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Internet-Based Relapse Prevention Works in People with Anorexia

Anorexia nervosa is a severe eating disorder that deeply alters the relationship with body weight and food consumption in affected individuals. People with the disorder have significantly increased risks of dying prematurely, even when they initially respond well to treatment and at least partially regain their health. According to the results of a new study published in July 2013 in the Journal of Eating Disorders, anorexia relapse prevention programs that take place over the Internet can potentially play an important role in reducing anorexia-related mortality rates and helping recovering anorexics stay healthy. 

Anorexia Basics

People with anorexia develop preoccupations with thinness and body weight control that cause them to do such things as heavily limit the types and quantities of the foods they eat, avoid eating in many or most circumstances, and avoid gaining weight through extreme exercise participation or the use of laxatives, diuretics or diet pills. By definition, these behaviors cause a drop in body weight that places the affected person below 85 percent of his or her expected weight level. The long-term effects of an anorexic eating pattern can seriously, severely or fatally damage a range of critical body systems, including the cardiovascular (heart and blood vessel) system, nervous system, gastrointestinal system and endocrine (hormone) system. Women and girls develop anorexia roughly eight to nine times more often than men and boys. Depending on the studies used for reference, the disorder affects 0.5 percent to nearly 4 percent of U.S. women, as well as roughly 1 percent of teenage girls. Since the illness can ultimately produce a number of fatal outcomes (including organ failure, suicide or extreme malnutrition), no one really knows how many anorexics die each year, the National Association of Anorexia and Associated Disorders explains. Combined death rates for adults and teens of both genders may fall around 4 percent, while as many as 20 percent of affected women may eventually die from an anorexia-related cause.

Relapse Risks

Anorexia is well known for its ability to reappear after a person starts to improve with proper treatment. According to the results of a study published in 2004 in the journal Psychological Medicine, about 35 percent of recovering anorexics will experience a serious relapse of their symptoms; after the onset of such a relapse, the average person dies within a year and a half. Factors that increase the risks for the recurrence of anorexia symptoms include the experience of previous relapses, retention of some of the underlying attitudes that lead to anorexic behavior, a rapid return to heavy exercise, previous attempts to commit suicide and the presence of symptoms associated with obsessive-compulsive tendencies.

New Findings

Doctors commonly treat anorexia with a form of psychotherapy called cognitive behavioral therapy (CBT), which gradually teaches recovering anorexics how to modify their reactions to high-stress situations that can trigger their symptoms. In the study published in the Journal of Eating Disorders, a team of German researchers examined the usefulness of monitored, Internet-based cognitive behavioral therapy as a tool for preventing anorexia relapses. This type of therapy combines visual CBT presentations with some form of individual or group feedback between patient and therapist. There were 210 women who participated in the study and received therapist-directed, Internet-delivered cognitive behavioral therapy. Some of these women completed a full course of nine months of treatment, while others completed only a partial course of treatment. After reviewing the results of treatment, the study’s authors found that Internet-based cognitive behavioral therapy shows significant potential as a means for preventing the recurrence of anorexia symptoms. Not surprisingly, people who faithfully participate in all nine months of treatment experience much better results than people who complete only part of their treatment. Factors that increase a person’s chances of sticking through a full course of Internet-based treatment include periodic use of face-to-face psychotherapy during treatment, a rapid enrollment in treatment after anorexia symptoms first appear, and long-term control of the anxiety and depression symptoms that commonly affect people diagnosed with anorexia nervosa.


Not all symptoms of anorexia improve in people who receive Internet-based cognitive behavioral therapy, the authors of the study in the Journal of Eating Disorders note. Specific benefits attributed to this approach include a restoration of body weight, improved menstruation and a reduction in the purging behaviors practiced by some anorexic individuals. Overall, these benefits are substantial enough for the authors to recommend the continued study of Internet-based CBT as a way of preventing anorexia-related relapses.

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