Stepped care treatment for eating disorders.
A stepped care approach would link different patient needs to therapeutic modalities that range from simple advice to intensive inpatient care. Brief methods, including self-help and psychoeducation, may be effective for a subset of patients with bulimia nervosa and binge eating disorder. Identifying this subset remains a challenge. It is unclear how patients who fail to respond to evidence-based, first-line treatments should be treated. Given the absence of data on effective treatment of anorexia nervosa (AN), discussion of a stepped care approach is speculative. Because AN typically demands expert and sustained treatment, the lower levels of stepped care models are inapplicable for these patients. A stepped care approach poses methodological challenges for clinical research and raises important clinical issues, such as when to switch from 1 level of treatment to another.
Wilson
G T
GT
Eating Disorders Clinic, Rutgers, State University of New Jersey, University College-Piscataway 08854, USA.
Vitousek
K M
KM
Loeb
K L
KL
D000856:Anorexia Nervosa / Q000628:therapy; D002032:Bulimia / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D001068:Feeding and Eating Disorders / Q000523:psychology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D010347:Patient Care Planning; D010353:Patient Education as Topic; D018579:Patient Selection; D011615:Psychotherapy, Group / Q000379:methods*; D012657:Self-Help Groups; D017211:Treatment Failure; D014481:United States