Why is treating anorexia difficult

But when she searched the literature to find out more about this decision-making process, she came up empty-handed. To fill that gap, Steinglass and her colleagues at NYSPI decided to conduct a study of their own to figure out how people with anorexia made decisions about what to eat, and whether those findings could provide new ways to help them get well and stay well. Steinglass recruited a group of women recently hospitalized for anorexia although men do get anorexia, the researchers excluded them from the study to prevent any sex or gender influences on the results and a similar number of healthy controls.

First, she had them rate a series of 76 foods on healthfulness and tastiness. After the participants made their ratings, the researchers took one of the items that they deemed neutral on both qualities. With that item serving as a kind of baseline, the researchers then asked each participant to choose between that food and two other foods, a low-fat option like carrots and a high-fat option like chocolate cake while their brains were being scanned by fMRI.

To make sure the decisions were as accurate as possible, the researchers then required each person to eat the food they had chosen as a snack. Not surprisingly, the women with anorexia were significantly less likely to choose the cake than the healthy controls. But the brain-imaging data were much more striking.

Individuals without eating disorders typically evaluate a variety of criteria when deciding what to eat, such as how hungry they are and how much they like the foods on offer, and their brain-imaging data reflected this. Those with anorexia, however, showed increased activity in the area of the brain called the dorsal striatum, which plays a role in decision-making, reward, and, importantly, habitual behaviors.

When her patients left treatment, they often returned to their old environment, which was filled with cues related to eating-disorder behaviors. These cues, then, triggered the behaviors that her patients had struggled so hard to break.

They also suggest replacing long-form trainings on single treatment manuals for specific diagnostic problems with briefer trainings that focus on the main principles underlying the manuals. Training would also dedicate time to teaching the clinicians important contextual markers, such as when to move away from the manual for example, patient hesitancy to change or need to further develop clinical formulation and empirically supported interventions appropriate for that circumstance for example, use motivational enhancement techniques [ 84 ].

Adoption of a more flexible core principle approach to treatment has implications for how adherence is assessed. We are in no way calling for an abandonment of treatment manuals or randomised controlled trials evaluating them. These trials, which need strict adherence to assist replicability, provide important data on which techniques should be included in a core principle approach for example, weighing the patient. The document produced by Hurst et al.

Of course, the key assessment is to monitor patient outcome on a regular basis [ 7 ]. Assessment of treatment acceptability, in either a strict or flexible form, to both therapist and patient may also be important. This paper recognises the important advances that treatment manuals have provided our field. Manuals promote rigorous research, provide clear training and clinical guidelines, allow broader dissemination and accessibility, and create a common language and platform from which to research necessary adaptations.

We know that training in the delivery of manualised treatment does make the clinician more adherent to the delivery of that manualised treatment [ 69 ]. However, a growing body of literature from both the field of general psychotherapy and within eating disorders specifically indicates that treatment adherence does not consistently predict patient outcomes and may indeed be contraindicated in some cases.

In combination, these factors allow a clinician to truly engage in evidence-informed practice. We would recommend future research is undertaken regarding formulation-driven adaptation of manuals, and training and supervision that goes beyond strict adherence to treatment manuals in the field of eating disorders. Eating disorders. Article Google Scholar. Treatment manual for anorexia Nervosa: a family-based approach.

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An exploratory evaluation of the family meal intervention for adolescent Anorexia Nervosa. Fam Process. Comparison of 2 family therapies for adolescent anorexia nervosa: a randomized parallel trial. JAMA Psychiat. Medically reviewed by Harry Croft, MD. All Rights Reserved. Site last updated November 12, In treating eating disorders, any of the following difficulties may derail a person's progress: Loneliness Backsliding Repeated attempts Self-blame Self-doubt Loneliness in Treating Eating Disorders Eating disorders can make people feel like they are fighting the battle alone and that no one understands their struggles.

It's important to remember though, many people are involved in treating eating disorders and eating disorders help and eating disorders support are available through: Therapy Support groups Online support groups, forums and discussions Faith groups Talking to others who are working on recovering can remind the patient they are not alone and this connection can support them through the treatment process.

A Backslide Means Treating the Eating Disorder Has Been a Failure Often when treating an eating disorder, a patient finds they have reverted back to some of their old eating patterns. Repeated Attempts at Treatment One of the difficulties in treating eating disorders is often the repeated attempts the patient has previously made. Self-Blame for Not Successfully Treating Eating Disorders When an attempt at treating an eating disorder doesn't work, it is not the fault of the patient, and is not a failure.

Self-Doubt Overcoming an eating disorder is a very big commitment and, for many, a difficult choice to make. Related Articles. If you or someone you know may be suffering from anorexia, please visit the National Association of Anorexia Nervosa and Associated Disorders for more information on how to get help.

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