Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy.
Int J Eat Disord. 2020 Aug;53(8):1320-1321. doi: 10.1002/eat.23295. Epub 2020 May 13.
There is currently no evidence-based definition of severe and enduring anorexia nervosa (SE-AN) with which to reliably inform clinical practice and research. Indeed, data on the effect of AN severity and duration on treatment outcome are inconsistent. A large group of patients with SE-AN are repeatedly unsuccessfully managed with the available eating disorders treatments and have no access to adequate treatment for their illness. Cognitive behavioral therapy (CBT) adapted for SE-AN has been designed to enhance quality of life and reduce harm rather than promoting weight gain in such patients, and has had some success. However, a percentage of patients with SE-AN achieves remission, or at least returns to a normal weight range, with available evidence-based treatments for eating disorders, such as enhanced CBT (CBT-E). It would therefore be worth conducting a large-scale randomized controlled trial comparing CBT adapted for SE-AN with CBT-E to assess their relative acceptability; efficacy, including their effect on quality of life and medical stability; cost-effectiveness; and the treatment response moderators that might allow better matching of patients with SE-AN to a treatment oriented either to harm reduction or to change.
目前尚无循证定义的严重和持久神经性厌食症（SE-AN），无法可靠地为临床实践和研究提供信息。实际上，关于 AN 严重程度和持续时间对治疗结果的影响的数据不一致。很大一部分 SE-AN 患者反复接受现有饮食失调症治疗均未成功，并且无法获得适当的疾病治疗。为 SE-AN 设计的认知行为疗法（CBT）旨在提高生活质量并减少伤害，而不是促进此类患者的体重增加，并且取得了一定的成功。但是，对于 SE-AN 患者，有一定比例的患者通过现有的饮食失调症循证治疗（例如增强型 CBT（CBT-E））达到缓解，或者至少恢复到正常体重范围。因此，值得进行一项大规模的随机对照试验，比较为 SE-AN 设计的 CBT 与 CBT-E，以评估它们的相对可接受性；疗效，包括对生活质量和医学稳定性的影响；成本效益；以及可能允许更好地将 SE-AN 患者与以减少伤害或改变为导向的治疗相匹配的治疗反应调节剂。
