Anorexia Nervosa

What Are The Treatments For Anorexia Nervosa?

There are a number of treatments used for anorexia nervosa. A treatment plan is developed to address the specific needs of the individual. It usually includes treating any serious medical problems first and then focusing on weight gain and addressing the psychological issues that have led to the development and maintenance of the anorexia nervosa.

Regaining weight is a key part of any treatment plan since improvements in mood, personality, and interpersonal relationships cannot be sustained without it.

Factors that determine the types of treatments are:

• The person’s age
• Current living arrangements
• How long the person has had anorexia nervosa
• Overall medical condition, including weight
• Other eating disorder symptoms, such as binge eating, vomiting, or laxative abuse
• Poor results with previous treatments
• Severity of other associated psychological symptoms, such as depression, problems controlling impulses, and personality problems

The overall goals of treatment are to:

• Treat medical complications
• Gradually gain weight to a level that allows normal menstrual periods to begin
• Normalize eating
• Eliminate inappropriate weight control behaviors
• Help the person cope with changes in eating and weight
• Deal with psychological and family problems that have caused the disorder or have led to it being maintained over time

The types of treatments that may be used for anorexia nervosa include:

• Psychotherapy
• Support groups
•  Medication
• Hospitalization

Psychotherapy

• Individual psychotherapy is the cornerstone of treatment for anorexia nervosa, especially for people who are beyond adolescence and who are not living at home. Individual therapy provides a safe place to learn how to identify concerns, solve problems, overcome fears, and test new skills.

  There are many types of individual therapy. Cognitive behavioral approaches can help to develop healthy ways of thinking and patterns of behavior, particularly with food and relationships. Other kinds of therapy emphasize important interpersonal relationships and psychological issues, such as self-esteem.

• Family therapy is almost always used as part of treatment when the person with anorexia nervosa is young or living at home. Family therapy can be useful to provide information about anorexia nervosa, assess the impact of the disorder on the family, help members overcome guilt, improve communication and decision-making skills, develop strategies for coping, and develop practical strategies for overcoming the disorder.

• Marital therapy is almost always valuable when the person with anorexia nervosa is married. The primary goal of marital therapy is to strengthen the relationship. It can provide practical suggestions on how to deal with the disorder. It may also help identify and resolve communication problems.
• Group therapy can play an important role as part of hospital treatment, partial hospitalization or intensive day treatment. There are many different types of groups, each with different goals and orientations. Some groups are “task-oriented” and may focus on food, eating, body image, interpersonal skills, and vocational training. Other groups are aimed at understanding the psychological factors that may have led to the development and maintenance of the disorder.

  Groups can assist in dealing with other associated emotional symptoms, such as anxiety, depression and anger. Sharing experiences with others in a group can be very effective in helping reduce guilt, shame, and isolation, and can lead to important insights regarding strategies for recovery.

Support Groups

Support groups led by non-professionals may be helpful under certain circumstances; however, it is usually best to have groups facilitated by a professional. Support groups can provide people with anorexia nervosa and their families with mutual support and advice about how to cope with the disorder. They can also prepare someone for therapy who is afraid of it. Support groups can be counterproductive if they foster an “anorexic identity” or provide peer-group support for maintaining eating disorder behaviors.

Medication

Many medications have been tried in treating anorexia nervosa. It is generally agreed that medication alone is not effective. Because depression and other emotional problems are often a result of starvation, it is best to focus on weight gain rather than medication. In addition, the effects of starvation decrease the effectiveness of antidepressants and worsen the side effects. However, occasionally, medication may be required to deal with overwhelming anxiety, obsessions, depression, or gastric discomfort following meals.

Hospitalization

Hospitalization is rarely sufficient to cure anorexia nervosa. However, it may be required to:

• Interrupt steady weight loss or promote weight gain if there has been a failure to gain weight in outpatient care
• Interrupt bingeing and vomiting
• Control weight gain that is occurring too rapidly
• Evaluate and treat physical complications
• Address other serious psychological problems reflected by severe depression, suicidal behavior, self-destructive behavior, or substance abuse

One of the advantages of hospital treatment is that it provides a safe environment where food and weight can be carefully monitored while psychological concerns are explored.

There are various settings in which hospitalization can occur, including general hospitals, psychiatric hospitals, and specialized eating disorders programs. Although there are advantages and disadvantages to each of these settings, they can all lead to treatment success. While in the hospital, a variety of types of treatment may be used, such as family meetings, individual therapy, group therapy, occupational therapy, and occasionally medication.

Partial care programs share many features with inpatient programs. Patients receive similar therapeutic services; however, the major difference is that they do not stay overnight. Partial hospitalization has economic and clinical advantages over inpatient treatment.

Partial programs usually provide enough structure around meal times, plus the possibility for intensive therapy, that is sufficient for most patients to make behavioral changes, without requiring them to be totally disengaged from the supports and the therapeutic challenges outside of the hospital.

Inpatient treatment is still the preferred treatment for patients who:

• Are seriously emaciated
• Require close medical monitoring
• Fail to progress in partial care
• Are at serious risk for self-harm

Outcomes of Treatment:

Although weight gain can occur quickly once treatment begins, complete recovery can take a number of years. Many of those who recover in terms of weight remain overly concerned about eating and weight. Relapse can occur during periods of stress.

About 75% of people with anorexia nervosa continue to show improvement after initial treatment.

• About 45% of these people have an excellent outcome
• Another 30% experience considerable improvement
• About 20% of those receiving treatment remain seriously impaired
• Between 2% and 10% die because of the disorder. Deaths are usually related to complications of starvation or suicide. However, death rates appear to be decreasing due to improved treatments.

Factors associated with successful recovery include:

• Motivation to change
• Young age when anorexia nervosa starts
• Short length of illness
• Absence of binge eating or purging

However, recovery is possible in those who have had anorexia nervosa for many years and who have not succeeded with previous treatments. With proper treatment and a strong desire to change, people with anorexia nervosa can go on to live healthy, productive, and satisfying lives.

Early diagnosis and treatment can help prevent serious medical and psychological problems from developing and increase the chance of regaining good health. So, if you think you may have anorexia nervosa, talk with your health care provider or a mental health professional. If you think someone you know may have anorexia nervosa, encourage her or him to get professional help.

How Can I help a Family Member or Friend with Anorexia Nervosa?

Family members and friends of a person with anorexia nervosa can provide important help and support. Here are some suggestions:

• Learn about anorexia nervosa, including treatment options.
• Talk with the person about your concerns, including specific behaviors you have noticed.
• Encourage the person to talk with her or his health care provider or a mental health professional. Offer to go with the person to the appointment.
• If the person denies the problem or refuses to get professional help, suggest that he or she talk with another trusted adult, such as a family member, friend, or teacher.
• Exercise responsibility and authority in getting treatment if the person is a minor.
• Be understanding and patient, but firm. Dealing successfully with anorexia nervosa takes time.
• Do not blame yourself or the person with anorexia nervosa. It is not anyone’s fault.
• Do not focus on or try to control the person’s eating, weight, or appearance.
• Accept the person as he or she is, talk about feelings, and emphasize her or his strengths.
• Take care of your needs too. Consider attending a support group.