Pathways to improved treatment of anorexia nervosa: a need for reconceptualization

Given anorexia nervosa's (AN) status as one of the most difficult psychiatric disorders to treat, with the highest mortality rate, with millions of dollars spent on researching its treatment, and decades of assiduous study, it is surprising and distressing that treatment outcomes have remained essentially unimproved since the first treatments were presented over 70 years ago. Recent theorizing argues for a more personalized approach to treatment but cannot yet specify what that should look like.

The current paper argues that classifying AN patients into more useful subgroups is necessary for treatment-particularly individualized treatment-to progress, rather than treating the disorder as a unitary phenomenon based on issues concerning body image. The literature on contributors and characteristics of groups of AN patients is critically reviewed including comorbidities with other psychiatric disorders, environmental stressors and life events, and pre-existing personality makeup.

The examination of the data helps to identify what distinguishes individuals who respond to treatment and recover from AN from those who remain disordered. We suggest aspects of AN that contribute to treatment success or failure and suggest ways to ascertain how the disorder develops in different individuals.

We conclude that more attention is needed to distinguish between people who develop the disorder in reaction to environmental stressors or events, people who appear to have a physiological, possibly genetic predisposition to psychiatric dysfunction, and people who have both a predisposition to disorder and an environmental trigger.