Table Of ContentManaging Severe and Enduring
Anorexia Nervosa
Based on the only evidence-based randomized controlled trial yet under-
taken in patients with severe and enduring anorexia nervosa, Managing
Severe and Enduring Anorexia Nervosa uses the results of that trial to pre-
sent a new paradigm for treatment. This informative new text assembles
the leading scientists across several continents to provide a comprehensive
overview and new paradigm for treatment and stimulate interest in the
development of new psychosocial approaches. Students, clinicians, and
researchers in the field of eating disorders will find this edited volume a
valuable reference handbook in the clinical management of patients with
anorexia nervosa.
Stephen Touyz, PhD, FAED, is a Professor of Clinical Psychology and
Clinical Professor in Psychiatry at the University of Sydney. He is Chair of
the Executive Committee of the Centre for Eating and Dieting Disorders,
Co-Editor in Chief of the Journal of Eating Disorders, on the Editorial
Board of the International Journal of Eating Disorders and other lead-
ing journals in the area. In 2006 he was elected President of the Eating
Disorders Research Society. He has received numerous awards for his
work in research in the field of eating disorders, including the prestig-
ious Leadership in Research Award from the international Academy for
Eating Disorders in 2012, the first Lifetime Achievement Award from
the Australian and New Zealand Academy for Eating Disorders, and the
Ian Campbell Memorial Prize from the Australian Psychological Society
in 2014.
Daniel Le Grange, PhD, FAED, is a Benioff UCSF Professor in Children’s
Health, and Eating Disorders Director in the Department of Psychiatry at
the University of California, San Francisco, CA, and Emeritus Professor
of Psychiatry and Behavioral Neuroscience at The University of Chicago,
Chicago, IL. He is a Fellow of the Academy for Eating Disorders, a Member
of the Eating Disorders Research Society, Associate Editor for the Journal of
Eating Disorders and BMC Psychiatry, and serves on the Editorial Boards
of the European Eating Disorders Review and the International Journal
of Eating Disorders. He is the 2013–2014 recipient of the Presidential Chair
Award at UCSF, and the 2014 recipient of the Academy for Eating Disorders
Leadership in Research Award.
J. Hubert Lacey, MD, MPhil, FRCPsych, is Emeritus Professor of
Psychiatry at St. George’s, University of London where he was Chairman
of Department. He is Medical Director of the Eating Disorders (ED)
Units at Newbridge House, Birmingham and the Nightingale Hospital in
London. He developed the St. George’s ED Service into the largest in the
United Kingdom, for which he received NHS awards. He has designed
and established seven other ED services, in-patient, day- and out-patient
services. He is Senior Board Trustee on the UK charity for ED. He has
held senior positions in the University of London, the Royal College of
Psychiatrists, and the National Health Service. He is Chairman of the
European Council on ED and member of other international ED organiza-
tions. He is on the Boards of ED journals. Professor Lacey has published
extensively on ED over 45 years, including the first published treatment
for bulimia nervosa and the first description of multi-impulsive EDs.
He has published on diagnosis, pathogenesis, and different treatment
approaches. He has received many awards for teaching. He has a special
interest in patients with SE-AN.
Phillipa Hay, DPhil (Oxon), MD (Otago), FAED, FRANZCP, is
Foundation Chair of Mental Health at Western Sydney University and
Senior Consultant in Psychiatry at Campbelltown Hospital. Among other
journal responsibilities, she is Co-Editor-in-Chief of the Journal of Eating
Disorders, Academic Editor for PLOS Medicine, and on the Editorial
Board of the International Journal of Eating Disorders. She is Deputy
Chair of the National Eating Disorders Collaboration and was Chair
of the 2014 Royal Australian and NZ College of Psychiatrist Clinical
Practice Guidelines for Eating Disorders. In 2015 she received the Lifetime
Achievement Award from the Australian and New Zealand Academy for
Eating Disorders.
Managing Severe and
Enduring Anorexia Nervosa
A Clinician’s Guide
Edited by Stephen Touyz,
Daniel Le Grange,
J. Hubert Lacey, and Phillipa Hay
First published 2016
by Routledge
711 Third Avenue, New York, NY 10017
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
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Library of Congress Cataloging in Publication Data
Names: Touyz, S. W. (Stephen W.), editor. | Le Grange, Daniel,
editor. | Lacey, J. Hubert, editor. | Hay, Phillipa, editor.
Title: Managing severe and enduring anorexia nervosa : a clinician’s
guide / edited by: Stephen Touyz, Daniel Le Grange, J. Hubert Lacey,
and Phillipa Hay.
Description: New York, NY : Routledge, 2016. | Includes
bibliographical references and index.
Identifiers: LCCN 2015038724| ISBN 9781138777873
(hbk : alk. paper) | ISBN 9781138777903 (pbk. : alk. paper) |
ISBN 9781315772349 (ebk)
Subjects: | MESH: Anorexia Nervosa—diagnosis. | Anorexia
Nervosa—physiopathology. | Anorexia Nervosa—therapy. |
Chronic Disease. | Severity of Illness Index. | Treatment Outcome.
Classification: LCC RC552.A5 |
NLM WM 175 |
DDC 616.85/262—dc23
LC record available at http://lccn.loc.gov/2015038724
ISBN: 978-1-138-77787-3 (hbk)
ISBN: 978-1-138-77790-3 (pbk)
ISBN: 978-1-315-77234-9 (ebk)
Typeset in Sabon
by Keystroke, Station Road, Codsall, Wolverhampton
Dedications
To my wife Wren, whose unwavering love and support has become the
rock upon which my career has been built. To my children, Justin and
Lauren, for their unconditional love, encouragement, and support. To
Alex Winkler for both his enthusiasm and invaluable computer skills.
Finally, to my patients, who provide me with the inspiration to constantly
seek answers where they currently do not exist.
Stephen Touyz
This one is for Tom.
Daniel Le Grange
Whatever I have achieved would never have happened without the love
and massive support of my wife, Sue. I dedicate this book to her and to
our children, Emma, Ben, and Joff, all of whom have followed me into
medicine. Finally, I thank my patients over 46 years who have generously
allowed me to research into difficult areas of their lives, on which this
work is based.
J. Hubert Lacey
To Anne Hall and Kevin Pile.
Phillipa Hay
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Contents
List of contributors xi
Foreword xvii
B. TIMOTHY WALSH
Preface xix
1 What Do We Know About Severe and Enduring
Anorexia Nervosa? 1
ANNA C. CIAO, ERIN C. ACCURSO, AND STEPHEN A. WONDERLICH
2 Quality of Life and Psychosocial Functioning in Severe
and Enduring Anorexia Nervosa 13
DEBRA L. FRANKO, HELEN B. MURRAY, CHRISTOPHER J. MANCUSO,
AND KAMRYN T. EDDY
3 Perpetuating Factors in Severe and Enduring
Anorexia Nervosa 28
TIMOTHY D. BREWERTON AND AMY BAKER DENNIS
4 How Does Anorexia Nervosa Become Resistant to Change? 64
JOANNA E. STEINGLASS AND KARIN FOERDE
5 Treating Severe and Enduring Anorexia Nervosa:
A Randomized Controlled Trial 76
STEPHEN TOUYZ, DANIEL LE GRANGE, J. HUBERT LACEY,
PHILLIPA HAY, REBECCA SMITH, SARAH MAGUIRE,
BRYONY BAMFORD, KATHLEEN M. PIKE, AND ROSS D. CROSBY
6 Managing the Patient with Severe and Enduring
Anorexia Nervosa 95
STEPHEN TOUYZ AND MICHAEL STROBER
viii Contents
7 Specialist Supportive Clinical Management for
Severe and Enduring Anorexia Nervosa: A
Clinician’s Manual 112
PHILLIPA HAY, GINI MCINTOSH, AND CYNTHIA BULIK
8 Cognitive Behavioral Therapy for Severe and Enduring
Anorexia Nervosa 128
KATHLEEN M. PIKE AND MARION P. OLMSTED
9 Administering Treatments for Severe and Enduring
Anorexia Nervosa: Examples from Treatment
Experiences 146
COLLEEN STILES-SHIELDS, BRYONY BAMFORD, AND LUCY SERPELL
10 Who is Best Placed to Treat Clients with Severe and
Enduring Anorexia Nervosa? 155
BRYONY BAMFORD, VICTORIA MOUNTFORD, AND JOSIE GELLER
11 Hospital Admissions in Severe and Enduring Anorexia
Nervosa: When to Admit, When Not to Admit, and
When to Stop Admitting 171
D. BLAKE WOODSIDE, RICHELLE M. TWOSE, ALEXANDRA OLTEANU,
AND CHARLENE SATHI
12 Is Involuntary (Compulsory) Treatment Ever Justified
in Patients with Severe and Enduring Anorexia Nervosa?
An International Perspective 185
JOEL YAGER, TERRY CARNEY, AND STEPHEN TOUYZ
13 Severe and Enduring Anorexia Nervosa: A New
Approach to its Diagnosis, Features, and Treatment 202
J. HUBERT LACEY AND RICHARD SLY
14 The Role of Palliative Care in Severe and Enduring
Anorexia Nervosa 223
ALLAN S. KAPLAN AND AMY MILES
15 Treating Males with Severe and Enduring Anorexia
Nervosa: Different to Females? 231
THEODORE E. WELTZIN
Contents ix
16 Pharmacotherapy and Novel Biological Approaches
in Severe and Enduring Anorexia Nervosa: Helpful
or Harmful? 246
ANGÉLICA MEDEIROS CLAUDINO, MARA FERNANDES MARANHÃO,
AND EVELYN ATTIA
17 A Life Wasted: The Patient Perspective 273
JUNE ALEXANDER
Index 286
