Enhanced cognitive behavior therapy for severe and extreme anorexia nervosa: An outpatient case series

Int J Eat Disord. 2021 Mar;54(3):305-312. doi: 10.1002/eat.23428. Epub 2020 Nov 28.


Objective: The study aimed to assess outcomes in patients with severe and extreme anorexia nervosa managed with enhanced cognitive behavior therapy (CBT-E) in a real-world outpatient setting.

Method: Thirty patients with anorexia nervosa and body mass index (BMI) <16 aged ≥17 years were recruited from consecutive referrals to an eating disorder service clinic offering outpatient CBT-E. BMI and Eating Disorder Examination Questionnaire (EDE-Q), Brief Symptom Inventory (BSI), and Clinical Impairment Assessment (CIA) scores were recorded at admission, end of treatment, and 20- and 60-week follow-ups for treatment completers.

Results: Twenty patients (66.7%) completed the treatment and showed both considerable weight gain (Cohen's f = 1.43), and significantly reduced scores for clinical impairment (f = 1.26) and eating-disorder (f = 1.03) and general psychopathology (f = 0.99). Changes remained stable at both follow-ups. About half of the patients who completed treatment had a BMI ≥18.5 at the end of treatment and follow-ups.

Discussion: CBT-E seems suitable and promising for patients with severe and extreme anorexia nervosa seeking treatment in a real-world clinical setting, provided that their medical conditions are stable, and they have no current major depressive episodes or substance abuse; it may represent a valid alternative to inpatient treatment for those who are able to sustain engagement in a full course of outpatient treatment.

Keywords: anorexia nervosa; cognitive behavior therapy; extreme; outpatient treatment; severe; treatment outcomes.

MeSH terms

  • Ambulatory Care
  • Anorexia Nervosa* / therapy
  • Cognitive Behavioral Therapy*
  • Depressive Disorder, Major*
  • Humans
  • Outpatients
  • Treatment Outcome