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

Summary

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.

Introduction

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.