**10. Challenges in Treating Anorexia Nervosa**

From the Lancet, "Stephan Zipfel and colleagues present results of the Anorexia Nervosa Treatment of OutPatients (ANTOP) study, in which two manual-based outpatient treatments (focal psychodynamic therapy and enhanced cognitive behaviour therapy) were compared with optimised treatment as usual, which included careful and regular monitoring by family doctors linked to care at specialist treatment

### *Anorexia Nervosa: Opportunities and Challenges in Treatment DOI: http://dx.doi.org/10.5772/intechopen.103751*

centres" [8]. The findings provide some rather sobering observations about treatment of anorexia nervosa, and highlight the difficulties of implementing clinical trials for this disorder. This include treatment for anorexia nervosa takes a long time, at an average of 10 months' duration. No brief interventions for the disorder have been judged effective. Also, response rate was low as almost a third of patients were lost to follow-up a year after the end of treatment (although, compared with other anorexia trials, this dropout rate is not bad). For many patients, psychotherapy alone did not suffice, and inpatient treatment was needed for some patients during the trial [8].

Challenges with residential treatment are of various dimensions and can include various factors, including intensity of treatment care and cost. If there is no insurance coverage, the cost of residential treatment can be difficult to afford, while some insurance companies will only cover a limited length of stay within residential care.

For some people, transiting from residential treatment to lower levels of treatment can be very difficult, as residents are not always prepared and equipped for the triggers of the outside world after their stay.

There should be allowances made for intermittent hospitalisations during anorexia outpatient trials because recovery from this disorder is rarely linear. Moreover, precipitous weight loss and other medical complications needing hospital treatment do not necessarily mean that outpatient care will ultimately fail.

Establishing a collaborative working relationship with families with a young person with anorexia nervosa presents a particular challenge that requires time and expertise to balance the competing needs of different family members.

A prominent challenge in treating anorexia is that people may not want treatment. Barriers to treatment include:


People receiving inpatient treatment for anorexia nervosa have been found to be twice as likely to drop out of treatment compared to general psychiatric inpatients [9].
