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Treating severe and enduring anorexia nervosa: a randomized controlled trial

  • S. Touyz (a1), D. Le Grange (a2), H. Lacey (a3), P. Hay (a4) (a5), R. Smith (a1), S. Maguire (a1), B. Bamford (a3), K. M. Pike (a6) and R. D. Crosby (a7)...

There are no evidence-based treatments for severe and enduring anorexia nervosa (SE-AN). This study evaluated the relative efficacy of cognitive behavioral therapy (CBT-AN) and specialist supportive clinical management (SSCM) for adults with SE-AN.


Sixty-three participants with a diagnosis of AN, who had at least a 7-year illness history, were treated in a multi-site randomized controlled trial (RCT). During 30 out-patient visits spread over 8 months, they received either CBT-AN or SSCM, both modified for SE-AN. Participants were assessed at baseline, end of treatment (EOT), and at 6- and 12-month post-treatment follow-ups. The main outcome measures were quality of life, mood disorder symptoms and social adjustment. Weight, eating disorder (ED) psychopathology, motivation for change and health-care burden were secondary outcomes.


Thirty-one participants were randomized to CBT-AN and 32 to SSCM with a retention rate of 85% achieved at the end of the study. At EOT and follow-up, both groups showed significant improvement. There were no differences between treatment groups at EOT. At the 6-month follow-up, CBT-AN participants had higher scores on the Weissman Social Adjustment Scale (WSAS; p = 0.038) and at 12 months they had lower Eating Disorder Examination (EDE) global scores (p = 0.004) and higher readiness for recovery (p = 0.013) compared to SSCM.


Patients with SE-AN can make meaningful improvements with both therapies. Both treatments were acceptable and high retention rates at follow-up were achieved. Between-group differences at follow-up were consistent with the nature of the treatments given.

Corresponding author
*Address for correspondence: S. Touyz, Ph.D., School of Psychology and Centre for Eating and Dieting Disorders (Boden Institute), School of Psychology, Room 151, Mackie Bldg K01, University of Sydney, 2006 NSW, Australia. (Email:
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Psychological Medicine
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