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Individual psychotherapy in the outpatient treatment of adults with anorexia nervosa

  • Review
  • Intervention




Anorexia nervosa is a disorder with high morbidity and significant mortality. It is commonest in young adult women, in whom the incidence may be increasing. The focus of treatment has moved to an outpatient setting and a number of differing psychotherapies are presently used in treatment.


The aim of the present review was to evaluate the evidence from randomised controlled trials for the efficacy of outpatient psychotherapies used in the treatment of older adolescents and adults with anorexia nervosa.

Search methods

CCDANCTR-Studies and CCDANCTR-References were searched on 12/2/2008. Further database searches of MEDLINE, EXTRAMED, EMBASE, PSYCLIT, CURRENT CONTENTS were carried out, hand-search of The International Journal of Eating Disorders, and the reference lists of all papers selected. Personal letters were sent to identified notable researchers who had published in the area, requesting information on trials that are unpublished or in progress. The search was updated to December 2005 (MEDLINE and CCDAN registers) and then to Feb 2008 (MEDLINE, SCOPUS, and CCDAN registers).

Selection criteria

All randomised controlled trials of adult individual outpatient therapy for anorexia nervosa, as defined by DSM-IV or similar international criteria. Quality assessment was made according to Quality Rating Scale criteria and in addition, whether the trial had examined treatment integrity.

Data collection and analysis

A range of outcome variables were selected, including physical state, severity of eating disorder attitudes and beliefs, interpersonal function, and general psychiatric symptom severity. Continuous outcome data comparisons used the standardised mean difference statistic, and binary outcome comparisons used relative risk. Reliability of data extraction and quality assessment were made with the kappa statistic. Sensitivity analyses to evaluate the effects of trial quality and subgroup analyses to explore specific questions of treatment effects from different settings, frequency and duration of therapies were planned.

Main results

Seven small trials only, two of which included children or adolescents, were identified from the search, and aggregation of data was not possible. Bias was possible due particularly to lack of blinding of outcome assessments. The results in two trials suggested that 'treatment as usual' or similar may be less efficacious than a specific psychotherapy. No specific treatment was consistently superior to any other specific approach. Dietary advice as a control arm had a 100% non-completion rate in one trial. One trial found a nonspecific therapy was favoured over two specific psychotherapies.

Authors' conclusions

No specific approach can be recommended from this review. It is unclear why 'treatment as usual' performed so poorly, or why dietary advice alone appeared so unacceptable, as the reasons for non-completion were not reported. There is an urgent need for large well-designed trials in this area.








搜尋策略是搜尋資料庫 MEDLINE, EXTRAMED, EMBASE, PSYCLIT, CURRENT CONTENTS, the Cochrane Depression, Anxiety and Neurosis Cochrane Group Controlled Trials Register (CCDANCTR), 尋找紙本的 The International Journal of Eating Disorders, 以及所選文章的參考文獻。寄信詢問相關領域的研究者有關未發表或正在進行的研究內容。搜尋至2005年12月(MEDLINE and CCDANCTR)。


選擇所有有關成人神經性厭食症的門診心理治療的隨機對照試驗,神經性厭食症是根據DSMIV或相似的國際準則來診斷。根據Quality Rating Scale criteria 來進行品質評估,而且也對研究本身是否驗證治療的完整性進行評估。


選擇相當多的結果變項,包括:身體狀況、厭食症相關的態度及信念的嚴重程度、人際功能和一般精神症狀的嚴重程度。連續變項的比較是使用標準差來統計,名義變項的比較是使用相對風險(relative risk)資料篩選的信度和品質評估都是使用 kappa 來計算。同時進行敏感度分析來評估試驗的品質,並進行次組別分析來評估在不一樣的場所、不一樣頻率、不一樣的治療時間的效果。







此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。



Plain language summary

Outpatient psychotherapy for anorexic adults

This review aimed to assess evidence about the effects of outpatient psychotherapy on older adolescents and adults with anorexia nervosa. Although anorexia nervosa is a severe and disabling disorder, only seven trials were found. The trials used different types of psychotherapy. It was not possible to make firm conclusions about the therapies tested. Participants who did not receive psychotherapy (e.g. were in a waiting-list control group or who got 'treatment as usual') did poorly. In one study, all those in the control group who got only 'dietary advice' dropped out. There is an urgent need for multi-centre, large randomized controlled trials of commonly used psychotherapies in older adolescents and adults with anorexia nervosa.