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Treating severe and enduring anorexia nervosa: a randomized controlled trial

Published online by Cambridge University Press:  03 May 2013

S. Touyz ,
D. Le Grange ,
H. Lacey ,
P. Hay ,
R. Smith ,
S. Maguire ,
B. Bamford ,
K. M. Pike  and
R. D. Crosby
S. Touyz*
Affiliation:
School of Psychology and Centre for Eating and Dieting Disorders (Boden Institute), School of Psychology, University of Sydney, NSW, Australia
D. Le Grange
Affiliation:
Department of Psychiatry, The University of Chicago, Chicago, IL, USA
H. Lacey
Affiliation:
Eating Disorders Research Team, PHSE, St George's, University of London, UK
P. Hay
Affiliation:
School of Medicine, University of Western Sydney, NSW, Australia School of Medicine, James Cook University, Queensland, Australia
R. Smith
Affiliation:
School of Psychology and Centre for Eating and Dieting Disorders (Boden Institute), School of Psychology, University of Sydney, NSW, Australia
S. Maguire
Affiliation:
School of Psychology and Centre for Eating and Dieting Disorders (Boden Institute), School of Psychology, University of Sydney, NSW, Australia
B. Bamford
Affiliation:
Eating Disorders Research Team, PHSE, St George's, University of London, UK
K. M. Pike
Affiliation:
Department of Psychiatry, Columbia University, New York, NY, USA
R. D. Crosby
Affiliation:
Neuropsychiatric Research Institute and the University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
*
*Address for correspondence: S. Touyz, Ph.D., School of Psychology and Centre for Eating and Dieting Disorders (Boden Institute), School of Psychology, Room 151, Mackie Bldg K01, University of Sydney, 2006 NSW, Australia. (Email: [email protected])
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Abstract

Background

There are no evidence-based treatments for severe and enduring anorexia nervosa (SE-AN). This study evaluated the relative efficacy of cognitive behavioral therapy (CBT-AN) and specialist supportive clinical management (SSCM) for adults with SE-AN.

Method

Sixty-three participants with a diagnosis of AN, who had at least a 7-year illness history, were treated in a multi-site randomized controlled trial (RCT). During 30 out-patient visits spread over 8 months, they received either CBT-AN or SSCM, both modified for SE-AN. Participants were assessed at baseline, end of treatment (EOT), and at 6- and 12-month post-treatment follow-ups. The main outcome measures were quality of life, mood disorder symptoms and social adjustment. Weight, eating disorder (ED) psychopathology, motivation for change and health-care burden were secondary outcomes.

Results

Thirty-one participants were randomized to CBT-AN and 32 to SSCM with a retention rate of 85% achieved at the end of the study. At EOT and follow-up, both groups showed significant improvement. There were no differences between treatment groups at EOT. At the 6-month follow-up, CBT-AN participants had higher scores on the Weissman Social Adjustment Scale (WSAS; p = 0.038) and at 12 months they had lower Eating Disorder Examination (EDE) global scores (p = 0.004) and higher readiness for recovery (p = 0.013) compared to SSCM.

Conclusions

Patients with SE-AN can make meaningful improvements with both therapies. Both treatments were acceptable and high retention rates at follow-up were achieved. Between-group differences at follow-up were consistent with the nature of the treatments given.

Keywords

Chronic enduring anorexia nervosacognitive-behavior therapyspecialist supportive clinical management
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 12 , December 2013 , pp. 2501 - 2511
Copyright
Copyright © Cambridge University Press 2013 

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