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Severe and Enduring Anorexia Nervosa: Enduring Wrong Assumptions?

Emilio Gutiérrez^1,2, Olaia Carrera²

¹Department of Clinical Psychology and Psychobiology, College of Psychology, University of Santiago, Santiago de Compostela, Spain.

Frontiers in Psychiatry

|March 4, 2021

Summary

Current anorexia nervosa (AN) treatments show similar efficacy, including "treatment as usual." This suggests treatment inefficacy, not patient nature, causes chronic AN. Diagnostic criteria may also distort the disorder.

Keywords:

acculturation body image disturbances fat phobia invalidation treatment efficacy

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Area of Science:

Psychiatry
Clinical Psychology
Eating Disorders

Background:

Severe and enduring anorexia nervosa (SE-AN) is often defined by treatment resistance.
Current evidence-based treatments for anorexia nervosa (AN) include specialized and novel approaches.
Randomized control trials indicate comparable efficacy across existing AN treatments.

Purpose of the Study:

To scrutinize the effectiveness of current treatments for anorexia nervosa (AN).
To analyze the role of treatment inefficacy and diagnostic criteria in the chronicity of AN.
To examine the historical development of AN diagnostic criteria and their impact on patient perspectives.

Main Methods:

Review of randomized control trials on AN treatments.
Historical analysis of the concept of "typical" AN and Hilde Bruch's contributions.
Critical evaluation of current diagnostic criteria for AN.

Main Results:

Efficacy is similar across various AN treatments, including control conditions.
Past treatments may have had iatrogenic effects due to flawed assumptions.
Current diagnostic criteria may distort the essence of AN and invalidate patient experiences.

Conclusions:

The inefficacy of treatments and flawed underlying assumptions contribute significantly to AN chronicity.
Diagnostic criteria, shaped by cultural factors, may not accurately represent the core of AN.
Revisiting treatment approaches and diagnostic frameworks is crucial for improving outcomes and validating patient perspectives.