The Eating Disorder Treatment Program: Family-Centered Care and Clinical Research on Anorexia Nervosa
from Practice Update, Spring 2006
The Eating Disorder Treatment Program at The Children’s Hospital was established in 1988. Since then, it has expanded to include a full continuum of care, including outpatient consultation and treatment services through adolescent medicine, a specialized day treatment and inpatient program and comprehensive inpatient medical care for patients who are medically unstable. The program provides care for children, adolescents and young adults through age 21. Our multidisciplinary approach to treatment includes a focus on family involvement and helping the family learn how to help their child regain normal eating behaviors while addressing the distorted thoughts that develop with an eating disorder. Parents begin to work with the program dietitians at the onset of treatment, and individual and family therapies are directed toward helping the child and parent work together toward recovery from the illness. Over the years, we have seen a decrease in the average age of patients, and an increase in the number of males with anorexia nervosa.
Over 60 percent of the patients in the program are diagnosed with anorexia nervosa. Anorexia nervosa is an illness that often begins during adolescence. The primary care doctor is often the first person the family will contact with concerns about weight loss. A change in weight related to height (“Falling off the curve”) during a routine physical exam may be the warning sign that prompts a more comprehensive evaluation.
Anorexia nervosa can become chronic and life threatening. The cause of anorexia nervosa is unknown. Symptoms of the illness include:
- weight loss leading to a weight that is < 85 percent of Ideal Body Weight (or failure to gain weight during a period of growth, leading to weight < 85 percent of that expected)
- an abnormally strong desire to be thin (Drive for thinness)
- intense anxiety about gaining weight
- distorted body image, or denial about the seriousness of the current low body weight
Treatment usually includes psychotherapy and support for changing behavior in order to improve nutrition and gain weight. Even with the best care available, over 33 percent of people with anorexia nervosa develop chronic, persistent illness. Anorexia nervosa has the highest mortality rate of any psychiatric illness, related to suicide and premature death resulting from chronic severe malnutrition. Although this is a serious illness, there are no psychotropic medications approved for the treatment of anorexia nervosa. For example, antidepressants are often prescribed for anorexia nervosa but studies have found them to be ineffective for treatment of anorexia nervosa during the low-weight phase of the illness. There is one study indicating that fluoxetine may help patients remain in recovery after they have reached 85 percent of Ideal Body Weight (IBW).
Advancing Treatment Through Research
In addition to providing high-quality, state-ofthe-art care for individuals with anorexia nervosa, we are also committed to understanding more about the causes of anorexia nervosa and to advancing treatment.
Research, including brain imaging and genetic studies, suggests that chemical imbalances in the brain related to dopamine and serotonin are likely to be involved in this illness. The lack of effective medications for the symptoms of anorexia nervosa, combined with early promising findings in case reports and one open study of atypical neuroleptics, have led to increased use of these medications in patients with anorexia nervosa. It is possible that this class of medication may specifically target the symptoms at the core of anorexia nervosa: distorted body image and irrational anxiety about food and weight. Despite the widespread use of atypical neuroleptics for the treatment of symptoms associated with anorexia nervosa, there are no double-blind placebo controlled studies demonstrating efficacy.
Jennifer Hagman, MD (Associate Professor of Psychiatry, UCHSC) and Eric Sigel, MD (Associate Professor of Pediatrics, UCHSC) developed a study to determine the safety and efficacy of risperidone for the treatment of anorexia nervosa with a double-blind placebo controlled study. The study is supported by the Pediatric General Clinical Research Center through a grant from the National Institute of Health and through an Investigator Initiated grant from Janssen. We are enrolling patients in a double-blind, placebo controlled study of risperidone for the treatment of anorexia nervosa. Risperidone is currently approved by the Food and Drug Administration (FDA) to treat bipolar disorder and schizophrenia. This study will help us learn if risperidone can also be used to improve outcomes for people with anorexia nervosa.
The study is open to females ages 12-21 and involves taking the study medication (risperidone or placebo) until the individual reaches their target body weight, and has maintained that weight for one month. A unique software program using the subject’s digital image is used to monitor changes in body image distortion. In addition to studying changes in eating disorder specific symptoms, we are also monitoring labs, ECG, resting energy expenditure, and leptin levels in the course of the study. Most patients are in the medication phase of the study for three to four months.
Learn more about the Eating Disorder Treatment Program at The Children’s Hospital
