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:
- 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 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.
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 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