REVIEW   

Minerva Psichiatrica 2017 September;58(3):162-80

DOI: 10.23736/S0391-1772.17.01936-7

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Psychodynamic psychotherapies for feeding and eating disorders

Carlotta DE-BACCO, Enrica MARZOLA, Secondo FASSINO, Giovanni ABBATE-DAGA ✉

Department of Neuroscience, Eating Disorders Center, University of Turin, Turin, Italy

INTRODUCTION: Eating disoders (EDs) are complex mental illnesses with a multifactorial etiopathogenesis. These disoders are typically ego-syntonic thus entailing a protracted course in a substantial proportion of cases. Anorexia nervosa (AN) has been reported to have the greatest mortality of any other mental illnesses but all EDs strongly impact patients’ lives. International guidelines highlight psychotherapy as a useful therapeutic intervention for EDs with respect to both short- and long-term outcomes. The most used approaches include: psychodynamic psychotherapy, cognitive-behavioral therapy and family-based therapy. This review aims to provide the reader with an update on the available psychotherapy approaches in the ED treatment and to convey some clinical inputs on how to choose the different psychotherapy techniques.
EVIDENCE ACQUISITION: The online search was performed on Medline and PsycInfo databases then a hand-search of the reference list has been also carried out. Inclusion criteria were the following: 1) papers published between 1980 and February 2017; 2) studies focusing on individuals with AN, bulimia nervosa (BN), and binge-eating disorder (BED); 3) research articles and case reports; 4) English language. Reviews were not included.
EVIDENCE SYNTHESIS: Sixty articles were finally retained in the present review. Eighteen studies analyzed psychodynamic treatments in AN with the majority of articles reporting that psychodynamic therapies are effective with results maintained at follow-up. Twelve studies on psychodynamic therapies in BN were included. Psychodynamic therapies were not found to be clearly more effective than other approaches. Thirteen articles analyzed psychodynamic therapies in BED. Data are scarce, but all studies found that psychodynamic therapies are effective in both general psychopathology and eating psychopathology with results overall maintained at follow-up. Fifteen articles analyzed psychodynamic therapies in mixed diagnoses and psychodynamic therapies to be effective in improving weight and psychiatric symptoms with satisfactory results at follow-up.
CONCLUSIONS: Research is still needed to clarify the effectiveness of psychodynamic psychotherapies in the ED field also because of methodological flaws making the available studies difficultly comparable to each other. Nevertheless, psychodynamic interventions showed to be effective, mostly for AN, in treating particularly severe conditions like EDs.

KEY WORDS: Psychotherapy - Anorexia nervosa - Bulimia nervosa - Binge-eating disorder - Psychotherapy, psychodynamic - Cognitive therapy