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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

Other Research Relevant to Treatment Management

We know that our treatments are imperfect, but intervening soon after illness onset probably has a better chance of restoring health in persons with AN than when treatment waits until middle or late adulthood, at least judging from the poor results of adult treatment trials. This being the case, there are three crucially relevant empirical observations that inform the use of benchmarks in treatment management:

1. Because weight gain during the course of treatment is often partial, psychopathological symptoms can persist for years. For some, the pattern remains stable, for others symptoms wax and wane in intensity through adult life.

2. Prospective research in other psychiatric conditions—e.g., schizophrenia20 and major affective illnesses21—shows that even when very mild symptoms persist, the risk of later relapse is greatly increased. For an illustration in AN, the reader is referred to Lowe et al.22 and Strober et al.23

3. There is literature in the pharmacotherapy and cognitive behavior therapy (CBT) of depression,24 CBT for bulimia nervosa,25 and FBT for AN26 showing that greater symptom reduction in the very early weeks of these (time limited) therapies predicts a more robust end-of-treatment outcome. In other words, if early treatment improvement is nil the likelihood of a favorable short-term outcome is low. The implication for managing the trajectory of weight gain in the early phase of outpatient therapy couldn’t be more obvious.