Young anorexia patients needed for two Stanford/Packard studies

STANFORD, Calif. - The devastation wrought by anorexia nervosa includes severe cognitive and physical changes that researchers say kill one in 10 patients and debilitate many others. But doctors and scientists have only a weak understanding of how to repair the damage. That's why clinical trials at the Stanford University School of Medicine and Lucile Packard Children's Hospital are now recruiting anorexia nervosa patients to test disease therapies in adolescents and young adults.

The two studies focus on different patient populations and aspects of anorexia treatment. One will be the largest-ever randomized clinical trial to compare therapies that use patients' families to facilitate anorexia treatment in adolescents. The second trial tests a method for helping young adult anorexia patients change their disordered thinking patterns and become more receptive to treatment.

"People have trouble accepting how serious these problems really are," said James Lock, MD, PhD, professor of psychiatry and behavioral sciences. "And then, when they do seek treatment, we don't understand how best to help them." Patients with anorexia nervosa inaccurately perceive themselves as fat and maintain dangerously low body weight by methods such as overexercising and refusing to eat, he explained. Lock also directs psychiatric services at the Comprehensive Eating Disorders Program at Packard Children's.

The first of the two studies, a multicenter trial funded by a grant from the National Institute of Mental Health, is seeking a total of 160 adolescent patients, aged 12 to 18, at seven study sites in the United States and Canada. The Stanford/Packard site, which is the coordinating site for the study, will enroll about 30 patients. "The treatments we are testing for adolescents are based on the idea that these patients are each embedded in a family," Lock said.

Subjects will receive nine months of treatment using one of two family-based programs. One method - systemic family therapy - has been used for anorexia nervosa since the 1970s and takes a psychological approach toward examining the family's thinking and interactions. "The notion behind this therapy is that family processes such as criticism, hostility and failure to resolve differences are somehow encouraging or helping maintain anorexia nervosa," Lock said. Despite wide application, the method has never been tested in a randomized clinical trial, so physicians are unsure how well it works.

Systemic family therapy will be compared with a behavior-based therapy that Lock and others have studied in the past. The behavioral approach focuses on changing the family environment to disrupt behaviors that maintain anorexia nervosa. "It aims to help parents to take charge of their child's eating, exercise and activity," Lock said.

The two treatments' efficacy will be evaluated at the end of the nine-month treatment period and again six and 12 months after the therapies end.

The second study, in young adults age 18 and older, targets thinking patterns that may interfere with anorexia nervosa treatment. "Young adult patients have been ill longer, and are sometimes resistant to starting and being engaged in treatment," Lock said. Over time, patients with anorexia nervosa tend to develop inflexible thinking patterns, have trouble adapting their behavior to meet changing goals, and focus their thinking on small details to the exclusion of the big picture.

The study, funded by a three-year, $750,000 grant from the National Institute of Mental Health, tests a treatment called cognitive behavioral therapy, which aims to change rigid thinking before patients begin other aspects of anorexia treatment. Lock's team will examine whether cognitive behavioral therapy is acceptable to patients, makes patients more likely to stick with subsequent anorexia treatment and makes treatment more successful. The team is recruiting 46 anorexia nervosa patients for six months of therapeutic sessions and a follow-up evaluation six months after therapy ends.

Those interested in volunteering for the study of family therapies in adolescent anorexia nervosa patients aged 12 to 18 should call Alaina Critchlow at (650) 721-6740.

Prospective subjects for the study of cognitive behavioral therapy in young adults aged 18 and up with anorexia nervosa should call Judy Beenhakker at (650) 723-7885.