reply to drs bergh and södersten

European Eating Disorders ReviewEur. Eat. Disorders Rev. 12, 337 (2004)

ViewpointReply to Drs Bergh and SoderstenDrs Bergh and Sodersten have written a verydetailed reply to my Viewpoint piece. There is a lotone could say in response to each point. However, Ihave been asked to keep to 500 words and by neces-sity I will therefore limit myself to what I see as someof the key issues:

(1) I wrote my piece on the Mandometer treatmentof eating disorders out of a genuine sense of curi-osity after I had heard Dr Bergh speak at a con-ference in Helsinki. The part of the treatmentthat fascinated me most and which promptedme to write the piece was the mandometer appa-ratus itself, the feedback it generates and howthis relates to the Bergh and Sodersten modelof anorexia nervosa. The mandometer has beenpublicized elsewhere as a core component ofthe treatment (www:mando:se). Disappoint-ingly, their reply does not touch on the mand-ometer at all, nor do they take up the challengeof responding to the suggestions that the mand-ometer feedback could be experimentallymanipulated, and that it would also be impor-tant to know how much—if anything—themandometer adds to the efficacy of their treat-ment. This is important as their treatment pro-gramme is an intensive, prolonged treatment,which includes multiple components. And cer-tainly at the conference I attended the hopes ofthe Finnish patient and carer organizations allseemed to be pinned on the mandometer itself,rather than other aspects of their treatment.

(2) Drs Bergh and Sodersten suggest that there is nocompelling evidence that any of the standardtreatments that are presently used to treat eat-ing disorders are effective. This view is not

supported by the recent NICE guidelinewhich was based on a careful systematic reviewof the available evidence (www:nice:org) andwhich concluded that there was A-grade evi-dence to support the efficacy of cognitive beha-vioural therapy (CBT) for bulimia nervosaand B-grade evidence to support the use offamily based interventions for adolescents withanorexia nervosa. Both of those would lendthemselves as comparison treatments to themandometer treatment in future randomizedcontrolled trials.

(3) Like Drs Bergh and Sodersten I would bedelighted if there were a real breakthrough inthe treatment of eating disorders, comparableto that of the discovery that lime or lemon juiceprotects against scurvy, or the use of antibioticsfor the treatment of helicobacter pylori infec-tions. However, one can think of many treat-ments of mental disorders, based on plausiblebiological rationales, which were initially hailedas a major break-through but which with moreresearch have not lived up to initial expectations,such as for example, debriefing or rapid eyemovement desensitization in the treatment ofpost-traumatic stress disorder.

All in all it seems to me that the jury is still out onthe mandometer treatment and a lot more research isneeded to know how well this treatment compareswith other treatments of eating disorders.

Ulrike SchmidtEating Disorders Unit

Maudsley HospitalDenmark Hill, London UK

Copyright # 2004 John Wiley & Sons, Ltd and Eating Disorders Association.

Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/erv.611