Treatment-Resistant Eating Disorders
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.
KeywordsEating disorder Anorexia nervosa Bulimia nervosa Binge eating disorder Cognitive remediation therapy Oxytocin
- 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
- 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
- 23.Department of Health. The NHS improvement plan. 2004. www.dh.gov.uk/publications.
- 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.Google Scholar
- 42.Sabatier N, Leng G, Menzies J. Oxytocin, feeding, and satiety. Front Endocrinol. 2013;35(4):1–10.Google Scholar