Immunology

A large-scale study has now shown that adult women with anorexia whose disorder is not too severe can be treated successfully on an out-patient basis. Even after conclusion of therapy, they continue to make significant weight gains. Two new psychotherapeutic methods offer improved opportunities for successful therapy. However, one quarter of the patients participating in the study did not show rapid results. These are the findings of the world's largest therapy trial on anorexia nervosa published in the renowned medical journal The Lancet. The Anorexia Nervosa Treatment of OutPatients (ANTOP) study was conducted at ten German university eating disorder centers and was designed by the departments for psychosomatic medicine at the university hospitals of Heidelberg (Director: Prof. Wolfgang Herzog) and T-bingen (Director: Prof. Stephan Zipfel).

Psychotherapy has been recognized as the treatment of choice for anorexia nervosa and in Germany, is covered by health insurance. However, to date there have been no large-scale clinical studies that examine the efficacy of different treatment methods on a comparative basis, constituting a glaring research gap considering the severity of the disease.

Anorexia nervosa - the most lethal mental disorder

"In the long-term course, in up to 20 percent of the cases, anorexia leads to death, making it the most lethal of all of the mental disorders. Patients with anorexia often suffer from the psychological or physical consequences of the disease their entire lives," explained Prof. Zipfel. To date, no convincing studies on specific therapy programs have been available in adults. Furthermore, randomized controlled studies comparing promising therapy methods are rare. "Well-controlled, clinical studies with a high level of reliability are rare, especially for out-patient therapy, creating enormous problems," said Prof. Herzog.

Around 1 percent of the population has anorexia nervosa, with the disorder affecting nearly only girls and young women. Patients with anorexia are very underweight due to their long-term food restriction and, in many cases, their urge to over-exercise. Self-induced vomiting, the use of laxatives, diuretics or appetite suppressants exacerbate the weight loss. The patients' body weight is no more than 85 percent of normal weight (body mass index (BMI) of less than 17.5 kg/m-). Patients with anorexia have an intense fear of gaining weight and their perception of their own figure is distorted. They often have other mental disorders such as depression, anxiety and compulsive disorders.

Treatment by experienced psychotherapists in cooperation with family physicians

The ANTOP study, which accompanied 242 adult women over a period of 22 months (10 months of therapy, 12 months of follow-up observation) now allows scientific conclusions to be drawn about the efficacy of different types of psychotherapy for the first time. Three groups of either 82 or 80 patients each underwent a different method of out-patient psychotherapy. The therapy involved two new psychotherapy methods that were specially developed for out-patient treatment of anorexia and an optimized form of the currently practiced standard psychotherapy ("optimized treatment as usual"). For the specific therapies, treatment manuals were developed in conjunction with international eating disorder experts. The therapy comprises 40 out-patient individual therapy sessions over a period of 10 months.

For all 242 patients, specially trained psychotherapists conducted the therapy with the patients. The patients' family physicians were informed about the therapy and were involved in the treatments and the patients were examined by their family physician at least once a month. Around one third of the patients had to be admitted for in-patient treatment temporarily due to their poor state of health. Approx. one quarter of the patients discontinued their participation before the trial had ended.

Three psychotherapy methods were compared: