Eating disorders: Efficacy of pharmacological and psychological interventions

Bulimia Nervosa: A Comprehensive Analysis of Treatment, Policy, and Social Work Ethics

Bulimia nervosa is an often debilitating eating disorder with a biopsychosocial set of risk factors. Those presenting are at an increased mortality rate and often have physical health complications as well as harmful cognitions related to self-esteem and overall self-concept. This article examines treatment, policy, and social work ethics as they relate to bulimia nervosa. A comprehensive cognitive-behavioral approach including psychoeducation, self-monitoring, exposure therapy, interpersonal therapy, body image therapy, energy balance training, and relapse prevention is recommended as evidence-based practice for treating bulimia nervosa. Authors identify health care policy and analyze it as a common barrier to treatment access. They also review ethical principles of competency and social justice as they relate to social work practitioners working with those diagnosed with bulimia nervosa.

Evaluation of the efficacy and safety of olanzapine as an adjunctive treatment for anorexia nervosa in adolescent females: a randomized, double-blind, placebo-controlled trial

BACKGROUND

Anorexia Nervosa (AN) is a serious, debilitating condition that causes significant physical, emotional, and functional impairment. The condition is characterized by destructive weight loss behaviours and a refusal to maintain body weight at or above a minimally normal weight for age and height. AN often develops in adolescence and is a predominantly female disorder. Treatment for AN typically involves medical, nutritional and psychological interventions. Pharmacotherapy is also often used; however, the literature on the effectiveness of these drugs in a pediatric population is very limited. Olanzapine, which is an 'atypical' antipsychotic, is becoming more widespread in the treatment of AN. Olanzapine is hypothesized to facilitate weight gain, while decreasing levels of agitation and decreasing resistance to treatment in young women with AN. This randomized, double-blind placebo-controlled trial seeks to examine the effectiveness and safety of olanzapine in female youth with AN.

METHODS/DESIGN

Adolescent females between the ages of 12 and 17 diagnosed with AN (either restricting or binge/purge type) or Eating Disorder Not Otherwise Specified with a Body Mass Index of less than or equal to 17.5, will be offered inclusion in the study. Patients will be randomly assigned to receive either olanzapine or placebo. Patients assigned to receive olanzapine will start at a low dose of 1.25 mg/day for three days, followed by 2.5 mg/day for four days, 5 mg/day for one week, then 7.5 mg/day (the target dose chosen) for 10 weeks. After 10 weeks at 7.5 mg the medication will be tapered and discontinued over a period of two weeks. The effectiveness of olanzapine versus placebo will be determined by investigating the change from baseline on measures of eating attitudes and behaviors, depression and anxiety, and change in Body Mass Index at week 12, and after a follow-up period at week 40. It is anticipated that 67 participants will be recruited over two years to complete enrollment.

DISCUSSION

Randomized controlled trials designed to measure the safety and effectiveness of olanzapine in comparison to placebo are desperately needed, particularly in the adolescent population.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN23032339.

Cognitive-behavioral therapy for bulimia nervosa: an empirical analysis of clinical significance

OBJECTIVE

The purpose of this review was to assess the clinical significance of cognitive-behavioral therapy for bulimia nervosa using the reliable change index and normative comparison analyses.

METHOD

Fifteen treatment outcome studies using either individual or group cognitive-behavioral therapy for bulimia nervosa were selected for inclusion.

RESULTS

Results suggest that cognitive-behavioral therapy for bulimia nervosa produces clinically significant change for many treatment outcome measures when using the reliable change index. However, posttreatment symptomatology is rarely within a normative range when examined with normative comparison analyses.

DISCUSSION

This review provides a first step in examining the clinical significance of treatment for bulimia nervosa. Future studies should further this work by comparing the clinical significance of different types of treatment for bulimia nervosa using additional assessment measures.

Olanzapine use as an adjunctive treatment for hospitalized children with anorexia nervosa: case reports

OBJECTIVE

A recent case report suggested that olanzapine resulted in improved weight gain and maintenance, as well as decreased anxiety and agitation, for two hospitalized inpatients with anorexia nervosa (AN). However, a subsequent larger case study did not show a relationship between the use of olanzapine and rate of weight gain among a primarily adult population. The aim of this case report was to clinically examine the therapeutic benefit and tolerability of olanzapine as an adjunctive treatment for four children with AN in a pediatric inpatient setting.

RESULTS

Olanzapine use was associated with considerable weight gain and maintenance, with an average rate of weight gain during hospitalization of 0.99 kg per week. In addition to weight gain, olanzapine was associated with a clinically notable decrease in levels of agitation and premeal anxiety and almost immediate improvement in sleep, general functioning, and overall compliance with treatment. Olanzapine was also well tolerated in these young patients.

DISCUSSION

These case report findings warrant more controlled research, including randomized controlled studies, to better determine the therapeutic benefits and safety of olanzapine use in children with AN.

Integrating the prevention of eating disorders and obesity: feasible or futile?

The rate of obesity in adults and youth has doubled in the past 20 years; during this same period there has been an increase in the prevalence of "dysfunctional eating behaviors," including eating disorders and unhealthy weight loss practices. Despite the fact that obesity, eating disorders, and unhealthy weight loss practices are cultivated in the same cultural context-an increasingly "toxic" environment regarding food and weight-these problems are regarded as distinct, with different origins, courses, and approaches to prevention and treatment. In this article, we present conceptual and practical reasons for adopting an integrated approach to the prevention of the spectrum of problems related to eating and weight (i.e., eating disorders, obesity, and unhealthy weight loss practices), suggest personal, socioenvironmental, and behavioral factors to be included in an integrated approach to prevention, and provide some ideas for developing an integrated program using a media literacy/advocacy approach. We conclude with a discussion of challenges to the development of interventions aimed at the broad spectrum of weight-related problems and suggestions for addressing these challenges.

Personality differences between eating-disordered women and a nonclinical comparison sample: a discriminant classification analysis

The present study evaluated the extent to which eating-disordered and nonclinical comparison samples could be differentiated on self-reported personality measures of autonomy and sociotropy and a projective measure of dependency. Sixty-two women meeting diagnostic criteria for eating disorder and a nonpsychiatric comparison group of 62 women completed the autonomy and sociotropy subscales of the Personal Style Inventory-II and the Rorschach Oral Dependency Scale (ROD). A discriminant classification analysis indicated 85.5% of eating-disordered subjects and 88.7% of control subjects were identified accurately from their scores on autonomy, sociotropy. and ROD. Results suggest that the experience of eating disorders is associated with a mixed clinical presentation characterized by issues related to sociotropy-dependency, and especially, achievement-related vulnerabilities. Potentially fruitful areas for future study include assessing the utility of autonomy and sociotropy as predictors of eating disturbances in prospective research and evaluating their utility in predicting treatment prognosis among patients with eating disorders.