Skip to main content
Übersichtsarbeiten/Overview articles

Clinical Problems Encountered in the Treatment of Adolescents with Anorexia Nervosa

1Both authors contributed equally.

Published Online:https://doi.org/10.1024/1422-4917/a000259

The conceptualization of anorexia nervosa (AN) depends on the diagnostic criteria. Most patients with teenage onset AN seem to remit within 3–10 years depending on the definitions of recovery. The mortality of adolescent onset anorexia nervosa (AN) has fortunately decreased over the last two decades. Based on randomized controlled trials, we review different treatments including individual and group psychotherapy, family therapy, psychopharmacology, and hormone therapy. Treatment settings vary over time for any individual patient. Despite high rates of inpatient treatment, the respective evidence for effectiveness is meager. In underage patients with severe AN clinical, ethical and legal aspects need to be dealt with systematically if intermittent compulsory treatment is deemed necessary. The prolonged and frequently chronic course of AN often entails therapeutic discontinuity; the transition into adulthood requires a graded therapeutic concept that considers the severity of the disorder, developmental and chronological age, and parental involvement. Finally, we consider future clinical and research options to improve treatment and outcome of this eating disorder.


Klinische Herausforderungen in der Behandlung von Jugendlichen mit Anorexia nervosa

Unser Konzept vom Störungsbild Anorexia nervosa (AN) wird von den diagnostischen Kriterien bestimmt. Die Mehrheit der Patientinnen, die im Jugendalter an AN erkrankt sind, scheint nach Studienlage in Abhängigkeit von der Definition der Remission innerhalb von 3–10 Jahren zu remittieren. Die Mortalität der AN mit Beginn im Jugendalter ist glücklicherweise innerhalb der letzten zwei Dekaden gesunken. Basierend auf randomisiert-kontrollierten Studien stellen wir die verschiedenen Therapieoptionen vor, inklusive Psychotherapie, Psychopharmakologie und Hormontherapie. Das Behandlungssetting variiert bei jeder Patientin über die Zeit; die empirische Evidenz für die längerfristige Überlegenheit einer stationären Therapie ist trotz häufig durchgeführter stationärer Behandlungen als gering anzusehen. Wenn eine zwischenzeitliche Zwangsbehandlung bei minderjährigen Patientinnen mit schwerer AN notwendig erscheint, müssen klinische, ethische und juristische Aspekte systematisch abgewogen werden. Der langwierige und häufig chronische Verlauf der AN hat oft eine Behandlungsdiskontinuität zur Folge. Der Übergang ins Erwachsenenalter erfordert ein gestuftes therapeutisches Konzept, das abhängig ist von der Schwere der Erkrankung, dem Entwicklungs- und chronologischem Alter und der elterlichen Unterstützung. Abschließend beschäftigen wir uns mit zukünftigen notwendigen Forschungsfragen.

References

  • Allison, D. B. , Mentore, J. L. , Heo, M. , Chandler, L. P. , Cappelleri, J. C. , Infante, M. C. et al. (1999). Antipsychotic-induced weight gain: A comprehensive research synthesis. American Journal of Psychiatry, 156, 1686–1696. First citation in articleGoogle Scholar

  • American Psychiatric Association . (2006). Practice guideline for the treatment of patients with eating disorders (3rd ed.). Retrieved from psychiatryonline.org/pdfaccess.ashx?ResourceID=243187 &PDFSource=6 First citation in articleGoogle Scholar

  • Arcelus, J. , Bouman, W. P. , Morgan, J. F. (2008). Treating young people with eating disorders: Transition from child mental health to specialist adult eating disorder services. European Eating Disorders Review, 16, 30–36. First citation in articleCrossref MedlineGoogle Scholar

  • Arcelus, J. , Mitchell, A. J. , Wales, J. , Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Archives of General Psychiatry, 68, 724–731. First citation in articleCrossref MedlineGoogle Scholar

  • Bachar, E. , Latzer, Y. , Kreitler, S. , Berry, E. M. (1999). Empirical comparison of two psychological therapies. Self-psychology and cognitive orientation in the treatment of anorexia and bulimia. Journal of Psychotherapy Practice and Research, 8, 115–128. First citation in articleMedlineGoogle Scholar

  • Bergh, C. , Brodin, U. , Lindberg, G. , Sodersten, P. (2002). Randomized controlled trial of a treatment for anorexia and bulimia nervosa. Proceedings of the National Academy of Sciences of the United States of America, 99, 9486–9491. First citation in articleGoogle Scholar

  • Beumont, P. J. , Russell, J. D. , Touyz, S. W. (1993). Treatment of anorexia nervosa. Lancet, 26, 1635–1640. First citation in articleCrossrefGoogle Scholar

  • Biederman, J. , Herzog, D. B. , Rivinus, T. M. , Harper, G. P. , Ferber, R. A. , Rosenbaum, J. F. et al. (1985). Amitriptyline in the treatment of anorexia nervosa: A double-blind, placebo-controlled study. Journal of Clinical Psychopharmacology, 5, 10–16. First citation in articleCrossref MedlineGoogle Scholar

  • Bulik, C. M. , Sullivan, P. F. , Tozzi, F. , Furberg, H. , Lichtenstein, P. , Pedersen, N. L. (2006). Prevalence, heritability, and prospective risk factors for anorexia nervosa. Archives of General Psychiatry, 63, 305–312. First citation in articleCrossref MedlineGoogle Scholar

  • Carney, T. , Tait, D. , Touyz, S. (2007). Coercion is coercion? Reflections on trends in the use of compulsion in treating anorexia nervosa. Australasian Psychiatry, 15, 390–397. First citation in articleCrossref MedlineGoogle Scholar

  • Court, A. , Mulder, C. , Kerr, M. , Yuen, H. P. , Boasman, M. , Goldstone, S. et al. (2010). Investigating the effectiveness, safety and tolerability of quetiapine in the treatment of anorexia nervosa in young people: A pilot study. Journal of Psychiatric Research, 44, 1027–1034. First citation in articleCrossref MedlineGoogle Scholar

  • Couturier, J. , Kimber, M. , Szatmari, P. (2013). Efficacy of family-based treatment for adolescents with eating disorders: A systematic review and meta-analysis. International Journal of Eating Disorders, 46, 3–11. First citation in articleCrossref MedlineGoogle Scholar

  • Dimitropoulos, G. , Tran, A. F. , Agarwal, P. , Sheffield, B. , Woodside, B. (2012). Navigating the transition from pediatric to adult eating disorder programs: Perspectives of service providers. International Journal of Eating Disorders, 45, 759–767. First citation in articleCrossref MedlineGoogle Scholar

  • Divasta, A. D. , Feldman, H. A. , Giancaterino, C. , Rosen, C. J. , Leboff, M. S. , Gordon, C. M. (2012). The effect of gonadal and adrenal steroid therapy on skeletal health in adolescents and young women with anorexia nervosa. Metabolism, 61, 1010–1020. First citation in articleCrossref MedlineGoogle Scholar

  • Eisler, I. , Dare, C. , Hodes, M. , Russell, G. , Dodge, E. , Le Grange, D. (2000). Family therapy for adolescent anorexia nervosa: The results of a controlled comparison of two family interventions. Journal of Child Psychology and Psychiatry, 41, 727–736. First citation in articleCrossref MedlineGoogle Scholar

  • Exner, C. , Hebebrand, J. , Remschmidt, H. , Wewetzer, C. , Ziegler, A. , Herpertz, S. et al. (2000). Leptin suppresses semi-starvation induced hyperactivity in rats: Implications for anorexia nervosa. Journal of Molecular Psychiatry, 5, 476–481. First citation in articleCrossref MedlineGoogle Scholar

  • Fairburn, C. G. (2005). Evidence-based treatment of anorexia nervosa. International Journal of Eating Disorders, 37(Suppl.), S26–30, S41–S42. First citation in articleCrossrefGoogle Scholar

  • Faje, A. T. , Fazeli, P. K. , Katzman, D. K. , Miller, K. K. , Breggia, A. , Rosen, C. J. et al. (2012). Sclerostin levels and bone turnover markers in adolescents with anorexia nervosa and healthy adolescent girls. Bone, 51, 474–479. First citation in articleCrossref MedlineGoogle Scholar

  • Favaro, A. , Caregaro, L. , Tenconi, E. , Bosello, R. , Santonastaso, P. (2009). Time trends in age at onset of anorexia nervosa and bulimia nervosa. Journal of Clinical Psychiatry, 70, 1715–1721. First citation in articleCrossref MedlineGoogle Scholar

  • Fazeli, P. K. , Calder, G. L. , Miller, K. K. , Misra, M. , Lawson, E. A. , Meenaghan, E. et al. (2012). Psychotropic medication use in anorexia nervosa between 1997 and 2009. International Journal of Eating Disorders, 45, 970–976. First citation in articleCrossref MedlineGoogle Scholar

  • Fichter, M. M. , Quadflieg, N. (1999). Six-year course and outcome of anorexia nervosa. International Journal of Eating Disorders, 26, 359–385. First citation in articleCrossref MedlineGoogle Scholar

  • Fichter, M. M. , Quadflieg, N. , Hedlund, S. (2006). Twelve-year course and outcome predictors of anorexia nervosa. International Journal of Eating Disorders, 39, 87–100. First citation in articleCrossref MedlineGoogle Scholar

  • Fisher, C. A. , Hetrick, S. E. , Rushford, N. (2010). Family therapy for anorexia nervosa. Cochrane Database of Systematic Reviews, 14, CD004780. First citation in articleGoogle Scholar

  • Föcker, M. , Knoll, S. , Hebebrand, J. (2013). Anorexia nervosa. European Child and Adolescent Psychiatry, 22, 29–35. First citation in articleCrossrefGoogle Scholar

  • Föcker, M. , Timmesfeld, N. , Scherag, S. , Bühren, K. , Langkamp, M. , Dempfle, A. et al. (2011). Screening for anorexia nervosa via measurement of serum leptin levels. Journal of Neural Transmission, 118, 571–578. First citation in articleCrossref MedlineGoogle Scholar

  • Geist, R. , Heinmaa, M. , Stephens, D. , Davis, R. , Katzman, D. K. (2000). Comparison of family therapy and family group psychoeducation in adolescents with anorexia nervosa. Canadian Journal of Psychiatry, 45, 173–178. First citation in articleCrossref MedlineGoogle Scholar

  • Godart, N. , Berthoz, S. , Curt, F. , Perdereau, F. , Rein, Z. , Wallier, J. et al. (2012). A randomized controlled trial of adjunctive family therapy and treatment as usual following inpatient treatment for anorexia nervosa adolescents. PLoS One, 7, e28249. First citation in articleGoogle Scholar

  • Gordon, C. M. , Grace, E. , Emans, S. J. , Feldman, H. A. , Goodman, E. , Becker, K. A. et al. (2002). Effects of oral dehydroepiandrosterone on bone density in young women with anorexia nervosa: a randomized trial. Journal of Clinical Endocrinology and Metabolism, 87, 4935–4941. First citation in articleCrossref MedlineGoogle Scholar

  • Gordon, C. M. , Grace, E. , Emans, S. J. , Goodman, E. , Crawford, M. H. , Leboff, M. S. (1999). Changes in bone turnover markers and menstrual function after short-term oral DHEA in young women with anorexia nervosa. Journal of Bone and Mineral Research, 14, 136–145. First citation in articleCrossref MedlineGoogle Scholar

  • Gowers, S. , Norton, K. , Halek, C. , Crisp, A. H. (1994). Outcome of outpatient psychotherapy in a random allocation treatment study of anorexia nervosa. International Journal of Eating Disorders, 15, 165–177. First citation in articleCrossref MedlineGoogle Scholar

  • Gowers, S. G. , Clark, A. , Roberts, C. , Griffiths, A. , Edwards, V. , Bryan, C. et al. (2007). Clinical effectiveness of treatments for anorexia nervosa in adolescents: Randomized controlled trial. British Journal of Psychiatry, 191, 427–435. First citation in articleCrossref MedlineGoogle Scholar

  • Gross, H. A. , Ebert, M. H. , Faden, V. B. , Goldberg, S. C. , Nee, L. E. , Kaye, W. H. (1981). A double-blind controlled trial of lithium carbonate primary anorexia nervosa. Journal of Clinical Psychopharmacology, 1, 376–381. First citation in articleCrossref MedlineGoogle Scholar

  • Guarda, A. S. , Pinto, A. M. , Coughlin, J. W. , Hussain, S. , Haug, N. A. , Heinberg, L. J. (2007). Perceived coercion and change in perceived need for admission in patients hospitalized for eating disorders. American Journal of Psychiatry, 164, 108–114. First citation in articleCrossref MedlineGoogle Scholar

  • Gueguen, J. , Godart, N. , Chambry, J. , Brun-Eberentz, A. , Foulon, C. , Divac, S. M. et al. (2012). Severe anorexia nervosa in men: Comparison with severe AN in women and analysis of mortality. International Journal of Eating Disorders, 45, 537–545. First citation in articleCrossref MedlineGoogle Scholar

  • Hagman, J. , Gralla, J. , Sigel, E. , Ellert, S. , Dodge, M. , Gardner, R. et al. (2011). A double-blind, placebo-controlled study of risperidone for the treatment of adolescents and young adults with anorexia nervosa: A pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 915–924. First citation in articleCrossref MedlineGoogle Scholar

  • Hall, A. (1987). The place of family therapy in the treatment of anorexia nervosa. Australian and New Zealand Journal of Psychiatry, 21, 568–574. First citation in articleCrossref MedlineGoogle Scholar

  • Halmi, K. A. , Eckert, E. , LaDu, T. J. , Cohen, J. (1986). Anorexia nervosa. Treatment efficacy of cyproheptadine and amitriptyline. Archives of General Psychiatry, 43, 177–181. First citation in articleCrossref MedlineGoogle Scholar

  • Hebebrand, J. (2011). Pharmacotherapy of anorexia nervosa: More questions than answers. Journal of the American Academy for Child and Adolescent Psychiatry, 50, 854–856. First citation in articleCrossref MedlineGoogle Scholar

  • Hebebrand, J. , Albayrak, O. (2012). Leptin treatment of patients with anorexia nervosa? The urgent need for initiation of clinical studies. European Child and Adolescent Psychiatry, 21, 63–66. First citation in articleCrossref MedlineGoogle Scholar

  • Hebebrand, J. , Bulik, C. M. (2011). Critical appraisal of the provisional DSM-5 criteria for anorexia nervosa and an alternative proposal. International Journal of Eating Disorders, 44, 665–678. First citation in articleCrossref MedlineGoogle Scholar

  • Hebebrand, J. , Himmelmann, G. W. , Herzog, W. , Herpertz-Dahlmann, B. M. , Steinhausen, H. C. , Amstein, M. et al. (1997). Prediction of low body weight at long-term follow-up in acute anorexia nervosa by low body weight at referral. American Journal of Psychiatry, 154, 566–569. First citation in articleCrossref MedlineGoogle Scholar

  • Hebebrand, J. , Muller, T. D. , Holtkamp, K. , Herpertz-Dahlmann, B. (2007). The role of leptin in anorexia nervosa: Clinical implications. Molecular Psychiatry, 12, 23–35. First citation in articleCrossref MedlineGoogle Scholar

  • Herpertz, S. , Hagenah, U. , Vocks, S. , von Wietersheim, J. , Cuntz, U. , Zeeck, A. , German Society of Psychosomatic Medicine and Psychotherapy, German College for Psychosomatic Medicine . (2011). The diagnosis and treatment of eating disorders. Deutsches Ärzteblatt, 108, 678–685. Retrieved from www.awmf.org/uploads/tx_szleitlinien/051026m_S3_Diagnostik_Therapie_Essstoerungen.pdf First citation in articleGoogle Scholar

  • Herpertz-Dahlmann, B. M. , Muller, B. , Herpertz, S. , Heussen, N. , Hebebrand, J. , Remschmidt, H. et al. (2001). Prospective 10-year follow-up in adolescent anorexia nervosa – Course, outcome, psychiatric comorbidity, and psychosocial adaptation. Journal of Child Psychology and Psychiatry, 42, 603–612. First citation in articleCrossref MedlineGoogle Scholar

  • Herpertz-Dahlmann, B. M. , Remschmidt, H. (1993). Depression in anorexia nervosa at follow-up. International Journal of Eating Disorders, 14, 163–169. First citation in articleCrossref MedlineGoogle Scholar

  • Herpertz-Dahlmann, B. M. , Salbach-Andrae, H. (2009). Overview of treatment modalities in adolescent anorexia nervosa. Child and Adolescent Psychiatric Clinics of North America, 18, 131–145. First citation in articleCrossref MedlineGoogle Scholar

  • Herpertz-Dahlmann, B. M. , Wewetzer, C. , Schulz, E. , Remschmidt, H. (1996). Course and outcome in adolescent anorexia nervosa. International Journal of Eating Disorders, 19, 335–345. First citation in articleCrossref MedlineGoogle Scholar

  • Hill, K. , Bucuvalas, J. , McClain, C. , Kryscio, R. , Martini, R. T. , Alfaro, M. P. et al. (2000). Pilot study of growth hormone administration during the refeeding of malnourished anorexia nervosa patients. Journal of Child and Adolescent Psychopharmacology, 10, 3–8. First citation in articleCrossref MedlineGoogle Scholar

  • Ho, B. C. , Andreasen, N. C. , Ziebell, S. , Pierson, R. , Magnotta, V. (2011). Long-term antipsychotic treatment and brain volumes: A longitudinal study of first-episode schizophrenia. Archives of General Psychiatry, 68, 128–137. First citation in articleCrossref MedlineGoogle Scholar

  • Holm, J. S. , Brixen, K. , Andries, A. , Hörder, K. , Stöving, R. K. (2012). Reflections on involuntary treatment in the prevention of fatal anorexia nervosa: A review of five cases. International Journal of Eating Disorders, 45, 93–100. First citation in articleCrossref MedlineGoogle Scholar

  • Holtkamp, K. , Herpertz-Dahlmann, B. , Vloet, T. , Hagenah, U. (2005). Group psychoeducation for parents of adolescents with eating disorders: The Aachen program. Journal of Eating Disorders, 13, 381–390. First citation in articleCrossref MedlineGoogle Scholar

  • House, J. , Schmidt, U. , Craig, M. , Landau, S. , Simic, M. , Nicholls, D. et al. (2012). Comparison of specialist and nonspecialist care pathways for adolescents with anorexia nervosa and related eating disorders. International Journal of Eating Disorders, 45, 949–956. First citation in articleCrossref MedlineGoogle Scholar

  • Kafantaris, V. , Leigh, E. , Hertz, S. , Berest, A. , Schebendach, J. , Sterling, W. M. et al. (2011). A placebo-controlled pilot study of adjunctive olanzapine for adolescents with anorexia nervosa. Journal of Child and Adolescent Psychopharmacology, 21, 207–212. First citation in articleCrossref MedlineGoogle Scholar

  • Keel, P. K. , Brown, T. A. (2010). Update on course and outcome in eating disorders. International Journal of Eating Disorders, 43, 195–204. First citation in articleCrossref MedlineGoogle Scholar

  • Keski-Rahkonen, A. , Hoek, H. W. , Susser, E. S. , Linna, M. S. , Sihvola, E. , Raevuori, A. et al. (2007). Epidemiology and course of anorexia nervosa in the community. American Journal of Psychiatry, 164, 1259–1265. First citation in articleCrossref MedlineGoogle Scholar

  • Knoll, S. , Bulik, C. M. , Hebebrand, J. (2011). Do the currently proposed DSM-5 criteria for anorexia nervosa adequately consider developmental aspects in children and adolescents? European Child and Adolescent Psychiatry, 20, 95–101. First citation in articleCrossref MedlineGoogle Scholar

  • Krauth, C. , Buser, K. , Vogel, H. (2002). How high are the costs of eating disorders – anorexia nervosa and bulimia nervosa – for German society? European Journal of Health Economics, 3, 244–250. First citation in articleCrossref MedlineGoogle Scholar

  • Le Grange, D. , Eisler, I. , Dare, C. , Russel, G.F. M. (1992). Evaluation of family treatments in adolescent anorexia nervosa: A pilot study. International Journal of Eating Disorders, 12, 347–357. First citation in articleCrossrefGoogle Scholar

  • Le Grange, D. , Swanson, S. A. , Crow, S. J. , Merikangas, K. R. (2012). Eating disorder not otherwise specified presentation in the US population. International Journal of Eating Disorders, 45, 711–718. First citation in articleCrossref MedlineGoogle Scholar

  • Lebow, J. , Sim, L. A. , Erwin, P. J. , Murad, M. H. (2013). The effect of atypical antipsychotic medications in individuals with anorexia nervosa: A systematic review and meta-analysis. International Journal of Eating Disorders, 46, 332–339. First citation in articleCrossref MedlineGoogle Scholar

  • Lock, J. , Agras, W. S. , Bryson, S. , Kraemer, H. C. (2005). A comparison of short- and long-term family therapy for adolescent anorexia nervosa. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 632–639. First citation in articleCrossref MedlineGoogle Scholar

  • Lock, J. , Le Grange, D. (2001). Can family-based treatment of anorexia nervosa be manualized? Journal of Psychotherapy Practice Research, 10, 253–261. First citation in articleMedlineGoogle Scholar

  • Lock, J. , Le Grange, D. , Agras, W. S. , Moye, A. , Bryson, S. W. , Jo, B. (2010). Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Archives of General Psychiatry, 67, 1025–1032. First citation in articleCrossref MedlineGoogle Scholar

  • Lucas, A. R. , Beard, C. M. , O’Fallon, W. M. , Kurland, L. T. (1991). 50-year trends in the incidence of anorexia nervosa in Rochester, Minn.: A population-based study. American Journal of Psychiatry, 148, 917–922. First citation in articleCrossref MedlineGoogle Scholar

  • Misra, M. , Katzman, D. , Miller, K. K. , Mendes, N. , Snelgrove, D. , Russell, M. et al. (2011). Physiologic estrogen replacement increases bone mass density in adolescent girls with anorexia nervosa. Journal of Bone and Mineral Research, 88, 5615–5623. First citation in articleGoogle Scholar

  • Mitrany, E. , Melamed, Y. (2005). Compulsory treatment of anorexia nervosa. Israel Journal of Psychiatry and Related Sciences, 42, 185–190. First citation in articleMedlineGoogle Scholar

  • Munoz-Solomando, A. , Townley, M. , Williams, R. (2010). Improving transitions for young people who move from child and adolescent mental health services to mental health services for adults: Lessons from research and young people’s and practitioners’ experiences. Current Opinion in Psychiatry, 23, 311–317. First citation in articleCrossref MedlineGoogle Scholar

  • National Institut for Health and Clinical Excellence (NICE) . (2004). Eating disorders. Retrieved from www.nice.org.uk/nicemedia/live/10932/29218/29218.pdf First citation in articleGoogle Scholar

  • Nilsson, K. , Hägglöf, B. (2005). Long-term follow-up of adolescent onset anorexia nervosa in Northern Sweden. European Eating Disorders Review, 13, 89–100. First citation in articleCrossrefGoogle Scholar

  • Preti, A. , Girolamo, Gd. , Vilagut, G. , Alonso, J. , Graaf, Rd. , Bruffaerts, R. et al. (2009). The epidemiology of eating disorders in six European countries: Results of the ESEMeD-WMH project. Journal of Psychiatric Research, 43, 1125–1132. First citation in articleCrossref MedlineGoogle Scholar

  • Ramsay, R. , Ward, A. , Treasure, J. , Russell, G. F. (1999). Compulsory treatment in anorexia nervosa. Short-term benefits and long-term mortality. British Journal of Psychiatry, 175, 147–153. First citation in articleCrossref MedlineGoogle Scholar

  • Råstam, M. , Gillberg, I. C. , Gillberg, C. (1995). Anorexia nervosa 6 years after onset: Part II. Comorbid psychiatric problems. Comprehensive Psychiatry, 36, 70–76. First citation in articleCrossref MedlineGoogle Scholar

  • Robin, A. L. , Siegel, P. T. , Koepke, T. , Moye, A. W. , Tice, S. (1994). Family therapy versus individual therapy for adolescent females with anorexia nervosa. Journal of Developmental and Behavioral Pediatrics, 15, 111–116. First citation in articleCrossref MedlineGoogle Scholar

  • Robin, A. L. , Siegel, P. T. , Moye, A. W. , Gilroy, M. , Dennis, A. B. , Sikand, A. (1999). A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1482–1489. First citation in articleCrossref MedlineGoogle Scholar

  • Russell, G. F. , Szmukler, G. I. , Dare, C. , Eisler, I. (1987). An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Archives of General Psychiatry, 44, 1047–1056. First citation in articleCrossref MedlineGoogle Scholar

  • Smink, F. R. , van Hoeken, D. , Hoek, H. W. (2012). Epidemiology of eating disorders: Incidence, prevalence and mortality rates. Current Psychiatry Reports, 14, 406–414. First citation in articleGoogle Scholar

  • Steinhausen, H. C. (2002). The outcome of anorexia nervosa in the 20th century. American Journal of Psychiatry, 159, 1284–1293. First citation in articleCrossref MedlineGoogle Scholar

  • Steinhausen, H. C. (2009). Outcome of eating disorders. Child and Adolescent Psychiatric Clinics of North America, 18, 225–242. First citation in articleCrossref MedlineGoogle Scholar

  • Steinhausen, H. C. , Boyadjieva, S. , Grigoroiu-Serbanescu, M. , Neumärker, K. J. (2003). The outcome of adolescent eating disorders: Findings from an international collaboration study. European Child and Adolescent Psychiatry, 12, 191–198. First citation in articleGoogle Scholar

  • Steinhausen, H. C. , Grigoroiu-Serbanescu, M. , Boyadjieva, S. , Neumärker, K. J. , Metzke, C. W. (2009). The relevance of body weight in the medium-term to long-term course of adolescent anorexia nervosa. Findings from a multisite study. International Journal of Eating Disorders, 42, 19–25. First citation in articleCrossref MedlineGoogle Scholar

  • Strober, M. , Freeman, R. , Morrell, W. (1997). The long-term course of severe anorexia nervosa in adolescents: Survival analysis of recovery, relapse, and outcome predictors over 10–15 years in a prospective study. International Journal of Eating Disorders, 22, 339–360. First citation in articleCrossref MedlineGoogle Scholar

  • Swanson, S. A. , Crow, S. J. , Le Grange, D. , Swendsen, J. , Merikangas, K. R. (2011). Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement. Archives General Psychiatry, 68, 714–723. First citation in articleCrossref MedlineGoogle Scholar

  • Tan, J. O. , Hope, P. T. , Stewart, D. A. , Fitzpatrick, P. R. (2006). Competence to make treatment decisions in anorexia nervosa: Thinking processes and values. Philosophy, Psychiatry and Psychology, 13, 267–282. First citation in articleGoogle Scholar

  • Tan, J. O. , Stewart, A. , Fitzpatrick, R. , Hope, T. (2010). Attitudes of patients with anorexia nervosa to compulsory treatment and coercion. International Journal of Law and Psychiatry, 33, 13–19. First citation in articleCrossref MedlineGoogle Scholar

  • Thiels, C. (2008). Forced treatment of patients with anorexia. Current Opinion in Psychiatry, 21, 495–498. First citation in articleCrossref MedlineGoogle Scholar

  • Treasure, J. , Schmidt, U. , Hugo, P. (2005). Mind the gap: Service transition and interface problems for patients with eating disorders. British Journal of Psychiatry, 187, 398–400. First citation in articleCrossref MedlineGoogle Scholar

  • Uher, R. , Rutter, M. (2012). Classification of feeding and eating disorders: Review of evidence and proposals for ICD-11. World Psychiatry, 11, 80–92. First citation in articleCrossref MedlineGoogle Scholar

  • van Son, G. E. , van Hoeken, D. , Bartelds, A. I. , van Furth, E. F. , Hoek, H. W. (2006). Time trends in the incidence of eating disorders: A primary care study in the Netherlands. International Journal of Eating Disorders, 39, 565–569. First citation in articleCrossref MedlineGoogle Scholar

  • Vostanis, P. (2005). Patients as parents and young people approaching adulthood: How should we manage the interface between mental health services for young people and adults? Current Opinion in Psychiatry, 18, 449–454. First citation in articleCrossref MedlineGoogle Scholar

  • Wallin, U. , Kronovall, P. , Majewski, M. L. (2000). Body awareness therapy in teenage anorexia nervosa: Outcome after 2 years. European Eating Disorders Review, 8, 19–30. First citation in articleCrossrefGoogle Scholar

  • Watson, T. L. , Bowers, W. A. , Andersen, A. E. (2000). Involuntary treatment of eating disorders. American Journal of Psychiatry, 157, 1806–1810. First citation in articleCrossref MedlineGoogle Scholar

  • Wentz, E. , Gillberg, C. , Gillberg, I. C. , Råstam, M. (2001). Ten-year follow-up of adolescent-onset anorexia nervosa: Psychiatric disorders and overall functioning scales. Journal of Child Psychology and Psychiatry, 42, 613–622. First citation in articleCrossref MedlineGoogle Scholar

  • Wentz, E. , Gillberg, I. C. , Anckarsäter, H. , Gillberg, C. , Råstam, M. (2009). Adolescent-onset anorexia nervosa: 18-year outcome. British Journal of Psychiatry, 194, 168–174. First citation in articleCrossref MedlineGoogle Scholar

  • Wilson, A. J. , Touyz, S. W. , O’Connor, M. , Beumont, P. J. (1985). Correcting the eating disorder in anorexia nervosa. Journal of Psychiatry Research, 19, 449–451. First citation in articleCrossref MedlineGoogle Scholar

  • Wilson, G. T. , Grilo, C. M. , Vitousek, K. M. (2007). Psychological treatment of eating disorders. American Psychologist, 62, 199–216. First citation in articleCrossref MedlineGoogle Scholar

  • Zucker, N. L. , Marcus, M. , Bulik, C. (2006). A group parent-training program: A novel approach for eating disorder management. Eating and Weight Disorders, 11, 78–92. First citation in articleCrossref MedlineGoogle Scholar