Research Highlights the Need for Individualized Anorexia Treatment

Researchers from Europe and Australia conducted a systematic review of literature on the anorexia nervosa treatments suggested by international clinical guidelines and found that no single option out-performed the others.

The findings highlight why an individualized approach to treating the eating disorder is so important; not only can anorexia nervosa cause lasting damage to a person's body and mind, it can also be fatal.

The review, which was published in The Lancet Psychiatry journal in February, looked at over 14,000 studies. The researchers used 13 randomized controlled trials for psychological treatments to compare 1,047 patients in a meta-analysis.

Of the patients included, 97.4% were female. This statistic reflects how few studies on anorexia nervosa include men, as well as the fact that men often underreport disordered eating behaviors.

The researchers reviewed several anorexia nervosa treatments, including:

• Cognitive-behavioral therapy (CBT)
• The Maudsley Method for adults
• Family-based treatment
• Psychodynamic-oriented psychotherapies
• A form of CBT targeting compulsive exercise
• Cognitive remediation therapy followed by CBT

The researchers evaluated three key areas of each treatment to assess its effectiveness:

• Eating disorder symptoms
• Body mass index (BMI)
• All-cause dropout rate up to 52 weeks of follow up

The authors wrote that "none of the interventions outperformed treatment as usual in our primary outcomes, but the all-cause dropout rate was lower for CBT than for psychodynamic-oriented psychotherapist."

What Is Anorexia Nervosa?

Anorexia nervosa is an eating disorder. Any person, of any age, race, or ethnicity can develop the condition.

A person with anorexia nervosa typically has difficulty maintaining a weight that is considered appropriate for their height and age. They may lose a lot of weight or, if they are children, not gain weight when they should be.

People with anorexia nervosa might limit how much food they eat or the kinds of foods they eat, or they might use compensatory behaviors when they eat (such as exercising a lot, using laxatives, or throwing up what they eat).

Why Do People Develop Anorexia Nervosa?

Eating disorders are not caused by a single factor. Rather, it's a combination of a person's genetics, other mental or physical health conditions they have, as well as their life experiences, that contribute to their risk of developing an eating disorder.

Certain aspects of someone's personality can also make them more prone to eating disordered behaviors, especially those associated with anorexia nervosa.

"Individuals with anorexia often control their eating because they feel helpless in all other areas of their life," Leela R. Magavi, MD, the regional medical director for Community Psychiatry in California, tells Verywell. "People are clinging on to what feels safe and comfortable and what is in their control, and for some people, that is their ability to refuse to eat, binge, or purge."

What Are the Signs of Anorexia Nervosa?

The possible warning signs and symptoms of an eating disorder can be behavioral and physical. The National Eating Disorders Association (NEDA) says that a person might have anorexia nervosa if they:

• Refuse to eat certain foods, often progressing to restrictions against whole categories of food 
• Maintains an excessive, rigid exercise regimen
• Seems concerned about eating in public
• Develops symptoms like stomach cramps, other non-specific gastrointestinal complaints, and dizziness

What Happens If Anorexia Nervosa Is Not Treated?

Every part of the body, including the mind, can be affected by anorexia nervosa. The damage can have long-lasting effects on a person's health and, in some cases, can be fatal.

A few examples of possible medical complications of anorexia nervosa include:

• Mitral valve prolapse, fainting, and sudden cardiac death
• Digestive problems, such as gastroparesis and constipation
• Loss of menstrual cycle and infertility
• Sarcopenia, bone loss, and dental problems
• Poor wound healing and a weakened immune system
• Depression, anxiety, and suicide

Over time, anorexia nervosa can cause changes to the body's ability to digest the food that can, in turn, make the physical and emotional experiences of recovery more challenging.

"In a healthy body, food leaves the stomach into the small intestine in about an hour," Neeru Bakshi, MD, FAPA, CEDS, regional medical director of Eating Recovery Center in Washington, tells Verywell. "For patients with anorexia, it may be there for a few hours, leaving them feeling full. This can cause many problems, as a patient may complain of feeling full and not wanting to eat."

While complications from anorexia nervosa can be serious if not life-threatening, timely and appropriate treatment can help mitigate those risks. Bakshi says that even though every system of the body can be affected by the condition, "almost all medical complications of anorexia nervosa are treatable and reversible with timely and competent medical care."

Preventing Relapse

Anorexia nervosa can be managed, but people with the disorder can relapse. That's another reason why finding treatments that work for more people is vital.

A 2016 study published in the MBC Psychiatry journal found that when using the Guideline Relapse Prevention Anorexia Nervosa, 11% of participants had a full relapse, 19% of participants had a partial relapse, and 70% of participants did not relapse after 18 months.

"It’s important for patients to know that relapse is often a reality in eating disorder recovery and that it’s nothing to be ashamed of. It’s equally important to know that recovery is possible," Bakshi says. "The less weight-restored a patient is when they are leaving treatment—that is, if they didn’t reach their ideal body weight range during treatment—the more likely that they are to relapse."

The Importance of Individualized Care

The systematic review of treatment methods for anorexia nervosa highlights why finding a treatment that is universal would be life-changing, if not life-saving, for people with the condition. The researchers concluded that "there is an urgent need to fund new research to develop and improve therapies for adults with anorexia nervosa."

When choosing from treatments that are currently available, Magavi recommends that healthcare professionals consider how each person's experiences can shape their treatment needs.

"Every individual has a different story, personality, and set of needs," Magavi says. "And remaining rigid and prescribing the same therapy and set of medications to each and every patient could be detrimental."

Kindness and compassion for people with anorexia nervosa could also go a long way. A 2013 study published in the International Journal of Eating Disorders found that addressing the shame around eating disorders can help patients better address their behavior.

Magavi adds that many individuals "experience shame and guilt and do not confide in even family members and friends." She says that's why it's important for healthcare providers to "ask open-ended questions to elicit this important information." From there, patients with anorexia nervosa will be able to get "resources, therapy, and pharmacologic agents if warranted," she adds.