Anorexia nervosa treatment: A systematic review of randomized controlled trials

Authors

  • Cynthia M. Bulik PhD,

    Corresponding author
    1. Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    2. Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
    • Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive, CB #7160, Chapel Hill, NC 27599-7160
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  • Nancy D. Berkman PhD,

    1. Research Triangle Institute-UNC Evidence-Based Practice Center, Research Triangle Park, North Carolina
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  • Kimberly A. Brownley PhD,

    1. Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • Jan A. Sedway PhD,

    1. Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • Kathleen N. Lohr PhD

    1. Research Triangle Institute-UNC Evidence-Based Practice Center, Research Triangle Park, North Carolina
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  • Disclaimer: The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.

Abstract

Objective:

The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC) systematically reviewed evidence on efficacy of treatment for anorexia nervosa (AN), harms associated with treatments, factors associated with treatment efficacy, and differential outcome by sociodemographic characteristics.

Method:

We searched six major databases for studies on the treatment of AN from 1980 to September 2005, in all languages against a priori inclusion/exclusion criteria focusing on eating, psychiatric or psychological, or biomarker outcomes.

Results:

Thirty-two treatment studies involved only medications, only behavioral interventions, and medication plus behavioral interventions for adults or adolescents. The literature on medication treatments and behavioral treatments for adults with AN is sparse and inconclusive. Cognitive behavioral therapy may reduce relapse risk for adults with AN after weight restoration, although its efficacy in the underweight state remains unknown. Variants of family therapy are efficacious in adolescents, but not in adults.

Conclusion:

Evidence for AN treatment is weak; evidence for treatment-related harms and factors associated with efficacy of treatment are weak; and evidence for differential outcome by sociodemographic factors is nonexistent. Attention to sample size and statistical power, standardization of outcome measures, retention of patients in clinical trials, and developmental differences in treatment appropriateness and outcome is required. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007

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