Psychological Medicine

Invited Review

Update on the treatment of anorexia nervosa: review of clinical trials, practice guidelines and emerging interventions

H. J. Watsona1a2a3 and C. M. Bulika4a5 c1

a1 Centre for Clinical Interventions, Department of Health in Western Australia, Perth, WA, Australia

a2 Eating Disorders Program, Princess Margaret Hospital for Children, Perth, WA, Australia

a3 School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia

a4 Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

a5 Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

Abstract

Background Anorexia nervosa is a potentially deadly psychiatric illness that develops predominantly in females around puberty but is increasingly being recognized as also affecting boys and men and women across the lifespan. The aim of this environmental scan is to provide an overview of best practices in anorexia nervosa treatment across the age spectrum.

Method A triangulation approach was used. First, a detailed review of randomized controlled trials (RCTs) for anorexia nervosa published between 1980 and 2011 was conducted; second, clinical practice guidelines were consulted and reviewed; third, information about RCTs currently underway was sourced. This approach facilitated a comprehensive overview, which addressed the extant evidence base, recent advances in evidence and improvements in treatment, and future directions.

Results The evidence base for the treatment of anorexia nervosa is advancing, albeit unevenly. Evidence points to the benefit of family-based treatment for youth. For adults no specific approach has shown superiority and, presently, a combination of renourishment and psychotherapy such as specialist supportive clinical management, cognitive behavioral therapy, or interpersonal psychotherapy is recommended. RCTs have neither sufficiently addressed the more complex treatment approaches seen in routine practice settings, such as multidisciplinary treatment or level of care, nor specifically investigated treatment in ethnically diverse populations. Methodological challenges that hinder progress in controlled research for anorexia nervosa are explained.

Conclusions The review highlights evidence-based and promising treatment modalities for anorexia nervosa and presents a triangulated analysis including controlled research, practice guidelines, and emerging treatments to inform and support clinical decision making.

(Received January 23 2012)

(Revised September 28 2012)

(Accepted October 11 2012)

(Online publication December 10 2012)

Key words

  • Anorexia nervosa;
  • antidepressants;
  • antipsychotics;
  • clinical trials;
  • cognitive behavioral therapy;
  • eating disorders;
  • family therapy;
  • family-based treatment;
  • reviews;
  • systematic reviews;
  • treatment

Correspondence

c1 Address for correspondence: C. M. Bulik, Ph.D., Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive, CB #7160, Chapel Hill, NC 27599-7160, USA. (Email: cbulik@med.unc.edu)

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