New approach successful for most eating disorders

UK researchers have identified a type of treatment that can help most people with eating disorders, with lasting results.

“Now for the first time, we have a single treatment which can be effective at treating the majority of cases without the need for patients to be admitted into hospital,” lead researcher Dr. Christopher G. Fairburn of the University of Oxford commented in a press release.

“Eating disorder not specified,” in which a person has disordered eating patterns but doesn’t meet criteria for bulimia nervosa or anorexia nervosa, is the most common type of eating disorder, followed by bulimia nervosa, Fairburn and his team note in the American Journal of Psychiatry. Eighty percent of patients undergoing outpatient treatment for an eating disorder fit into one of these two categories, but the best treatment for patients with non-specified eating disorders has not been studied.

The researchers developed a therapy for treating these patients, and those with bulimia, called enhanced cognitive behavioral therapy (CBT-E). In 2004, the UK’s National Institute of Health and Clinical Excellence recommended CBT-E for use throughout the country’s National Health Service.

Fairburn and his team compared two approaches derived from CBT-E. The first, CBT-Ef, “targets eating disorder psychopathology exclusively,” while the second, CBT-Eb, treatment as appropriate for “mood intolerance, clinical perfectionism, low self-esteem, or interpersonal difficulties” is added to the CBT-Ef approach.

The researchers enrolled 154 patients who had been diagnosed with an eating disorder but were not extremely underweight. The subjects underwent 20 weeks of either treatment (consisting of a 50-minute outpatient session once a week), and then 60 weeks of follow-up or an 8-week waitlist period.

Sixty weeks after the end of treatment the researchers found that the level of disordered eating had been reduced to normal range in 61.4 percent of patients with bulimia nervosa and 45.7 percent of those with an unspecified eating disorder.

Their analysis also suggested that patients with more psychological problems did better with CBT-Eb, while those with fewer problems did better with CBT-Ef.

“The simpler focused form of the treatment, CBT-Ef, should perhaps be viewed as the default form as it is easier to learn and implement, with the more complex form, CBT-Eb, reserved for patients with marked additional psychopathology of the type it targets,” they conclude.

SOURCE: American Journal of Psychiatry, online December 15, 2008.

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