Page 16 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

16 Chapter 1
including personality disorders, psychiatric comorbidity appears to be of more predictive value for mental and physical well-being after surgery, than that it is predictive for weight loss.
In the Netherlands, some hospitals exclude patients who are diagnosed with a binge eating disorder or other specified feeding or eating disorder similar to binge eating disorder. Those patients are referred for treatment of their disturbed eating behavior to a specialized eating disorder facility, prior to surgery.
Literature suggests that, in some cases, pre-operative binge eating pathology disappears after surgery, while, at the same time, it is reported that post-operative disturbed eating behavior may develop though not being present pre-operatively (Meany, Conceição, & Mitchell, 2014). Post-operative, early identification of psycho- social factors negatively associated with suboptimal weight loss, such as loss of control over eating and low motivation for behavior change, may help improve the overall efficacy of bariatric surgery (Sheets et al., 2015).
Outline of this thesis
Part I consists of Chapter 2 and concerns the efficacy of specialized psychological treatments for anorexia nervosa. As there has been a recent increase of high-quality randomized controlled trials, run with newly developed psychological treatments, it made sense to conduct a meta-analysis examining whether the evidence base for specialized psychological treatments can be broadened. Previously, no significant benefits of specialized treatments over control conditions on either weight regain or decrease of eating disorder psychopathology, could be established. In Chapter 2, we systematically assess whether specialized treatments for anorexia nervosa are superior to non-specialized, control treatments, by conducting a meta-analysis. We hypothesized that a difference in treatment effect would be found on either weight regain or on the improvement of eating disorder pathology, in favor of specialized psychological treatments.
Since for anorexia nervosa a multimodal treatment, aimed at nutritional & phys- ical rehabilitation, besides targeting the eating disorder psychopathology, is recom- mended for patients with anorexia nervosa, examining the benefits of psychological interventions when treating severe anorexia nervosa patients is complicated. Conse- quently, various types of multifarious interventions (i.e. somatic- nutritional-, phar- macological- and psychological interventions) are offered, particularly when under- weight patients are treated within an inpatient setting. The effect of psychological interventions on outcome offered within a multimodal treatment may therefore be limited.