Iatrogenic factors in the treatment of Anorexia Nervosa.

Background: Iatrogenic factors are widely recognized in the field of medical treatments. However, when it comes to psychological treatments these effects have not been systematically documented. Therefore, a critical review of the literature was conducted in order to investigate the potential negative effects that might come with widely recognized treatments of anorexia nervosa (AN). Methods: The critical review was conducted following PRISMA and PICOS criteria. The databases PubMed and PsycInfo were searched. Keywords indicating negative effects of treatment (“negative effects”, “adverse effects”, “adverse events”, “harm”, “symptom exacerbation”, “treatment failure”, “clinical deterioration”, “negative outcome”, “harmful effects”, “patient safety”, “negative therapeutic reaction”, or “negative results”) were combined using Boolean operators with keywords indicating AN treatments (“cognitive behavioral therapy”, “family intervention”, “nutritional rehabilitation”, or “refeeding”) and (“anorexia nervosa”). Results: Database search produced a total of 82 studies, of which 14 were selected. Numerous data emerged regarding iatrogenic factors of nutritional rehabilitation and refeeding. However, no specific negative effects resulted for psychotherapies or family treatments. Conclusion: Results of this critical review further underline a disproportion between the literature about iatrogenic effects in the medical field and the studies about these negative effects in psychotherapy. This discrepancy may be explained by the lack of shared criteria in the literature to identify iatrogenic effects in psychological treatments and it does not exclude their presence in this field. Future studies should focus on developing a shared model to identify and classify iatrogenic factors in psychotherapeutic treatments for AN and other eating disorders.