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CC BY 4.0 · Avicenna J Med 2023; 13(01): 003-014
DOI: 10.1055/s-0042-1758859
DOI: 10.1055/s-0042-1758859
Review Article
A Clinical Overview of Anorexia Nervosa and Overcoming Treatment Resistance
Abstract
Anorexia nervosa (AN) is a type of eating disorder that has been increasing in incidence and has been encountered more commonly by physicians in their daily practice. Both environmental and genetic risk factors paired along with a more susceptible neurobiology are at play in the emerging resistance to treatment in AN. Preoccupations with intense fear of weight gain, dietary restrictions, excessive exercise, and how the individual is perceived by society mixed with underlying psychopathology all further add to the issue. Many patients who fall into this cycle of obsessive and restrictive patterns refuse to get treatment. As clinicians, it is essential we recognize the early signs of both eating disorders during the initial primary care appointments.
To review the literature on the etiology of AN, possible misdiagnosis leading to inappropriate management of this condition, and understand the treatment-resistant AN and its management. Additionally, it will explore possible reasons that contribute to the resistance to treatment, the underlying psychopathology of anorexics, its genetic predisposition, psychiatric comorbidities, identification of the early signs and symptoms, and timely prevention.
Early recognition by a physician includes a thorough history and physical examination, pertinent laboratory, and electrolyte studies, and identifying comorbid psychiatric conditions. The treatment of AN is intricate and requires a holistic approach. Treatment includes multiple modalities such as nutritional rehabilitation and psychosocial and pharmacological therapies. An interdisciplinary team of medical professionals for managing chronic AN is recommended.
Keywords
anorexia nervosa - treatment-resistant anorexia - eating disorders - psychiatric disorders - managing chronic anorexia - psychosocial treatments of anorexia - deep brain stimulation in anorexicsPublikationsverlauf
Artikel online veröffentlicht:
21. Dezember 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Hoek HW. Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Curr Opin Psychiatry 2006; 19 (04) 389-394
- 2 Petkova H, Simic M, Nicholls D. et al. Incidence of anorexia nervosa in young people in the UK and Ireland: a national surveillance study. BMJ Open 2019; 9 (10) e027339
- 3 Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry 2011; 68 (07) 724-731
- 4 Salbach-Andrae H, Lenz K, Simmendinger N, Klinkowski N, Lehmkuhl U, Pfeiffer E. Psychiatric comorbidities among female adolescents with anorexia nervosa. Child Psychiatry Hum Dev 2008; 39 (03) 261-272
- 5 Bulik C, Kennedy M, Wade T. ANGI - anorexia nervosa genetics initiative. Twin Res Hum Genet 2020; 23 (02) 135-136
- 6 Kaye WH, Bulik CM, Thornton L, Barbarich N, Masters K. Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry 2004; 161 (12) 2215-2221
- 7 Kan C, Treasure J. Recent research and personalized treatment of anorexia nervosa. Psychiatr Clin North Am 2019; 42 (01) 11-19
- 8 Hudson JI, Hiripi E, Pope Jr HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 2007; 61 (03) 348-358 Erratum in: Biol Psychiatry. 2012 Jul 15;72(2):164. PMID: 16815322; PMCID: PMC1892232
- 9 Ceccarini MR, Tasegian A, Franzago M. et al. 5-HT2AR and BDNF gene variants in eating disorders susceptibility. Am J Med Genet B Neuropsychiatr Genet 2020; 183 (03) 155-163
- 10 Thornton LM, Welch E, Munn-Chernoff MA, Lichtenstein P, Bulik CM. Anorexia nervosa, major depression, and suicide attempts: shared genetic factors. Suicide Life Threat Behav 2016; 46 (05) 525-534
- 11 Cederlöf M, Thornton LM, Baker J. et al. Etiological overlap between obsessive-compulsive disorder and anorexia nervosa: a longitudinal cohort, multigenerational family and twin study. World Psychiatry 2015; 14 (03) 333-338
- 12 Bulik CM, Thornton LM, Root TL, Pisetsky EM, Lichtenstein P, Pedersen NL. Understanding the relation between anorexia nervosa and bulimia nervosa in a Swedish national twin sample. Biol Psychiatry 2010; 67 (01) 71-77
- 13 Sovetkina A, Nadir R, Fung JNM, Nadjarpour A, Beddoe B. The physiological role of ghrelin in the regulation of energy and glucose homeostasis. Cureus 2020; 12 (05) e7941
- 14 Mehler PS, Brown C. Anorexia nervosa - medical complications. J Eat Disord 2015; 3: 11
- 15 Cost J, Krantz MJ, Mehler PS. Medical complications of anorexia nervosa. Cleve Clin J Med 2020; 87 (06) 361-366
- 16 Garber AK, Cheng J, Accurso EC. et al. Weight loss and illness severity in adolescents with atypical anorexia nervosa. Pediatrics 2019; 144 (06) e20192339
- 17 Harrington BC, Jimerson M, Haxton C, Jimerson DC. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. Am Fam Physician 2015; 91 (01) 46-52
- 18 Walsh JM, Wheat ME, Freund K. Detection, evaluation, and treatment of eating disorders the role of the primary care physician. J Gen Intern Med 2000; 15 (08) 577-590
- 19 Misra M, Aggarwal A, Miller KK. et al. Effects of anorexia nervosa on clinical, hematologic, biochemical, and bone density parameters in community-dwelling adolescent girls. Pediatrics 2004; 114 (06) 1574-1583
- 20 Pritts SD, Susman J. Diagnosis of eating disorders in primary care. Am Fam Physician 2003; 67 (02) 297-304
- 21 Jáuregui-Lobera I. Neuropsychology of eating disorders: 1995-2012. Neuropsychiatr Dis Treat 2013; 9: 415-430
- 22 Broomfield C, Stedal K, Touyz S. The neuropsychological profile of severe and enduring anorexia nervosa: a systematic review. Front Psychol 2021; 12: 708536
- 23 Peterson CB, Pisetsky EM, Swanson SA. et al. Examining the utility of narrowing anorexia nervosa subtypes for adults. Compr Psychiatry 2016; 67: 54-58
- 24 Lebow J, Mattke A, Narr C. et al. Can adolescents with eating disorders be treated in primary care? A retrospective clinical cohort study. J Eat Disord 2021; 9 (01) 55
- 25 Casper RC. Depression and eating disorders. Depress Anxiety 1998; 8 (Suppl 1): 96-104
- 26 Gaitonde DY, Rowley KD, Sweeney LB. Hypothyroidism: an update. Am Fam Physician 2012; 86 (03) 244-251
- 27 Phillipou A, Castle DJ, Rossell SL. Direct comparisons of anorexia nervosa and body dysmorphic disorder: a systematic review. Psychiatry Res 2019; 274: 129-137
- 28 Juli MR. Analysis of multi-instrumental assessment of eating disorders: comparison between anorexia and bulimia. Psychiatr Danub 2012; 24 (Suppl 1): S119-S124
- 29 Yager J, Devlin MJ, Halmi KA. et al. American Psychiatric Association Work Group on Eating Disorders. Practice Guideline for the Treatment of Patients with Eating Disorders. 3rd edition. Washington, DC: American Psychiatric Association; 2006
- 30 Glorio R, Allevato M, De Pablo A. et al. Prevalence of cutaneous manifestations in 200 patients with eating disorders. Int J Dermatol 2000; 39 (05) 348-353
- 31 Otte C, Gold SM, Penninx BW. et al. Major depressive disorder. Nat Rev Dis Primers 2016; 2: 16065
- 32 Croxson MS, Ibbertson HK. Low serum triiodothyronine (T3) and hypothyroidism in anorexia nervosa. J Clin Endocrinol Metab 1977; 44 (01) 167-174
- 33 Hartmann AS, Thomas JJ, Greenberg JL, Elliott CM, Matheny NL, Wilhelm S. Anorexia nervosa and body dysmorphic disorder: a comparison of body image concerns and explicit and implicit attractiveness beliefs. Body Image 2015; 14: 77-84
- 34 Slaughter JR, Sun AM. In pursuit of perfection: a primary care physician's guide to body dysmorphic disorder. Am Fam Physician 1999; 60 (06) 1738-1742
- 35 Seeman MV. Eating disorders and psychosis: seven hypotheses. World J Psychiatry 2014; 4 (04) 112-119
- 36 Thomas JJ, Lawson EA, Micali N, Misra M, Deckersbach T, Eddy KT. Avoidant/restrictive food intake disorder: a three-dimensional model of neurobiology with implications for etiology and treatment. Curr Psychiatry Rep 2017; 19 (08) 54
- 37 Brigham KS, Manzo LD, Eddy KT, Thomas JJ. Evaluation and treatment of avoidant/restrictive food intake disorder (ARFID) in adolescents. Curr Pediatr Rep 2018; 6 (02) 107-113
- 38 Bell L. What can we learn from consumer studies and qualitative research in the treatment of eating disorders?. Eat Weight Disord 2003; 8 (03) 181-187
- 39 Golden NH, Meyer W. Nutritional rehabilitation of anorexia nervosa. Goals and dangers. Int J Adolesc Med Health 2004; 16 (02) 131-144
- 40 Willer MG, Thuras P, Crow SJ. Implications of the changing use of hospitalization to treat anorexia nervosa. Am J Psychiatry 2005; 162 (12) 2374-2376
- 41 Redgrave GW, Coughlin JW, Schreyer CC. et al. Refeeding and weight restoration outcomes in anorexia nervosa: Challenging current guidelines. Int J Eat Disord 2015; 48 (07) 866-873
- 42 Re-feeding syndrome: A complication associated with anorexia nervosa. Center For Discovery. Accessed November 7, 2022, at: https://centerfordiscovery.com/blog/re-feeding-syndrome-deadly-complication-associated-an
- 43 Robb AS, Silber TJ, Orrell-Valente JK. et al. Supplemental nocturnal nasogastric refeeding for better short-term outcome in hospitalized adolescent girls with anorexia nervosa. Am J Psychiatry 2002; 159 (08) 1347-1353
- 44 Imbierowicz K, Braks K, Jacoby GE. et al. High-caloric supplements in anorexia treatment. Int J Eat Disord 2002; 32 (02) 135-145 Accessed August 12, 2021
- 45 Carrera O, Gutiérrez E. Hyperactivity in anorexia nervosa: to warm or not to warm. That is the question (a translational research one). J Eat Disord 2018; 6: 4
- 46 Gutierrez E, Vazquez R. Heat in the treatment of patients with anorexia nervosa. Eat Weight Disord 2001; 6 (01) 49-52
- 47 Birmingham CL, Gutierrez E, Jonat L, Beumont P. Randomized controlled trial of warming in anorexia nervosa. Int J Eat Disord 2004; 35 (02) 234-238
- 48 de Vos J, Houtzager L, Katsaragaki G, van de Berg E, Cuijpers P, Dekker J. Meta analysis on the efficacy of pharmacotherapy versus placebo on anorexia nervosa. J Eat Disord 2014; 2 (01) 27
- 49 Andersen AE. Using medical information psycho-therapeutically. In Mehler PS, Andersen AE, eds. Eating Disorders: A Guide to Medical Care and Complications. Baltimore, MD: Johns Hopkins University Press; 1999: 192-201
- 50 Agras WS. Eating Disorders: Management of Obesity, Bulimia and Anorexia Nervosa. Oxford, UK: Pergamon; 1987
- 51 Castro J, Gila A, Puig J, Rodriguez S, Toro J. Predictors of rehospitalization after total weight recovery in adolescents with anorexia nervosa. Int J Eat Disord 2004; 36 (01) 22-30
- 52 Pike KM, Walsh BT, Vitousek K, Wilson GT, Bauer J. Cognitive behavior therapy in the posthospitalization treatment of anorexia nervosa. Am J Psychiatry 2003; 160 (11) 2046-2049
- 53 Khalsa SS, Portnoff LC, McCurdy-McKinnon D, Feusner JD. What happens after treatment? A systematic review of relapse, remission, and recovery in anorexia nervosa. J Eat Disord 2017; 5 (01) 20
- 54 Russell GF, Szmukler GI, Dare C, Eisler I. An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Arch Gen Psychiatry 1987; 44 (12) 1047-1056
- 55 Eisler I, Dare C, Russell GF, Szmukler G, le Grange D, Dodge E. Family and individual therapy in anorexia nervosa. A 5-year follow-up. Arch Gen Psychiatry 1997; 54 (11) 1025-1030
- 56 Attia E, Haiman C, Walsh BT, Flater SR. Does fluoxetine augment the inpatient treatment of anorexia nervosa?. Am J Psychiatry 1998; 155 (04) 548-551
- 57 Strober M, Pataki C, Freeman R, DeAntonio M. No effect of adjunctive fluoxetine on eating behavior or weight phobia during the inpatient treatment of anorexia nervosa: an historical case-control study. J Child Adolesc Psychopharmacol 1999; 9 (03) 195-201
- 58 Kaye WH, Nagata T, Weltzin TE. et al. Double-blind placebo-controlled administration of fluoxetine in restricting- and restricting-purging-type anorexia nervosa. Biol Psychiatry 2001; 49 (07) 644-652
- 59 Walsh BT, Kaplan AS, Attia E. et al. Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial. JAMA 2006; 295 (22) 2605-2612
- 60 Bergh C, Eriksson M, Lindberg G, Södersten P. Selective serotonin reuptake inhibitors in anorexia. Lancet 1996; 348 (9039): 1459-1460
- 61 Lacey JH, Crisp AH. Hunger, food intake and weight: the impact of clomipramine on a refeeding anorexia nervosa population. Postgrad Med J 1980; 56 (Suppl 1): 79-85
- 62 Barbarich NC, McConaha CW, Gaskill J. et al. An open trial of olanzapine in anorexia nervosa. J Clin Psychiatry 2004; 65 (11) 1480-1482
- 63 Cassano GB, Miniati M, Pini S. et al. Six-month open trial of haloperidol as an adjunctive treatment for anorexia nervosa: a preliminary report. Int J Eat Disord 2003; 33 (02) 172-177
- 64 Golden NH, Lanzkowsky L, Schebendach J, Palestro CJ, Jacobson MS, Shenker IR. The effect of estrogen-progestin treatment on bone mineral density in anorexia nervosa. J Pediatr Adolesc Gynecol 2002; 15 (03) 135-143
- 65 Treasure JL, Russell GF, Fogelman I, Murby B. Reversible bone loss in anorexia nervosa. Br Med J (Clin Res Ed) 1987; 295 (6596): 474-475
- 66 Klibanski A, Biller BM, Schoenfeld DA, Herzog DB, Saxe VC. The effects of estrogen administration on trabecular bone loss in young women with anorexia nervosa. J Clin Endocrinol Metab 1995; 80 (03) 898-904
- 67 Halmi KA. Perplexities of treatment resistance in eating disorders. BMC Psychiatry 2013; 13: 292
- 68 Smith S, Woodside DB. Characterizing treatment-resistant anorexia nervosa. Front Psychiatry 2021; 11: 542206
- 69 Madden S, Hay P, Touyz S. Systematic review of evidence for different treatment settings in anorexia nervosa. World J Psychiatry 2015; 5 (01) 147-153
- 70 Bailer UF, Frank GK, Price JC. et al. Interaction between serotonin transporter and dopamine D2/D3 receptor radioligand measures is associated with harm avoidant symptoms in anorexia and bulimia nervosa. Psychiatry Res 2013; 211 (02) 160-168
- 71 Bloss CS, Berrettini W, Bergen AW. et al. Genetic association of recovery from eating disorders: the role of GABA receptor SNPs. Neuropsychopharmacology 2011; 36 (11) 2222-2232
- 72 Treasure J, Russell G. The case for early intervention in anorexia nervosa: theoretical exploration of maintaining factors. Br J Psychiatry 2011; 199 (01) 5-7
- 73 Strober M. Managing the chronic, treatment-resistant patient with anorexia nervosa. Int J Eat Disord 2004; 36 (03) 245-255
- 74 Murray SB, Loeb KL, Le Grange D. Dissecting the core fear in anorexia nervosa: can we optimize treatment mechanisms?. JAMA Psychiatry 2016; 73 (09) 891-892
- 75 Liu W, Zhan S, Li D. et al. Deep brain stimulation of the nucleus accumbens for treatment-refractory anorexia nervosa: a long-term follow-up study. Brain Stimul 2020; 13 (03) 643-649
- 76 Lipsman N, Lam E, Volpini M. et al. Deep brain stimulation of the subcallosal cingulate for treatment-refractory anorexia nervosa: 1 year follow-up of an open-label trial. Lancet Psychiatry 2017; 4 (04) 285-294
- 77 Eisler I, Simic M, Hodsoll J. et al. A pragmatic randomised multi-centre trial of multifamily and single family therapy for adolescent anorexia nervosa. BMC Psychiatry 2016; 16 (01) 422
- 78 Villalba Martínez G, Justicia A, Salgado P. et al. A randomized trial of deep brain stimulation to the subcallosal cingulate and nucleus accumbens in patients with treatment-refractory, chronic, and severe anorexia nervosa: initial results at 6 months of follow up. J Clin Med 2020; 9 (06) 1946
- 79 Pacilio RM, Livingston RK, Gordon MR. The use of electroconvulsive therapy in eating disorders: a systematic literature review and case report. J ECT 2019; 35 (04) 272-278
- 80 Touyz S, Le Grange D, Lacey H. et al. Treating severe and enduring anorexia nervosa: a randomized controlled trial. Psychol Med 2013; 43 (12) 2501-2511
- 81 Fairburn CG, Cooper Z, Doll HA, O'Connor ME, Palmer RL, Dalle Grave R. Enhanced cognitive behaviour therapy for adults with anorexia nervosa: a UK-Italy study. Behav Res Ther 2013; 51 (01) R2-R8
- 82 Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B. Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Arch Gen Psychiatry 2010; 67 (10) 1025-1032