The Psychological Needs of Adolescents Diagnosed With Anorexia Nervosa - A Literature Review

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Boston College
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Literature review
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Anorexia nervosa is a biologically-based critical mental condition and is also heritable just like psychiatric conditions like bipolar disorder, schizophrenia, and depression. Being and eating disorder, anorexia is often associated with various emotional and cognitive functioning impairments that will limit the individuals daily functioning to a great extent (Kaye et al., 2013). It is clear that despite its somatic symptoms like starvation and weight loss, young girls who experience the condition have psychological needs that are not met and therefore manifest physically. Research identifies that the condition continues to have the highest mortality when compared to other psychiatric conditions. It is also evident that many girls who are experiencing anorexia have to battle with other co-occurring psychological conditions including depression, anxiety, substance abuse and much more (Zipfel et al., 2015). Research identifies self-esteem as a central psychological issue in the development of anorexia. It often manifests as a critical voice within the individual, which leads to the creation and feeding of perceptions a body image that is poor (Brockmeyer et al., 2013). When the adolescent develops a low self-esteem, she also develops negative perceptions of her physical appearance (Collin et al., 2016). Therefore, the only effort that will lead to the reconciliation of the adolescents body image is the correction of internal low self-esteem issues. According to Zipfel et al. (2014), the international treatment guidelines identify psychotherapy as the preferred option for treatment of anorexia. The researchers, however, state that there lacks evidence that favors one psychotherapy approach over the other. Numerous studies carried out on the psychological treatment of anorexia identify the use of cognitive behavior therapy and family therapy in addressing the condition (Calugi et al., 2015; Dalle Grave et al., 2013; Espie & Eisler, 2015; Hughes et al., 2015; Zipfel et al., 2014). The studies also indicate the level of effectiveness of the methods and what more can be done especially on the efficacy of CBT and family therapy.

Zipfel et al. (2014) carry out a randomized controlled efficacy trial of female participants who have anorexia. The researchers use focal psychodynamic approach and enhanced cognitive behavior therapy on outpatient individuals with the condition. The results after the study period indicated a decrease in the psychopathology related to anorexia and appropriate gains in weight during the period of treatment. These positive effects were observable in the participants beyond the treatment period. However, the ANTOP study they conducted aimed at identifying any differences in the effectiveness of the treatment procedures in the two group and the results nullified their hypothesis which was that there was no difference in the weight gain between the two groups. Espie and Eisler (2015) also focus on the findings of various randomized controlled trials to identify the effectiveness of family therapy and CBT in the treatment of anorexia. From the findings, the researchers indicate that family therapy remains effective but may not work for all adolescents. Therefore, alternative methods like CBT are used in such instances.

In another study carried out by Calugi et al., (2015) the researchers aim at providing benchmark data on the length of treatment time necessary to restore the weight of adolescents and adults treated for anorexia using CBT. They select ninety-five participants from referrals made to the eating disorder clinics and offer each participant forty enhanced cognitive behavior therapy sessions for a period of forty weeks. The results indicated that a higher number of teenagers achieved the goal of the study than the adults. In the study by Dalle Grave et al. (2013), the researchers identify that family therapy is the best option for adolescents suffering from schizophrenia. They, however, identify that family therapy may fail in some instances necessitating the use of other therapeutic methods and specifically enhanced cognitive behavior therapy. The researchers aim at identifying the level of efficiency of CBT-E and therefore recruit a group of adolescents from referrals to the eating disorder clinic. The participants get forty sessions of CBT-E for forty weeks as the researchers record the effectiveness of the therapy. The results indicated that two-thirds of the individuals responded well to the treatment with the remaining one-third being identified as non-responders. Their conclusion was that there was promise in the effectiveness of CBT-E in treating anorexia without additional input.

Evidence indicates that two psychological interventions stand out for the treatment of anorexia. Many researchers conducted studies to show the efficacy of both family therapy and enhanced cognitive behavior therapy in dealing with anorexia. Gabel et al. (2014) identify that family therapy is effective in dealing with anorexia for other areas across the world as they conduct their study among Canadian adolescents. They explain that there is limited evidence on how the therapy works on adolescents despite their study indicating positive results in the efficacy of the method. They, however, recommend for a more rigorous study on the psychological intervention to clearly outline its effectiveness. These studies show that family therapy has worked so far in the treatment of anorexia. However, due to individual and environmental differences among those affected by the condition, the therapy may not be effective for every patient. It, however, stands out as the ideal treatment method for anorexia as identified by numerous scholastics. Many refer to it as the promising treatment for adolescents with anorexia (Murray & Le Grange, 2014; Voriadaki et al., 2015; Gabel et al., 2014). Many of the researchers who recommend family therapy for treatment of anorexia accord numerous advantages to this form of psychotherapy. In client reviews on the effectiveness of family therapy enhanced by emotion-focused therapy, one client revealed that she often turns to her parents and peers for various forms of support (Robinson, Dolhanty & Greenberg, 2013).

Despite the numerous recommendations for family therapy in the treatment of anorexia Dalle Grave et al. (2013) identify that the psychological treatment does not lack its limitations. The researchers admit that the psychotherapy may not be acceptable to some families due to its labor intensiveness thus proves to be costly to the family. According to the researchers, fewer than half of the patients who through family therapy will make full recovery. They recommend for the modification of the treatment model to ensure that it is more effective and acceptable. It is an indication that other forms of therapy will be applied in instances where family therapy is not effective. Cognitive therapy is often recommended by many researchers and those who have carried out studies using CBT in adolescents with anorexia believe that the therapy will work for the clients. Enhanced cognitive behavior therapy appears to work as well as family therapy despite many psychologists having a preference for family therapy.

In the study done by Dalle Grave et al. (2013) who were attempting to identify whether CBT may act as a replacement for family therapy, the researchers identify that even without the input of any other form of psychotherapy enhanced cognitive behavior therapy worked well for individuals who were treated for anorexia. More than half of those who were exposed to CBT were identified to have responded well to the treatment. Just like family therapy, which has credit for addressing anorexia to a given level, CBT can also be said to be effective for the condition. In the study, many of those who were non-responders were concerned about their physical well-being, stopped attending the sessions or they lacked progress and therefore required additional input to help in their recovery. It is evident that the nonresponders were ruled out not because CBT was entirely ineffective but because various individual and environmental factors played a role in the efficacy of the treatment.

As Legenbauer & Meule (2015) identify, cognitive behavior therapy often aims at adjusting the individuals maladjusted cognitive and behavioral characteristics through the therapist engaging the individual in exercises that help work on both the cognitive and behavioral aspects. In another study done by Calugi et al. (2015) where the researchers aimed at the restoration of body weight for adults and adolescents affected by anorexia, the researchers identified that CBT was effective especially for the adolescents. The results indicated that event as the adolescents made more progress than the adults, their progress rate was even higher. The study indicates that even in the absence of interventions CBT will be effective in dealing with anorexia and especially for the adolescents. Dalle Grave et al. (2016) recognized that though there exists strong evidence in support of treatment of anorexia using family therapy and its effectiveness, it does not stand as the only treatment option and other psychological interventions including CBT may be effective in instances where family therapy is not.

The studies and scholarly evidence indicate the effectiveness and preference of family therapy for the treatment of anorexia. Many focus on family therapy or CBT as individual therapies while other compare and contrast the effectiveness of both interventions in dealing with anorexia (Espie & Eisler, 2015; Hughes et al., 2015; Zipfel et al., 2014). The researchers ensure that they approve or nullify their hypotheses concerning the treatment of the condition through statistics of studies they carry out. It is therefore indisputable that family therapy will work and its long-term application through the years proves its reliability. It however also undisputable that the therapy may not work to the maximum and in such instances will require the use of other therapies like CBT. CBT could be as effective but the limited research on the intervention provides limited support for the intervention. It is clear that many psychologists are currently discovering the effectiveness of CBT and therefore continue to carry out studies that support the use of the therapy. There is also limited evidence on the effectiveness of the two methods when used concurrently. The evidence is also limited especially on the use of these methods in conjunction with other psychological interventions apart from the study done by Robinson, Dolhanty & Greenberg, (2015) where the researchers find family therapy to be more effective when combined with emotion focused therapy. There is a need for further research on the effectiveness of both family therapy and cognitive behavior therapy when combined for treatment and the combination of other psychological interventions in support of CBT and family therapy.



Brockmeyer, T., Holtforth, M. G., Bents, H., Kammerer, A., Herzog, W., & Friederich, H. C. (2013). The Thinner the Better: SelfEsteem and Low Body Weight in Anorexia Nervosa. Clinical psychology & psychotherapy, 20(5), 394-400.

Calugi, S., Dalle Grave, R., Sartirana, M., & Fairburn, C. G. (2015). Time to restore body weight in adults and adolescents receiving cognitive behaviour therapy for anorexia nervosa. Journal of eating disorders, 3(1), 21.

Collin, P., Karatzias, T., Power, K., Howard, R., G...

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