News Release

By DAVID WILLIAMSON
UNC News Services

CHAPEL HILL—Nonspecific, supportive care from specialists was superior to two psychotherapies in treating people with anorexia nervosa, a new clinical trial shows.

The unusual condition is a life-threatening eating disorder during which patients -- mostly girls and young women -- refuse to eat enough to stay healthy and continue to believe themselves overweight.

"Results of this new work surprised us," said Dr. Cynthia M. Bulik of the University of North Carolina at Chapel Hill School of Medicine. "They were the opposite of what we thought we’d find, and they challenge assumptions about the effective ingredients of successful treatment for anorexia nervosa."

Researchers evaluating patients found significantly better results those who underwent and completed supportive management delivered by eating disorders specialists than among those who underwent cognitive behavior therapy or interpersonal psychotherapy. They studied 56 young women in New Zealand.

A report on the study appears in the April issue of the American Journal of Psychiatry. Authors include Drs. Virginia McIntosh and Peter R. Joyce of the Christchurch School of Medicine & Health Sciences in New Zealand.

Before moving to the United States, Bulik, William and Jeanne Jordan distinguished professor of eating disorders at UNC, was principal investigator for the study and recipient of the grant from the New Zealand Health Research Council that funded it. She and colleagues undertook the investigation since few randomized, controlled trials have examined the effectiveness of treatments for anorexia nervosa.

"We thought that nonspecific supportive clinical management would be a control condition, and we hypothesized that interpersonal psychotherapy might be better than cognitive behavior therapy for anorexia nervosa," Bulik said. "That’s because patients with this disorder often have difficulties in interpersonal relationships. However, the control condition actually outperformed cognitive behavior therapy."

Nonspecific supportive clinical management still needs to be delivered by someone trained in eating disorder treatment, she said.

"Basically, the focus is always nutritional stabilization and appropriate weight gain, but after that, therapy sessions are more driven by patients and what she -- or occasionally he -- brings to treatment sessions each week," Bulik said.

"We think that this approach may have been more effective because it allowed patients to feel that they had some control over their therapy and were collaborating actively with therapists," Joyce said.

The new findings do not support using interpersonal psychotherapy as the first line of treatment for anorexia nervosa patients despite hopes that it would be an improvement, she said.

"Most critically, it gives us another tool for treating anorexia nervosa, for which validated evidence-based treatments are scarce," Bulik said.

Clinical trials of anorexia nervosa have tended to be in other countries, Bulik said. U.S. funding for such studies has been inadequate, despite the sometimes-fatal outcome of the eating disorder.

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Note: Bulik can be reached at (919) 843-1689 or cbulik@med.unc.edu.

News Services contact: David Williamson, (919) 962-8596