Treatment of anorexia, as with all eating disorders, can be challenging. Effective treatment addresses the underlying emotional and mental health issues, issues that often date back to childhood and a person’s self-perception and self-image. Indeed, many of the treatment approaches described below focus on helping a person with anorexia to understand how their own self-image impacts their eating behavior. Self-image can be seen as a foundation of the change that a person with anorexia needs to address, as inaccurate self-image can be devastating — to the point where an emaciated individual still see themselves as overweight.
Some people with anorexia can be in what psychologists call “denial.” That is, they deny even having a problem, even if their body weight is dangerously low. They may point to supermodels or other celebrities as proof that they don’t have a problem and just want to “look as thin as they do.” Part of the challenge of treatment with anorexia, then, may be just helping the person with anorexia understand they do have a serious mental health concern that needs professional treatment (see Family Therapy below).
While there are many different routes to treatment, virtually all of them begin with seeing an eating disorder specialist. Usually this individual is a psychologist who has deep experience and training in helping a person with anorexia. A physical examination and workup by a medical doctor is also an initial part of the standard treatment of anorexia, to understand and begin addressing the physical problems that may have occurred as a result of the disorder.
Psychotherapy for Anorexia
Psychotherapy is the most common treatment for anorexia and has the greatest research support. Psychotherapy can involve a significant time and financial commitment, particularly if you are struggling with other issues (sexual abuse, depression, substance use, relationship problems). Psychotherapy can be very helpful in addressing not only your disordered eating, but also your overall emotional health and happiness. Indeed, the focus of psychotherapy treatment will be to address the underlying emotional and cognitive issues that result in the disordered eating.
Cognitive behavioral therapy (CBT) is considered the treatment of choice for people with anorexia. With the support of decades’ worth of research, CBT is a time-limited and focused approach that helps a person understand how their thinking and negative self-talk and self-image can directly impact their eating and negative behaviors.
Cognitive behavioral therapy is the gold standard treatment for anorexia.
Cognitive-behavioral therapy will often focus on identifying and altering dysfunctional thought patterns, attitudes and beliefs, which may trigger and perpetuate the person’s restrictive eating. A researcher in the early 1980s by the name of Chris Fairburn developed a specific model of cognitive-behavioral therapy to help in the treatment of anorexia, using the traditional foundations of CBT therapy — helping a person understand, identify and change their irrational thoughts (the “cognitive” part), and helping a person make the changes real through specific behavioral interventions (such as promoting health eating behaviors through goal setting, rewards, etc.).
Cognitive-behavioral therapy is time-limited, meaning that a person with anorexia will go into treatment for a specific period of time with specific goals in mind. Like all psychotherapy, it can be conducted in either an outpatient (once weekly) or inpatient setting. If done in an inpatient setting, eating disorders are often treated at residential treatment facilities, since eating is such an integral and necessary part of our lives.
According to an article published in 2008 from the U.S. National Guideline Clearinghouse, “For adults, preliminary evidence suggested that cognitive behavioral therapy may reduce the relapse risk after weight restoration. For adolescents, evidence supported specific forms of family therapy that initially focused on parental control of re-nutrition.”
“Among anorexia nervosa patient populations, at least one-half no longer suffered from anorexia nervosa at follow up [after cognitive-behavioral therapy treatment], but many continued to have other eating disorders; mortality was significantly higher than would be expected in the population.
“Factors associated with recovery or good outcomes were lower levels of depression and compulsivity. Factors associated with mortality included concurrent alcohol and substance use disorders.
Another form of psychotherapy is known as family therapy. Family therapy helps a person with anorexia see and understand the often-times dysfunctional role they play within the family, and how their eating behaviors maintain that role.
Family therapy is usually conducted with the person who has anorexia and their family. However, in some instances, a few family therapy sessions may involve therapy without the person who has anorexia present. This may help the family understand the roles they are playing in supporting the disordered eating, and suggest ways the family can help the person with anorexia acknowledge the problem and seek out treatment.
The “Maudsley Method” is a specific form of family therapy where parents assume responsibility for feeding their anorexic teen to help them gain weight and improve the teen’s eating habits. Research has demonstrated its effectiveness in the treatment of adolescents and children especially, before the disordered eating has become a chronic behavior.