Science of Eating Disorders
evidence-based treatment
A Study Without a Control Group? Evidence for Enhanced Cognitive Behavioural Therapy for Adults with Anorexia Nervosa
Here’s a quick tip: when a study that purports to find evidence of treatment effectiveness–preliminary or not–doesn’t have a control group (a group that doesn’t undergo treatment but is otherwise similar to the group that does), you should raise your eyebrows. Or shake your head. Or roll your eyes. Whichever you prefer.
Why do we need a control group? If the treatment works, we will see improvement in the patients, so isn’t that evidence enough? Well, no.
(By the way, I recommend reading the article I just quoted, ”How to Be a Wise Consumer of Psychological Research” from the American Psychological Association.)
In the introduction, the authors of this study make the case that anorexia nervosa (AN) is difficult to treat and difficult to study (low prevalence, high dropout, necessary long-length of follow-up, etc…) and so if we could have treatment approach that would be successful on an outpatient basis, that would be great.
No argument there. There is a lot of consensus that long-term continuous low-intensity care is crucial for sustained recovery. (A short stay at a hospital …
Chronicity in Eating Disorders: How Do We Define It and What Do We Do About It?
It comes as no surprise that the earlier eating disordered individuals receive treatment, the higher the likelihood that they will make a full recovery. In other words, the duration of the illness is inversely proportional with the likelihood of full recovery.
The problem is that a lot of eating disorders are not caught early. That a lot of people don’t have access to the treatment they need. Insurance will not cover it, their doctors don’t think it is a problem or won’t treat it, or there is simply no space. And even if there is space, and insurance will cover it, dropout rates are incredibly high and treatment success is meager. The end result? Sometimes it is a success story – a full or partial recovery. But other times, the stories make headlines across the world, and not for good reason.
So then, what can we do about the individuals who don’t recover within the first one or two years of getting sick?
Again, it comes as no surprise that this question has not been explored in much depth …
How Can We Treat Chronic and Severe Anorexia Nervosa? (On the Need for New Approaches)
Treating anorexia nervosa is hard. Treating chronic and severe anorexia nervosa is a lot harder. Although the situation seems to be improving, there are really no evidence-based treatments for anorexia nervosa – particularly for those who have been sick for a long time.
The treatments that many often claim are evidence-based are often only applicable to a select subgroup of ED patients, and even then, the evidence is usually weak. (I’m referring to Maudsley/FBT (family-based therapy) for adolescents with <3 yrs duration of AN and CBT for bulimia nervosa.) But what about those with long-standing anorexia nervosa? In a recent review, Phillipa Hay and colleagues set out to conduct a systematic review of randomized controlled trials of treatment for chronic AN.
Randomized controlled trials or RCTs are at the heart of evidence-based medicine:
Hay et al searched the literature to identify RCTs where, among other criteria, the mean duration of illness was at least three years. They found eleven studies, but they could only confirm that a majority had a mean duration of over 3 years in just four of those …
Should Insurance Companies Cover Residential Treatment for Eating Disorders?
Should insurance companies cover residential treatment for eating disorders? The price tag is high, about $1,000/day on average, but evidence of treatment effectiveness is astonishingly low. Practically nil, as I’ve recently discovered. Despite spending my free time punching away different keywords into the PubMed search bar, I came up with very little. And you know what I think? I think treatment centers should be embarrassed. And I think, wow, maybe insurance companies have a point? (A scary thought! I don’t actually think they do, though – but then, I just can’t wrap my head around for-profit healthcare, having lived all my life with socialized healthcare, and loving it.)
Carrie over at ED-Bites recently blogged about the fact that there a dearth of evidence-based treatment for eating disorders. It is a complicated issue, I know, but I do think that any organization or center that offers treatment (especially at such a high price) has no excuse when it comes to providing information about the effectiveness of its programs. I’ll repeat that: they have no excuse. So, can I …
The Research-Practice Gap in Eating Disorder Treatment
The approaches used in clinical practice to treat patients often lag behind the most up-to-date developments in research. It can take a long time to integrate scientific findings into clinical practice. This, of course, is not limited to eating disorders or even mental health issues. This so-called “science-practice gap” exists for many reasons, which vary depending on the medical discipline.
This issue, though, seems particularly bad when it comes to eating disorder treatment.
There’s the issue of conducting good studies – how do we determine what is efficacious? That’s a complicated task. What is “recovery” and how long is long-enough for follow-up? Is what we consider to be efficacious really efficacious or just slightly better than the rest?
Then there’s the training: mental health seems to be undervalued in medical school curricula for one, but even more importantly: “Clinicians tend to give more weight to their personal experiences than to science when making treatment decision.” And can’t you really blame them, most of us tend to stick to what we know and to doing things the way we were initially taught.
Wallace and von Ranson wanted …
- Transitioning from Adolescent to Adult Eating Disorder Treatment Programs: What Are The Challenges?
- Bingeing and Purging: Keeping the “Positives” and Eliminating The Negatives?
- Dancing Your Way to Recovery from Anorexia Nervosa
- International Conference on Eating Disorders (ICED) 2013: Personal Reflections
- Pills for Bites: The Alarming Link between Drug Abuse and Eating Disorders
- Factors Associated with Recovery from Anorexia Nervosa
- Patient Perspectives on Anorexia, Treatment, and Therapeutic Alliance
- Family-Based Treatment for Adolescents with Anorexia Nervosa: Hype or Hope?
- Nonpurging Bulimia Nervosa: Where Does It Fit?
- What’s The Point of Bingeing and Purging? And Why Can’t You Just Stop?
- Should Insurance Companies Cover Residential Treatment for Eating Disorders?
- Does Too Much Exposure to Thin Models Cause Eating Disorders? Anorexia, Bulimia in Blind Women
- Are All Anorexics Just Afraid Of Being Fat and Can We Blame The Western Media?
- What’s Wrong with How We Talk About Eating Disorders in the Media and in ED Communities – Part 2
- When Clinicians Do More Harm Than Good (Attitudes Toward Patients with Eating Disorders)
- Family-Based Treatment for Adolescents with Anorexia Nervosa: Hype or Hope?
- International Conference on Eating Disorders (ICED) 2013: Personal Reflections
- The “Double Life” of Bulimia Nervosa: Patients’ Perspectives
- How Can We Treat Chronic and Severe Anorexia Nervosa? (On the Need for New Approaches)
- What’s Wrong with How We Talk About Eating Disorders in the Media and in ED Communities – Part 1
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ES I'm not sure that it's just an 'ano
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Liz Agreed! It sounds like they are missing out on a L
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Andrea Hi Liz, Sorry if I was unclear in the post; in th
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Charlotte I can't articulate how much I can relate to e
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peridot
This article really resonates with me because I ha
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Pre-morbid BMI, weight restoration, and amenorrhoe
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ko I read your comment and can relate to everything y
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Liz
"Could it not be a more parsimonious explanat
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A:)
Also, this post made me wonder. . . what about jus
Science of Eating Disorders by Tetyana Pekar is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
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