Recent changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) have prompted clinicians and academics alike to consider the progress of eating disorders treatment.
In the latest volume of the International Journal of Eating Disorders, Professor Cynthia Bulik has provided a commentary on the prevention and treatment of eating disorders, by considering the progress made in the last 40 years alongside literature dedicated to other psychiatric illnesses, such as schizophrenia.
While there has been considerable development in defining prevention, development and treatment of eating disorders, Bulik acknowledges that the field is still a long way from having a solid understanding of the causes of these illnesses, which ultimately impacts on the effectiveness of interventions.
This commentary sits alongside a systematic review of the evidence for psychological treatments in eating disorders from 2005-2012, conducted by Professor Phillipa Hay (2013). Following on from a series of reviews by Bulik et al. (2007), this research suggests that there has been substantial progress in the evidence base for:
- Family based treatment (FBT) in adolescents with anorexia
- Cognitive behavioural therapy (CBT) in both full and guided self-help formats
- Internet-based modes of delivery for bulimia nervosa binge eating disorder, and eating disorders previously classified as EDNOS.
The review also identified several promising interventions. In particular:
- Interpersonalpsychotherapy (IPT), which is associated with improvements over time, showing similar rates of effectiveness to CBT in anorexia nervosa and binge eating disorder
- An enhanced form of CBT (CBT-E), which has shown to improve outcomes in people with eating disorders who are not underweight, but who may have added complications including mood intolerance, interpersonal deficits, clinical perfectionism and/or low self-esteem.
There is still considerable gap in evidence-based options for adults with anorexia nervosa. Furthermore, for all of the eating disorders, we lack a clear direction when treatments prove ineffective. We know very little about predicting who will respond well to standard models of treatment and who will require multiple or extended interventions.
There is room for refinement of conventional eating disorder treatment approaches in terms of efficacy and effectiveness. In addition, there are promising approaches that deserve further research, particularly with regard to technology enhanced interventions that may provide flexible, accessible and cost-effective support to large populations, to reduce the personal and societal burdens arising from these severe illnesses.
When reviewing of evidence based treatment, it is important to consider the dissemination and implementation of such treatments. While there is an assumption that evidence-based models will be absorbed into clinical practice, in fact there are considerable barriers to the implementation of these practices:
- Some interventions are suitable for only a narrow range of people, and show limited clinical range
- Many psychological treatments require intensive training from expert therapists
- Treatments that are lengthy and require constant professional input are too labour intensive
Implementing evidence-based practice is difficult and needs strategies that address the complexity of care systems, needs of individual practitioners and health care cultures. When enough research evidence is available, practice should be guided by research evidence in conjunction with clinical expertise and consumer experience.
If you would like to undertake further reading, the research referenced in this article can be found in the Knowledge Hub:
Bulik, C. M. (2013). Are we really paddling as fast as we can? Reflections on why eating disorders treatment and research always seem to be one step behind: Commentary on Hay, Mitchell, and Stice & Becker: Prevention and treatment. International Journal of Eating Disorders, 46(5), 489-491.
Fairburn, C. G., & Wilson, G. T. (2013). The dissemination and implementation of psychological treatments: Problems and solutions. International Journal of Eating Disorders, 46(5), 516-521.
Hay, P. (2013). A systematic review of evidence for psychological treatments in eating disorders: 2005–2012. International Journal of Eating Disorders, 46(5), 462-469.
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