1989 Food intake in baboons: Effects of diazepam, Psychopharmacology, 97, 443-447.
GMI. 2005 American public opinion on eating disorders. Seattle: National Eating Disorders Association.
Goldfarb, L. A., Fuhr, R., Tsujimoto, R. N., and Fischman, S. E. 1987 Systematic desensitisation and relaxation as adjuncts in the treatment of anorexia nervosa: A preliminary study, Psychological Reports, 60, 511–518.
Gross, H. A., et al. 1981 A double-blind controlled trial of lithium carbonate in primary anorexia nervosa, Journal of Clinical Psychopharmacology, 1, 376–381.
Halmi, K.A., Eckert, E., LaDue, T.J., and Cohen, J. 1986 Anorexia nervosa. Treatment efficacy of cyproheptadine and amitriptyline. Archives of General Psychiatry, 43, 177–181.
Hansen, L. 1999 Olanzapine in the treatment of anorexia nervosa, British Journal of Psychiatry, 175, 592.
Hoek, H. W., and van Hoeken, D. 2003 Review of the prevalence and incidence of eating disorders, International Journal of Eating Disorders, 34, 383–396.
Hudson, J. I., Hiripi, E., Pope, H. G., and Kessler, R. C. 2007 The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61, 348-358.
Johnson, J. G., Cohen, P., Kotler, L., Kasen, S. and Brook, J. S. 2002 Psychiatric Disorders Associated With Risk for the Development of Eating Disorders During Adolescence and Early Adulthood, Journal of Consulting and Clinical Psychology, 70, 1119- 1128.
Kaye, W. H., Weltzin, T. E., Hsu, G. L. K., et al. 1997 Relapsenprevention with fluoxetine in anorexia nervosa: A double-blind placebo-controlled study (1997). Presented at the 150th annual meeting of the American Psychiatric Association, San Diego, CA.
Kaye, W. H., Nagata, T., Weltzin, T. E., Hsu, L. K., Sokol, M. S., McConaha, C., et al. 2001 Double-blind placebo-controlled administration of fluoxetine in restricting- and purging-type anorexia nervosa, Biological Psychology, 49, 644-652.
Kring, A. M., Davison, G. C., Neale, J. M., and Johnson, S. L. 2007 Abnormal Psychology, 10th edition. United States of America: John Wiley & Sons, Inc.
Lacey, J. H. & Crisp, A. H. 1980 Hunger, food intake and weight: The impact of clomipramine on a refeeding anorexia nervosa population, Postgraduate Medical Journal, 56, 79–85.
La Via, M. C., Gray, N., Kaye, W. H. 2000 Case reports of olanzapine treatment of anorexia nervosa, International Journal of Eating Disorders, 27, 363–6.
Le Grange, D., Eisler, I., Dare, C., and Russell, G. F. M. 1992 Evaluation of family treatments in adolescent anorexia nervosa: A pilot study, International Journal of Eating Disorders, 12, 347-357.
Lett, B. T., Grant, V. L., Neville, L. L., Davis, M. J., and Koh, M. T. 1997 Chlordiazepoxide Counteracts Activity-Induced Suppression of Eating in Rats, Experimental and Clinical Psychopharmacology, 5, 24-27.
Lett, B. T., Grant, V. L., Koh, M. T., and Parons, J. F. 1998 Chlordiazepoxide Attenuates Activity-Induced Anorexia and Weight Loss in Rats, Experimental and Clinical Psychopharmacology, 6, 360-366.
Lucas, A. R. (1991). Eating Disorders. In Hewitt, P. L., Coren, S., and Steel, G. D. 2001 Death from anorexia nervosa: age span and sex differences. Aging and Mental Health, 5, 41-46.
Mayer, L. E. S., and Walsh, B.T. 1998 Pharmacotherapy of eating disorders. In H.W. Hoek , J. L. Treasure & M. A. Katzman (Ed.), Neurobiology in the treatment of eating disorders. (pp. 383–405). New York: Wiley.
McKenzie, J. M., and Joyce, P. R. 1992 Hospitalization for anorexia nervosa. International Journal of Eating Disorders, 2, 235-241.
National Institute for Clinical Excellence. 2004 Eating disorders—Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders (Clinical Guideline No. 9). London: Author. (Available at www. nice.org.uk/guidance/CG9).
NEDA. 2009 National Eating Disorders Association. Retrieved November 15, 2012, from http://www.nationaleatingdisorders.org/information-resources/general-information. php# facts-statistics
Pike, K. M., Walsh, B. T., Vitousek, K., Wilson, G. T., and Bauer, J. 2003 Cognitive behaviour therapy in the posthospitalization treatment of anorexia nervosa, American journal of Psychiatry, 160, 2046-2049.
Pillay, M., and Crisp, A. H. 1981 The impact of social skills training within an established inpatient treatment programme for anorexia nervosa, British Journal of Psychiatry, 139, 533–539.
Raymond, L., Friedlander, M. L., Heatherington, L., Ellis, M. V., and Sargent, J. 1993 Communication processes in structural family therapy: case study of an anorexic family, Journal of Family Psychology, 6, 308-326.
Robin, A. L., Siegel, P. T., Moye, A.W., Gilroy, M., Dennis, A. B., and Sikand, A. 1999 A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa, American Academy of Child and Adolescent Psychiatry, 38, 1482–1489.
Russell, G. F. M., Szmukler, G. l., Dare, C., and Eisler, I. 1987 An evaluation of family therapy in anorexia nervosa and bulimia nervosa, Archives of General Psychiatry, 44, 1047-1056.
Steinhausen, H. C. 2002 The outcome of anorexia nervosa in the 20th century. American Journal of Psychiatry, 159, 1284-1293. Treasure, J., Todd, G., Brolly, M., Tiller, J., Nehmed, A., & Denman, F. 1995 A pilot study of a randomized trial of cognitive analytical therapy vs. educational behavioral therapy for adult anorexia nervosa, Behavioural Research Therapy, 33, 363-367.
Vandereycken, W., and Pierloot, R. 1982 Pimozide combined with behaviour therapy in the shortterm treatment of anorexia nervosa. A double-blind placebo-controlled cross-over study, Acta Psychiatrica Scandinavica, 66, 445– 450.
Vandereycken, W. 1984 Neuroleptics in the short-term treatment of anorexia nervosa. A double-blind placebo- controlled study with sulpiride, British Journal of Psychiatry, 144, 288–292.
Vitiello, B., and Lederhendler, I. 2000 Research on eating disorders: Current status and future prospects, Biological Psychiatry, 47, 777-786.
Wallin, U., Kronovall, P., and Majewski, M. L. 2000 Body awareness therapy in teenage anorexia nervosa: Outcome after two years, European Eating Disorders Review, 8, 19- 30.
Wilson, G. T. & Fairburn, C. G. 1993 Cognitive treatments for eating disorders, Journal of Counselling and Clinical Psychology, 61, 261-169.
Wilson, G. T. & Fairburn, C. G. 2002 Treatment for eating disorders. In P. E. Nathan & J. M. Gorman (Ed.), A guide to treatments that work (2nd Ed.) (pp.559-592). New York: Oxford University Press.
Zipfel, S., Loewe, B., Reas, D. L., Deter, H. C., and Herzog, W. 2000 Long-term prognosis in sanorexia nervosa: Lessons from a 21-year follow-up study. Lancet, 355, 721-722.
Agras, W. S., et al. 2004 Report of the National Institutes of Health Workshop on Overcoming Barriers to Treatment Research in Anorexia Nervosa, International Journal of Eating Disorders, 35, 509– 521.
Attia, E., Haiman, C., Walsh, B.T. and Flater, S.R. 1998 Does Fluoxetine augment the inpatient treatment of anorexia nervosa? American Journal of Psychiatry, 155, 548–551.
Attia, E., Mayer, L., and Killory, E. 2001 Medication response in the treatment of patients with anorexia nervosa, Journal of Psychiatric Practice, 7,157-162.
Bachar, E., Latzer, Y., Kreitler, S., and Berry, E.M. 1999 Empirical comparison of two psychological therapies, Journal of Psychotherapy Practice and Research, 8, 115–128.
Baranowska, B., Rozbicka, G., Jeske, W., and Abdel-Fattah, M. H. 1984 The role of endogenous opiates in the mechanism of inhibited luteinizing hormone (LH) secretion in women with anorexia nervosa: The effect of endorphin secretion, Journal of Clinical Endocrinology Metabolosm, 59, 412–6.
Baran, S. A., Weltzin, T. E., and Kaye, W. H. 1995 Low discharge weight and outcome in anorexia nervosa, American Journal of Psychiatry, 152, 1070-1072.
Barlow, D. H. and Durand, V. M. 2005 Abnormal psychology an integrative approach, 4th edition. United States of America: Thomson Wadsworth, Inc.
Ben-Tovim, D. 1997) What works in the treatment of AN? Paper presented at the Max Planck Research Workshop, Palm Cove, Australia.
Biederman, J., et al. 1985 Amitriptyline in the treatment of anorexia nervosa: A double-blind, placebo-controlled study. Journal of Clinical Psychopharmacology, 5, 10–16.
Carney, J. M. 2009 A demographic and symptom descriptive study of callers to the National Association of Anorexia Nervosa and associated disorders: linking research and advocacy. Eating Disorder, 17, 293-301.
Channon S., de Silva P., Hemsley D., Perkins, R. 1989 A controlled trial of cognitive-behavioural and behavioural treatment of anorexia nervosa, Behavioural Research and Therapy, 27, 529-535.
Crisp, A. H., Lacey, J. H., Crutchfield, M. 1987 Clomipramine and “drive” in people with anorexia nervosa, British Journal of Psychiatry, 150, 355–8.
Crisp, A. H., et al 1991 A controlled study of the effect of therapies aimed at adolescent and family psychopathology in anorexia nervosa, British Journal of Psychiatry, 59, 325–333.
Dare, C., Eisler, I., Russell, G., Treasure, J., and Dodge, L. 2001 Psychological therapies for adults with anorexia nervosa: Randomised controlled trial of out-patient treatments, British Journal of Psychiatry, 178, 216–221. De Zwann, M., Roerig, J. L., and Mitchell, J. E. 2004 Pharmacological treatment of anorexia nervosa, bulimia nervosa and binge eating disorder. In J. K. Thompson (Ed.) Handbook of eating disorders and obesity (pp.186-217). New York: J ohn Wiley.
DSM-IV. American Psychiatric Association. 1994 Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC.
Eisler, I., Dare, C., Hodes, M., Russell, G., Dodge, E., and Le Grange, D. 2000 Family therapy for adolescent anorexia nervosa: The results of a controlled comparison of two family interventions, Journal of Child Psychology & Psychiatry & Allied Disciplines, 41, 727–736.
Foltin, R. W., Fischman, M. W., and Byrne, M. F. 1989 Food intake in baboons: Effects of diazepam, Psychopharmacology, 97, 443-447.
GMI. 2005 American public opinion on eating disorders. Seattle: National Eating Disorders Association.
Goldfarb, L. A., Fuhr, R., Tsujimoto, R. N., and Fischman, S. E. 1987 Systematic desensitisation and relaxation as adjuncts in the treatment of anorexia nervosa: A preliminary study, Psychological Reports, 60, 511–518.
Gross, H. A., et al. 1981 A double-blind controlled trial of lithium carbonate in primary anorexia nervosa, Journal of Clinical Psychopharmacology, 1, 376–381.
Halmi, K.A., Eckert, E., LaDue, T.J., and Cohen, J. 1986 Anorexia nervosa. Treatment efficacy of cyproheptadine and amitriptyline. Archives of General Psychiatry, 43, 177–181.
Hansen, L. 1999 Olanzapine in the treatment of anorexia nervosa, British Journal of Psychiatry, 175, 592.
Hoek, H. W., and van Hoeken, D. 2003 Review of the prevalence and incidence of eating disorders, International Journal of Eating Disorders, 34, 383–396.
Hudson, J. I., Hiripi, E., Pope, H. G., and Kessler, R. C. 2007 The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61, 348-358.
Johnson, J. G., Cohen, P., Kotler, L., Kasen, S. and Brook, J. S. 2002 Psychiatric Disorders Associated With Risk for the Development of Eating Disorders During Adolescence and Early Adulthood, Journal of Consulting and Clinical Psychology, 70, 1119- 1128.
Kaye, W. H., Weltzin, T. E., Hsu, G. L. K., et al. 1997 Relapsenprevention with fluoxetine in anorexia nervosa: A double-blind placebo-controlled study (1997). Presented at the 150th annual meeting of the American Psychiatric Association, San Diego, CA.
Kaye, W. H., Nagata, T., Weltzin, T. E., Hsu, L. K., Sokol, M. S., McConaha, C., et al. 2001 Double-blind placebo-controlled administration of fluoxetine in restricting- and purging-type anorexia nervosa, Biological Psychology, 49, 644-652.
Kring, A. M., Davison, G. C., Neale, J. M., and Johnson, S. L. 2007 Abnormal Psychology, 10th edition. United States of America: John Wiley & Sons, Inc.
Lacey, J. H. & Crisp, A. H. 1980 Hunger, food intake and weight: The impact of clomipramine on a refeeding anorexia nervosa population, Postgraduate Medical Journal, 56, 79–85.
La Via, M. C., Gray, N., Kaye, W. H. 2000 Case reports of olanzapine treatment of anorexia nervosa, International Journal of Eating Disorders, 27, 363–6.
Le Grange, D., Eisler, I., Dare, C., and Russell, G. F. M. 1992 Evaluation of family treatments in adolescent anorexia nervosa: A pilot study, International Journal of Eating Disorders, 12, 347-357.
Lett, B. T., Grant, V. L., Neville, L. L., Davis, M. J., and Koh, M. T. 1997 Chlordiazepoxide Counteracts Activity-Induced Suppression of Eating in Rats, Experimental and Clinical Psychopharmacology, 5, 24-27.
Lett, B. T., Grant, V. L., Koh, M. T., and Parons, J. F. 1998 Chlordiazepoxide Attenuates Activity-Induced Anorexia and Weight Loss in Rats, Experimental and Clinical Psychopharmacology, 6, 360-366.
Lucas, A. R. (1991). Eating Disorders. In Hewitt, P. L., Coren, S., and Steel, G. D. 2001 Death from anorexia nervosa: age span and sex differences. Aging and Mental Health, 5, 41-46.
Mayer, L. E. S., and Walsh, B.T. 1998 Pharmacotherapy of eating disorders. In H.W. Hoek , J. L. Treasure & M. A. Katzman (Ed.), Neurobiology in the treatment of eating disorders. (pp. 383–405). New York: Wiley.
McKenzie, J. M., and Joyce, P. R. 1992 Hospitalization for anorexia nervosa. International Journal of Eating Disorders, 2, 235-241.
National Institute for Clinical Excellence. 2004 Eating disorders—Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders (Clinical Guideline No. 9). London: Author. (Available at www. nice.org.uk/guidance/CG9).
NEDA. 2009 National Eating Disorders Association. Retrieved November 15, 2012, from http://www.nationaleatingdisorders.org/information-resources/general-information. php# facts-statistics
Pike, K. M., Walsh, B. T., Vitousek, K., Wilson, G. T., and Bauer, J. 2003 Cognitive behaviour therapy in the posthospitalization treatment of anorexia nervosa, American journal of Psychiatry, 160, 2046-2049.
Pillay, M., and Crisp, A. H. 1981 The impact of social skills training within an established inpatient treatment programme for anorexia nervosa, British Journal of Psychiatry, 139, 533–539.
Raymond, L., Friedlander, M. L., Heatherington, L., Ellis, M. V., and Sargent, J. 1993 Communication processes in structural family therapy: case study of an anorexic family, Journal of Family Psychology, 6, 308-326.
Robin, A. L., Siegel, P. T., Moye, A.W., Gilroy, M., Dennis, A. B., and Sikand, A. 1999 A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa, American Academy of Child and Adolescent Psychiatry, 38, 1482–1489.
Russell, G. F. M., Szmukler, G. l., Dare, C., and Eisler, I. 1987 An evaluation of family therapy in anorexia nervosa and bulimia nervosa, Archives of General Psychiatry, 44, 1047-1056.
Steinhausen, H. C. 2002 The outcome of anorexia nervosa in the 20th century. American Journal of Psychiatry, 159, 1284-1293. Treasure, J., Todd, G., Brolly, M., Tiller, J., Nehmed, A., & Denman, F. 1995 A pilot study of a randomized trial of cognitive analytical therapy vs. educational behavioral therapy for adult anorexia nervosa, Behavioural Research Therapy, 33, 363-367.
Vandereycken, W., and Pierloot, R. 1982 Pimozide combined with behaviour therapy in the shortterm treatment of anorexia nervosa. A double-blind placebo-controlled cross-over study, Acta Psychiatrica Scandinavica, 66, 445– 450.
Vandereycken, W. 1984 Neuroleptics in the short-term treatment of anorexia nervosa. A double-blind placebo- controlled study with sulpiride, British Journal of Psychiatry, 144, 288–292.
Vitiello, B., and Lederhendler, I. 2000 Research on eating disorders: Current status and future prospects, Biological Psychiatry, 47, 777-786.
Wallin, U., Kronovall, P., and Majewski, M. L. 2000 Body awareness therapy in teenage anorexia nervosa: Outcome after two years, European Eating Disorders Review, 8, 19- 30.
Wilson, G. T. & Fairburn, C. G. 1993 Cognitive treatments for eating disorders, Journal of Counselling and Clinical Psychology, 61, 261-169.
Wilson, G. T. & Fairburn, C. G. 2002 Treatment for eating disorders. In P. E. Nathan & J. M. Gorman (Ed.), A guide to treatments that work (2nd Ed.) (pp.559-592). New York: Oxford University Press.
Zipfel, S., Loewe, B., Reas, D. L., Deter, H. C., and Herzog, W. 2000 Long-term prognosis in sanorexia nervosa: Lessons from a 21-year follow-up study. Lancet, 355, 721-722.