{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T07:46:56Z","timestamp":1791532016356,"version":"4.3.4"},"reference-count":27,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,11,28]],"date-time":"2020-11-28T00:00:00Z","timestamp":1606521600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Eating Disorders"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The study aimed to assess outcomes in patients with severe and extreme anorexia nervosa managed with enhanced cognitive behavior therapy (CBT\u2010E) in a real\u2010world outpatient setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Thirty patients with anorexia nervosa and body mass index (BMI) &lt;16 aged \u226517\u2009years were recruited from consecutive referrals to an eating disorder service clinic offering outpatient CBT\u2010E. BMI and Eating Disorder Examination Questionnaire (EDE\u2010Q), Brief Symptom Inventory (BSI), and Clinical Impairment Assessment (CIA) scores were recorded at admission, end of treatment, and 20\u2010 and 60\u2010week follow\u2010ups for treatment completers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty patients (66.7%) completed the treatment and showed both considerable weight gain (Cohen's <jats:italic>f<\/jats:italic> = 1.43), and significantly reduced scores for clinical impairment (<jats:italic>f<\/jats:italic> = 1.26) and eating\u2010disorder (<jats:italic>f<\/jats:italic> = 1.03) and general psychopathology (<jats:italic>f<\/jats:italic> = 0.99). Changes remained stable at both follow\u2010ups. About half of the patients who completed treatment had a BMI \u226518.5 at the end of treatment and follow\u2010ups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>CBT\u2010E seems suitable and promising for patients with severe and extreme anorexia nervosa seeking treatment in a real\u2010world clinical setting, provided that their medical conditions are stable, and they have no current major depressive episodes or substance abuse; it may represent a valid alternative to inpatient treatment for those who are able to sustain engagement in a full course of outpatient treatment.<\/jats:p><\/jats:sec>","DOI":"10.1002\/eat.23428","type":"journal-article","created":{"date-parts":[[2020,11,28]],"date-time":"2020-11-28T09:52:02Z","timestamp":1606557122000},"page":"305-312","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Enhanced cognitive behavior therapy for severe and extreme anorexia nervosa: An outpatient case series"],"prefix":"10.1002","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4028-1877","authenticated-orcid":false,"given":"Simona","family":"Calugi","sequence":"first","affiliation":[{"name":"Department of Eating and Weight Disorders Villa Garda Hospital  Garda Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Sartirana","sequence":"additional","affiliation":[{"name":"Department of Eating and Weight Disorders Villa Garda Hospital  Garda Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stein","family":"Frostad","sequence":"additional","affiliation":[{"name":"Department of Mental Health Research, Division of Psychiatry Haukeland University Hospital  Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9796-3721","authenticated-orcid":false,"given":"Riccardo","family":"Dalle Grave","sequence":"additional","affiliation":[{"name":"Department of Eating and Weight Disorders Villa Garda Hospital  Garda Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,11,28]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/erv.1131"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.23206"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2009.11.001"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2008.06.012"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291717001349"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40519-018-0477-2"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.20591"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.2044-8260.1993.tb01045.x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291700048017"},{"key":"e_1_2_7_12_1","volume-title":"Cognitive behavior therapy and eating disorders","author":"Fairburn C. 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