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Management of anorexia nervosa revisited

Early intervention can help—but some cases still need tertiary inpatient care 

A recent review of outcome in anorexia nervosa pessimistically stated that the 20th century has seen no apparent improvement1: half the patients still never fully recover, overall mortality remains at 5%, and 20% of patients stay chronically ill. Is treatment efficacy really this bad? And where does this leave the clinician?

Early intervention might be expected to exert a positive effect, and indeed this was evident in the 21 year follow up by Zipfel et al of 84 patients.2 More support comes from a recently published prevalence study of 208 patients that reported no excess mortality at 27 year follow up.3 The high rate of anorexia of 0.48% in the study on which this was based suggests that mild or early cases may have been included, though safer management of medically compromised patients might also have been a factor.

The concept of treating patients with eating disorders as hospital inpatients has its detractors, and some have claimed that treatment in general makes no difference to outcome.4 However, the study that purported to show this was flawed and could not have been considered a treatment outcome …