Treatment Options

How is it treated?

There are many factors that contribute to the development of an eating disorder, and because each individual's situation is different, the "best treatment" must be tailored for that individual. The process begins with an evaluation by a physician or psychiatrist. From there, a variety of approaches are used to treat individuals with anorexia nervosa and bulimia nervosa.

The intensity of the treatment required and the need for outpatient (appointments with a doctor at an office) or inpatient (hospitalization) therapy should be determined based on the severity of the individual's disease. Determining the seriousness of the associated medical complications and psychological problems will lead to the evaluation of disease severity.

Hospitalization may be needed for those individuals who exhibit the following:

• A significant weight loss (more than 30% less than normal weight); particularly if the weight loss has been recent and rapid
• Medical complications such as seizures, heart failure, or irregular heart rhythms
• Chemical imbalances or dehydration
• An overriding psychiatric problem such as depression or thoughts of suicide
• No response to outpatient treatment after 3 to 4 months

The goals of outpatient treatment of eating disorders are nutritional rehabilitation (balanced diets), weight restoration, stopping weight loss behaviors, improvement in eating behaviors, and improvement of psychological and emotional states. The goals for hospitalized individuals are the same as outpatient management but with increased intensity. If a patient is admitted to the hospital for treatment, resolving medical complications and stabilizing nutritional status are the first and most important goals. If severe weight loss and malnutrition are apparent, intravenous feeding (receiving nutrition through one's veins) will be needed.

Psychotherapy

• Psychodynamic therapy is a general name for approaches that attempt to get the individual to surface his or her true feelings and then to understand those feelings. This therapy focuses on the basic assumption that everyone has an unconscious mind (sometimes called the subconscious) and that feelings held in the unconscious mind are often too painful to be faced. Psychodynamic therapy helps the individual to deal with subconscious feelings.

• Cognitive therapy focuses on changing negative thoughts and behaviors and recognizing what triggers them. Cognitive therapy may focus on weight restoration with meal planning, assistance with developing regular eating patterns, and discouraging the use of dieting. This type of behavioral therapy provides a structured, safe, and supportive environment to discuss the foods the individual fears most.

• Family therapy is important for patients who live at home because family dynamics play an important role in eating disorders. Parents and siblings can be deeply affected by the presence of an eating disorder within the family and need an outlet to understand the disease and recovery process. Family therapy provides a meeting place to communicate concerns and needs between the family and the patient.
• Group therapy, when the individual is ready, this can be an important source for peer support. Goals of group therapy typically include the following: (1) exploring underlying emotional conflicts that may be expressed by eating behaviors, (2) sharing problem solving and effective coping strategies, (3) developing realistic weight goals and a healthy relationship with food, and (4) improving interpersonal communications. These groups often focus on exploring the roots and influences of negative body image on the individual and work towards body acceptance.

A professional nutritionist or dietician can help patients learn how to manage their weight effectively. Individualized guidance and a meal plan that provides a framework for meals and food choices (but not a rigid diet) are helpful for most individuals. Nutritionists can also help individuals better understand how their eating disorders can create serious medical problems.

Drug Therapy

Drug therapy in the treatment of anorexia nervosa and bulimia nervosa should be used in combination with psychotherapy and nutritional therapy.

For anorexia nervosa, medications are used most frequently after weight and normal eating behaviors have been restored. Medications including certain antidepressants, antipsychotics, and gastrointestinal stimulants are used to treat psychiatric and gastrointestinal symptoms that may coincide with eating disorders. Also calcium plus vitamin D supplementation is recommended for people with low bone mineral density (BMD) because of their high risk of developing bone loss and/or osteoporosis.

For bulimia nervosa, medications are used to reduce the frequency of disturbed eating behaviors such as binge eating and vomiting. Medications are often used to improve symptoms that may accompany depression, anxiety, or obsessive behaviors. The medications used in the treatment of bulimia nervosa include antidepressants, the antipsychotic drug lithium, and the anticonvulsant drug topiramate (brand name: Topamax). Although lithium is now falling out of favor due to ineffectiveness in bulimia nervosa, its side effect of weight gain, and need of frequent blood monitoring to avoid toxic drug levels. The long-term benefits of using antidepressants for bulimia nervosa are unclear, as relapse rates are high with up to 80% of patients relapsing.

For binge-eating, medications are used to reduce the frequency of binging and also to cause weight loss in binge eaters who are obese. The medications used in the treatment of binge-eating include antidepressants, anticonvulsants topiramate and zonisamide, and the appetite-suppressant sibutramine (brand name: Meridia).

To learn more about the drugs used to treat eating disorders, click on the drug class links below.

Although eating disorders are treatable and many people recover from them, recovery is a complex process that can take several months or even years. Some individuals do better than others - the success often depends on the individual's drive to seek help and reach out to their support system. Seeking treatment from physicians and psychiatrists typically offers the greatest success in the recovery process.

Drug classes used to treat Eating Disorders

Anticonvulsants

Atypical Antipsychotics

Miscellaneous Antidepressants

Noradrenergic/Serotonergic Agent

Promotility Agents

Selective Serotonin Reuptake Inhibitors

Typical Antipsychotics

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