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.
Unlike depression or panic disorder, there are no specific medications that are used to treat anorexia nervosa. First and foremost, a physician — after a complete medical exam and workup — will prescribe medication that will treat any medical problems, like electrolyte abnormalities or abnormal heart rhythms.
- Antidepressants: Many people with anorexia often also have depression, and these depressive symptoms may respond to antidepressants. There is no data, however, that shows that antidepressants are effective in the acute treatment of anorexia. Research has shown that people respond to medication much better after they are restored to a weight closer to within their normal limits. Some antidepressants have a side effect of weight gain, which may have unintended consequences in the treatment of anorexia if not carefully considered within the full treatment plan.
- Estrogen: Women with anorexia are at risk of fractures; this is as a result of osteoporosis. The lack of periods from their low body weight puts them in a state like early menopause. There is some suggestion that taking estrogen can help some women re-mineralize their bones and perhaps keep them from having fractures in the future. However, like any medication, the decision to consider taking estrogen must be weighed with the negative side effects of it.
Residential Treatment Facilities for Anorexia
Residential treatment facilities offer a complete array of treatment services in one place.
One place where all of the above treatment options are available is called a residential treatment center. Such treatment centers are located throughout the United States and in many other countries as well, and focus on the treatment of all the different types of eating disorders (including anorexia). Such facilities usually include a wide range of specialists — psychologists, medical doctors, nutritionists, meditation and relaxation professionals, and fitness experts. They help a person learn all of the skills necessary (through the cognitive-behavioral techniques outlined above), and put them into daily practice in a safe, relaxed setting.
Often these kinds of treatments may be paid for by an individual’s private health insurance, for up to a certain period of time (often 30 days). Check with your health insurance provide to see if such coverage is available for you.
Hospitalization for Anorexia
In cases where a person with anorexia is severely ill and has a relapse from baseline weight, or is below 15 percent of appropriate body weight, or the individual has other serious medical problems, inpatient hospitalization may be necessary. During such hospitalizations, people with anorexia are encouraged to eat regular meals with liquid supplements, but those who refuse feedings are given feedings through a nasogastric tube (plastic tube passed through nose, down esophagus, into stomach). Group and individual therapy supplement dietary and medical therapies.
At one time inpatient treatment lasted many weeks, if not months, but in today’s climate the goals of hospitalization are weight gain and medical stabilization. The patient is moved to outpatient therapy when it is considered safe to do so.
Self-Help for Anorexia
There are a variety of self-help methods available for eating disorders, including anorexia. Self-help support groups are a great way of getting emotional support while trying to make changes in one’s life to support a healthier self-image and eating behaviors. Self-help books on anorexia can be a great place to start to gain some insights and tips on changing one’s self-image and disordered eating.
Since many people with anorexia use food as a coping skill for dealing with negative emotions, finding other, healthier coping skills may be a good place to start.
Our positive self-image and eating issues blog Weightless is a great place to find more tips on improving your coping skills and self-image. However, you can also start with these tips about how to improve your body image from the Something Fishy website:
- Wear clothes you feel comfortable in – Dress to express yourself, not to impress others. You should feel good in what you wear.
- Stay away from the scale – If your weight needs to be monitored, leave that up to the doctors. How much you weigh should never affect your self-esteem.
- Stay away from fashion magazines – Unless you can look through these magazines knowing they are purely fantasy, it’s just better to stay away from them.
- Do nice things for your body – Get a massage, a manicure, or a facial. Pamper yourself with a candlelight bath, scented lotion, or a new perfume.
- Stay active – Movement therapy helps improve your sense of wellbeing. Take up Yoga or Tai’ Chi, play volleyball with the kids, or bike ride with friends. Make angels in the snow or sandcastles at the beach. Be active and enjoy life!