Largest therapy trial worldwide: Psychotherapy treats anorexia effectively

Posted on October 23, 2013

Continuous weight gain after application of three psychotherapy approaches. Two new special therapy methods most effective.

A large-scale study has now shown that adult women with anorexia whose disorder is not too severe can be treated successfully on an out-patient basis. Even after conclusion of therapy, they continue to make significant weight gains. Two new psychotherapeutic methods offer improved opportunities for successful therapy. However, one quarter of the patients participating in the study did not show rapid results. These are the findings of the world’s largest therapy trial on anorexia nervosa published in the renowned medical journal The Lancet.

Psychotherapy has been recognized as the treatment of choice for anorexia nervosa and in Germany, is covered by health insurance. However, to date there have been no large-scale clinical studies that examine the efficacy of different treatment methods on a comparative basis, constituting a glaring research gap considering the severity of the disease.

Anorexia nervosa – the most lethal mental disorder

“In the long-term course, in up to 20 percent of the cases, anorexia leads to death, making it the most lethal of all of the mental disorders. Patients with anorexia often suffer from the psychological or physical consequences of the disease their entire lives,” explained Prof. Zipfel. To date, no convincing studies on specific therapy programs have been available in adults. Furthermore, randomized controlled studies comparing promising therapy methods are rare. “Well-controlled, clinical studies with a high level of reliability are rare, especially for out-patient therapy, creating enormous problems,” said Prof. Herzog.

Around 1 percent of the population has anorexia nervosa, with the disorder affecting nearly only girls and young women. Patients with anorexia are very underweight due to their long-term food restriction and, in many cases, their urge to over-exercise. Self-induced vomiting, the use of laxatives, diuretics or appetite suppressants exacerbate the weight loss. The patients’ body weight is no more than 85 percent of normal weight (body mass index (BMI) of less than 17.5 kg/m²). Patients with anorexia have an intense fear of gaining weight and their perception of their own figure is distorted. They often have other mental disorders such as depression, anxiety and compulsive disorders.

Three psychotherapy methods were compared:

1. Focal psychodynamic therapy addresses the way negative associations of relationships and disturbances affect the way patients process emotions. The working relationship between the therapist and the patient plays a key role in this method. The patients are specifically prepared for everyday life after conclusion of the therapy.

2. Cognitive behavior therapy has two focuses: normalization of the eating behavior and weight gain, as well as addressing the problem areas connected to the eating disorders, such as deficits in social competence or in problem-solving ability. The patients are also assigned “homework” by their therapists.

3. Standard psychotherapy was conducted as optimized treatment as usual by experienced psychotherapists selected by the patients themselves. The patients’ family physicians were included in the treatment. The patients also visited their respective study center five times during the study.

Psychotherapies offer realistic chances for cure

The patients with anorexia in all three groups had made significant weight gains after the end of therapy and at a 12-month follow-up visit. Their BMI had increased by 1.4 BMI points on average (the equivalent of an average of 3.8 kg). “Overall, the two new types of therapy demonstrated advantages compared to the optimized therapy as usual,” said Prof. Zipfel. “At the end of our study, focal psychodynamic therapy proved to be the most successful method, while the specific cognitive behavior therapy resulted in more rapid weight gain.” Furthermore, the patients undergoing focal psychodynamic therapy required additional in-patient treatment less often. While the acceptance of the two new psychotherapy methods by the patients was very high, at 1 year after the end of therapy, approx. one quarter of the patients continued to have full syndrome anorexia nervosa.


Category(s):Eating Disorders

Source material from Heidelberg University Hospital


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