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How Is Anorexia Nervosa Treated?
Treatment for anorexia nervosa is a multidisciplinary process. With treatment, about 60% of people with anorexia nervosa make a full recovery. Another 20% make a partial recovery but remain very focused on food and weight.
In consultation with the doctor, a dietitian (food and nutrition expert) creates meal plans to help people gain weight safely. Most people work with a team that includes a mental health clinician, dietitian, and medical support.
Slow, steady weight gain is vital because “refeeding syndrome” is a potentially life-threatening complication of anorexia nervosa. The risk of developing complications is greater when significant weight loss is followed by rapid weight gain. The body’s delicate balance can be disrupted by too-aggressive nutritional treatment.
During recovery, problems may arise that require medical treatment. Some people experience tremor, seizures, or other neurological problems caused by abnormal levels of phosphate, potassium, and magnesium (electrolytes) during the early stages of refeeding. When malnourishment is severe, hospitalization may be necessary to correct drastic electrolyte imbalances.
The best way to prevent complications is to limit both calories and fluids when restarting food in someone who is severely malnourished. Vitamin B1 (thiamine) supplements are given at the beginning of refeeding and continued twice daily for 7-10 days. Problems can usually be avoided by closely monitoring food intake to avoid a rapid increase in the number of daily calories.
Mental health treatment
A mental health clinician typically coordinates care in an eating disorder treatment setting. People with anorexia nervosa often suffer from perfectionism, which makes them feel that they can never be thin enough. They tend to restrict eating as a way to control high levels of anxiety. Psychological treatment to address flawed thinking and poor self-image often involves a number of different therapies:
- Individual, group, and family psychotherapy. The multifaceted approach focuses on thinking and behaviors. A psychotherapist works one-on-one to support the individual. Family therapy helps parents and adolescents work through relationship problems or interpersonal issues.
- Cognitive behavioral therapy (CBT) is the leading evidence-based treatment for adults with eating disorders. It can also be adapted for younger people with anorexia nervosa. The treatment addresses cognitive factors like negative body image, core beliefs about self-worth, and perfectionism. CBT also helps with behavioral factors like dietary restriction, self-harm, and body avoidance.
- Dialectical behavioral therapy (DBT) combines Eastern wisdom with techniques for healthy emotional regulation. The focus is on acceptance (rather than change) and coping with difficult emotions. The DBT approach helps people cope with feelings that tend to trigger unhealthy eating patterns. DBT teaches skills ranging from mindfulness to distress tolerance, emotion regulation, and interpersonal effectiveness.
- Motivation to Change therapy is a therapeutic intervention that works best when someone is ready for behavioral change. Therapy includes support, education, and efforts to increase motivation. The goal is to move someone from denial to acceptance about anorexia nervosa.
Pharmacotherapy. Although not a first-line treatment, medications can help people whose anorexia is related to obsessive-compulsive disorder or other treatable mental illnesses. Specialized treatment may be needed to address various mental health diagnoses.
Angela Guarda, MD
Angela Guarda, MD is the Stephen and Jean Robinson Associate Professor of Eating Disorders in the Department of Psychiatry and Behavioral Sciences at…Read More…
It is impossible to recover from Anorexia unless you reach a minimal normal weight.
– Angela Guarda, MD
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