Paradigm Shift toward Outpatient Treatment of Eating Disorders

Abstract

Historically, patients with anorexia nervosa had been metaphorically represented as a little pretty bird in the golden cage. However, family styles and patient features have diversified and now there have been an increase in other family styles such as stepfamilies and disintegration of the traditional family unit. Moreover, there have been increases in impulsivity, avoidant personality disorder (generalized social anxiety disorder), neurodevelopmental disorders, complex post-traumatic stress disorder/developmental trauma disorder, and/or attachment problems. As a result, both heterogeneity and therapeutic difficulties are increasing. Thus, a paradigm shift from inpatient to outpatient treatment has occurred, because isolation from families is not necessarily, anymore. To overcome these challenges, case formulation should be based on prototypical rather than categorical diagnosis and consider comorbidities of personality and neurodevelopmental disorders. Validation rather than empathic listening, and attitudes with radical genuineness rather than just genuineness should be applied to build solid therapeutic alliances.