Is psychotherapy mandatory during the acute refeeding period in the treatment of anorexia nervosa?

Forty-five adolescent and preadolescent patients (42 females, three males) with anorexia nervosa (AN) were treated in a pediatric day care unit of a large urban hospital by a multidisciplinary team. In our treatment model, the pediatrician has the responsibility for the initial evaluation and physical rehabilitation while the pediatric psychiatrist does the initial evaluation of the patient and family and is available for intervention in an emergency. Parents are actively involved in the treatment program. Family psychotherapy is recommended for each patient and his or her family. Among 45 patients, 24 did not enter psychotherapy during the first 2 months of the refeeding period, while the remaining 21 patients started psychotherapy (family and/or individual) during this period. Weight gain was higher in the group without formal psychotherapy during the initial period of refeeding (7.3 +/- 3.1 kg versus 5 +/- 2.5 kg; p less than 0.01). It is suggested that the initiation of structured psychotherapy is not mandatory and does not contribute to treatment effectiveness in the acute phase when emaciation and negativism may hinder the psychotherapeutic process. We believe a multidisciplinary team, together with the parents, is the treatment of choice during the acute phase of AN.