New treatments for eating disorders

Clinical eating disorders have one of the highest mortalities of any psychiatric category. They can be long lasting and life blighting. However, too often they are thought of by the general public, and sometimes even by health care professionals, either as trivial and perhaps glamorous or as rare and extraordinary.

A team of Leicester researchers is keen to correct these misconceptions and to portray eating disorders as important, serious, ordinary - and treatable. Getting better and escaping from an eating disorder is a demanding and active business but if sufferers can apply resolve and determination, modern treatments can provide reliable ladders that they use to climb back to health and a life worth living.

The researchers, based in the University of Leicester Department of Health Sciences (Division of Psychiatry), are conducting a major randomised controlled trial of psychological treatment for eating disorders, one of the largest ever trials of any psychological treatment.

Psychiatrist Dr Bob Palmer, a senior lecturer at the University, and his colleagues are comparing two new versions of cognitive behavioural therapy (CBT). The work, funded by a programme grant from the Wellcome Trust, is a joint project with the Department of Psychiatry at Oxford University, where the treatments have been developed by Professor Christopher Fairburn and Dr Zafra Cooper.

This two-centre study breaks new ground in a number of ways. Firstly, the treatments are novel and promise to be more effective than standard treatments.

Secondly, the recruitment of patients is aimed to be as wide and unselective as possible so as to avoid the criticism that research trials tend to select only 'special' or 'easy' patients. With few exceptions, if a patient referred to the Eating Disorders Service based at the Brandon Unit, run by Leicestershire Partnership NHS Trust, is confirmed as having an eating disorder, comes from a defined catchment area which the team calls 'Wellcomeshire' and consents to take part, then they are in the trial.

And thirdly, the trial is the first to include not only people with anorexia nervosa (AN) and bulimia nervosa (BN) but also the many patients who present with severe eating disorders that do not precisely fit either diagnosis. These people are often described as having 'atypical' disorders but the term is questionable since together they are numerous and not at all unusual. Furthermore, their disorders may be just as severe and serious as those that do neatly fit the full criteria. However, such cases have almost always been excluded from previous treatment research.

Dr Palmer explained: “People who suffer from either of the two main eating disorders - AN and BN - tend to worry to an unusual degree about weight, shape and eating. Ideas about weight and eating control seem to become tangled up with wider personal issues such as what they feel about themselves, what they think others think of them and so on. They usually try to control themselves and restrain their eating but the attempt at control itself gets out of control.

“The AN sufferer ‘succeeds’ but the control in eating restraint goes way too far and she finds herself at an abnormally low weight - sometimes dangerously so. The person with BN 'fails' in her efforts at restraint and breaks out into binge eating and may then desperately try to compensate for this by inducing vomiting or taking large quantities of laxatives. People with 'atypical' eating disorders usually share many of these features but have them in different combinations.”

The research being undertaken with Leicestershire Partnership NHS Trust aims to answer important questions about just how effective the newest treatments are and how they work. The project is more than half completed but it will be a couple more years before the results will be available.

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