The British Journal of Psychiatry


Background Currently, without systematic evidence, psychotherapy for anorexia nervosa in adults draws on psychodynamic, cognitive and systemic theories.

Aims To assess effectiveness of specific psychotherapies in out-patient management of adult patients with anorexia nervosa.

Method Eighty-four patients were randomised to four treatments: three specific psychotherapies — (a) a year of focal psychoanalytic psychotherapy; (b) 7 months of cognitive—analytic therapy (CAT); (c) family therapy for 1 year — and (d) low contact, ‘routine’ treatment for 1 year (control).

Results At 1 year, there was symptomatic improvement in the whole group of patients. This improvement was modest, several patients being significantly undernourished at follow-up. Psychoanalytic psychotherapy and family therapy were significantly superior to the control treatment; CAT tended to show benefits.

Conclusions Psychoanalytic and family therapy are of specific value in the out-patient treatment of adult patients with anorexia.

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