Treatment of anorexia nervosa in adults

Abstract

It essential to match the treatment for anorexia nervosa to the needs of the individual. This requires a careful assessment of risk and resources. A risk assessment of anorexia nervosa includes consideration of several dimensions: physical health, clinical features, capacity, motivation and social factors. The outcome of anorexia nervosa; in terms of recovery and mortality rates is improved if the illness is short in duration i.e. early interventions are to be recommended. However because the onset is in early adolescence in most cases those presenting to adult services have had the illness for over 3 years and so the prognosis is less good. Severe weight loss is dangerous in the short term and leads to an adverse long-term outcome. Specialized treatments are more acceptable, efficacious and cost effective in anorexia nervosa than non-specialised treatment. Anorexia nervosa has a relatively uniform clinical picture: onset age 15, median duration 6 years. Early intervention services need to be focused on 16–21 year olds. The services for adult cases include the poor prognostic group and therefore will need a higher level of resources with a greater proportion of more intensive interventions. 20–30% have a chronic course with both physical and psychological morbidity. Approximately 30% of adult cases can be expected to have a good outcome after a year of treatment.