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The Need for Complex Ideas in Anorexia Nervosa: Why Biology, Environment, and Psyche All Matter, Why Therapists Make Mistakes, and Why Clinical Benchmarks Are Needed for Managing Weight Correction

Michael Strober, PhD, ABPP1, 2* Craig Johnson, PhD3, 4

Our Backgrounds

Obviously, we wouldn’t have written it if we didn’t consider the question posed to us at dinner to be meaningful and answerable. Still, a perspective is personal, so we thought a brief summary of our backgrounds would be important.

Our careers have been long, nearing 40 years now. We were fortunate that our doctoral training in clinical psychology crossed several theoretical domains—social learning theory, cognitive and developmental psychology and psychopathology, principles of behavioral and psychodynamic theory, and brain–behavior relationships—and that after graduating we devoted much time to connecting research with patient-based experience; also, bio-phobic we’re not. The lead author’s masters and dissertation research investigated sleep electrophysiology in newborns at risk for severe mental disorder, and both of us have collaborated with authors of the AED Position Paper on Eating Disorders as Biologically Based Mental Illness1 in the Price Foundation and National Institute of Mental Health funded studies of genetic factors in eating disorders.5 In addition, MS was a founding Fellow of the American Academy of Clinical Psychopharmacology and is a longstanding member of the Society of Biological Psychiatry, and CJ is a Principal Investigator in an NIMH-funded multi-center study comparing family behavioral treatment to systemic family therapy in adolescents with AN. Similarly, our academic and postdoctoral experiences were further strengthened by supervised experience in interdisciplinary clinical settings from multiple therapeutic viewpoints. Finally, we have spent our entire career working in combined service and research environments that provide care to the most seriously ill children and adults (and families), as well as to those less impaired. Between us, the number of patients and families we have treated privately, treatments that we have supervised directly in the centers we direct, and consultations we have conducted with juvenile and adult patients (and families), is on the order of 12,000.

The summary will strike some as overly self-regarding, but seeing how ideas on etiology and treatment are now as easily accepted as they are dismissed, there is no stand-in for theoretical diversity and depth of clinical experience when taking on matters about which so many in the Academy disagree. Thus, we feel well prepared to address the disciplinary blinders and doctrinaire attitudes now hindering the rapprochement of ideas our field urgently needs.