Skip to main content

Psychological therapies for adults with anorexia nervosa: Randomised controlled trial of out-patient treatments

  • Chris Dare (a1), Ivan Eisler (a1), Gerald Russell (a2), Janet Treasure (a1) and Liz Dodge (a3)...

Currently, without systematic evidence, psychotherapy for anorexia nervosa in adults draws on psychodynamic, cognitive and systemic theories.


To assess effectiveness of specific psychotherapies in out-patient management of adult patients with anorexia nervosa.


Eighty-four patients were randomised to four treatments: three specific psychotherapies – (a) a year of focal psychoanalytic psychotherapy; (b) 7 months of cognitive-analytic therapy (CAT); (c) family therapy for 1 year – and (d) low contact, ‘routine’ treatment for 1 year (control).


At 1 year, there was symptomatic improvement in the whole group of patients. This improvement was modest, several patients being significantly undernourished at follow-up. Psychoanalytic psychotherapy and family therapy were significantly superior to the control treatment; CAT tended to show benefits.


Psychoanalytic and family therapy are of specific value in the out-patient treatment of adult patients with anorexia.

Corresponding author
Dr Christopher Dare, Section of Psychotherapy, Department of Psychiatry, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF
Hide All

Declaration of interest

Research support comes from the Leverhulme Foundation and the Mental Health Research Fund.

Hide All
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). Washington, DC: APA.
Channon, S., De Silva, W. P., Hemsley, D., et al (1989) A controlled trial of cognitive–behavioural and behavioural treatment of anorexia nervosa. Behaviour Research and Therapy, 27, 529535.
Crisp, A. H., Norton, K., Gowers, S., et al (1991) A controlled study of the effect of therapies aimed at adolescent and family psychopathology in anorexia nervosa. British Journal of Psychiatry, 159, 325333.
Dare, C. (1991) The place of psychotherapy in the management of anorexia nervosa. In Psychotherapy in Psychiatric Practice (ed. Holmes, J.), pp. 395418. Edinburgh: Churchill Livingstone.
Dare, C. (1995) Psychoanalytic psychotherapy (of eating disorders). In Treatment of Psychiatric Disorders (ed. Gabbard, G. O.), pp. 21292151. Washington, DC: American Psychiatric Press.
Dare, C. & Crowther, C. (1995) Living dangerously: psychoanalytic psychotherapy of anorexia nervosa. In Eating Disorders: Handbook of Theory, Treatment and Research (eds Szmukler, G., Dare, C. & Treasure, J.). Chichester: John Wiley & Sons.
Dare, C. & Eisler, I. (1995) Family therapy. In Eating Disorders: Handbook of Theory, Treatment and Research (eds Szmukler, G., Dare, C. & Treasure, J.). Chichester: John Wiley & Sons.
Eisler, I., Dare, C., Russell, G. F. M., et al (1997) Family and individual therapy in anorexia nervosa. Archives of General Psychiatry, 54, 10251030.
Eisler, I., Dare, C., Hodes, M., et al (2000) Family therapy for anorexia nervosa in adolescents: the results of a controlled comparison of two family interventions. Journal of Child Psychology and Psychiatry, 41, 727736.
Fairburn, C. G. (1997) Eating disorders. In Science and Practice of Cognitive Behaviour Therapy (eds Clark, D. M. & Fairburn, C. G.), pp. 209241. Oxford: Oxford University Press.
Fairburn, C. G. Norman, P. A., Welch, S. L., et al (1995) A prospective study of outcome in bulimia nervosa and the long-term effects of three psychological treatments. Archives of General Psychiatry, 52, 304312.
Gowers, S., Norton, K., Yeldham, D., et al (1988) The St Georges prospective treatment study of anorexia nervosa: a discussion of methodological problems. In Eating Disorders in Adolescents and Young Women (eds Hardoff, D. & Chigier, E.), pp. 301311. London: Freund.
Hamburg, P. (1996) How long is long-term therapy for anorexia nervosa? In Treating Eating Disorders (ed. Werne, J.), pp. 7199. San Francisco, CA: Jossey-Bass.
Johnson, C., (ed.) (1991) Psychodynamic Treatment of Anorexia Nervosa and Bulimia. New York: Guilford.
Malan, D. H. (1976) Toward the Validation of Dynamic Psychotherapy. New York: Plenum.
Morgan, H. G. & Russell, G. F. M. (1975) Value of family background and clinical features as predictors of long-term outcome in anorexia nervosa. Psychological Medicine, 5, 355371.
Pocock, S. J. (1983) Clinical Trials: A Practical Approach. Chichester: John Wiley & Sons.
Robin, L., Siegel, P. T. & Moye, A. (1995) Family versus individual therapy for anorexia: impact on family conflict. Topical Section: treatment and therapeutic processes. International Journal of Eating Disorders, 17, 313322.
Russell, G. F. M., Szmukler, G., Dare, C., et al (1987) An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Archives of General Psychiatry, 44, 10471056.
Ryle, A. (1990) Cognitive–analytic Therapy: Active Participation in Change. London: John Wiley & Sons.
Schmidt, U. & Marks, I. M. (1989) Exposure plus prevention of bingeing vs. exposure plus prevention of vomiting in bulimia nervosa: a crossover study. Journal of Nervous and Mental Disease, 177, 259266.
Sours, J. A. (1980) Starving to Death in a Sea of Objects: The Anorexia Nervosa Syndrome. New York: Jason Aronson.
Treasure, J., Todd, G., Brolly, M., et al (1995) A pilot study of a randomised trial of cognitive analytical therapy vs educational behavioural therapy for adult anorexia nervosa. Behaviour Research and Therapy, 33, 363367.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 11 *
Loading metrics...

Abstract views

Total abstract views: 41 *
Loading metrics...

* Views captured on Cambridge Core between 3rd January 2018 - 19th March 2018. This data will be updated every 24 hours.

Psychological therapies for adults with anorexia nervosa: Randomised controlled trial of out-patient treatments

  • Chris Dare (a1), Ivan Eisler (a1), Gerald Russell (a2), Janet Treasure (a1) and Liz Dodge (a3)...
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *