Anorexia Nervosa: Optimized Psychodynamic, Cognitive Behavior Therapy Interview with
Stephan  Zipfel  MD
Professor of Medicine & Dean of Medical Education
Head Department of Internal Medicine VI
(Psychosomatic Medicine and Psychotherapy)
University Medical Hospital Tuebingen
President of the German College of Psychosomatic Medicine (DKPM)
Co-Director of the centre for nutritional Medicine Tuebingen-Hohenheim
72076 Tuebingen / Germany What are the main findings of the study?

Prof. Zipfel: Outpatient treatment of adults with anorexia nervosa by either enhanced cognitive-behaviour therapy, focal psychodynamic therapy, or optimised treatment as usual led to relevant weight gains and a decrease in general and eating disorder-specific psychopathology during the course of treatment. These positive effects continued beyond treatment until 12-month follow-up. Most patients completed treatment and the acceptance of both specific therapy approaches was high among both patients and therapists. Were any of the findings unexpected?

Prof. Zipfel: It was unexpected that the control condition, i.e. optimised treatment as usual, which included a combination of outpatient psychotherapy in combination with regular monitoring by GPs linked to specialised eating disorder centres, was not inferior in terms of weight gain. Overall, the specific therapy approaches had clear advantages, however: At the end of the study period, focal psychodynamic therapy was most successful, whereas enhanced cognitive-behaviour therapy resulted in a faster weight gain. Further, patients in the psychodynamic arm needed less additional hospitalisation. What should clinicians and patients take away from your report?

Prof. Zipfel: Adult patients with anorexia nervosa have a realistic chance to surmount the illness when treated by specific therapies at specialised eating disorder centres. Major challenges for prevention and early treatment of anorexia nervosa remain, however.

Psychotherapy is the treatment of choice for patients with anorexia nervosa. New more specific forms of psychotherapy for the treatment of anorexia nervosa have advantages particularly in terms of long-term results. What recommendations do you have for future research as a result of this study?

Prof. Zipfel: Additional measurements beyond the 1-year follow-up are neccessary in order to secure the success of the treatments involved. Currently, the 5-year follow-up measurements are taking place at the 10 ANTOP centres. Future research should focus on improving strategies of prevention and early intervention as well as optimising existing treatment approaches. To include the perspective of patients and their relatives seems to be an important aspect.

Further refinements of psychotherapy is necessary as well as aspects of patient preferences and treatment experiences.


Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial
Prof Stephan Zipfel MD,Beate Wild PhD,Gaby Groß PhD,Hans-Christoph Friederich MD,Martin Teufel MD,Dieter Schellberg PhD,Katrin E Giel PhD,Prof Martina de Zwaan MD,Andreas Dinkel PhD,Prof Stephan Herpertz MD,Prof Markus Burgmer MD,Prof Bernd Löwe MD,Sefik Tagay PhD,Prof Jörn von Wietersheim PhD,Prof Almut Zeeck MD,Carmen Schade-Brittinger MA,Prof Henning Schauenburg MD,Prof Wolfgang Herzog MD,on behalf of the ANTOP study group
The Lancet – 14 October 2013
DOI: 10.1016/S0140-6736(13)61746-8


Last Updated on October 17, 2013 by Marie Benz MD FAAD