Chapter 11 - Outpatient Treatment of Anorexia Nervosa following Weight Restoration: Practical and Conceptual Issues

Abstract

The treatment of patients with anorexia nervosa (AN) after their weight has been restored offers the opportunity to address the fundamental issues that gave rise to the disease. These concerns tend to be obscured by malnutrition, and are of lower priority during inpatient or residential treatment. Despite the emphasis on the opportunities for thoroughly addressing psychosocial factors after weight restoration, weight and eating behaviors remain dangerous vulnerabilities for the AN patient. Body image concerns linger, exploring their origins and meanings, both developmentally and interpersonally, can be a bridge that shifts the psychotherapy focus from body and eating to relational and developmental issues. Ultimately, treatment for weight-restored AN patients needs to focus on the interpersonal and characterological factors that were involved in the development of the disorder. If unmodified, these factors will continue to support the maintenance of the illness. Treatment research in AN remains one of the most pressing needs of the entire field of ED. A few controlled trials have been conducted, with mixed results, and it is critical to undertake future research on groups of different weight status and age. Meanwhile, the outpatient clinician must continue to work with patients, integrating the art of psychotherapy with the emerging research.