Elements of Resistance to a Combined Medical and Psychotherapeutic Program in Anorexia nervosa

Abstract

According to several follow-up studies in the literature, anorexia nervosa has to be considered as an affection with a grave prognosis. We have studied the outcome in a group of 32 female patients who could be considered as homogeneous in a number of aspects. The following five criteria, on which the delineation of the syndrome is based, were realized in all the patients: considerable weight loss; limited food intake; amenorrhea; juvenile age of onset; absence of primary organic or specific psychotic disorder. All of them presented a serious symptomatology and had undergone some previous treatment under the form of ambulatory psychotherapy and/or forced feeding. They all received, during their admission in the same hospital, the same form of combined intensive medical and psychotherapeutic treatment. All of them maintained regular psychotherapeutic contacts with the same psychiatrist. According to the outcome, the patients could be categorized into three groups: the cured, the improved, the unimproved. In order to circumscribe some prognostic elements, we have compared a number of clinical, family and personality variables in these groups. As favorable clinical factors can be mentioned: younger age at admission and shorter duration of the illness. Manifestations of impulsive behavior (automutilation, kleptomania, fugues, etc...) and suicide attempts are unfavorable. No definite family factors can be defined, although the absence of psychological interaction with the father seems to be unfavorable. A better prognostic outcome is offered by the following personality characteristics, determined by psychological testing: lower neuroticism and higher self-defensiveness on the ABV; a lower general profile and especially a lower score on the schizophrenia scale of the MMPI; less pronounced tendencies to infantile regression, passivity and sexual repression as these are expressed in the TAT.

Does early intervention improve the prognosis in anorexia nervosa? A systematic review of the treatment-outcome literature

“…Willi, Limacher, Helbling, and Nussbaum (1989) have already questioned this conclusion. As Willi et al argued on the basis of their data: The relation between a longer duration of illness and a negative treatment outcome may simply reflect the role of denial of illness (Pierloot, Wellens, & Houben, 1975); it cannot, therefore, be concluded that earlier intervention would have helped in such cases. Willi et al (1989) emphasize a more general problem of the interpretation of nonrandomized studies: potentially confounding variables (Shaw & Garfinkel, 1990;Steinhausen & Glanville, 1983c).…”

Follow-up studies of anorexia nervosa: a review of research findings

“…(a) Age of onset Most workers associate an early onset with a favourable prognosis (Lesser et al 1960;Frazier, 1965;Theander, 1970;Halmi et al 1973Halmi et al , 1976Morgan & Russell, 1975;Pierloot et al 1975;Willi & Hagemann, 1976;Sturzenbergere/a/. 1977;Hsu et al 1979).…”

“…(c) Parent-child relationship Good relations between the patient and his/her parents are said to indicate a good outcome by several workers (Kay & Shapira, 1965;Dally, 1969;Crisp et al 1974;Morgan & Russell, 1975;Hsu et al 1979), but this is questioned by Pierloot et al (1975) and Theander (1970).…”

Do doctors recognise eating disorders in children?

“…In older patients with an eating disorder, a shorter history of illness before treatment has been found to be a predictor of good outcome. [2][3][4][5] By implication, a delay between onset and treatment may be unfavourable in terms of prognosis. We therefore addressed the question: Do doctors consider a diagnosis of eating disorder in children?…”