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Matching treatment of anorexia nervosa to need and acceptability

In spite of what we know about the effectiveness of treatments for eating disorders overall, there remain many questions of what is cost effective and/or acceptable for individual patients. The broad clinical presentation of anorexia nervosa over age and severity, and the paucity of evidence, means that there is great uncertainty whether any of the findings can be generalized. There needs to be a careful evaluation of the risks and resources and hence prognosis for individual patients. Matching the intensity and type of treatment to need involves a careful risk assessment of medical, clinical and psychosocial factors. There is a need to balance the severity of the weight loss against the resources that the patient has to implement renutrition and to judge whether starvation requires acute management. Inpatient treatment was regarded as standard, as reflected in the American Psychiatric Association guidelines. Indeed it is highly effective in correcting malnutrition in the short term although the long-term outcome is less certain. A wider range of management strategies may be more cost effective and acceptable. For example, the management plan may include day and outpatient care with complex mixes of types of therapy, and number of hours, over a variety of durations and with an individual and various members of the patient’s family. If there is less of a need for urgent attention to nutrition then it is possible to consider various forms of outpatient psychotherapy.

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