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. 1977 Nov 5;117(9):1041–1045.

Prognosis in anorexia nervosa as influenced by clinical features, treatment and self-perception.

P E Garfinkel, H Moldofsky, D M Garner
PMCID: PMC1880207  PMID: 912628

Abstract

The use of behaviour modification in the treatment of anorexia nervosa has been controversial and has not undergone controlled studies. An investigation of 42 patients with anorexia nervosa treated a mean of 31.7 months earlier was conducted to determine factors related to prognosis. The three areas studied were (a) clinical features, (b) treatment (behaviour modification versus medical and psychologic therapy) and (c) self-perception (with a distorting photographic technique). Clinical outcome was assessed as "excellent" in 7, "much improved" in 14, "symptomatic" in 13 and "poor" In 8. Analysis of variance showed that vomiting (P less than 0.01), bulimia (P less than 0.01), poor educational/vocational adjustment (P less than 0.01) and higher global clinical score (P less than 0.001) were associated with a poor prognosis. There were no differences at follow-up between patients treated by behaviour modification and those treated by other methods; the data suggest that behaviour modification, while not harmful, does not provide long-term benefits. Self-estimates of body size were highly predictive of outcome (P less than 0.002); all patients with a poor outcome overestimated their size. Patients with only marginal improvement might be helped by treatment directed to self-perceptual disturbances.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Agras W. S., Barlow D. H., Chapin H. N., Abel G. G., Leitenberg H. Behavior modification of anorexia nervosa. Arch Gen Psychiatry. 1974 Mar;30(3):279–286. doi: 10.1001/archpsyc.1974.01760090003001. [DOI] [PubMed] [Google Scholar]
  2. Azerrad J., Stafford R. L. Restoration of eating behavior in anorexia nervosa through operant conditioning and environmental manipulation. Behav Res Ther. 1969 May;7(2):165–171. doi: 10.1016/0005-7967(69)90028-x. [DOI] [PubMed] [Google Scholar]
  3. Bhanji S., Thompson J. Operant conditioning in the treatment of anorexia nervosa: a review and retrospective study of 11 cases. Br J Psychiatry. 1974 Feb;124(579):166–172. doi: 10.1192/bjp.124.2.166. [DOI] [PubMed] [Google Scholar]
  4. Crisp A. H., Kalucy R. S. Aspects of the perceptual disorder in anorexia nervosa. Br J Med Psychol. 1974 Dec;47(4):349–361. doi: 10.1111/j.2044-8341.1974.tb02300.x. [DOI] [PubMed] [Google Scholar]
  5. Crisp A. H. Some aspects of the evolution, presentation and follow-up of anorexia nervosa. Proc R Soc Med. 1965 Oct;58(10):814–820. doi: 10.1177/003591576505801027. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Elkin T. E., Hersen M., Eisler R. M., Williams J. G. Modification of caloric intake in anorexia nervosa: an experimental analysis. Psychol Rep. 1973 Feb;32(1):75–78. doi: 10.2466/pr0.1973.32.1.75. [DOI] [PubMed] [Google Scholar]
  7. FRAZIER S. H. ANOREXIA NERVOSA. Dis Nerv Syst. 1965 Mar;26:155–159. [PubMed] [Google Scholar]
  8. Frisch R. E., McArthur J. W. Menstrual cycles: fatness as a determinant of minimum weight for height necessary for their maintenance or onset. Science. 1974 Sep 13;185(4155):949–951. doi: 10.1126/science.185.4155.949. [DOI] [PubMed] [Google Scholar]
  9. Garfinkel P. E., Kline S. A., Stancer H. C. Treatment of anorexia nervosa using operant conditioning techniques. J Nerv Ment Dis. 1973 Dec;157(6):428–433. doi: 10.1097/00005053-197312000-00004. [DOI] [PubMed] [Google Scholar]
  10. Garner D. M., Garfinkel P. E., Stancer H. C., Moldofsky H. Body image disturbances in anorexia nervosa and obesity. Psychosom Med. 1976 Sep-Oct;38(5):327–336. doi: 10.1097/00006842-197609000-00005. [DOI] [PubMed] [Google Scholar]
  11. Halmi K. A., Powers P., Cunningham S. Treatment of anorexia nervosa with behavior modification. Effectiveness of formula feeding and isolation. Arch Gen Psychiatry. 1975 Jan;32(1):93–96. doi: 10.1001/archpsyc.1975.01760190095011. [DOI] [PubMed] [Google Scholar]
  12. Halmi K., Brodland G., Loney J. Prognosis in anorexia nervosa. Ann Intern Med. 1973 Jun;78(6):907–909. doi: 10.7326/0003-4819-78-6-907. [DOI] [PubMed] [Google Scholar]
  13. KAY D. W., LEIGH D. The natural history, treatment and prognosis of anorexia nervosa, based on a study of 38 patients. J Ment Sci. 1954 Apr;100(419):411–431. doi: 10.1192/bjp.100.419.411. [DOI] [PubMed] [Google Scholar]
  14. Leitenberg H., Agras W. S., Thomson L. E. A sequential analysis of the effect of selective positive reinforcement in modifying anorexia nervosa. Behav Res Ther. 1968 May;6(2):211–218. doi: 10.1016/0005-7967(68)90009-0. [DOI] [PubMed] [Google Scholar]
  15. Lobb L. G., Schaefer H. H. Successful treatment of anorexia nervosa through isolation. Psychol Rep. 1972 Feb;30(1):245–246. doi: 10.2466/pr0.1972.30.1.245. [DOI] [PubMed] [Google Scholar]
  16. Slade P. D., Russell G. F. Awareness of body dimensions in anorexia nervosa: cross-sectional and longitudinal studies. Psychol Med. 1973 May;3(2):188–199. doi: 10.1017/s0033291700048510. [DOI] [PubMed] [Google Scholar]
  17. Stunkard A. New therapies for the eating disorders. Behavior modification of obesity and anorexia nervosa. Arch Gen Psychiatry. 1972 May;26(5):391–398. doi: 10.1001/archpsyc.1972.01750230001001. [DOI] [PubMed] [Google Scholar]

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