Development of Innovative Interventions for Adult Anorexia Nervosa
Mark Chavez, Ph.D.
Program Chief, Eating Disorders Research Program
Division of Adult Translational Research and Treatment Development
This initiative would encourage pilot intervention studies to develop novel, innovative treatments for Anorexia Nervosa (AN) in older adolescents and adults.
The core features of Anorexia Nervosa include severe food restriction, maintenance of abnormally low body weight, an intense fear of gaining weight even though underweight, and an excessive influence of body weight and shape on self-evaluation. AN is often associated with severe medical complications, substantial psychiatric comorbidities, and has a mortality rate as high as any psychiatric illness. This disorder usually begins during mid- to late-adolescence or early adulthood, and often runs a chronic course, resulting in the majority of individuals with AN being older adolescents and adults.
Although there are substantial gaps in knowledge regarding evidence-based treatments for both adolescent and adult AN populations, family-based therapy appears to be a promising treatment for younger adolescents who have been ill for a relatively short period of time. Currently there are both large and small scale NIMH-supported intervention studies assessing the efficacy of different treatment modalities, including family therapy, for adolescents with AN. In contrast, there are currently no clearly efficacious, evidenced-based treatments that target the core symptoms of AN in adults, and many of the standard treatments (e.g., cognitive behavioral therapy, interpersonal therapies, exposure therapy with response prevention, selective serotonin reuptake inhibitors, etc.) that have been shown to be relatively effective for other psychiatric disorders have not been efficacious for AN.
In a recent NIH workshop convened to address the research priorities for AN treatment, one area identified as ripe for development was supporting novel small-scale AN intervention studies that could be used to guide future larger scale research efforts (for the report describing the proceedings of the NIH workshop focusing on the development of research priorities for AN, please see http://www3.interscience.wiley.com/cgi-bin/abstract/108068601/).
To address the challenges mentioned above, this potential initiative would encourage pilot intervention studies to develop novel, innovative treatments for AN in older adolescents and adults. It is important to note that this initiative would not solicit applications that focus on slight modification of existing treatments for AN.
Below are types of approaches for which applications would be solicited. The list is not exhaustive, and it is expected that additional important research topics may be identified.
- Critical interventions that explore optimal approaches to refeeding that lead to sustained weight gain, minimize relapse, and are tolerable to patients.
- Trials of novel medications that target the core cognitive symptoms and biological processes of AN.
- Tests of novel psychotherapeutic and/or medication interventions that have been shown to be effective for other psychiatric disorders (e.g., OCD, drug addictions, depression) and are tailored to the unique core pathology of eating disorders (e.g., drive for thinness, body dissatisfaction, appetite dysregulation).
- Optimal formats for therapy-delivery for late adolescents or adults with AN (e.g. individual therapy, group therapy, family therapy, or couples therapy.
- Innovative and novel interventions combining medications and behavioral interventions (e.g., psychotherapy).
- Innovative interventions that supplement traditional face-to-face interventions with email, the Internet, personal digital assistants, text messaging, chat, and other technological approaches.
This initiative was published as RFA-MH-07-090: Innovative Trials for the Treatment of Anorexia Nervosa in Late Adolescence and Adulthood (R01).
For a broader description of the NIMH research areas of interest for eating disorders, please refer to the following standing NIMH program announcement “Translational Research on Eating Disorders” (http://grants1.nih.gov/grants/guide/pa-files/PA-07-285.html).