A Clinical Overview of Anorexia Nervosa and Overcoming Treatment Resistance

Nagy, Hassan; Paul, Tanya; Jain, Esha; Loh, Hanyou; Kazmi, Syeda Hafsa; Dua, Rishbha; Rodriguez, Ricardo; Naqvi, Syed Ali Abbas; U., Metu Chiamaka; Bidika, Erjola

doi:10.1055/s-0042-1758859

Cited by 11 publications

(7 citation statements)

References 80 publications

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“…AN presents clinicians with significant challenges due to its chronicity, high relapse risk, and considerable morbidity and mortality rates [5][6][7][8]. The ego-syntonic nature of the disorder, characterized by denial and lack of treatment motivation, distinguishes AN from other mental disorders [3,4]. Despite limited scientific evidence on SE-AN treatments, the future holds encouraging prospects for developing more effective therapeutic approaches [19,20].…”

Section: Discussionmentioning

confidence: 99%

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Severe enduring anorexia nervosa (SE-AN) treatment options and their effectiveness: a review of literature

Marcolini,

Ravaglia,

Tempia Valenta

et al. 2024

J Eat Disord

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Introduction For nearly 20% of patients diagnosed with Anorexia Nervosa (AN), the eating disorder (ED) is prolonged and becomes long-lasting. It has been reported that patients diagnosed with Severe Enduring Anorexia Nervosa (SE-AN) have worse ED symptoms, higher rates of lifetime hospitalization, and lower psychosocial well-being compared to patients with shorter disease duration. Objectives This review aims to describe the treatments proposed to date and their effectiveness on SE-AN-related outcomes. Methods We conducted a PubMed search for studies addressing the issue of treatment approach to SE-AN adults, that were published between 2003 and 2023, peer-reviewed, written in the English language, and available in full-text. Next, we inductively created relevant macro-themes by synthesizing the data from the included articles. Results Of 251 PubMed studies, 25 articles were considered for data extraction, all published between 2003 and 2022. We identified three macro-themes. The first macro-theme, “Psychotherapy”, mostly takes into consideration treatment effectiveness of cognitive behavioral therapy (CBT). Various reports determined its greater effectiveness compared to Specialist Supportive Clinical Management (SSCM), and one study proved that outpatient CBT is a valid alternative to hospitalization. The second one involves “Pharmacological Treatments”. Research on dronabinol, a synthetic orexigenic cannabinoid, antipsychotics (in particular, olanzapine and haloperidol), and ketamine showed some mixed results regarding the often-complementary areas of weight gain and improvement in ED-related symptoms. Regarding the third macro-theme, “Brain Stimulation Therapies,” such as Repetitive Transcranial Magnetic Stimulation (rTMS) and Deep Brain Stimulation (DBS), we found promising results in improving ED-related psychological traits (such as mood and anxiety), affective regulation, and quality of life. However, we have observed divergent results regarding outcome measures such as BMI and weight gain. Conclusions SE-AN patients are predicted to encounter both medical complications and psychological distress of increasing severity that will inevitably affect their quality of life; to our knowledge, research evidence on treatment options for SE-AN remains limited, and the methodological quality of studies is generally low. These findings denote the need to focus future research efforts on effective treatment strategies specific to long-lasting EDs.

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Section: Discussionmentioning

confidence: 99%

“…About 50–80% of people diagnosed with Anorexia Nervosa (AN) have been estimated to achieve full or partial recovery [ 1 , 2 ] . However, for nearly 20% of patients, the eating disorder (ED) is prolonged and becomes long-lasting [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Severe enduring anorexia nervosa (SE-AN) treatment options and their effectiveness: a review of literature

Marcolini,

Ravaglia,

Tempia Valenta

et al. 2024

J Eat Disord

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“…Previous studies showed that children with obesity are more likely to be victims of bullying and have less self-esteem [ 41 - 43 ], which explains these motivators in addition to the adolescent period that increases image obsession [ 44 ]. However, this body image obsession was found to lead to extreme weight loss measures that are unhealthy and sometimes dangerous and can also cause eating disorders [ 45 , 46 ]. Our study found that effective weight loss strategies included consistent physical exercise, and walking was favored.…”

Section: Reviewmentioning

confidence: 99%

Barriers and Motivators to Weight Loss in People With Obesity

Binsaeed,

Aljohani,

Alsobiai

et al. 2023

Cureus

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Introduction: Obesity has become a global public health challenge with associated health risks. Effective weight-loss interventions are crucial to mitigating these risks and improving overall well-being. However, individuals with obesity often encounter various barriers that hinder their weight loss efforts, while specific motivators can drive them towards successful outcomes. This systematic review aimed to explore the barriers and motivators to weight loss in people with obesity. Methods: A literature search was conducted using relevant keywords in electronic databases such as PubMed, Medline, PsycINFO, and Google Scholar. Studies published in peer-reviewed journals during the last 10 years were considered for inclusion. We included studies investigating both barriers and/or motivators to weight loss published in English. Results: The findings showed that motivators for weight loss include health concerns, body satisfaction, family support, normalcy restoration, emotional encouragement, self-determination, and mindful food choices. Motivators involve exercise facilities, balanced diets, and assistance from healthcare providers, peers, friends, or family. Gender influences healthcare providers’ influence on weight loss, with women trusting providers more while men lean towards medication options. Healthcare providers play a role in impacting weight loss through discussions and educating patients. Age also influences motivators; adolescents emphasize health, self-esteem, and bullying avoidance, while young women focus on lifestyle influence, resources, and joy. Barriers include insufficient self-control, physical pain, time constraints, dietary restrictions, and a lack of support. Logistical issues, patient readiness, healthcare providers' views, resource scarcity, and social dynamics are also barriers. Dietary barriers involve triggers, emotional states, and limited healthy options. School-aged children with obesity face curriculum challenges and resource scarcity. Conclusion: These findings show the intricate interplay between motivators and barriers, underscoring the multifaceted nature of weight loss in people with obesity. Targeted interventions that address these factors holistically are essential for successful weight management.

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“…Anorexia nervosa (AN) is one of the most recognizable, life-threatening eating disorders, commonly beginning during adolescence and early adulthood [ 1 , 2 ]. The median onset age for is approximately 12 [ 3 ], with a remarkable increase in incidence among girls aged 10-14 [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Potential applications of Schema Therapy in the treatment of adolescents with anorexia nervosa: a theoretical analysis

Kleszczewska-Albińska

2023

ppn

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Purpose The main purpose of the article is to present basic theoretical assumptions on Schema Therapy and its hypothetical application among adolescents suffering with anorexia nervosa. Views Anorexia nervosa is a very deadly mental disease, more frequently suffered by females than males, with the mean age of onset at approximately 14-15. Studies underline the relatively poor effectiveness of currently applied treatment methods and the need for new approaches that could be recommended for adolescent patients suffering with this disease. The results of studies conducted to date lead to the conclusion that Schema Therapy is a promising approach for this group. It is a transdiagnostic method of work that compiles elements known in other therapeutic approaches, aiming at an increase in the individual’s awareness of their feelings and emotional needs, applied both in adolescent and adult groups of patients. Since the symptoms of eating disorders observed in adolescents are strongly connected with family systems it seems reasonable to use treatment techniques that rigorously address the unmet needs and rejected emotions of the individual. Conclusions Based on the data published so far it might be hypothesized that the techniques characteristic for Schema Therapy (e.g. imagery rescripting, chairwork, limited reparenting) could be eligible for use with adolescent patients with anorexia nervosa.They address unmet needs, rejected emotions, and early maladaptive schemas that are very frequent in patients with AN. Since the analysis presented provides only hypotheses and the discussion of theoretical aspects, empirical research in this area is needed.

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A Clinical Overview of Anorexia Nervosa and Overcoming Treatment Resistance

Cited by 11 publications

References 80 publications

Severe enduring anorexia nervosa (SE-AN) treatment options and their effectiveness: a review of literature

Severe enduring anorexia nervosa (SE-AN) treatment options and their effectiveness: a review of literature

Barriers and Motivators to Weight Loss in People With Obesity

Potential applications of Schema Therapy in the treatment of adolescents with anorexia nervosa: a theoretical analysis

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