The report also noted that the relationships' between parents were often strengthened by both types of family therapy and many couples reported greater warmth. (Eisler, Dare, Hodes, Russell, Dodge, & Le Grange, 2000, pp. 727-736) A second work supports the idea that family therapy is often less helpful for older an patients, as family dynamics at an older age tend to be historical rather than current and that individual CBT stands out as the most affective psychological option for such individuals. This may have been the best option for Carpenter and at a later age Ricci as both were or should have been fundamentally separated from their origin family by the time they were recognized as in need of treatment, yet given the fundamentally challenging character of the known family dynamic between Carpenter and her small family, often together for work family therapy may have been a good choice to supplement individual CBT. The study also stresses that though general and family CBT seemed less effective on study participants for older an patients individualized and specialized (an specific) an treatment was the obvious statistical winner. Patients the last option in the study individualizes, specialized an CBT were most likely to report greater success and also less likely to relapse during the follow up periods. It is also noted by the study researchers that for older an patients either inpatient or outpatient individualized and specialized CBT was effective and given the resistance of many older patients to interrupt their lives by entering inpatient treatment the efficacy for outpatient treatment was supported. (Dare, Eisler, Russell, Treasure & Dodge, 2001, pp. 216-221)

Finally, the last article that spoke of an was a generalized article offering physiological explanations for the variations in a cases and the inability of family and historical/genetic histories to connect with the phenomenology of the disorder, or the lived experience of it, and especially the skewed body image associated with believing one was still overweight when their physical appearance was actually emaciated.

According to Guisinger, "Psychological and societal factors account for the decision to diet but not for the phenomenology of the disorder; theories of biological defects...

745) This research or theory based article offers a completely novel approach to the disorder and stresses that even CBT or other interventions no matter how tailored to the individual case may not be addressing the entire situation and that more care needs to be taken to address the physiological adaptation of the disorder at various stages of development. The researcher offers a whole host of interesting questions regarding an and then also discusses possible comprehensive solutions to the problem.
Several lines of evidence, considered together, suggest that, rather than psychological or medical pathology causing the bizarre behaviors and cognitions of an, it is weight loss that leads to the symptoms. If the interpretation of the direction of causality is reconsidered, a number of discordant observations fall into place. (Guisinger, 2003, p.745)

Guisinger's basic premise is that the weight loss itself, in some people triggers a fundamental physiological response, that is anthropologically related to hunter gatherer, survival instincts, that are basically hardwired in the brain and body and ultimately is a response to the instinct to flee from famine situations, i.e. associated especially with the reported feeling so wellness, and boundless energy to exercise that is reported by an symptom sufferers during periods of extreme physical malnutrition and weight loss. This is obviously a novel approach to the disorder but does not discount a possible CBT solution after address of the physiological manifestations.

Resources

Dare, C. Eisler, I. Russell, G. Treasure, J. & Dodge, L. (2001), Psychological Therapies for Adults with Anorexia Nervosa. British Journal of Psychiatry. 178, 216-221.

Eisler, I. Dare, C. Hodes, M. Russell, G. Dodge, E. & Le Grange, D. (2000) Family Therapy for Adolescent Anorexia Nervosa: The Results of a Controlled Comparison of Two Family Interventions. The Journal of Child Psychology and Psychiatry and Allied Disciplines. 41, 727-736.

Guisinger, S. (2003) Adapted to Flee Famine: Adding an Evolutionary Perspective

on Anorexia Nervosa. Psychological Review, 10 (4) 745-761.