Other psychological management strategies for anorexia nervosa

In addition to having the highest rate of mortality among all psychiatric disorders and causing profound negative effects on quality of life, anorexia nervosa (AN) remains challenging to address. Apart from cognitive behavioural therapy and family therapy (FT), the current National Institute for Health and Care Excellence guidelines recommend several types of psychological therapy as first-line treatment for AN, including the Maudsley Model of Anorexia Nervosa Treatment for Adults, specialist supportive clinical management, and focal psychodynamic therapy for adults and adolescent-focused psychotherapy for young people. This article aims to describe these treatments and the existing evidence base. Research suggests that all recommended treatments for AN are equally effective at addressing core eating disorder psychopathology and increasing body mass index (BMI) in adults, while FT appears to be more effective at increasing BMI in young people. However, the evidence base remains very limited, and relapse rates can range from 9% to 52%. Barriers to conducting trials of interventions for AN include broader factors, such as lack of statistical power due to recruitment challenges, and illness-specific factors, such as patient resistance to change, cognitive rigidity and avoidance. Non-specific therapy-related factors, particularly therapeutic alliance, might play an important role in overall treatment outcomes. More longitudinal evidence and research into the effects of comorbidities is needed to draw stronger conclusions regarding the effectiveness of psychological management strategies for AN.