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Treatment Resistance in Psychiatry pp 253–260Cite as

Treatment-Resistant Eating Disorders

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Abstract

Eating disorders have a protracted course, with a median duration of 10 years. They also have a profoundly detrimental impact on social, vocational, psychological, and physical health; systematic reviews report recovery rates of less than 50%. Although there may be good responses to standard treatment in the early stages, once the illness has become severe and enduring, it becomes less responsive to any kind of treatment. A novel theory is that neuro-adaptive changes in response to the highly disturbed eating pattern cause treatment resistance. For individuals who are resistant to standard first-line treatment, it can be beneficial to use treatments that directly target some of the dysregulated circuits that maintain the disorder. These may circumvent the need to work only through top-down processes, which are disabled by the progressive neurological changes that ingrain the habits and fears that maintain the illness. New interventions targeting the neural changes reported in enduring eating disorders may improve the response to treatment.

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References

  1. Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biol Psychiatry. 2007;61(3):348–58.

    Article  Google Scholar 

  2. Vos T, Mathers C, Herrman H, et al. The burden of mental disorders in Victoria, 1996. Soc Psychiatry Psychiatr Epidemiol. 2001;36(2):53–62.

    Article  CAS  Google Scholar 

  3. Hjern A, Lindberg L, Lindblad F. Outcome and prognostic factors for adolescent female in-patients with anorexia nervosa: 9-to 14-year follow-up. Br J Psychiatry. 2006;189:428–32.

    Article  Google Scholar 

  4. Harris EC, Barraclough B. Excess mortality of mental disorder. Br J Psychiatry. 1998;173:11–53.

    Article  CAS  Google Scholar 

  5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

    Book  Google Scholar 

  6. Treasure J, Cardi V, Leppanen J, Turton R. New treatment approaches for severe and enduring eating disorders. Physiol Behav. 2015;152:456–65.

    Article  CAS  Google Scholar 

  7. Holland J, Hall N, Yeates DGR, Goldacre M. Trends in hospital admission rates for anorexia nervosa in Oxford (1968–2011) and England (1990–2011): database studies. J R Soc Med. 2016;109(2):59–66.

    Article  Google Scholar 

  8. Treasure J, Stein D, Maguire S. Has the time come for a staging model to map the course of eating disorders from high risk to severe enduring illness? An examination of the evidence. Early Intervent Psychiatry. 2015;9(3):173–84.

    Article  Google Scholar 

  9. Berk M, Conus P, Kapczinski F, et al. From neuroprogression to neuroprotection: implications for clinical care. Med J Aust. 2010;193(4):S36–40.

    PubMed  Google Scholar 

  10. Schmidt U, Treasure J. Anorexia nervosa: valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. Br J Clin Psychol. 2006;45:343–66.

    Article  Google Scholar 

  11. Touyz S, Le Grange D, Lacey H, et al. Treating severe and enduring anorexia nervosa: a randomized controlled trial. Psychol Med. 2013;43(12):2501–11.

    Article  CAS  Google Scholar 

  12. Treasure J, Schmidt U. The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. J Eat Disord. 2013;1(13):1–10.

    Google Scholar 

  13. Treasure J, Cardi V, Schmidt U. Moving to establish the mechanisms underpinning the biopsychiatric models of eating disorders with brain-based translational treatments: from paradigm clash to paradigm complementarity. Adv Eat Disord: Theory, Res Pract. 2014;2(2):171–9.

    Article  Google Scholar 

  14. Zabala MJ, Macdonald P, Treasure J. Appraisal of caregiving burden, expressed emotion and psychological distress in families of people with eating disorders: a systematic review. Eur Eat Disord Rev. 2009;17(5):338–49.

    Article  Google Scholar 

  15. Sepulveda AR, Kyriacou O, Treasure J. Development and validation of the accommodation and enabling scale for eating disorders (AESED) for caregivers in eating disorders. BMC Health Serv Res. 2009;9:171.

    Article  Google Scholar 

  16. Long S, Wallis D, Leung N, Meyer C. “All eyes are on you”: anorexia nervosa patient perspectives of in-patient mealtimes. J Health Psychol. 2012;17(3):419–28.

    Article  Google Scholar 

  17. Wyrwicka W. Anorexia nervosa as a case of complex instrumental conditioning. Exp Neurol. 1984;84(3):579–89.

    Article  CAS  Google Scholar 

  18. Treasure J, Cardi V, Kan C. Eating in eating disorders. Eur Eat Disord Rev. 2012;20(1):e42–e9.

    Article  Google Scholar 

  19. Avena NM, Bocarsly ME. Dysregulation of brain reward systems in eating disorders: neurochemical information from animal models of binge eating, bulimia nervosa, and anorexia nervosa. Neuropharmacology. 2012;63(1):87–96.

    Article  CAS  Google Scholar 

  20. Volkow ND, Wang GJ, Fowler JS, Tomasi D. Addiction circuitry in the human brain. In: Insel PA, Amara SG, Blaschke TF, editors. Annual review of pharmacology and toxicology, vol. 52. Palo Alto: Annual Reviews; 2012. p. 321–36.

    Google Scholar 

  21. Gladwin TE, Figner B, Crone EA, Wiers RW. Addiction, adolescence, and the integration of control and motivation. Dev Cogn Neurosci. 2011;1(4):364–76.

    Article  Google Scholar 

  22. Everitt BJ, Belin D, Economidou D, Pelloux Y, Dalley JW, Robbins TW. Neural mechanisms underlying the vulnerability to develop compulsive drug-seeking habits and addiction. Trans Royal Soc B-Biol Sci. 2008;363(1507):3125–35.

    Article  Google Scholar 

  23. Department of Health. The NHS improvement plan. 2004. www.dh.gov.uk/publications.

  24. Nelson G, Ochocka J, Janzen R, Trainor J. A longitudinal study of mental health consumer/survivor initiatives: Part 1 – literature review and overview of the study. J Community Psychol. 2006;34(3):247–60.

    Article  Google Scholar 

  25. Turton P, Demetriou A, Boland W, et al. One size fits all: or horses for courses? Recovery-based care in specialist mental health services. Soc Psychiatry Psychiatr Epidemiol. 2011;46(2):127–36.

    Article  Google Scholar 

  26. Hay P, Chinn D, Forbes D, et al. Royal Australian and New Zealand College of Psychiatrists Clinical practice guidelines for the treatment of eating disorders. Aust N Z J Psychiatry. 2014;48(11):977–1008.

    Article  Google Scholar 

  27. Stoving RK, Andries A, Brixen K, Bilenberg N, Horder K. Gender differences in outcome of eating disorders: a retrospective cohort study. Psychiatry Res. 2011;186(2–3):362–6.

    Article  Google Scholar 

  28. Hay PJ, Touyz S, Sud R. Treatment for severe and enduring anorexia nervosa: a review. Aust N Z J Psychiatry. 2012;46(12):1136–44.

    Article  Google Scholar 

  29. Wonderlich S, Mitchell JE, Crosby RD, et al. Minimizing and treating chronicity in the eating disorders: a clinical overview. Int J Eat Disord. 2012;45(4):467–75.

    Article  Google Scholar 

  30. Harrison A, Mountford VA, Tchanturia K. Social anhedonia and work and social functioning in the acute and recovered phases of eating disorders. Psychiatry Res. 2014;218(1–2):187–94.

    Article  Google Scholar 

  31. Bamford BH, Mountford VA. Cognitive behavioural therapy for individuals with longstanding anorexia nervosa: adaptations, clinician survival and system issues. Eur Eat Disord Rev. 2012;20(1):49–59.

    Article  Google Scholar 

  32. Tchanturia K, Lloyd S, Lang K. Cognitive remediation therapy for anorexia nervosa: current evidence and future research directions. Int J Eat Disord. 2013;46(5):492–5.

    Article  Google Scholar 

  33. Lang K, Treasure J, Tchanturia K. Acceptability and feasibility of self-help cognitive remediation therapy for anorexia nervosa delivered in collaboration with carers: a qualitative preliminary evaluation study. Psychiatry Res. 2015;225(3):387–94.

    Article  Google Scholar 

  34. Mathews A, MacLeod C. Cognitive vulnerability to emotional disorders. Annu Rev Clin Psychol. 2005;1:167–95.

    Article  Google Scholar 

  35. Brockmeyer T, Schmidt U, Friederich HC. The ABBA study – approach bias modification in bulimia nervosa and binge eating disorder: study protocol for a randomised controlled trial. Trials. 2016;17:466.

    Article  Google Scholar 

  36. Cardi V, Esposito M, Bird G, et al. A preliminary investigation of a novel training to target cognitive biases towards negative social stimuli in Anorexia Nervosa. J Affect Disord. 2015;188:188–93.

    Article  Google Scholar 

  37. McClelland J, Bozhilova N, Nestler S, et al. Improvements in symptoms following neuronavigated repetitive transcranial magnetic stimulation (rTMS) in severe and enduring anorexia nervosa: findings from two case studies. Eur Eat Disord Rev. 2013;21(6):500–6.

    Article  Google Scholar 

  38. Downar J, Bakker N, Geraci J, et al. RTMS of the dorsomedial prefrontal cortex FFR binge and purge behaviours in refractory anorexia and bulimia nervosa: a case series. Biol Psychiatry. 2013;73(9):99S.

    Google Scholar 

  39. Blevins JE, Schwartz MW, Baskin DG. Evidence that paraventricular nucleus oxytocin neurons link hypothalamic leptin action to caudal brain stem nuclei controlling meal size. Am J Phys Regul Integr Comp Phys. 2004;287(1):R87–96.

    CAS  Google Scholar 

  40. Insel TR. The challenge of translation in social neuroscience: a review of oxytocin, vasopressin, and affiliative behavior. Neuron. 2010;65(6):768–79.

    Article  CAS  Google Scholar 

  41. Maguire S, O’Dell A, Touyz L, Russell J. Oxytocin anorexia nervosa: a review of the emerging literature. Eur Eat Disord Rev. 2013;21:475–8.

    Article  Google Scholar 

  42. Sabatier N, Leng G, Menzies J. Oxytocin, feeding, and satiety. Front Endocrinol. 2013;35(4):1–10.

    Google Scholar 

  43. Kim YR, Kim CH, Cardi V, Eom JS, Seong Y, Treasure J. Intranasal oxytocin attenuates attentional bias for eating and fat shape stimuli in patients with anorexia nervosa. Psychoneuroendocrinology. 2014;44:133–42.

    Article  CAS  Google Scholar 

  44. Kim YR, Kim CH, Park JH, Pyo J, Treasure J. The impact of intranasal oxytocin on attention to social emotional stimuli in patients with anorexia nervosa: a double blind within-subject cross-over experiment. PLoS One. 2014;9(3):e90721.

    Article  Google Scholar 

  45. Kim YR, Eom JS, Yang JW, Kang J, Treasure J. The impact of oxytocin on food intake and emotion recognition in patients with eating disorders: a double blind single dose within-subject cross-over design. PLoS One. 2015;10(9):e0137514.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Psychiatry, Seoul Paik Hospital, Inje University, Seoul, South Korea

    Youl-Ri Kim

  2. Institute of Eating Disorders and Mental Health, Inje University, Gimhae, South Korea

    Youl-Ri Kim & Jione Kim

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  1. Youl-Ri Kim
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  2. Jione Kim
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Editors and Affiliations

  1. Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea (Republic of)

    Yong-Ku Kim

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© 2019 Springer Nature Singapore Pte Ltd.

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Kim, YR., Kim, J. (2019). Treatment-Resistant Eating Disorders. In: Kim, YK. (eds) Treatment Resistance in Psychiatry. Springer, Singapore. https://doi.org/10.1007/978-981-10-4358-1_17

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  • DOI: https://doi.org/10.1007/978-981-10-4358-1_17

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-4357-4

  • Online ISBN: 978-981-10-4358-1

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