Professor, Columbia University Medical Center
Director, Division of Clinical Therapeutics New York State Psychiatric Institute
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A: Anorexia Nervosa is a real challenge and we have a long way to go to better understand it in a clinically useful way and how to treat it. Probably the most dramatic advancement in the treatment territory in the past decade is the development of the Maudsley Method for the treatment of adolescents. This method authorizes the parents to really take over the major thrust of the intervention of the child with Anorexia Nervosa.
A: When this was first introduced a decade ago, it was enormously and still is somewhat controversial. The old idea was to keep these pathological parents away from their poor, long-suffering child. No one certainly proved that parents were pathological but it was the common idea that for whatever reason, the child was not thriving in this enviornment and therefore the child needed to be pulled away and treated somewhat independently of the parents. The Maudsley Method really flipped this idea around. I think the data are quite strong and it can be a very useful treatment for youngsters with Anorexia because we have a population that we need to be aggressive about treating and it also emphasizes the move away from blaming parents for their kids’ mental illness.
A: The average person we see with Anorexia Nervosa is a person in her mid 20s or older and they have had the illness for 5-10 years. There is no reason and no evidence to involve her parents in her treatment. This is also not likely to be successful since she has not been living at home for some time so the advancement for kids, doesn’t extrapolate very easily to most adults, even for college age kids. Treating adults remains a big challenge for all of us. There continues to be good work and explorations of new psychological treatment and work on new medications. The group at Columbia is exploring the use of Olanzapine and we hope that it will be of some use with the Anorexia population.
A: There are 2 broad ideas: (1): Plain and simple, it pushes the appetite harder. People with Anorexia Nervosa have the normal biological signals to eat, they just fight them successfully. It may be that this medication pushes harder and amplifies those signals and in some people, that is helpful. (2): Olanzapine does have psychological effects that allow them to give in less to the psychological forces that keep them trapped. One efficaceous study found that weight gain was quicker in patients that got the drug but also found that people who received the drug had a greater decrease in obsessionality. So, maybe it has an anti-anxiety, anti-obsessionality effect that also helps people get better.
A:Addiction links to eating disorders are clearly there. The patterns of behavior and patterns of thought that people with eating disorders engage in at times have stiking similarities to the patterns of behavior of people who abuse substances, so it is very hard to dismiss that these disorders have something in common in terms of mechanisms. We now know with much certainty the dopamine and rewards systems are the parts of the brain targeted by substance abuse. It would be very hard not to believe that eating disorders are not involved with those same systems. Additionally supporting the link to addiction are these rewards systems that nature created that help regulate your food intake. This is an important clue for us to pursue and further our understanding. I think there are some common biological features that eating disorders share with addiction but I think there are paramount clinical complexities with eating disorders that should not be overlooked either and should be treated differently than cocaine and heroin abuse disorders.
