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AHRQ releases a new report on therapies for anorexia nervosa

No medications are available that effectively treat patients suffering from anorexia nervosa, but a few behavioral therapies may help prevent a relapse and offer other limited benefits, according to a new review of current available research on eating disorders released by the Agency for Healthcare Research and Quality (AHRQ). The review also found evidence that several medications and behavioral therapies can help patients suffering from bulimia nervosa and binge eating disorder.

Eating disorders are psychiatric illnesses with serious, potentially life-threatening medical consequences. Anorexia nervosa is characterized by an obsession with weight, severely restrained eating, sometimes exercising excessively, and an inability to maintain a healthy body weight. In bulimia nervosa, excessive eating is followed by efforts to compensate by vomiting, misusing laxatives or diuretics, fasting, or exercising excessively. Those who suffer from binge eating disorder eat excessively but do not purge.

This review of the scientific literature published since 1980 was conducted by AHRQ's Evidence-based Practice Center at RTI International—University of North Carolina at Chapel Hill. It did not find any medications effective in treating anorexia nervosa but did find several behavioral therapies that appear to offer limited help. Cognitive behavioral therapy (CBT), a form of psychotherapy that encourages patients to develop thinking patterns that will counteract their unhealthy eating behavior, helped prevent relapse in adult anorexic patients once their weight had been restored to a normal level. There was not enough evidence to determine whether CBT works during the acute phase of the illness, before a patient with anorexia nervosa has been restored to a normal weight.

The researchers concluded that family therapy does not appear to work with adults with longstanding anorexia nervosa. One study found that family therapy worked better for younger patients than for older patients who had anorexia nervosa chronically. One particular kind of family therapy, which starts by encouraging parents to oversee a young person's nutrition, appeared to help patients gain weight and make psychological improvements.

Both medications and behavioral therapies were found helpful in treating bulimia nervosa; however, there was no clear information about how to combine medications with behavioral treatments.

The selective serotonin reuptake inhibitor (SSRI) fluoxetine, commonly known as Prozac, was found helpful in treating bulimia in a short-term clinical trial. Patients given a dose of 60 mg/day for 16 to 18 weeks had reduced symptoms and were less likely to experience a relapse by the end of 1 year. CBT, offered either individually or in a group, and interpersonal psychotherapy were also helpful in reducing the core symptoms of bulimia nervosa, binge eating and purging, and in alleviating the psychological symptoms of this disorder. However, the optimum length of treatment and the best strategy for maintaining these health benefits remain unknown.

Several types of medications helped patients suffering from binge eating disorder make at least short-term improvements to their health; these medications included SSRIs, tricyclic antidepressants, an anticonvulsant, and an appetite suppressant. CBT was also helpful in treating binge eating disorder, reducing the number of binge days or binge episodes patients experienced. It did not help patients with binge eating disorder control their weight.

The review concludes that more research is needed to determine the best strategies for combining medication and behavioral therapy, possible harms of treatment, and whether treatments should be tailored to a patient's age, sex, gender, or other personal characteristics. A major gap in knowledge exists about how to treat patients with bulimia nervosa who do not respond either to fluoxetine or to CBT.

Funded by the Office of Research on Women's Health at the National Institutes of Health and the Health Resources and Services Administration's Office of Women's Health, the report was requested by the American Psychiatric Association and the Laureate Psychiatric Clinic and Hospital on behalf of an expert working group on eating disorders.

The report Management of Eating Disorders Evidence Report No. 135 (Publication No. 06-E010) is available online at http://www.ahrq.gov/clinic/tp/eatdistp.htm or through AHRQ Publications Clearinghouse.

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