Published online Dec 12, 2014. doi: 10.5528/wjtm.v3.i3.150
Revised: September 13, 2014
Accepted: October 1, 2014
Published online: December 12, 2014
Psychological treatment in anorexia nervosa (AN) is disheartening. Psychotherapy is the “treatment of choice” for adults though this recommendation is grounded on the absence of good quality clinical studies. This paper seeks to address the question of why improvements in the psychological treatment of AN have been thwarted, and why one of the best treatments available for adult patients is specialist supportive clinical management that has entered the stage through the backdoor of nonspecific supportive treatments originally serving as a placebo treatment assigned in randomized clinical trials to control for non-specific aspects of true psychosocial treatments. The possibility that most of the psychopathological features that characterise the AN symptoms profile could be best understood as the direct consequences of emaciation would enhance the utility of research with animal models for generating new hypothesis to improve AN treatment.
Core tip: This paper presents an alternative explanation conspicuously lacking in the literature as to the scarce evidence concerning the efficacy of psychotherapy in anorexia nervosa. The absence of data supporting a particular treatment undermines the basic tenets underlying the theory on which it is grounded, or is at least a defective translation of the theory into the “dos” and “don’ts” of manualized treatment. This assertion is elucidated by recent research on a placebo and non-specific treatment that was found to be more effective than a number of specialized treatments.