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  • Print publication year: 2008
  • Online publication date: May 2010

38 - Other somatic physical treatments and complex interventions for eating disorders

from Part III - Specific treatments


Editor's note

There are many practices that are common in the management of eating disorders that do not have a satisfactory evidence base yet are still accepted as reasonable practice. Although it should not be assumed that what is reasonable is necessarily appropriate or true, it is important to acknowledge these areas of the subject, and this chapter is open and frank about the issues concerned. The chapter also points to other areas in which evaluative research is needed.


Potential somatic treatments for eating disorders include medications, feeding, light and heat treatments, exercise, electroconvulsive therapy and psychosurgery. Apart from feeding and psychopharmacology, these have been studied rarely for the treatment of eating disorders. The evidence base for these types of treatments for other disorders is discussed in Part II of this book. The literature regarding these interventions is mostly confined to case reports and case series, and many of these at this point are relatively old. With few exceptions, reports involve short-term rather than long-term outcomes. Apart from feeding, these approaches appear to be rarely used, infrequently advocated and have limited empirical support. Medication treatments are covered elsewhere in this volume. The existing literature for other somatic treatments is summarized below.

Intensive feeding

Refeeding is a necessary component of the treatment of anorexia nervosa. The methods, setting and rate of refeeding are much debated and there is little evidence to aid clinical practice.

American Dietetic Association (1994). Nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa and binge eating. Journal of the American Dietetic Association, 94 (8), 902–7.
Ash, J. B., Piazza, E. & Anderson, J. L. (1997). Light therapy in the clinical management of an eating-disordered adolescent with winter exacerbation. International Journal of Eating Disorders, 23(1), 93–7.
Bentovim, M. (2000). Ethical and legal issues. In Anorexia Nervosa and Related Eating Disorders in Childhood and Adolescence, ed. Lask, B. & Bryant–Waugh, R., 2nd edn, pp. 349–60, London: Psychology Press.
Bergh, C., Brodin, U., Lindberg, G. & Södersten, P. (2002). Randomized controlled trial of a treatment for anorexia and bulimia nervosa. Proceedings of the National Academy of Sciences, 99(14), 9486–91.
Bernstein, I. C. (1964). Anorexia nervosa treated successfully with electroshock therapy and subsequently followed by pregnancy. American Journal of Psychiatry, 120, 1021–5.
Bernstein, I. C. (1972). Anorexia nervosa: 94-year-old woman treated with electroshock. Minnesota Medicine, 55, 552–3.
Beumont, P. J., Beumont, C. C., Touyz, S. W. & Williams, H. (1997). nutritional counselling and supervised exercise. In Handbook of Treatment for Eating Disorders, ed. Garner, D. M. & Garfinker, P. E., 2nd edn, pp. 178–87. New York: Guilford Press.
Beumont, P. J., Arthur, B., Russel, J. D. & Touyz, S. W. & Stephen, W. (1994). Excessive physical activity in dieting disorder patients: Proposals for a supervised exercise program. International Journal of Eating Disorders, 15(1), 21–36.
Birmingham, C. L., Alothman, A. F. & Goldner, E. M. (1996). Anorexia nervosa: refeeding and hypophosphatamia. International Journal of Eating Disorders, 20(2), 211–13.
Birmingham, C. L., Guitierrez, E., Jonat, L. & Beumont, P. (2004). Randomized controlled trial of warming in anorexia nervosa. International Journal of Eating Disorders, 35(2), 234–8.
Blouin, A. G., Blouin, J. al. (1996). Light therapy in bulimia nervosa: a double-blind, placebo-controlled study. Psychiatry Research, 60(1), 1–9.
Braun, D. L., Sunday, S. R., Fornari, V. M. & Halmi, K. A. (1999). Bright light therapy decreases winter binge frequency in women with bulimia nervosa: a double-blind, placebo-controlled study. Comprehensive Psychiatry, 40(6), 442–8.
Bufano, G., Bellini, C.Cervellin, G. & Coscelli, C. (1990). Enteral nutrition in anorexia nervosa. Journal of Parenteral and Enteral Nutrition, 14(4), 404–7.
Carmody, J. T. B. & Vibbler, F. L. (1952). Anorexia nervosa treated by prefrontal lobotomy. Annals of Internal Medicine, 36, 647–52.
Carraro, A., Cognolato, S. & Fiorellini Bernadis, A. L. (1998). Evaluation of a program of adapted physical activity for ED patients. Eating Weight Disorders, 3, 110–14.
Crisp, A. H. & Kalucy, R. S. (1973). The effect of leucotomy in intractable adolescent weight phobia (primary anorexia nervosa). Postgraduate Medical Journal, 49, 883–93.
Dibble, L. & Tandon, R. (1992). Post-ECT myoclonic jerks in a depressed patient with bulimia. Convulsive Therapy, 8(4), 285–9.
Drury, M. O. (1950). An emergency leucotomy. British Medical Journal, 2, 609.
Ferguson, J. M. (1993). The use of electroconvulsive therapy in patients with intractable anorexia nervosa. International Journal of Eating Disorders, 13(2), 195–201.
Friedman, S., Even, C., Dardennes, R. & Guelfi, J. D. (2002). Light therapy, obesity and night-eating syndrome. American Journal of Psychiatry, 159(5), 875–6.
Glazebrook, A. J., Matas, J. & Prosen, H. (1956). Compulsive neurosis with cachexia. Canadian Medical Association Journal, 75, 40–2.
Goldner E. M., Birmingham, C. L. & Smye, V. (1997). Addressing treatment refusal in anorexia nervosa: clinical, ethical and legal considerations. In Handbook of Treatment for Eating Disorders, ed. Garner, D. M. & Garfinkel, P. E., 2nd edn. New York: Guilford Press.
Greaves, E., Blades, M., Christie, R. A. S., Machen, J., Ryecart, C. N., Baird-Smith, S. (1991). Short communication. Anorexia nervosa: nocturnal supplementary nasogastric feeding in the community. Journal of Human Nutrition and Dietetics, 4, 165–70.
Grounds, A. (1982). Transient psychoses in anorexia nervosa: a report of 7 cases. Psychological Medicine, 12, 107–13.
Gutierrez, E.Vazquez, R. (2001). Heat in the treatment of patients with anorexia nervosa. Eating and Weight Disorders, 6, 49–52.
Gutierrez, E., Vazquez, R. & Beumont, P. (2002). Do people with anorexia nervosa use sauna baths? A reconsideration of heat treatment in anorexia nervosa. Eating behaviors, 3, 133–42.
Hemphill, R. E. (1944). Return of virility after prefrontal lencotomy. Lancet, 2, 345–6.
Hemphill, R. E. & Dubl, M. D. (1944). Return of virility after prefrontal leucotomy. Lancet, 2, 345–6.
Hill, R., Haslett, C. & Kumar, S. (2001). Anorexia nervosa in an elderly woman. Australian and New Zealand Journal of Psychiatry, 35, 246–8.
Kay, D. W. K. (1953). Anorexia nervosa: a study in prognosis. Proceedings of the Royal Society of Medicine, 46, 669–74.
Kelly, D. & Mitchell-Heggs, N. (1973). Stereotactic limbic leucotomy. A follow-up study of thirty patients. Postgraduate Medical Journal, 49, 852–65.
Lam, R. W. (1989). Light therapy for seasonal bulimia. American Journal of Psychiatry, 146(12), 1640–1.
Lam, R. W., Goldner, E. M. & Grewal, A. K. (1996). Seasonality of symptoms in anorexia and bulimia nervosa. International Journal of Eating Disorders, 19, 35–44.
Lam, R. W., Lee, S. K., Tam, E. M., Grewal, A. & Yatham, L. N. (2001). An open trial of light therapy for women with seasonal affective disorder and comorbid bulimia nervosa. Journal of Clinical Psychiatry, 62(3), 164–8.
Levine, M. D., Marcus, M. D. & Moulton, P. (1996). Exercise in the treatment of binge-eating disorder. International Journal of Eating Disorders, 19, 171–7.
Mehler, P. S. & Weiner, K. L. (1993). Anorexia nervosa and total parenteral nutrition. International Journal of Eating Disorders, 14(3), 297–304.
Morgan, J. F. & Crisp, A. H. (2000). Use of leucotomy for intractable anorexia nervosa: a long-term follow-up study. International Journal of Eating Disordes, 27(3), 249–58.
Morgan, H. G., Purgold, J. & Welbourne, J. (1983). Management and outcome in anorexia nervosa: a standardized prognostic study. British Journal of Psychiatry, 143, 282–7.
National Collaborating Centre for Mental Health (2004). Other physical interventions in: eating disorders. Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. British Psychological Society and Gaskell, pp. 100–4.
Neiderman, M., Zarody, M., Tattersall, M. & Lask, B.(2000). Enteric feeding in severe adolescent anorexia nervosa: a report of four cases. International Journal of Eating Disorders, 28, 470–5.
Neiderman, M., Farley, A., Richardson, J. & Lask, B. (2001). Nasogastric feeding in children and adolescents with eating disorders: towards good practice. International Journal of Eating Disorders, 29, 441–8.
Pendleton, V. R., Goodrick, G. K., Poston, W. S., Reeves, R. & Foreyt, J. P. (2002). Exercise augments the effects of cognitive-behavioral therapy in the treatment of binge-eating. International Journal of Eating Disorders, 31(2), 172–84.
Pesenti, F., Mavrotheris, S., Serra, C., Lucchio, P. & Pucciarelli, S. (1999). Use of percutaneous endoscopic gastrostomy in anorexia nervosa: case report. Rivista Italiana di Nutrizione Parenterale ed Enterale, 17(1), 24–7.
Pertschuk, M. J., Forster, J., Buzby, G. & Mullen, J. L. (1981). The treatment of anorexia nervosa with total parenteral nutrition. Biological Psychiatry, 16(6), 539–50.
Robb, A. S., Silber, T. J., Orrell-Valente, J. al. (2002). Supplemental nocturnal nasogastric refeeding for better short term outcome in hospitalised adolescent girls with anorexia nervosa. The American Journal of Psychiatry, 159(8), 1347–53.
Schwitzer, J., Neudorfer, C. & Fleischhacker, W. W. (1994). Seasonal bulimia treated with fluoxetine and phototherapy. American Journal of Psychiatry, 150(11), 1752.
Serfaty, M. & McCluskey, S. (1998). Compulsory treatment of anorexia nervosa and the moribund patient. European Eating Disorders Review, 6(1), 27–37.
Sundgot-Borgen, J., Rosenvinge, J. H., Bahr, R. & Schneider, L. S. (2002). The effect of exercise, cognitive therapy, and nutritional counselling in treating bulimia nervosa. Medicine & Science in Sports & Exercise, 34(2), 190–5.
Szabo, C. P. & Green, K. (2002). Hospitalized anorexics and resistance training: Impact on body composition and psychological well-being. A preliminary study. Eating and Weight Disorders, 7(4), 293–7.
Sifneos, P. E. (1952). A case of anorexia nervosa treated successfully by leucotomy. American Journal of Psychiatry, 109, 356–60.
Solomon, S. M. & Kirby, D. F. (1990). The refeeding syndrome: a review. Journal of Parenteral and Enteral Nutrition, 14, 90–7.
Thien, V., Thomas, A., Martin, D. & Birmingham, C. L. (2000). Pilot study of a graded exercise program for the treatment of anorexia nervosa. International Journal of Eating Disorders, 28(1), 101–6.
Touyz, S. W., Lennerts, W., Arthur, B. & Beumont, P. J. (1993). Anaerobic exercise as an adjunct to refeeding patients with anorexia nervosa: does it compromise weight gain?European Eating Disorders Review, 1(3), 177–82.
Vandereycken, W., Depreitere, L. & Probst, M. (1987). Body-oriented therapy for anorexia nervosa patients. American Journal of Psychotherapy, 41, 252–9.
Wall, J. H. (1958). Diagnosis, treatment and results in anorexia nervosa. Read at the 114th annual meeting of The American Psychiatric Association, San Francisco, California, May 12–16.
Zamboni, R., Larach, V., Poblete, al. (1993). Dorsomedial thalamotomy as a treatment for terminal anorexia: a report of two cases. Acta Neurochirurgica, 58, 34–5.
Zuercher, J. N., Cumella, E. J., Woods, B. K., Eberly, M. & Carr, J. K. (2003). Efficacy of voluntary nasogastric tube feeding in female inpatients with anorexia nervosa. Journal of Parenteral and Enteral Nutrition, 27(4), 268–76.