PSYCHODYNAMICALLY ORIENTATED TREATMENT IN ANOREXIA-NERVOSA - OVERVIEWAND SYSTEMATIC REVIEW

Psychodynamic approaches to treatment in anorexia nervosa (AN) remain influential. It is unclear, how a psychodynamic orientation influences outcome with this patient group. To our knowledge, there exists no sy stematic review (sensu Cochrane) of the subject. Methods: Extensive el ectronic and hand searches. were conduced (updated in December 1995) t o identify case reports and all longitudinal and comparison studies us ing ''psychodynamic'' treatment approaches, published in English, Fren ch and German. Case reports were examined for treatment ''components'' . Group studies meeting operationalised criteria were independently ra ted for methodological quality, 12 aspects of treatment and its delive ry (setting, type, orientation and focus) and therapy dose and duratio n. Effect sizes were calculated for post treatment and follow-up. Mult iple regression analysis was used to identify outcome predictors. Find ings: Six treatment comparison studies and seven follow-up studies met criteria. in most case reports and studies treatment included differe nt settings and techniques and an explicit focus on the symptom. In th e two studies directly comparing undifferentiated psychodynamic treatm ent and ''treatment as usual'' resp. with psychodynamically based diso rder specific treatments the latter had better results. Outpatient tre atment was as successful as inpatient treatment (in somewhat different populations). It was not possible to identify outcome predictors. Int erpretation: ''Psychodynamic'' treatment in AN is more pragmatic and d isorder orientated than generally acknowledged; patients seem to fare better in specialized treatment programmes delivered by experienced te ams; less cachectic patients can be treated as outpatients by a specia lized team. The exact contribution to treatment outcome of the psychod ynamic orientation remains to be delineated. There is a great need for well designed and well presented treatment outcome studies.